担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jcin.2009.08.025

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<bold>
<italic>Background—</italic>
</bold>
It recently has been hypothesized that a larger late loss may have a protective role against stent thrombosis. The relationship between angiographic late loss and the presence of thrombus based on angioscopic findings within paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) was investigated in this study.




<bold>
<italic>Methods and Results—</italic>
</bold>
Prospective 6-month follow-up angiographic and angioscopic examinations were performed on 18 patients for PES and on 20 patients for SES. Late loss was measured by quantitative coronary angiography. Angioscopic neointimal stent coverage (NSC) grade was classified as follows: 0=uncovered struts without neointima, 1=visible struts through thin neointima, and 2=no visible struts. In each patient, maximum NSC, minimum NSC, and the existence of thrombus were evaluated. Late loss and maximum NSC were greater in PES than in SES (0.38�0.43 versus 0.10�0.23 mm;
<italic>P</italic>
=0.02 and
<italic>P</italic>
=0.0004, respectively). Late loss was correlated with maximum NSC (grade 0, 0.06�0.01 mm; grade 1, 0.10�0.05 mm; and grade 2, 0.48�0.46 mm), whereas there was no correlation between late loss and minimum NSC. The prevalence of patients with uncovered struts did not differ (44% of PES, 40% of SES;
<italic>P</italic>
=0.78). In-stent thrombus was found more frequently in PES than in SES (72% versus 40%,
<italic>P</italic>
=0.046) despite no occurrence of stent thrombosis. Only within PES were thrombi found in the segments of NSC grade 2 associated with large late loss.




<bold>
<italic>Conclusion—</italic>
</bold>
The present study suggests that angiographic large late loss was not associated with a low risk of in-stent thrombus.

DOI： 10.1161/circinterventions.108.769448

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2007.09.070

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/eurheartj/ehl181

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/eurheartj/ehi744

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/eurheartj/ehi539

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2004.09.077

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担当区分：筆頭著者  

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/s0735-1097(03)00770-8

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/s0735-1097(01)01315-8

CiNii Books

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circrep.cr-24-0003

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/ehjcr/ytae025

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その他リンク： https://academic.oup.com/ehjcr/article-pdf/8/1/ytae025/56397918/ytae025.pdf

掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

Background

<p lang="en">High cardiovascular mortality has been reported in young patients with diabetes. However, the underlying pathology in different age groups of patients with diabetes has not been studied.

</p> Methods and Results

<p lang="en"> The aim of this study was to investigate the plaque characteristics and underlying pathology of acute coronary syndrome in different age groups of patients with or without diabetes in a large cohort. Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging were included. Culprit plaque was classified as plaque rupture, plaque erosion, or calcified plaque and stratified into 5 age groups. Plaque characteristics including features of vulnerability were examined by optical coherence tomography. Among 1394 patients, 482 (34.6%) had diabetes. Patients with diabetes, compared with patients without diabetes, had a higher prevalence of lipid‐rich plaque (71.2% versus 64.8%, P =0.016), macrophage (72.0% versus 62.6%, P &lt;0.001), and cholesterol crystal (27.6% versus 19.7%, P &lt;0.001). Both diabetes and nondiabetes groups showed a decreasing trend in plaque erosion with age (patients with diabetes, P =0.020; patients without diabetes, P &lt;0.001). Patients without diabetes showed an increasing trend with age in plaque rupture ( P =0.004) and lipid‐rich plaque ( P =0.018), whereas patients with diabetes had a high prevalence of these vulnerable features at an early age that remained high across age groups.

</p> Conclusions

<p lang="en">Patients without diabetes showed an increasing trend with age in plaque rupture and lipid‐rich plaque, whereas patients with diabetes had a high prevalence of these vulnerable features at an early age. These results suggest that atherosclerotic vascular changes with increased vulnerability start at a younger age in patients with diabetes.

</p> Registration

<p lang="en"> URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT04523194, NCT03479723. URL: https://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000041692.

</p>

DOI： 10.1161/jaha.123.031474

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background The prognostic impact of optical coherence tomography-diagnosed culprit lesion morphology in acute coronary syndrome (ACS) has not been systematically examined in real-world settings. Methods and Results This investigator-initiated, prospective, multicenter, observational study was conducted at 22 Japanese hospitals to identify the prevalence of underlying ACS causes (plaque rupture [PR], plaque erosion [PE], and calcified nodules [CN]) and their impact on clinical outcomes. Patients with ACS diagnosed within 24 hours of symptom onset undergoing emergency percutaneous coronary intervention were enrolled. Optical coherence tomography-guided percutaneous coronary intervention recipients were assessed for underlying ACS causes and followed up for major adverse cardiac events (cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization) at 1 year. Of 1702 patients with ACS, 702 (40.7%) underwent optical coherence tomography-guided percutaneous coronary intervention for analysis. PR, PE, and CN prevalence was 59.1%, 25.6%, and 4.0%, respectively. One-year major adverse cardiac events occurred most frequently in patients with CN (32.1%), followed by PR (12.4%) and PE (6.2%) (log-rank P<0.0001), primarily driven by increased cardiovascular death (CN, 25.0%; PR, 0.7%; PE, 1.1%; log-rank P<0.0001) and heart failure trend (CN, 7.1%; PR, 6.8%; PE, 2.2%; log-rank P<0.075). On multivariate Cox regression analysis, the underlying ACS cause was associated with 1-year major adverse cardiac events (CN [hazard ratio (HR), 4.49 [95% CI, 1.35-14.89], P=0.014]; PR (HR, 2.18 [95% CI, 1.05-4.53], P=0.036]; PE as reference). Conclusions Despite being the least common, CN was a clinically significant underlying ACS cause, associated with the highest future major adverse cardiac events risk, followed by PR and PE. Future studies should evaluate the possibility of ACS underlying cause-based optical coherence tomography-guided optimization.

DOI： 10.1161/JAHA.123.030412

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1 year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.

DOI： 10.1016/j.amjcard.2023.07.077

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

Abstract

Background

Diagnostic strategies depend on non-standardized workup, and the causes of myocardial infarction with non-obstructive coronary arteries remain unclear for some patients. Intracoronary imaging is recommended for detecting the missed causes by coronary angiography. Myocardial infarction with non-obstructive coronary arteries is a heterogeneous entity; a meta-analysis of myocardial infarction with non-obstructive coronary artery studies demonstrated that all-cause mortality rate at 1 year is 4.7%, and its prognosis is not so favourable.

Case summary

A 62-year-old man without remarkable medical history complained of acute chest pain at rest, which resolved at his arrival. Although echocardiography and electrocardiogram exhibited normal findings, the concentration of high-sensitive cardiac troponin T increased up to 0.384 from 0.04 ng/mL. Coronary angiography was performed, and mild stenosis of the proximal right coronary artery was detected. He was discharged without catheter intervention and medications as he reported no symptoms. He returned 8 days later because of inferoposterior ST-segment elevation myocardial infarction with ventricular fibrillation. Emergent coronary angiography showed that the mild stenosis of the proximal right coronary artery had progressed to total occlusion. Optical coherence tomography after thrombectomy revealed rupture of the thin-cap fibroatheroma and protruding thrombus.

Discussion

Patients presenting with myocardial infarction with non-obstructive coronary arteries and plaque disruption and/or thrombus detected by optical coherence tomography do not show normal coronaries on coronary angiography. Aggressive investigation into plaque disruption using intracoronary imaging is recommended even if coronary angiography demonstrates mild stenosis to prevent a fatal attack for suspicious cases of myocardial infarction with non-obstructive coronary arteries.

DOI： 10.1093/ehjcr/ytad225

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その他リンク： https://academic.oup.com/ehjcr/article-pdf/7/5/ytad225/50301314/ytad225.pdf

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2022.10.059

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/mca.0000000000001170

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Recent retrospective investigations have suggested that optical coherence tomography (OCT) enables the diagnosis of underlying acute coronary syndrome (ACS) causes such as plaque rupture, plaque erosion, and calcified nodule. The relationships of these etiologies with clinical outcomes, and the clinical utility of OCT-guided primary percutaneous coronary intervention (PCI) are not systematically studied in real-world ACS treatment settings. METHODS: The TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 21 hospitals in Japan. A total of 700 patients with ACS (symptom onset within 24 h) undergoing OCT-guided primary PCI will be enrolled. The primary endpoint of the study is to identify the underlying causes of ACS using OCT-defined morphological assessment of the culprit lesion. The key secondary clinical endpoints are hazard ratios of the composite of cardiovascular death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization in patients with underlying etiologies at the 12- and 24-month follow-ups. The feasibility of OCT-guided primary PCI for ACS will be assessed by the achievement rates of optimal post-procedural results and safety endpoints. CONCLUSION: The TACTICS registry will provide an overview of the underlying causes of ACS using OCT, and will reveal any difference in clinical outcomes depending on the underlying causes. The registry will also inform on the feasibility of OCT-guided primary PCI for patients with ACS.

DOI： 10.1016/j.jjcc.2022.07.002

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.

DOI： 10.1038/s41569-022-00687-9

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Helicopter emergency medical service (HEMS) has the potential to improve prognosis for acute coronary syndrome (ACS). However, adequacy and effectiveness of HEMS have not been fully evaluated. A total of 862 ACS patients transferred by emergency medical services were divided into two groups: patients transferred by HEMS (n = 171) or by ground ambulance (GA; n = 691). Among them, angiography images for 718 patients (149 in HEMS and 569 in GA group) and optical coherence tomography (OCT) images for 374 patients (75 in HEMS and 299 in GA groups) were analyzed. Additional analysis to compare 2-year cardiac mortality between groups was conducted following propensity score matching to adjust for inter-group differences. ST-segment elevation myocardial infarction (81% vs. 66%, p < 0.001) and cardiogenic shock (Killip IV; 20% vs. 10%, p < 0.001) at admission were more prevalent in HEMS than GA group. Time from admission to balloon angioplasty was shorter in HEMS group (median 54 min vs. 69 min, p < 0.001). Antegrade coronary flow was worse in HEMS group (TIMI flow grade 0 or 1; 68% vs. 51%, p < 0.001). Plaque rupture was more frequently detected by OCT in HEMS group (68% vs. 49%, p = 0.029). Following propensity score matching, the incidence of cardiac death was significantly lower in HEMS group (6.3% vs. 14.9%, p = 0.019). In conclusion, severe ACS patients requiring early reperfusion were appropriately triaged and transferred more rapidly by HEMS. Lower mortality in HEMS group after propensity score matching suggests that HEMS may improve cardiac mortality in ACS patients.

DOI： 10.1007/s00380-022-02022-1

PubMed

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記述言語：英語  

A 25-year-old woman diagnosed as having a non-massive pulmonary embolism and deep vein thrombosis from the right superficial femoral to the right common iliac vein was treated by deployment of a DENALI® Vena Cava Filter. Filter retrieval was attempted 6 months later using a BARD snare retrieval kit. However, the conventional technique was unsuccessful because of a tilt and attachment of the filter head to the vessel wall. Hence, we passed an EN Snare Endovascular Snare System through an Amplatz Left 1 guiding catheter to successfully penetrate the attached portion of the filter hook and vessel wall. This combination provided controlled direction and a strong backup force that helped capture and retrieve the filter. This technique could be an alternative method to retrieve inferior vena cava filter with severe tilt and tight attachment to the vena cava wall when the conventional technique is unsuccessful.

DOI： 10.1177/2050313X221086102

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 79-year-old man with a history of atrial fibrillation presented for evaluation of sudden onset of intermittent claudication of the left lower limb. An angiogram revealed thrombotic total occlusion of the left superficial femoral artery (SFA). A 10-Fr sheath was antegradely inserted into the left common femoral artery (CFA), and the guidewire penetrated the lesion. Thromboaspiration using an 8-Fr long sheath inserted into a 10-Fr short sheath was performed repeatedly. Intravenous anticoagulant was administrated immediately after endovascular treatment. Follow-up angiography performed 12 days after the procedure confirmed the absence of residual thrombus in the SFA. Thromboaspiration using a large-diameter catheter is a feasible, cost-effective strategy for treatment of acute and subacute limb ischemia.

DOI： 10.1272/jnms.JNMS.2021_88-511

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11909/j.issn.1671-5411.2021.10.010

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<sec xml:lang="en">
<title>Background</title>
<p xml:lang="en">A recent study reported that the outcome of patients with plaque erosion treated with stenting is poor when the underlying plaque is lipid rich. However, the detailed phenotype of patients with plaque erosion, particularly as related to different age groups, has not been systematically studied.


</sec>
<sec xml:lang="en">
<title>Methods and Results</title>
<p xml:lang="en">
Patients with acute coronary syndromes caused by plaque erosion were selected from 2 data sets. Demographic, clinical, angiographic, and optical coherence tomography findings of the culprit lesion were compared between 5 age groups. Among 579 erosion patients, male sex and current smoking were less frequent, and hypertension, diabetes, and chronic kidney disease were more frequent in older patients. ST‐segment–elevation myocardial infarction was more frequent in younger patients. Percentage of diameter stenosis on angiogram was greater in older patients. The prevalence of lipid‐rich plaque (27.3% in age &lt;45 years and 49.4% in age ≥75 years,
<italic>P</italic>
&lt;0.001), cholesterol crystal (3.9% in age &lt;45 years and 21.8% in age ≥75 years,
<italic>P</italic>
=0.027), and calcification (5.5% in age &lt;45 years and 54.0% in age ≥75 years,
<italic>P</italic>
&lt;0.001) increased with age. After adjusting risk factors, younger patients were associated with the presence of thrombus, and older patients were associated with greater percentage of diameter stenosis and the presence of lipid‐rich plaque and calcification.



</sec>
<sec xml:lang="en">
<title>Conclusions</title>
<p xml:lang="en">The demographic, clinical, angiographic, and plaque phenotypes of patients with plaque erosion distinctly vary depending on age. This may affect the clinical outcome in these patients.


</sec>
<sec xml:lang="en">
<title>Registration</title>
<p xml:lang="en">
URL:
<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</ext-link>
. Unique identifiers: NCT03479723, NCT02041650.



</sec>

DOI： 10.1161/jaha.120.020691

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2021.07.032

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2021.08.048

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

The mechanisms behind poorer cardiac outcomes in underweight patients with acute coronary syndrome (ACS) are not understood and features of coronary culprit lesions in underweight ACS patients have not been fully examined. A total of 1,683 patients with ACS were divided into 4 groups according to body mass index (BMI): <18.5 (n = 73), 18.5 to 24.9 (n = 995), 25 to 29.9 (n = 488), and ≥30 (n = 117). Angiography and optical coherence tomography (OCT) images were analyzed for 1,428 of these patients who had primary percutaneous coronary intervention (PCI) and 838 who had primary PCI with OCT guidance, respectively. Diabetes (p <0.001), hypertension (p <0.001), and dyslipidemia (p <0.001) were less prevalent in BMI <18.5. Statin prescription at discharge was less frequent in the BMI <18.5 group (p <0.001). Quantitative coronary angiography analyses revealed smaller reference vessel (p = 0.001) and minimum lumen diameters after PCI (p = 0.019) and OCT revealed longer lipidic plaque length (p = 0.029) in the BMI <18.5 group. Kaplan-Meier analyses revealed higher rates of cardiac mortality (p <0.001) and major bleeding (p = 0.034) during the 2-year follow-up in the BMI <18.5 group. After adjusting for traditional cardiovascular risk factors, BMI <18.5 independently predicted 2-year cardiac mortality (hazard ratio 1.917 [95% confidence interval [1.082 to 3.397], p = 0.026). In conclusion, being underweight contributed to poorer cardiac outcomes in established ACS population. Smaller minimum lumen diameter after PCI and further progressed atherosclerosis at the culprit lesions despite their lower prevalence of comorbid metabolic risk factors may be related partly to poorer cardiac outcomes.

DOI： 10.1016/j.amjcard.2021.07.041

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pathological studies have suggested that features of vulnerable atherosclerotic plaques likely to progress and lead to acute cardiovascular events have specific characteristics. Given the progress of intravascular coronary imaging technology, some large prospective studies have detected features of vulnerable atherosclerotic plaques using these imaging modalities. However, the rate of cardiovascular events, such as acute coronary syndrome, has been found to be considerably reduced in the limited follow-up period available in the statin era. Additionally, not all disrupted plaques lead to thrombus formation with clinical presentation. If sub-occlusive or occlusive thrombus formation does not occur, a thrombus on a disrupted plaque will organize without any symptoms, forming a "healed plaque". Although vulnerable plaque detection using intracoronary imaging is focused on "thin-cap fibroatheroma" leading to plaque rupture, superficial plaque erosion is increasingly recognized; however, the underlying mechanism of thrombus formation on eroded plaques is not well understood. One of intravascular imaging, optical coherence tomography (OCT) has the highest image resolution and has enabled detailed characterization of the plaque in vivo. Here, we reviewed the status and limitations of intravascular imaging in terms of detecting vulnerable plaque through mainly OCT studies. We suggested that vulnerable plaque should be reconsidered in terms of eroded plaque and healed plaque and that both plaque and circulating blood should be assessed in greater detail accordingly.

DOI： 10.11909/j.issn.1671-5411.2021.07.005

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

OBJECTIVES: This study aimed to investigate the vascular response of lesions with a layered phenotype. BACKGROUND: Recent studies have shown that layered plaques at culprit lesions detected by optical coherence tomography (OCT) have greater plaque burden and more inflammatory features than non-layered plaques. METHODS: This is a retrospective observational study. A total of 193 target lesions from 193 patients [100 patients with acute coronary syndromes (ACS) and 93 with stable angina pectoris (SAP)] who had undergone OCT imaging of the culprit lesion both before and after stenting were included. Layered plaques were identified by OCT as plaques with layers of different optical density. Patients were divided into two groups based on the presence or absence of a layered phenotype at the culprit lesion, and pre- and post-procedure OCT findings were compared. RESULTS: Among 193 patients, 36 (36.0%) lesions in ACS patients and 56 (60.2%) lesions in SAP patients were found to have a layered phenotype at the culprit lesion. At baseline, percent area stenosis was greater in layered plaque than in non-layered plaque (p = .019). Following stent implantation, the stent expansion ratio and mean stent eccentricity index were significantly lower in layered plaques than in non-layered plaques (p = .041, p = .017, respectively), mainly derived from ACS patients. CONCLUSION: Following stent implantation, plaques with a layered phenotype had less stent expansion and more eccentric lumens. Aggressive balloon dilation may be required to obtain optimal stent outcomes in patients with a layered plaque phenotype at the culprit lesion.

DOI： 10.1002/ccd.28940

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ccd.28940

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Europa Digital & Publishing  

DOI： 10.4244/eij-d-20-00996

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Antiplatelet agents and statin therapies are widely used in patients with known cardiovascular disease. Plaque rupture (PR) and plaque erosion (PE) are the most frequent underlying mechanisms of acute coronary syndromes (ACS). The conditions and medications that are associated with ST-segment elevation myocardial infarction (STEMI) following PR or PE have not been systematically studied. A total of 838 ACS patients (494 with STEMI, 344 with NSTE-ACS) who were diagnosed with PR or PE by optical coherence tomography were included. The patients were categorized into two groups based on underlying pathology, and the baseline characteristics and culprit plaque morphology associated with STEMI were investigated within each group. Among 838 patients, 467 (55.7%) had PR, and 371 (44.3%) were diagnosed with PE. Among patients with PR, older age, hyperlipidemia, no antiplatelet therapy, higher level of low-density lipoprotein cholesterol, and greater lipid burden and macrophage infiltration were associated with increased probability of STEMI. Among patients with PE, no dual antiplatelet therapy and no statin therapy were associated with increased probability of STEMI. The incidence of STEMI caused by PR was significantly lower on antiplatelet therapy (P < 0.001), and the incidence of STEMI caused by PE was significantly lower on antiplatelet therapy (P < 0.001) or on statin therapy (P < 0.001). Antiplatelet therapy is associated with lower probability of STEMI, regardless of underlying pathology, and statin therapy is associated with lower probability of STEMI in PE as clinical presentation of ACS. Statin therapy prior to the onset of acute coronary syndromes (ACS) may reduce the probability of plaque rupture. Antiplatelet therapy prior to the onset of ACS is associated with reduced probability of ST-segment elevation myocardial infarction (STEMI) following both plaque rupture and plaque erosion, and dual antiplatelet therapy offers additional protection compared to a single antiplatelet agent in plaque erosion. The combination of statin and antiplatelet therapy may have an additive effect on reducing the probability of STEMI caused by plaque erosion. Yellow: lipid pool(necrotic core); red: fibrin-rich thrombus; gray; platelet-rich thrombus.

DOI： 10.1007/s11239-020-02281-7

PubMed

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その他リンク： https://link.springer.com/article/10.1007/s11239-020-02281-7/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

OBJECTIVES: To compare the postprocedural optical coherence tomography (OCT) findings and in-hospital outcomes among the three subtypes of calcified plaques: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion. BACKGROUND: Recently, three subtypes of calcified culprit plaques were reported in patients with acute coronary syndrome (ACS). How these subtypes respond to stenting is unknown. METHODS: ACS patients with calcified plaque at the culprit lesion were selected from our database. OCT findings at baseline and after stent implantation were compared. RESULTS: In the final analysis, 87 cases were included. Preprocedural OCT showed eruptive calcified nodules in 19 (21.8%) cases, superficial calcific sheet in 63 (72.4%), and calcified protrusion in 5 (5.7%). Stent edge dissection (SED) and incomplete stent apposition (ISA) were frequently observed in the eruptive calcified nodules group compared to superficial calcific sheet or calcified protrusion (SED; 47.4% vs. 17.5% vs. 20.0%; p = .032, ISA; 94.7% vs. 58.7% vs. 0.0%; p < .001). The superficial calcific sheet group had the smallest minimal stent area (MSA) among the three groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 6.29 ± 2.41 vs. 4.72 ± 1.37 vs. 6.56 ± 1.13; p = .007). The superficial calcific sheet group had a higher rate of periprocedural myocardial infarction compared to the eruptive calcified nodules group (60.3% vs. 31.6%; p = .028). CONCLUSIONS: This study demonstrated eruptive calcified nodules are associated with higher incidence of SED and ISA, whereas superficial calcific sheets are associated with small MSA and higher periprocedural myocardial infarction.

DOI： 10.1002/ccd.28847

PubMed

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ccd.28847

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00-05:59, 06:00-11:59, 12:00-17:59, or 18:00-23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups. Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 09:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture significantly increased in the periods of 06:00-11:59 [odds ratio (OR) 2.13, 95% confidence interval (CI) 1.30-3.49, p = 0.002] and 12:00-17:59 (OR 2.10, 95% CI 1.23-3.58, p = 0.005), compared to the period of 00:00-05:59. This circadian pattern was observed only during weekdays (p = 0.010) and it was not evident during the weekend (p = 0.742). Plaque rupture occurred most frequently in the morning and this circadian variation was evident only during weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.

DOI： 10.1007/s11239-020-02220-6

PubMed

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その他リンク： https://link.springer.com/article/10.1007/s11239-020-02220-6/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/mca.0000000000001009

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

As the degree of luminal narrowing increases, shear stress increases, and high shear stress is known to activate platelets. However, the relationship between the degree of luminal narrowing and the composition of thrombus in patients with plaque erosion has not been studied. A total of 148 patients with plaque erosion and thrombus detected by optical coherence tomography were divided into tertiles based on the minimum lumen area (MLA) at the culprit lesion. Thrombus was categorized as platelet-rich or fibrin-rich. Among 148 patients, 50 (34%) were in the mild stenosis group, 49 (33%) were in the moderate stenosis group, and 49 (33%) were in the severe stenosis group. The composition of thrombus was significantly different among the 3 groups (prevalence of platelet-rich thrombus was 60% in the mild stenosis group; 78% in the moderate stenosis group; and 84% in the severe stenosis group; P = 0.021). The pattern of fibrin-rich thrombus showed the opposite: 40%, 22%, and 16%, respectively. In the multivariate analysis, current smoking was independently associated with fibrin-rich thrombus (odds ratio [OR] 2.364 [95% CI 1.004-5.567], P = 0.049). This study demonstrated that platelet-rich thrombus was the predominant type of thrombus in plaque erosion. The prevalence of fibrin-rich thrombus was highest in the mild stenosis group.

DOI： 10.1007/s11239-020-02159-8

PubMed

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その他リンク： https://link.springer.com/article/10.1007/s11239-020-02159-8/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

© 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University Background and aims: Peripheral artery disease (PAD), intermittent claudication, and impaired mobility contribute to the loss of skeletal muscle. This study investigated the impact of endovascular treatment (EVT) in patients suffering from PAD above the knee and its relation to baseline glycemic control. Methods and results: Mid-thigh muscle volume was measured before EVT, 3 months after EVT and 6 months after EVT. Mid-thigh muscle volumes of ipsilateral PAD patients with ischemic and non-ischemic legs were compared. Correlations between total thigh muscle volume and clinical characteristics were analyzed using univariable and multivariable analysis. Overall, thigh muscle volume increased after EVT. The mid-thigh muscle volume was significantly lower in patients with ipsilateral lesions and in those with ischemic lower limbs. The thigh muscle volume of those with ischemic lower limbs increased after EVT. Baseline glycated hemoglobin was the only factor that was negatively correlated with changes in the muscle volume after EVT. Muscle volume significantly increased in normoglycemic HbA1c<6.5% (47 mmol/mol) patients. There was no significant alteration in the muscle volume of hyperglycemic HbA1c ≥ 6.5% patients. Conclusion: Ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for a large-scale trial to investigate whether EVT can protect or delay skeletal muscle loss.

DOI： 10.1016/j.numecd.2020.09.003

Scopus

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Recent studies have shown that healed plaque at the culprit lesion detected by optical coherence tomography (OCT) is a sign of pan-vascular vulnerability and advanced atherosclerosis. However, the clinical significance of healed plaque is unknown. A total of 265 patients who had OCT imaging of a culprit vessel and 2-year clinical follow-up data were included. Patients were stratified based on the presence or absence of a layered plaque phenotype, defined as layers of different optical density by OCT at either culprit or non-culprit lesions. The association between layered plaque and major adverse cardiac events (MACE), defined as cardiac death, acute coronary syndromes (ACS), or revascularization, was studied. Among 265 patients, 96 (36.2%) had the layered plaque phenotype. Layered plaque was more frequently observed in stable angina pectoris patients than in ACS patients (57.8%vs. 25.1%, p < 0.001). The average clinical follow-up period was 672 ± 172 days. Cumulative MACE was significantly higher in patients with layered plaque (p = 0.041), which was primarily driven by the high revascularization rate at 2 years (p = 0.002). Multivariate regression analysis showed that presence of layered plaque and low-density lipoprotein cholesterol levels were independently associated with an increased risk of revascularization (p = 0.026, p = 0.008, respectively). Patients with healed plaque in the culprit vessel had a higher incidence of revascularization, as compared to those without healed plaque, at 2 years.

DOI： 10.1007/s11239-020-02076-w

PubMed

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その他リンク： https://link.springer.com/article/10.1007/s11239-020-02076-w/fulltext.html

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Statin therapy reduces low-density lipoprotein cholesterol (LDL-C), inflammation, and atherosclerotic cardiovascular disease. We investigated the association between LDL-C and statin therapy on the prevalence of plaque rupture (PR). Patients with acute coronary syndromes who underwent optical coherence tomography imaging of the culprit lesion were divided into 4 groups based on LDL-C level and statin use (Group 1: LDL-C ≤ 100 without statin; Group 2; LDL-C ≤ 100 with statin; Group 3: LDL-C > 100 with statin; Group 4: LDL-C > 100 without statin), and the prevalence of PR was compared between the groups. Among 896 patients, PR was diagnosed in 444 (49.6%) patients. The prevalence of PR was significantly different among the 4 groups (p = 0.007): it was highest in the high LDL-C without statin group and lowest in the low LDL-C without statin group (53.9% and 39.2%, respectively). Compared with the high LDL-C without statin group, the low LDL-C without statin and low LDL-C with statin groups had a significantly lower prevalence of PR (p = 0.001, p = 0.040, respectively), and the low LDL-C with statin group had a significantly higher prevalence of calcification (p = 0.037). The patients with naturally low LDL-C have the lowest risk of PR. The patients with low LDL-C achieved by statin therapy had a higher prevalence of calcification. When LDL-C level is elevated, early and aggressive treatment with statin may help to prevent PR by stabilizing plaques through calcification.

DOI： 10.1016/j.amjcard.2020.08.016

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<sec xml:lang="en">
<title>Background</title>
<p xml:lang="en">
Seasonal variations in acute coronary syndromes (
<styled-content style="fixed-case">ACS</styled-content>
) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative.



</sec>
<sec xml:lang="en">
<title>Methods and Results</title>
<p xml:lang="en">
Patients with
<styled-content style="fixed-case">ACS</styled-content>
who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with
<styled-content style="fixed-case">ACS</styled-content>
(885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (
<italic>P</italic>
=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157–2.359;
<italic>P</italic>
=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429–0.905;
<italic>P</italic>
=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (
<italic>P</italic>
=0.010), whereas no significant difference was observed in the other 2 groups.



</sec>
<sec xml:lang="en">
<title>Conclusions</title>
<p xml:lang="en">
Seasonal variations in the incidence of
<styled-content style="fixed-case">ACS</styled-content>
reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of
<styled-content style="fixed-case">ACS</styled-content>
depending on the season of its occurrence.



</sec>
<sec xml:lang="en">
<title>Registration</title>
<p xml:lang="en">
<styled-content style="fixed-case">URL</styled-content>
:
<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clini​caltr​ials.gov</ext-link>
. Unique identifier:
<styled-content style="fixed-case">NCT</styled-content>
03479723.



</sec>

DOI： 10.1161/jaha.119.015579

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Postmortem studies reported plaque erosion is frequent in young women. Recent in vivo studies failed to show age and sex differences in the plaque erosion prevalence. The aim of this study was to investigate the prevalence of plaque erosion by age and sex among acute coronary syndromes (ACS) patients. From 1699 ACS patients, 1083 with plaque erosion or rupture were analyzed. Patients were categorized as 5 age groups (≤ 50, 51-60, 61-70, 71-80, ≥ 81 years). Overall prevalence of plaque erosion was similar between males and females (p = 0.831). Males age ≤ 50 had higher (p = 0.018) and age 71-80 had lower (p = 0.006) prevalence of plaque erosion. Females age 61-70 had higher (p = 0.021) and age 71-80 had lower (p = 0.045) prevalence of plaque erosion. In advanced age groups (≥ 71 years), rupture was the dominant etiology in both sexes. In multivariate analysis of males, age ≤ 50 demonstrated a trend to increase (OR 1.418, 95% CI 0.961-2.093, p = 0.078) the erosion risk. Females age ≤ 70 independently increased (OR 2.138, 95% CI 1.249-3.661, p = 0.006) the risk for erosion. The prevalence of plaque erosion was similar between males and females. Plaque erosion risk was increased in the males age ≤ 50 and in the females age ≤ 70 among ACS patients.

DOI： 10.1007/s11239-019-01969-9

PubMed

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その他リンク： http://link.springer.com/article/10.1007/s11239-019-01969-9/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jcin.2020.02.027

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.jnms.2021_88-511

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<sec xml:lang="en">
<title>Background</title>
<p xml:lang="en">
Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (
<styled-content style="fixed-case">ACS</styled-content>
). Recent studies suggest that anti‐thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with
<styled-content style="fixed-case">ACS</styled-content>
to enable a diagnosis of erosion without additional invasive procedures.



</sec>
<sec xml:lang="en">
<title>Methods and Results</title>
<p xml:lang="en">
Patients with
<styled-content style="fixed-case">ACS</styled-content>
who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with
<styled-content style="fixed-case">ACS</styled-content>
, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–
<styled-content style="fixed-case">ST</styled-content>
‐segment elevation‐
<styled-content style="fixed-case">ACS</styled-content>
than in ST‐segment–elevation myocardial infarction (47.9% versus 29.8%,
<italic>P</italic>
=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age &lt;68 years, anterior ischemia, no diabetes mellitus, hemoglobin &gt;15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–
<styled-content style="fixed-case">ST</styled-content>
‐segment elevation‐
<styled-content style="fixed-case">ACS</styled-content>
, the probability of plaque erosion increased to 73.1%.



</sec>
<sec xml:lang="en">
<title>Conclusions</title>
<p xml:lang="en">
Clinical and laboratory parameters associated with plaque erosion are explored in this retrospective registry study. These parameters may be useful to identify the subset of
<styled-content style="fixed-case">ACS</styled-content>
patients with plaque erosion and guide them to conservative management without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studies.



</sec>
<sec xml:lang="en">
<title>Clinical Trial Registration</title>
<p xml:lang="en">
<styled-content style="fixed-case">URL</styled-content>
:
<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</ext-link>
. Unique identifier:
<styled-content style="fixed-case">NCT</styled-content>
03479723.



</sec>

DOI： 10.1161/jaha.119.012322

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Patients diagnosed with acute coronary syndrome (ACS) during winter have worse outcomes; however, mechanisms driving this trend are unclear. We examined coronary culprit lesion morphologies using optical coherence tomography (OCT). Features and outcomes were retrospectively compared between patients admitted with ACS in winter (W-ACS; n = 390) and in other seasons (O-ACS; n = 1,027). Angiography and OCT results were analyzed in patients who underwent OCT examination (173 patients in W-ACS and 450 in O-ACS). On initial angiography, minimum lumen diameter was smaller (median; 0.12 mm vs 0.25 mm, p = 0.021) and Thrombolysis in myocardial infarction flow grade was worse (Thrombolysis in myocardial infarction 0/1; 57% vs 44%, p = 0.005) in W-ACS. OCT performed before coronary interventions or just after intracoronary thrombectomy showed that plaque rupture (56% vs 46%) and calcified nodules (8% vs 5%) were more prevalent, and plaque erosion (37% vs 49%) was less prevalent in W-ACS (p = 0.039 for all 3 variables). At 2-year follow-up for all admitted ACS patients, Kaplan-Meier estimates showed higher cardiac mortality in W-ACS (11.8% vs 8.3%, p = 0.043). Multivariate Cox proportional hazard analysis showed that patients in W-ACS group had a 1.5-fold increased risk of cardiac death within 2 years after adjusting for traditional cardiovascular risk factors (hazard ratio, 1.54 [95% confidence interval, 1.06 to 2.23]; p = 0.024). In conclusion, patients diagnosed with ACS during winter had worse angiographic results and OCT revealed less plaque erosion (more plaque rupture or calcified nodules) at the culprit lesions, which may be partly associated with worse cardiac mortality within 2 years.

DOI： 10.1016/j.amjcard.2019.03.045

PubMed

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担当区分：最終著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Impact Journals, LLC  

DOI： 10.18632/aging.101969

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jcin.2019.01.001

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacep.2018.11.005

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

OBJECTIVES: This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS). BACKGROUND: Calcified plaques as an underlying pathology in patients with ACS have not been systematically studied. METHODS: From 1,241 patients presenting with ACS who had undergone pre-intervention optical coherence tomography imaging, 157 (12.7%) patients were found to have a calcified plaque at the culprit lesion. Calcified plaque was defined as a plaque with superficial calcification at the culprit site without evidence of ruptured lipid plaque. RESULTS: Three distinct types were identified: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion (prevalence of 25.5%, 67.4%, and 7.1%, respectively). Eruptive calcified nodules were frequently located in the right coronary arteries (44.4%), whereas superficial calcific sheet was most frequently found in the left anterior descending coronary arteries (68.4%) (p = 0.012). Calcification index (mean calcification arc × calcification length) was greatest in eruptive calcified nodules, followed by superficial calcific sheet, and smallest in calcified protrusion (median 3,284.9 [interquartile range (IQR): 2,113.3 to 5,385.3] vs. 1,644.3 [IQR: 1,012.4 to 3,058.7] vs. 472.5 [IQR: 176.7 to 865.2]; p < 0.001). The superficial calcific sheet group had the highest peak post-intervention creatine kinase values among the groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 241 [IQR: 116 to 612] IU/l vs. 834 [IQR: 141 to 3,394] IU/l vs. 745 [IQR: 69 to 1,984] IU/l; p = 0.032). CONCLUSIONS: Three distinct types of calcified culprit plaques are identified in patients with ACS. Superficial calcific sheet, which is frequently located in the left anterior descending coronary artery, is the most prevalent type and is also associated with greatest post-intervention myocardial damage. (Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome; NCT03479723).

DOI： 10.1016/j.jcin.2018.12.013

PubMed

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担当区分：最終著者  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: While preinfarction angina pectoris (pre-IA) is recognized as favorable effects on acute myocardial infarction (AMI), the detail has not been fully investigated. The aims of the current study were to clarify patient characteristics, lesion morphologies determined by optical coherence tomography (OCT), and cardiac outcomes related to pre-IA in patients with AMI. METHODS: Clinical data and outcomes were compared between AMI patients with pre-IA (pre-IA group, n = 507) and without pre-IA (non-pre-IA group, n = 653). Angiography and OCT findings were analyzed in patients with pre-intervention OCT and compared between groups of pre-IA (n = 219) and non-pre-IA (n = 269). RESULTS: ST-segment elevation myocardial infarction (61% vs. 75%, p < 0.001) and cardiogenic shock (8% vs. 14%, p = 0.001) were less prevalent in pre-IA group. Peak creatine kinase-MB levels were lower in pre-IA group (median 83 IU/mL vs. 126 IU/mL, p < 0.001). In pre-intervention coronary angiography findings, initial TIMI flow grade 0/1 (43% vs. 56%, p = 0.019) and Rentrop collateral circulation 0/1 (69% vs. 79%, p = 0.018) were less frequently observed in pre-IA than in non-pre-IA patients. In post-thrombectomy OCT images, plaque rupture (39% vs. 56%, p = 0.003) and red thrombi (42% vs. 54%, p = 0.027) were also less frequently observed in pre-IA group. Kaplan-Meier estimate survival curves showed that cardiac death at 12-months was lower in pre-IA group than in non-pre-IA group (6.9% vs. 10.1%, p = 0.036). CONCLUSIONS: Patients with pre-IA had less severe AMI on admission, smaller infarction size, and more favorable long-term survival, which may be caused by difference of lesion morphology between patients with and without pre-IA.

DOI： 10.1016/j.ijcard.2018.07.074

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Coronary angioscopy (CAS) is a robust imaging methodology for evaluation of vascular healing response after stenting. However, the procedure requires a guiding catheter with a diameter of more than 6 Fr, which is rather invasive at follow-up angiography. Recently, coronary angioscopes of a smaller diameter have been able to pass through a 4 Fr guiding catheter. This study aimed to investigate the feasibility and safety of slender CAS observation using a 4 Fr guiding catheter. METHODS AND RESULTS: Thirty-three consecutive patients who underwent follow-up angiography were evaluated. Following usual angiography via the radial artery, the stent segment was observed by non-occlusive CAS through a 4 Fr guiding catheter. Low molecular weight dextran-L (4 mL/sec) was flushed from a guiding catheter to replace coronary blood. The success rate, anatomical or procedural factors related to the success, and incidence of adverse events were examined. The success rate was 84.8% (n=28/33). The luminal diameter at the orifice of the target vessel was larger in the successful than in the failed group (4.03±0.61 mm vs. 3.39±0.61 mm, respectively; p=0.009). The presence of deep engagement of the guiding catheter into the target vessel was a key factor for sufficient observation (100% in the successful group vs. 0% in the failed group; p<0.0001). No adverse events, such as dissection or acute coronary syndrome, were reported. CONCLUSIONS: The new method of CAS through a 4 Fr guiding catheter demonstrated high feasibility and safety. This less invasive observation via CAS may be useful for stent follow-up.

DOI： 10.4244/AIJ-D-18-00003

PubMed

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<sec>
<title>Objective—</title>
Although postprandial hypertriglyceridemia can be a risk factor for coronary artery disease, the extent of its significance remains unknown.


This study aimed to investigate the correlation between the postprandial lipid profiles rigorously estimated with the meal tolerance test and the presence of lipid-rich plaque, such as thin-cap fibroatheroma (TCFA), in the nonculprit lesion.


</sec>
<sec>
<title>Approach and Results—</title>

A total of 30 patients with stable coronary artery disease who underwent a multivessel examination using optical coherence tomography during catheter intervention for the culprit lesion were enrolled. Patients were divided into 2 groups: patients with TCFA (fibrous cap thickness ≤65 µm) in the nonculprit lesion and those without TCFA. Serum remnant-like particle-cholesterol and ApoB-48 (apolipoprotein B-48) levels were measured during the meal tolerance test. The value of remnant-like particle-cholesterol was significantly greater in the TCFA group than in the non-TCFA group (
<italic>P</italic>
=0.045). Although the baseline ApoB-48 level was similar, the increase in the ApoB-48 level was significantly higher in the TCFA group than in the non-TCFA group (
<italic>P</italic>
=0.028). In addition, the baseline apolipoprotein C-III levels was significantly greater in the TCFA group (
<italic>P</italic>
=0.003). These indexes were independent predictors of the presence of TCFA (ΔApoB-48: odds ratio, 1.608; 95% confidence interval, 1.040–2.486;
<italic>P</italic>
=0.032; apolipoprotein C-III: odds ratio, 2.581; 95% confidence interval, 1.177–5.661;
<italic>P</italic>
=0.018).



</sec>
<sec>
<title>Conclusions—</title>
Postprandial hyperchylomicronemia correlates with the presence of TCFA in the nonculprit lesion and may be a residual risk factor for coronary artery disease.


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DOI： 10.1161/atvbaha.118.311245

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

The aims of the present study were to elucidate features of culprit lesion plaque morphology using optical coherence tomography (OCT) in relation to elevated serum uric acid (sUA) levels and to clarify the impact of sUA levels on adverse clinical outcomes in patients with acute coronary syndrome (ACS). Clinical data and outcomes were compared between ACS patients with sUA ≥6 mg/dl (high-sUA; n = 506) and sUA <6.0 mg/dl (low-sUA; n = 608). Angiography and OCT findings were analyzed in patients with preintervention OCT and compared between groups of high-sUA (n = 206) and low-sUA (n = 273). Patients with high-sUA were more frequently male (88% vs 74%, p <0.001), younger (median 65 years vs 67 years, p = 0.017), more obese (median body mass index; 24.3 kg/m2 vs 23.2 kg/m2, p <0.001), and had a more frequent history of hypertension (72% vs 62%, p <0.001). ACS with lung congestion or cardiogenic shock was more prevalent in patients with high-sUA (30% vs 13%, p <0.001). Plaque rupture (54% vs 42%, p = 0.021) and red thrombi (55% vs 41%, p = 0.010) were more prevalently observed by OCT in patients with high-sUA. Kaplan-Meier estimate survival curves showed that the 2-year cardiac mortality was higher in patients with high-sUA (12.1% vs 4.2%, p <0.001). The multivariate Cox proportional hazard analysis showed that sUA values independently and significantly predicted cardiac death within 2 years (hazard ratio 1.41 [95% confidence interval 1.26 to 1.57], p <0.001). In conclusion, sUA levels are associated with culprit lesion coronary plaque morphology and raised sUA levels affect cardiovascular mortality after adjusting for several cardiovascular risk factors.

DOI： 10.1016/j.amjcard.2018.03.022

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

Objectives: We sought to clarify clinical features and outcomes related to calcified nodules (CN) compared with plaque rupture (PR) and plaque erosion (PE) detected by optical coherence tomography (OCT) at the culprit lesions in patients with acute coronary syndrome (ACS). Methods: Based on OCT findings for culprit lesion plaque morphologies, ACS patients with analyzable OCT images (n = 362) were classified as CN, PR, PE, and other. Results: The prevalence of CN, PR, and PE was 6% (n = 21), 45% (n = 163), and 41% (n = 149), respectively. Patients with CN were older (median 71 vs. 65 years, p = 0.03) and more diabetic (71 vs. 35%, p = 0.002) than those without CN. In OCT findings, the distal reference lumen cross-sectional area (median 4.2 vs. 5.2 mm2, p = 0.048) and the postintervention minimum lumen cross-sectional area (median 4.5 vs. 5.3 mm2, p = 0.04) were smaller in lesions with CN than in those without. Kaplan-Meier estimate survival curves showed that the 500-day survival without target lesion revascularization (TLR) was lower (p = 0.011) for patients with CN (72.9%) than for those with PR (89.3%) or PE (94.8%). Conclusions: ACS patients with CN at the culprit lesion had more TLR compared to those with PR or PE.

DOI： 10.1159/000481931

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

Objectives: We aimed to examine the relations of very high levels of serum uric acid (sUA) with features of culprit lesion plaque morphology determined by optical coherence tomography (OCT) and adverse clinical outcomes in patients with acute coronary syndrome (ACS). Methods: We retrospectively compared ACS patients according to sUA levels of &gt; 8.0 mg/dL (n = 169), 7.1–8.0 mg/dL (n = 163), 6.1–7.0 mg/dL (n = 259), and ≤6.0 mg/dL (n = 717). Angiography and OCT findings were analyzed in patients with preintervention OCT and the 4 sUA groups (&gt; 8.0 mg/dL, n = 61; 7.1–8.0 mg/dL, n = 72; 6.1–7.0 mg/dL, n = 131; and ≤6.0 mg/dL, n = 348) were compared. Results: Cardiogenic shock was more prevalent in ACS patients with sUA &gt; 8.0 mg/dL (22% vs. 19% vs. 10% vs. 6%, p &lt; 0.001). Plaque rupture was observed more prevalently by OCT in patients with sUA &gt; 8.0 mg/dL (67% vs. 47% vs. 56% vs. 45%, p = 0.027). At the 2-year follow-up, Kaplan-Meier estimates showed higher cardiac mortality in patients with sUA &gt; 8.0 mg/dL (25% vs. 12% vs. 5% vs. 5%, p &lt; 0.001). After adjusting for traditional cardiovascular risk factors and creatinine levels, patients with sUA &gt; 8.0 mg/dL showed a 4.5-fold increased risk in 2-year cardiac death by multivariate Cox proportional hazard analysis (hazard ratio 4.54, 95% confidence interval 2.98–6.91; p &lt; 0.001). Conclusions: Very high sUA levels like &gt; 8.0 mg/dL are the primary predictor of 2-year cardiac mortality and could partly be caused by adverse effects of accumulated sUA on plaque morphology in patients with ACS.

DOI： 10.1159/000496053

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担当区分：責任著者   記述言語：英語   出版者・発行元：日本心臓血管内視鏡学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J06603&link_issn=&doc_id=20190422520004&doc_link_id=130007404274&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007404274&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. However, its clinical significance in coronary arteries has never been systematically investigated. OBJECTIVES: This study investigated the prevalence and clinical significance of LRP in the nonculprit region of the target vessel in patients undergoing percutaneous coronary intervention (PCI). METHODS: The study included 1,474 patients from 20 sites across 6 countries undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. Patients were followed for up to 4 years (median of 2 years). RESULTS: Lipid-rich plaque was detected in nonculprit regions of the target vessel in 33.6% of patients. The cumulative rate of nonculprit lesion-related MACE (NC-MACE) over 48 months in patients with LRP was higher than in those without LRP (7.2% vs. 2.6%, respectively; p = 0.033). Acute coronary syndrome at index presentation (risk ratio: 2.538; 95% confidence interval [CI]: 1.246 to 5.173; p = 0.010), interruption of statin use ≥1 year (risk ratio: 4.517; 95% CI: 1.923 to 10.610; p = 0.001), and LRP in nonculprit regions (risk ratio: 2.061; 95% CI: 1.050 to 4.044; p = 0.036) were independently associated with increased NC-MACE. Optical coherence tomography findings revealed that LRP in patients with NC-MACE had longer lipid lengths (p < 0.001), wider maximal lipid arcs (p = 0.023), and smaller minimal lumen areas (p = 0.003) than LRPs in patients without MACE. CONCLUSIONS: Presence of LRP in the nonculprit regions of the target vessel by OCT predicts increased risk for future NC-MACE, which is primarily driven by revascularization for recurrent ischemia. Lipid-rich plaque with longer lipid length, wider lipid arc, and higher degree of stenosis identified patients at higher risk of future cardiac events. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).

DOI： 10.1016/j.jacc.2017.03.556

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担当区分：責任著者  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1186/s12947-016-0090-3

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その他リンク： http://link.springer.com/article/10.1186/s12947-016-0090-3/fulltext.html

担当区分：責任著者   記述言語：英語   出版者・発行元：日本心臓血管内視鏡学会  

複数血管の血管内視鏡検査により、BMIと冠動脈硬化度との関連性について検討した。2000年9月〜2007年7月に複数血管の血管内視鏡検査を施行した冠動脈疾患患者89例を、BMIに基づいて過小体重(<20kg/m2)群7例、正常体重(20〜25kg/m2)群40例、過体重(25〜28kg/m2)群27例、肥満(≧28kg/m2)群15例に分けた。観察した冠動脈で認められた黄色プラーク数(NYP)を数え、各プラークの色をグレード1(淡黄色)、グレード2(黄色)、グレード3(濃い黄色)と定義した。1血管あたりのNYPと最大黄色グレード(MYG)を4群間で比較した。その結果、冠動脈硬化度の重症度(NYP、MYG)は有意に異なっていた。多変量回帰分析により、BMIは1血管あたりのNYPと独立して相関していることが明らかになった。過小体重患者の冠動脈硬化は正常および過体重患者よりも進行しており、低BMIは進行性冠動脈硬化と独立して関連していることが示された。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J06603&link_issn=&doc_id=20170619250004&doc_link_id=10.15791%2Fangioscopy.oa.16.0010&url=https%3A%2F%2Fdoi.org%2F10.15791%2Fangioscopy.oa.16.0010&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

担当区分：責任著者   記述言語：英語   出版者・発行元：日本心臓血管内視鏡学会  

症例は85歳女性で、脂質異常症、高血圧症、慢性腎臓病に罹患しており、労作時胸痛を訴え当院に入院となった。患者は2年前に安定狭心症のためステント植込み術を行っており、左前下行枝中部の責任病変をコバルトクロムエベロリムス溶出ステントで治療していた。冠状動脈造影でステント遠位部にステント内再狭窄が認められた。冠動脈内視鏡検査では、再狭窄病変の黄色プラークがステントを完全に覆っているのが確認された。そのため、non-slip element balloonによる治療を行い、stent-in-stentを避けるため薬剤被覆バルーンによる補助的血管形成術を施行した。胸痛は完全に消失し、臨床経過は良好であった。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J06603&link_issn=&doc_id=20170619250005&doc_link_id=10.15791%2Fangioscopy.cr.16.0009&url=https%3A%2F%2Fdoi.org%2F10.15791%2Fangioscopy.cr.16.0009&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Contrast media are considered to cause acute kidney injury by activating various factors that induce renal vasoconstriction. We analysed the renal microvascular haemodynamic response using the Doppler flow wire method. Then changes in urinary liver-type fatty acid-binding protein levels following contrast medium administration were compared between groups with or without a micro-injury of the kidney. In the group without renal micro-injury, the average peak velocity (APV) decreased significantly, whereas the renal artery resistance index (RI) increased significantly following contrast medium administration. In contrast, there was no significant change in either the APV or RI in the group with a renal micro-injury. A blunted microvascular response was found in the micro-injury group, whereas microvascular resistance increased in the non-micro-injury group.

DOI： 10.1111/1440-1681.12653

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Although an association has been reported between the microvascular complications of diabetic patients and their poor prognosis after cardiovascular events related to advanced atherosclerosis, it is not clear whether there is a relation between diabetic retinopathy (DR) and the severity of plaque vulnerability. Fifty-seven diabetic patients with coronary artery disease, classified as non-DR (n = 42) or DR (n = 15), underwent angioscopic observation of at least 1 entire coronary artery. The number of yellow plaques (NYP) through the observed coronary artery was counted and their color grades, defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow), were evaluated. The NYP per vessel and the maximum yellow grade were determined. The association between the presence of DR and incidences of acute coronary syndrome (ACS) was analyzed during the follow-up period (mean 7.1 ± 3.3 years; range, 0.83 to 11.75 years). Mean NYP per vessel and maximum yellow grade were significantly greater in DR than in non-DR patients (2.08 ± 1.01 vs 1.26 ± 0.77, p = 0.002, and 2.40 ± 0.74 vs 1.90 ± 0.82, p = 0.044, respectively). The cumulative incidences of ACS were higher in the DR group (p = 0.004), and the age-adjusted hazard ratio for ACS was 6.943 (95% CI 1.267 to 38.054; p = 0.026) for DR compared with non-DR patients. Our findings indicate that coronary atherosclerosis and plaque vulnerability are more severe in patients with DR. DR as a microvascular complication may be directly linked with macrovascular plaque vulnerability and fatal cardiovascular events such as ACS.

DOI： 10.1016/j.amjcard.2016.06.060

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

This study aimed to examine the association between the non-invasive measurement of the brachial artery volume elastic modulus (V E), an index of arterial stiffness, and the presence of coronary artery stenosis in patients with suspected stable coronary artery disease (CAD). A total of 135 patients with suspected stable CAD (87 men, mean age, 64 ± 12 years) underwent oscillometric measurement of the brachial artery to obtain V E. Coronary angiography was thereafter carried out to diagnose CAD, defined as having ≥75 % stenosis in the epicardial coronary arteries. V E was significantly higher in patients with CAD (1.94 ± 0.34 mmHg/%) than in those without CAD (1.71 ± 0.35 mmHg/%, P < 0.001). In multiple logistic regression analysis, V E was an independent predictor for the presence of CAD (odds ratio 1.19 per 0.1 mmHg/% increase, 95 % CI 1.04-1.51) even after adjusting for multiple potential confounders including the Framingham risk score (FRS). The area under the curve of the receiver operating characteristic curve analysis for discriminating CAD increased significantly after the addition of V E to the FRS (from 0.75 to 0.81, P = 0.034). The category-free net reclassification improvement and the integrated discrimination improvement by adding V E to the FRS were 0.476 (95 % CI 0.146-0.806) and 0.086 (95 % CI 0.041-0.132), respectively. In conclusion, the brachial V E was significantly associated with the presence of coronary artery stenosis. The additional measurement of V E to the FRS improved the ability to identify patients with coronary artery stenosis among those with suspected stable CAD.

DOI： 10.1007/s00380-015-0769-7

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その他リンク： http://link.springer.com/article/10.1007/s00380-015-0769-7/fulltext.html

担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Europa Digital & Publishing  

DOI： 10.4244/eijv12i6a121

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Sleep-disordered breathing (SDB) is known as a cardiovascular risk factor and has high prevalence in hypertension, which is a major risk factor of aortic dissection (AD). However, the impact of SDB on AD has not been fully clarified. The aim of this study is to elucidate the impact of SDB on AD, especially on the type of false lumen in AD. We enrolled twenty-three consecutive patients with acute AD (mean age: 66 ± 13 years). All subjects were evaluated by an ambulatory polygraphic sleep monitoring within 1 month from the onset. AD was evaluated by axial images of computed tomography. We comparatively analyzed SDB and AD. 35 % of the subjects presented severe OSA (apnea-hypopnea index: AHI ≥30). The patent false lumen group showed significantly higher systolic and diastolic blood pressure (BP) on arrival and AHI, and lower percutaneous oxygen saturation (SaO2) compared with those in the thrombosed false lumen group. The prevalence of severe SDB was higher in the patent false lumen group (60 vs 15 %, p = 0.039). Systolic BP on arrival was significantly correlated with AHI (r = 0.457, p = 0.033) and the minimum SaO2 (r = -0.537, p = 0.010). The present study revealed close linkage between SDB and AD, and a high prevalence of SDB among AD patients. Severe SDB was related to the development of AD, especially for the patent false lumen type through highly elevated BP which might be easily evoked in the presence of severe SDB. Repetitive occurrence of intrathoracic negative pressure also might influence the repair or closure of false lumen of AD, although the present analysis did not reach statistical significance.

DOI： 10.1007/s00380-015-0699-4

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その他リンク： http://link.springer.com/article/10.1007/s00380-015-0699-4/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

© 2015, Springer Japan. Even in the drug-eluting stent era, diabetes mellitus (DM) patients have high incidences of restenosis and repeat revascularization after percutaneous coronary intervention. The aim of this study was to compare vascular response after stent implantation between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) by using optical coherence tomography (OCT) in DM patients as well as in non-DM patients. In the Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT), the OCT sub-study enrolled 75 patients who underwent 8 months follow-up imaging after SES or PES implantation. Mean neointimal hyperplasia (NIH) thickness was significantly thinner in SES than PES in the DM group (77 ± 47 vs. 201 ± 114 μm, p < 0.001) and in the non-DM group (84 ± 37 vs. 212 ± 128 μm, p < 0.001). Unevenness of NIH thickness in longitudinal axis was significantly smaller in SES than PES in the DM group (348 ± 191 vs. 726 ± 385 μm, p < 0.001) and in the non-DM group (344 ± 174 vs. 679 ± 314 μm, p < 0.001). The percentage of uncovered struts was significantly greater in SES than PES in the DM group (24 ± 4 vs. 9 ± 14 %, p < 0.001) and in the non-DM group (16 ± 16 vs. 3 ± 4 %, p = 0.002). Compared with PES, SES showed more potent NIH inhibition in DM patients as well as in non-DM patients.

DOI： 10.1007/s00380-015-0636-6

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その他リンク： http://link.springer.com/article/10.1007/s00380-015-0636-6/fulltext.html

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

This case report describes a patient who underwent implantation of a bare-metal stent (BMS) for the treatment of everolimus-eluting stent (EES) restenosis caused by chronic stent recoil, and the BMS successfully escaped from duplicate restenosis and target lesion revascularization (TLR).

DOI： 10.1007/s00380-014-0588-2

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その他リンク： http://link.springer.com/article/10.1007/s00380-014-0588-2/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

BACKGROUND: Little is known about the very late-phase morphological vessel characteristics within the sirolimus-eluting stent (SES). METHODS AND RESULTS: We assessed a total of 12 patients with 15 SES implantations who underwent repeat angiographic and angioscopic procedures after 5 and 7 years. The degree of neointimal stent coverage (NSC) was classified as follows: grade 0, uncovered struts; grade 1, visible struts through a thin neointima; or grade 2, invisible struts with complete neointimal coverage. The maximum and minimum NSC grades were evaluated and the existence of in-stent thrombus was also recorded for all patients. The prevalence of a maximum NSC grade of 2 increased and that of a minimum NSC grade of 0 decreased, although there was no significant difference in prevalence between 5 and 7 years. One of four in-stent thrombus identified at 5 years had disappeared from 5 to 7 years and a new thrombus was found in another patient at 7 years. Thus, the incidence of in-stent thrombus did not change from 5 to 7 years. In one case, a thrombus was observed inside the angiographic aneurysmal change, but none of the thrombi were related to adverse events. CONCLUSION: This angioscopic study reported gradual arterial repair and continuous delayed healing associated with subclinical thrombus formation 7 years after SES deployment.

DOI： 10.1097/mca.0000000000000315

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Europa Digital & Publishing  

DOI： 10.4244/eijv11i9a209

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

Objectives: The present study sought to clarify the relationship between matrix metalloproteinase-9 (MMP-9) levels and plaque morphology demonstrated by optical coherence tomography (OCT), and to examine their prognostic impacts in patients with acute coronary syndrome (ACS). Methods: MMP-9 levels were measured for patients with ACS (n = 249). Among 249 patients, 120 with evaluable OCT images were categorized into patients with ruptured plaques (n = 65) and those with nonruptured plaques (n = 55) on the basis of culprit lesion plaque morphology demonstrated by OCT. Results: MMP-9 levels on admission were significantly higher in the rupture group than in the nonrupture group (p = 0.029). Although creatine kinase-MB (CK-MB) on admission was comparable between the groups, peak CK-MB was higher in the rupture group than in the nonrupture group (p &lt; 0.001). By receiver operating characteristic curve analysis, the optimal cut-off value of MMP-9 to detect ruptured plaques was 65.5 ng/ml (p = 0.029). There was a nonstatistically significant trend toward increased cardiac death at 2 years (5.9 vs. 1.0%, p = 0.059) in patients with high MMP-9 (≥65.5 ng/ml) compared to those with low MMP-9 (&lt;65.5 ng/ml). Conclusions: MMP-9 can differentiate ACS with ruptured plaques from nonruptured plaques, and MMP-9 may be a valuable predictor of long-term cardiac mortality in patients with ACS reflecting plaque rupture.

DOI： 10.1159/000445994

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Contrast-induced nephropathy (CIN) is considered to result from intrarenal vasoconstriction, and occurs more frequently in impaired than in normal kidneys. It was hypothesized that iodinated contrast media would markedly change renal blood flow and vascular resistance in functionally impaired kidneys. Thirty-six patients were enrolled (32 men; mean age, 75.3 ± 7.6 years) undergoing diagnostic coronary angiography and were divided into two groups based on the presence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min per 1.73 m(2) (CKD and non-CKD groups, n = 18 in both). Average peak velocity (APV) and renal artery resistance index (RI) were measured by Doppler flow wire before and after administration of the iodinated contrast media. The APV and the RI were positively and inversely correlated with the eGFR at baseline, respectively (APV, R = 0.545, P = 0.001; RI, R = -0.627, P < 0.001). Mean RI was significantly higher (P = 0.015) and APV was significantly lower (P = 0.026) in the CKD than in the non-CKD group. Both APV (P < 0.001) and RI (P = 0.002) were significantly changed following contrast media administration in the non-CKD group, but not in the CKD group (APV, P = 0.258; RI, P = 0.707). Although renal arterial resistance was higher in patients with CKD, it was not affected by contrast media administration, suggesting that patients with CKD could have an attenuated response to contrast media.

DOI： 10.1111/1440-1681.12479

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/1440-1681.12479

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

OBJECTIVE: This 8-year follow-up cohort study evaluated and compared the degree of coronary atherosclerosis in chronic kidney disease (CKD) according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification using multivessel angioscopy and investigated the impact of the vulnerability of coronary arteries on the relationship between the classification and risk of acute coronary syndromes (ACS). METHODS: We studied 89 coronary artery disease patients who underwent angioscopic observation of multiple coronary arteries. The patients were divided into 3 groups: Risk 0, 1, and 2 were equivalent to low risk, moderately high risk, and high and severely high risk, respectively. We examined the frequencies of complex and yellow plaques. Furthermore, we followed all patients for de novo ACS, dividing into two groups according to the existence of vulnerable coronary atherosclerosis (VCA) based on angioscopic findings. RESULTS: The number of yellow plaques per vessel, maximum yellow grade, number of complex plaques per vessel, and cumulative incidence of ACS in all patients were significantly associated with Risk grade progression (p < 0.05 for trend). Among the patients with VCA, Risk 2 had a higher incidence of ACS than Risk0 (p < 0.014) and Risk 1 (p < 0.007), whereas Risk 0 and Risk 1 had similar outcomes. Among the patients without VCA, no de novo ACS events were seen regardless of the Risk group. CONCLUSIONS: Coronary atherosclerosis progressed in the early stages of CKD, and once it reached to a vulnerable stage, advanced CKD patients had a synergistically increased risk of ACS.

DOI： 10.1016/j.atherosclerosis.2015.10.094

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担当区分：責任著者  

DOI： 10.4330/wjc.v7.i11.776

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担当区分：筆頭著者,　責任著者  

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担当区分：責任著者   記述言語：英語   出版者・発行元：日本心臓血管内視鏡学会  

74歳女。動脈硬化性閉塞症が疑われ、左大腿動脈よりクロスオーバーアプローチにて血管造影を行った。カテーテルインターベンションにて右総大腿動脈と外腸骨動脈の狭窄部は改善した。左大腿動脈の刺入部をAngio-Sealにて閉鎖したが止血できず、用手圧迫にて止血した。その直後は左膝窩動脈と足背は触知可能であった。翌日、間欠跛行を認め、足関節-上腕血圧指数が低下していた。膝窩動脈と足背動脈にて脈拍を認めず、大動脈-大腿動脈造影にて、浅大腿動脈(SFA)の閉塞を認め、大腿深動脈から側副血行路が生じていた。バルーンカテーテルにてSFAの拡張を行い、血管内視鏡にて赤色・白色血栓の残存と白色の集塊を認めた。カテーテルによる血栓除去を行い、左足の疼痛が残存したため、伏在静脈パッチと大腿大腿動脈バイパスグラフト移植を行い、症状は改善した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J06603&link_issn=&doc_id=20150626180006&doc_link_id=10.15791%2Fangioscopy.cr.15.0006&url=https%3A%2F%2Fdoi.org%2F10.15791%2Fangioscopy.cr.15.0006&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

担当区分：責任著者   記述言語：英語   出版者・発行元：日本心臓血管内視鏡学会  

Pre-diabetic患者におけるスタチン療法の効果を、冠動脈内視鏡を用いてアテローム性動脈硬化の程度を比較することにより評価した。pre-diabetic患者28名を対象に後向き研究を行った。黄色プラークの色等級は、血管内視鏡所見の半定量的分析に基づいて1度(淡黄色)、2度(黄色)、3度(濃黄色)に分類した。血管あたりの黄色プラーク数(NYP)と最大黄色度(MYG)を、スタチン治療群と非スタチン治療群の患者間で比較した。LDL-コレステロールの血清中濃度を含む基本的な特徴は、2群間で類似していた。平均NYPおよびMYGは非スタチン群よりスタチン群で有意に低く、それぞれ2.03±0.59対1.12±0.73および2.50±0.71対1.72±0.83であった。スタチン療法は、pre-diabetic患者におけるアテローム性動脈硬化の進行を抑制するのに重要な役割を果たしていると考えられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J06603&link_issn=&doc_id=20150626180004&doc_link_id=10.15791%2Fangioscopy.or.15.0005&url=https%3A%2F%2Fdoi.org%2F10.15791%2Fangioscopy.or.15.0005&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterol for primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome (ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.

DOI： 10.4239/wjd.v6.i1.184

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00392-014-0748-5

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その他リンク： http://link.springer.com/article/10.1007/s00392-014-0748-5/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2013.07.112

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2013.03.134

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Background Relationships between plaque morphology on optical coherence tomography (OCT) and biomarker levels in the patients with acute coronary syndrome (ACS) have not been fully investigated. Methods ACS patients (n = 128) were prospectively enrolled and their plasma levels of soluble lectin-like oxidized LDL receptor-1 (sLOX-1), high-sensitivity C-reactive protein (hs-CRP), and high-sensitivity troponin T (hs-TnT) were measured. Another set of 20 patients with stable angina pectoris (SAP) without plaque rupture or erosion served as controls. Among 128 ACS patients, 75 patients underwent OCT procedure to evaluate culprit plaque morphology, and were categorized into two groups; ACS with plaque rupture (ruptured ACS; R-ACS, n = 54) and ACS without plaque rupture (non-ruptured ACS; N-ACS, n = 21). Results Levels of sLOX-1 (p < 0.001), hs-CRP (p = 0.048) and hs-TnT (p < 0.001) were significantly higher in R-ACS than SAP. Levels of sLOX-1 were also significantly higher in R-ACS than in N-ACS (p < 0.001); whereas levels of hs-CRP (p = 0.675), as well as those of hs-TnT (p = 0.055), were comparable between R-ACS and N-ACS. Comparison of receiver operating characteristic (ROC) curves among sLOX-1, hs-CRP and hs-TnT to differentiate R-ACS from N-ACS revealed that the area under the curve (AUC) values of sLOX-1, hs-CRP and hs-TnT were 0.782, 0.531 and 0.643, respectively. ROC curves, generated for these biomarkers, to differentiate ACS with thin-cap fibroatheroma (TCFA) from those without demonstrated that the AUC values of sLOX-1, hs-CRP and hs-TnT were 0.718, 0.506 and 0.524, respectively. Conclusion sLOX-1, but not hs-CRP or hs-TnT, can differentiate ACS with plaque rupture from those without, and ACS with TCFA from those without. © 2013 Elsevier Ireland Ltd.

DOI： 10.1016/j.ijcard.2013.04.110

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

A 67-year-old male was admitted because of acute myocardial infarction (AMI). An emergent coronary angiography showed a total occlusion in the left anterior descending artery, and a stent was deployed. Moderate lesion stenosis was found in the right coronary artery (RCA). Fractional flow reserve indicated 0.96, and percutaneous coronary intervention was not performed. Six months later, the patient visited an emergency room due to AMI. Angiograms showed a patency of the previous stent and progressed stenosis with filling delay of the RCA. Protruding red thrombi and plaque disruption of thin-cap fibroatheroma (TCFA) were identified by optical coherence tomography. Mild to moderate lesions are physiologically benign but morphologically malignant in cases of TCFA. <Learning objective: Severe stenosis is a malignant index of plaque vulnerability on the basis of physiological and morphological evaluation. However, mild to moderate lesions are physiologically benign but morphologically malignant in cases of thin-cap fibroatheroma. Although fractional flow reserve can estimate the extent of severe stenosis, one of the elements of vulnerable plaques, it cannot always predict future events related to morphologically vulnerable plaques>.

DOI： 10.1016/j.jccase.2013.03.001

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Although several clinical trials have shown the superior efficacy and safety of second-generation everolimus-eluting stents (EES) in comparison with first-generation paclitaxel-eluting stents (PES), the differences in the vascular healing process between EES and PES in a human coronary artery during an early stage are unknown. METHODS: A prospective optical coherence tomography (OCT) observation was performed for 25 EES in 21 patients and 27 PES in 21 patients at 6 months after implantation. Cross-sections within single-stent segments were analyzed at intervals of 1mm. The neointimal (NI) thickness on each strut was measured. Uncovered struts (NI thickness=0 μm), malapposed struts, NI area (%), uncovered strut ratio >0.3 (UCSR; number of uncovered struts/number of total struts) per cross-section, and in-stent thrombus were evaluated. RESULTS: A total of 5198 EES struts in 514 cross-sections and 4243 PES struts in 469 cross-sections were identified. NI thickness and its area were smaller for EES than PES (80.0 ± 84.8 μm vs. 117.9 ± 140.0 μm and 19.1 ± 8.9% vs. 23.7 ± 11.5%, respectively; P<0.001). The frequencies of uncovered struts and malapposed struts were lower in EES compared to PES (2.3% vs. 5.2% and 2.1% vs. 5.7%, respectively; P<0.001). Patients who had cross-sections of UCSR >0.3 and thrombi were identified less frequently in EES than in PES group (5% vs. 57%; P<0.001, and 19% vs. 48%; P=0.05, respectively). CONCLUSIONS: Six-month OCT examination showed a favorable vessel healing response after the implantation of EES, demonstrating less in-stent late loss as well as fewer uncovered struts and better stent apposition to the vessel wall in comparison with PES.

DOI： 10.1016/j.ijcard.2011.10.102

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2012.09.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2012.08.1040

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Diabetes Association  

OBJECTIVE

To determine if prediabetes is associated with atherosclerosis of coronary arteries, we evaluated the degree of coronary atherosclerosis in nondiabetic, prediabetic, and diabetic patients by using coronary angioscopy to identify plaque vulnerability based on yellow color intensity.

RESEARCH DESIGN AND METHODS

Sixty-seven patients with coronary artery disease (CAD) underwent angioscopic observation of multiple main-trunk coronary arteries. According to the American Diabetes Association guidelines, patients were divided into nondiabetic (n = 16), prediabetic (n = 28), and diabetic (n = 23) groups. Plaque color grade was defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow) based on angioscopic findings. The number of yellow plaques (NYPs) per vessel and maximum yellow grade (MYG) were compared among the groups.

RESULTS

Mean NYP and MYG differed significantly between the groups (P = 0.01 and P = 0.047, respectively). These indexes were higher in prediabetic than in nondiabetic patients (P = 0.02 and P = 0.04, respectively), but similar in prediabetic and diabetic patients (P = 0.44 and P = 0.21, respectively). Diabetes and prediabetes were independent predictors of multiple yellow plaques (NYPs ≥2) in multivariate logistic regression analysis (odds ratio [OR] 10.8 [95% CI 2.09–55.6], P = 0.005; and OR 4.13 [95% CI 1.01–17.0], P = 0.049, respectively).

CONCLUSIONS

Coronary atherosclerosis and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable between prediabetic and diabetic patients. Slight or mild disorders in glucose metabolism, such as prediabetes, could be a risk factor for CAD, as is diabetes itself.

DOI： 10.2337/dc12-1635

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2012.06.097

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.52.9149

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掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

DOI： 10.1536/ihj.54.75

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

BACKGROUND: Although coronary vasospasm (CVS) would be one of the major causes of out-of-hospital cardiac arrest (OHCA), the characteristics of patients with cardiac arrest caused by CVS have not been clarified. METHODS AND RESULTS: In study 1, 1,000 consecutive patients with OHCA were retrospectively categorized based on the cause of OHCA, and the prevalence of CVS OHCA was elucidated. In study 2, 138 consecutive CVS patients were divided into 2 groups: CVS with cardiac arrest (arrest-CVS, n=12) and CVS without cardiac arrest (non-arrest-CVS, n=126). In study 1, 589 patients had OHCA caused by cardiovascular disease and 121 patients were successfully resuscitated. Among the 121 resuscitated patients, 9 had CVS OHCA. In study 2, the incidence of cardiac events (ie, cardiac arrest or chest pain) occurring on vigorous exertion, in the daytime and without prodromal chest symptoms was higher in the arrest-CVS group than in the non-arrest-CVS group. CONCLUSIONS: CVS is an important cause of OHCA. Because significantly different characteristics are observed between CVS patients with cardiac arrest and those without, care should be taken to diagnose CVS as the cause of cardiac arrest.

DOI： 10.1253/circj.cj-12-0846

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Background: Sleep disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease, although it is not clear whether SDB has any link to coronary atherosclerotic burden in patients with stable coronary artery disease (CAD). This study sought to analyze the links between SDB, coronary atherosclerotic burden, and cardiac biomarkers in stable CAD patients. Methods and results: We studied 83 consecutive patients who underwent coronary angiography or scheduled percutaneous coronary intervention. SDB was evaluated by an ambulatory polysomnographic monitoring device. Coronary atherosclerotic burden was evaluated by the Gensini score, and myocardial stress/injury were assessed by measuring plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT). Patients with an apnea hypopnea index (AHI). ≧ 15. events/h (n= 32) showed significantly higher Gensini score (35.7. ± 38.0 vs 20.1. ± 19.7, p= 0.033) than those with AHI. < 15. The higher AHI group showed significantly higher NT-proBNP (275.8. ± 402.6. pg/ml vs 131.9. ± 146.3. pg/ml, p= 0.047) and hs-TnT levels (0.011. ± 0.005. ng/ml vs 0.008. ± 0.003. ng/ml, p= 0.015). Furthermore it was revealed that AHI significantly correlated with the Gensini score (r= 0.253, p= 0.036), NT-proBNP (r= 0.266, p= 0.027), and hs-TnT (r= 0.274, p= 0.023), and multiple stepwise linear regression analysis revealed that AHI (β = 0.257, p= 0.029) and history of smoking (β. = 0.244, p= 0.038) were independently correlated with Gensini score among clinical and SDB-related parameters. Conclusions: Severity of SDB has a significant link to the severity of coronary atherosclerotic burden, which also reflected elevated NT-proBNP and hs-TnT as silent myocardial ischemia and minute myocardial injury even in stable CAD patients. © 2012 Japanese College of Cardiology.

DOI： 10.1016/j.jjcc.2012.03.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2011.07.063

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

We present the case of a 48-year-old man with unstable angina who underwent drug-eluting stent (DES) implantation for the left circumflex artery (LCx). Red thrombi within the stent were clearly found by coronary angioscopy. Dual antiplatelet therapy was orally given before the stenting. Twenty-two months after the procedure, the patient visited because of severe chest pain. The patient had stopped taking all prescriptions including antiplatelet drugs for the previous 18 months. The occurrence of late stent thrombosis (LST) derived from previously implanted DES in the LCx was strongly suspected. Unexpectedly, the left coronary angiograms showed neither in-stent restenosis nor thrombotic occlusion. Angioscopic images for the DES segment showed that there were no uncovered stent struts without neointimal coverage. Notably, red thrombi identified immediately after stenting by angioscopy had completely disappeared. Mural red thrombi at the first observation completely disappeared despite premature cessation of dual antiplatelet therapy. Early neointimal coverage may occasionally occur even under the condition of acute coronary syndrome. The leading cause of LST was not only the cessation of dual-antiplatelet therapy and multiple factors contribute to LST of DES. Relatively early and adequate neointimal stent coverage may reduce the risk of thrombus formation including LST even though anti-platelet therapy was discontinued prematurely.

DOI： 10.1016/j.jccase.2011.09.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

A 58-year-old male with a history of prior myocardial infarction, hypertension, and dyslipidemia was admitted due to deteriorating exertional angina. A bare metal stent (Multilink plus™, GUIDANT Corporation, Santa Clara, CA, USA) had been implanted into the proximal left anterior descending artery because of ST-elevation myocardial infarction 7 years earlier. Optical coherence tomography (OCT) showed a disruption of the atherosclerotic neointima overlying the stent. Intravascular imaging studies and pathological studies have shown that neointima within a bare-metal stent often transform into atherosclerotic tissue during an extended period of time. In the current report, OCT demonstrated that a disruption of the atherosclerotic neointima has the potential to cause the development of unstable clinical features. OCT examinations therefore help to understand the pathogenesis of acute coronary syndrome after stent implantation.

DOI： 10.1536/ihj.53.261

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

BACKGROUND: The association between elevated malondialdehyde-modified low-density lipoprotein (MDA-LDL) and plaque instability in patients with coronary artery disease (CAD) is suspected but not established. The aim of the present study was therefore to investigate the association between serum MDA-LDL and plaque characteristics on angioscopy. METHODS AND RESULTS: A total of 37 consecutive patients with CAD and single-vessel disease who underwent pre-interventional angioscopy, were studied. Using angioscopy at the target lesions, the presence of yellow plaque and complex plaque was examined. Moreover, we evaluated the yellow intensity, which has been shown to have an inverse correlation with the fibrous-cap thickness of the plaques, with quantitative colorimetry to identify a thin-cap atheroma. Serum MDA-LDL in patients with thin-cap atheroma diagnosed on quantitative colorimetry was significantly higher than in patients without thin-cap atheroma (P<0.0009). Univariate logistic regression indicated that serum MDA-LDL was a predictor for thin-cap atheroma (odds ratio [OR], 1.48; 95% confidence interval [CI]: 1.10-1.97; P=0.003) and for complex plaque (OR, 1.22; 95% CI: 1.00-1.48; P=0.046). On multivariate logistic regression serum MDA-LDL was the only independent predictor for thin-cap atheroma (OR, 1.48; 95% CI: 1.10-1.97; P=0.011). CONCLUSIONS: Using angioscopy and quantitative colorimetry, elevated MDA-LDL was confirmed to be associated with thin-cap atheroma in CAD patients.

DOI： 10.1253/circj.cj-12-0183

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-12-0190

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s12928-011-0057-0

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その他リンク： http://link.springer.com/article/10.1007/s12928-011-0057-0/fulltext.html

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Although very late stent thrombosis occurs several years after implantation of sirolimus-eluting stent (SES), the morphologic changes of the stent beyond 2 years have not yet been systematically studied in living patients. The late vascular response to SES was therefore evaluated by serial angioscopic studies at 2 and 5 years after stent implantation. METHODS: A total of 17 patients with 17 SES underwent a repeated angioscopy procedure at 2 and 5 years. Neointimal stent coverage (NSC) was classified as follows: grade 0, presence of uncovered struts; grade 1, visible struts through a thin neointima; or grade 2, complete neointimal coverage without visible struts. For each patient, the minimum and maximum NSC grade and the existence of in-stent thrombus were recorded. RESULTS: The minimum and maximum NSC grade did not increase between the 2 and 5 years (0.59 ± 0.51 vs 0.88 ± 0.70, P = .17, and 1.82 ± 0.39 vs 1.94 ± 0.24, P = .30, respectively). The prevalence of patients with uncovered struts did not significantly decrease from 2 to 5 years (41% vs 29%, P = .49). During the follow-up period, 3 of 6 thrombi disappeared, whereas new thrombus formation was found in 3 patients without any clinical symptoms. In-stent thrombus did not decrease (35% vs 35%, P > .99). CONCLUSIONS: The current serial angioscopic study suggests that incomplete NSC and the prevalence of latent thrombus within the SES segments did not decrease from 2 to 5 years. The risk of stent thrombosis related to incomplete healing of SES may continue for an extended period.

DOI： 10.1016/j.ahj.2011.03.006

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Although in-stent restenosis (ISR) after bare-metal stent (BMS) implantation is considered to be clinically benign, ISR is often associated with adverse complications, such as acute coronary syndrome (ACS). The frequency, type, and location of thrombi in ISR lesions and their clinical presentation have not yet been precisely validated. METHODS: Thirty angiographic ISR lesions occurring within 3 to 8 months after stenting were evaluated by optical coherence tomography (OCT). A thrombus was defined as a mass protruding into the lumen with an irregular surface, and its type was divided into red or white. The maximum size of a thrombus and the longitudinal distance from the thrombus to the narrowest lumen were measured. RESULTS: A thrombus was identified in 2 patients by angiography and in 10 patients by OCT (7% vs. 33%; P=0.01). OCT showed that 9 patients had white thrombus and another patient had both types of thrombi. ACS relevant to ISR was seen in 6 patients, and the frequency of ACS was significantly higher in patients with thrombus than in those without thrombus [50% (5/10) vs. 5% (1/20); P=0.003]. The maximum size of the thrombus was 412 ± 220 µm in height, 424 ± 251 µm in width, and the longitudinal distance between the thrombus and the minimum lumen area was 0.3 ± 0.7 mm. CONCLUSIONS: One third of ISR lesions following BMS deployment dominantly contained a white thrombus, and half of them were associated with ACS. A small thrombus formation adjacent to the narrowest lumen in an ISR lesion may therefore contribute to the clinical presentation of ACS.

DOI： 10.1016/j.ijcard.2009.12.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Disruption of vulnerable plaque and following thrombus formation are considered the main cause of acute coronary syndrome (ACS). Intracoronary angioscopy is an endoscopic technology that allows direct visualization of the coronary artery lumen and provides detailed information regarding plaque morphology in patients with coronary artery disease. The color and morphology of coronary plaque under angioscopy observation are proposed to be determinants for plaque stability. Angioscopically yellow plaque represents a thin-cap fibroatheroma, and is associated with a higher incidence of disruption and thrombus formation, and may be associated with future acute coronary syndromes. To circumvent the subjectivity of color interpretation, various quantitative methods have been proposed for identifying vulnerable plaques. Superior to other coronary imaging techniques such as VH IVUS and optical coherence tomography, angioscopy has impressively high sensitivity and specificity in detection of intraluminal thrombus. Angioscopy can also be used as an adjunctive technique during catheter intervention by directly visualizing the thrombus, stent struts and proliferating neointima. The time course and pattern of neointima coverage, as seen by angioscopy, various among different stent systems. Angioscopic assessment of serial changes after stent implantation may have potential benefits on patient's management after coronary stenting.

DOI： 10.1007/s12928-011-0055-2

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その他リンク： http://link.springer.com/article/10.1007/s12928-011-0055-2/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2011.01.073

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2010.06.012

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Atherosclerosis Society  

DOI： 10.5551/jat.8128

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：The Medical Association of Nippon Medical School  

The concept of vulnerable plaque (VP) has been widely accepted as the primary cause of acute coronary syndrome (ACS) and sudden cardiac death. ACS is thought to result from sudden disruption of a VP with subsequent occlusive thrombosis. VP typically consists of several components; a large necrotic core, thin fibrous cap, increase in macrophage activity, increase in vaso vasorum, and positive remodeling.<br> In recent years, invasive or non-invasive diagnostic imaging modalities have been developed for indentifying VP. VP has been recognized in various modalities not only by visualization of cross sectional images by high-resolution imaging modalities, such as virtual histology intravascular ultrasound (VH-IVUS) , integrated backscatter (IB) IVUS, and optical coherence tomography (OCT), but also by direct visualization by intracoronary angioscopy.<br> VH-IVUS uses advanced radiofrequency signal analysis of ultrasound signals and allows detailed qualitative and quantitative assessment of plaque composition, while IB-IVUS analyzes the radiofrequency signal by applying a fast Fourier transformation of the component of the backscattered signals. Different tissue components reflect the radiofrequency signaling at different power levels, which could be used to differentiate various tissue components. Angioscopy allows direct visualization of internal surface of the lumen, providing the detailed information of characteristics of plaque and thrombus. Optical coherence tomography (OCT) is an analog of IVUS, but uses light instead of sound. OCT has a 10-fold higher image resolution (10-15 μm) compared to conventional IVUS, therefore it is able to provide superior image quality. The commercially available versions of the technology used time-domain (TD) OCT (M2, M3, Lightlab, Westford, MA, USA) and fourier-domain (FD) OCT (C7XR, Lightlab, Westford, MA, USA) . OCT is the only imaging modality with high enough resolution to measure fibrous cap thickness and neovascularization. Moreover OCT has a unique ability of detecting macrophages.<br> In this review, we attempted to summarize the advantages and limitations of the currently available intravascular modalities.<br>

DOI： 10.1272/jnms.78.340

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2010.05.073

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

Very late stent thrombosis (VLST) after implantation of a drug-eluting stent (DES) is a rare but catastrophic complication and the mechanisms are not completely understood. We describe a 76-year-old patient with recurrent VLST of DES that developed at 13 and 23 months after the initial catheter procedure of DES implantation under the cessation of dual antiplatelet therapy. Optical coherence tomography (OCT) observation revealed small stent area of a DES. Based on the OCT findings, balloon angioplasty for expansion of the DES was performed and angiographic Thrombolysis In Myocardial Infarction grade 3 flow was subsequently obtained. Small stent area is considered a significant factor in acute or subacute stent thrombosis according to previous reports. The present report shows that small stent area of DES may be regarded as a key factor in recurrent VLST as well as cessation of dual antiplatelet therapy.

DOI： 10.1016/j.jccase.2010.07.002

PubMed

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2009.03.133

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

The AngioSculpt scoring balloon catheter (AngioScore, Inc., Fremont, California) has recently been developed for percutaneous intervention in coronary and peripheral arteries. This device is composed of two major components, a minimally compliant balloon and three nitinol wore. The three wires encapsulate the low-compliant balloon in a spiral configuration. The concept is for the spiral wires to score the lumen surface during balloon expansion. However, the precise mechanisms and efficacy of this scoring technology in humans had not yet to be determined. In this case, both a de novo coronary lesion and an in-stent restenosis lesion were treated with the scoring balloon and were subsequently observed via optical coherence tomography (OCT) with high-resolution images ( approximately 15 microm). OCT clearly demonstrated the effects of this device on plaque and neointimal hyperplasia scoring, as well as its ability to achieve sufficient lumen sizes after coronary artery dilatation.

DOI： 10.1016/j.ijcard.2008.11.154

PubMed

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記述言語：中国語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To evaluate the short- and long-term prevalence of persistent uncovered struts and in-stent thrombus after sirolimus-eluting stent (SES) implantation by optical coherence tomography (OCT). METHODS: OCT was performed for 31 SES in 21 patients at 3 months and for 30 SES in 21 patients at 2 years post SES implantation. Thickness of new intima inside each strut was measured and thickness equal to 0 microm was defined as an uncovered strut. Existence of in-stent thrombus was also evaluated. RESULTS: A total of 4545 struts and 3707 struts were evaluated at 3 months and at 2 years post SES implantation, respectively. New intima at 2 years was significantly thicker than that at 3 months [(71 +/- 93) microm vs. (29 +/- 41) microm, P < 0.01]. Percent of uncovered struts at 2 years was significantly lower than that at 3 months (5% vs. 15%, P < 0.01). Prevalence of uncovered struts was similar at 2 years and at 3 months (81% vs.95%, P > 0.05). Subclinical thrombus was recognized in 14% patients at 3 months and 2 years post SES implantation. CONCLUSIONS: Neointimal coverage inside the SES is a continuous process and the number of uncovered struts decreased from 3 months to 2 years after SES implantation. Few uncovered struts could still be visualized in the majority of patients at 2 years post SES implantation.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

The difference in neointimal stent coverage (NSC) between ruptured segments and adjacent nonruptured segments in infarct-related lesions (IRL) of acute myocardial infarction after bare metal stent (BMS) implantation was evaluated using coronary angioscopy. Serial angioscopic observations were performed for 19 IRLs immediately after the implantation of a BMS and at 1-month and 6-month follow-up. Stented segments were divided into the ruptured segment and the nonruptured segment based on the presence of a thrombus. The grade of NSC was divided into 0 = complete exposure, 1 = partial coverage, or 2 = complete coverage. The grade of plaque color was classified semiquantitatively as 0 = white, 1 = light yellow, or 2 = intense yellow. The existence of a thrombus was also determined. The grade of NSC in the ruptured segment was lower than that of the nonruptured segment at each follow-up. The grade of plaque color at the 1-month follow-up was higher in the ruptured segment than in the nonruptured segment. At 6 months, the grade of plaque color was similar between the ruptured and nonruptured segments. In all cases, thrombi existed in the ruptured segments immediately after stenting. Although thrombi still remained frequently at 1-month, most had disappeared at the 6-month follow-up. Neointimal proliferation of the ruptured segment in IRL advanced slowly in comparison to the adjacent nonruptured segment. The presence of an atherosclerotic yellow plaque and a thrombus may affect the delayed neointimal coverage after BMS implantation.

DOI： 10.1536/ihj.51.7

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-09-0769

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

Culprit lesions of acute coronary syndrome (ACS) were observed by intravascular optical coherence tomography (OCT). OCT images revealed diffuse intimal thickening, reduced lumen area with vascular contraction, and thrombus formation. No OCT images of atherosclerotic plaque disruption were found. Vascular contraction disappeared and the lumen was dilated after intracoronary injection of nitroglycerin. The main mechanism of ACS in this case was therefore considered to be coronary vasospasm. OCT may be useful for evaluating the mechanism of ACS.

DOI： 10.1536/ihj.51.291

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Plaque disruption, which may be associated with some coronary risk factors, plays a key role in the development of acute coronary syndromes and progression of atherosclerosis. However, the clinical profile of asymptomatic plaque disruption in stable ischemic heart disease has not been well evaluated. The aim of the present study was to investigate the frequency and determinants of silent plaque disruption (SPD) in patients with stable ischemic heart disease using coronary angioscopy. Forty-one patients with stable angina or old myocardial infarction (OMI) without any complaints within 3 months were included in the present study. Angioscopy was successfully performed through 49 nonischemic related coronary arteries. The presence of SPD and coronary risk factors were recorded. Silent plaque disruption was found in 12 patients with stable ischemic heart disease (12/41, 29.3%), and the frequency of SPD in nonischemic related coronary arteries was 26.5% (13/49). A significantly higher frequency of SPD was noted in yellow plaques than in white plaques (35.3% versus 6.7%, P = 0.043). Overall, the independent clinical risk factors of SPD in nonischemic related coronary arteries were diabetes mellitus (P = 0.018; OR, 18.8209; 95% CI, 1.6525 to 214.3523) and hypertension (P = 0.0313; OR, 6.6485; 95% CI, 1.1850 to 37.3019). These results suggest silent plaque disruption was commonly observed in nonischemic related coronary arteries in patients with stable ischemic heart disease and its determinants were diabetes mellitus and hypertension.

PubMed

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/clc.20352

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記述言語：日本語   出版者・発行元：Japan Heart Foundation  

31歳, 女性. 39.2℃の発熱があり, その2カ月後より眼前暗黒感を伴う眩暈を主訴に近医を受診. 両側橈骨動脈が触知不能のため高安動脈炎が疑われ紹介. 精査目的で入院するも妊娠6週1日目であることが判明し, 造影剤を使用した検査は中止. WBC 10,540/µL, CRP 0.73mg/dL, 血沈69mm/1時と炎症反応が亢進し, 頸動脈エコーでは両側の総頸動脈内中膜肥厚, および胸部MRAで大動脈弓3分枝の狭窄が認められた. 症状, 血液生化学検査, および画像診断より高安動脈炎I型と診断した. プレドニゾロン30mg/日の内服開始に伴い, 眩暈の改善および橈骨動脈の触知を認め外来加療とした. CRPと血沈を指標に外来でプレドニゾロンを漸減し, 継続加療を行った. 妊娠経過中に胎児の発達に問題なく, 妊娠も正常に経過した. 本症例の高安動脈炎病期はgroup I, 新生児予後スコアーは0点であることより自然経膣分娩とし, 妊娠39週3日に体重3,010gの男児を無事出産した. 高安動脈炎は全国に約5,000人の罹患患者がいるが, 妊娠症例の報告は比較的少なく, 本疾患妊娠症例の診断・治療, 妊娠分娩時の管理などにつき考察を加える.

DOI： 10.11281/shinzo.42.1323

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その他リンク： http://search.jamas.or.jp/link/ui/2011031673

担当区分：筆頭著者,　責任著者  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ahj.2009.04.016

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掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ  

DOI： 10.1136/hrt.2009.167759

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

<bold>
<italic>Background—</italic>
</bold>
Although coronary angiograms after bare-metal stent (BMS) implantation show late luminal narrowing beyond 4 years, the detailed changes inside the BMS have not yet been fully elucidated.




<bold>
<italic>Methods and Results—</italic>
</bold>
Serial angiographic and angioscopic examinations were performed immediately (baseline), 6 to 12 months (first follow-up), and ≥4 years (second follow-up) after stenting without target lesion revascularization in 26 segments of 26 patients who received BMS deployment for their native coronary arteries. Angioscopic observation showed atherosclerotic yellow plaque crushed out by stent struts in 22 patients (85%) and mural thrombus in 21 patients (81%) at baseline. At first follow-up, white neointimal hyperplasia was almost completely buried inside the struts, and both yellow plaque and thrombus had decreased in comparison with baseline (12% and 4%, respectively;
<italic>P</italic>
&lt;0.001). The frequencies of yellow plaque and thrombus increased from the first to second follow-ups (58% and 31%, respectively;
<italic>P</italic>
&lt;0.05). All of the yellow plaques in the second follow-up were located not exterior to the struts but protruding from the vessel wall into the lumen. Late luminal narrowing, defined as an increasing of percent diameter stenosis between the first and second follow-ups, was greater in segments with yellow plaque than in those without yellow plaque (18.4�17.3% versus 3.6�4.2%, respectively;
<italic>P</italic>
=0.011).




<bold>
<italic>Conclusions—</italic>
</bold>
This angiographic and angioscopic study suggests that white neointima of the BMS may often change into yellow plaque over an extended period of time, and atherosclerotic progression inside the BMS may contribute to late luminal narrowing.

DOI： 10.1161/circinterventions.109.854679

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2007.12.110

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jjcc.2008.08.011

CiNii Books

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担当区分：筆頭著者  

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-08-1166

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-07-0924

CiNii Books

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-08-0762

CiNii Books

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.diabres.2008.03.014

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.amjcard.2008.02.091

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/mca.0b013e32830042a8

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.amjcard.2007.09.116

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.amjcard.2007.09.106

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記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/manms.4.2

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その他リンク： http://search.jamas.or.jp/link/ui/2008162626

掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.72.399

CiNii Books

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions remains one of the major challenges in the field of interventional cardiology. Crossing guidewires through the CTO lesions has been conventionally performed from the proximal arteries to the lesions as an antegrade approach. To date, a retrograde approach, to penetrate PCI devices including guidewires and balloons into the distal end of CTO lesions via collateral vessels or coronary artery bypass grafts, has been attempted in order to achieve procedural success. With introduction of the retrograde approach for treatments of CTO lesions, several kinds of devices, techniques, and strategies have been developed. Although the techniques and strategies for the retrograde approach have not been worldwide accepted to interventional cardiologists, we introduce a way to obtain recanalization of the CTO lesions using the retrograde approach in this article.

PubMed

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担当区分：筆頭著者,　責任著者  

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担当区分：筆頭著者,　責任著者  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/mca.0b013e3282583be8

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s00059-007-2996-x

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その他リンク： http://link.springer.com/article/10.1007/s00059-007-2996-x/fulltext.html

担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2007.01.087

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ijcard.2006.11.211

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.amjcard.2006.11.068

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10554-007-9212-1

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その他リンク： http://link.springer.com/article/10.1007/s10554-007-9212-1/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

DOI： 10.1536/ihj.48.725

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ  

DOI： 10.1136/hrt.2007.131714

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.73.141

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/01.cir.0000159354.43778.69

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2004.05.066

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/01.cir.0000109696.92474.92

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掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

DOI： 10.1536/jhj.45.969

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal Association  

We examined vasospasms of the radial artery after a transradial approach was used for coronary angiography or angioplasty. In forty-eight patients (39 males and 9 females), arteriography of the radial artery was initially performed just after the transradial approach was used for coronary angiography and/or angioplasty. Then, five months later, a second arteriography of the radial artery was obtained after a transbrachial approach was used for coronary angiography. First and second arteriographies were compared to evaluate vaso-spasms of the radial artery. In the present study, more than 75% stenosis in the radial artery, 25-75% stenosis, and less than 25% stenosis were tentatively defined as severe spasms, moderate spasms, and mild spasms, respectively. In arteriographic studies on the radial artery, twenty-four patients (50%) had severe radial artery spasms, eleven patients (23%) had moderate spasms, and thirteen patients (27%) had mild spasms. The diameters of both the proximal and distal radial arteries in the severe spasm group were significantly smaller than those in the mild and moderate spasm groups (proximal site: severe group 2.39 ± 0.70 mm versus mild group 2.98 ± 0.46 mm, P < 0.05, and moderate group 2.96 ± 0.77 mm, P < 0.05, distal site: severe group 2.26 ± 0.60 mm versus mild group 2.73 ± 0.47 mm, P < 0.05, and moderate group 2.86 ± 0.71 mm, P < 0.05). We concluded that vasospasms of the radial artery occurred in most patients after the transradial approach. Furthermore, severe radial spasms were strongly correlated with the size of the diameter of the artery. <br>

DOI： 10.1536/jhj.45.723

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacc.2003.06.003

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/01.atv.0000080948.08888.bf

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Heart Journal (Japanese Heart Journal)  

DOI： 10.1536/jhj.44.271

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/ccd.10070

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担当区分：筆頭著者  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Limited  

To investigate the feasibility of angioscopic-guided percutaneoustransluminal coronary angioplasty and to elucidate the mechanismof efficacy of coronary stenting for acute myocardial infarction,we performed coronary angioscopy in 102 patients with stableangina or acute myocardial infarction. Thrombi and intimal flapswere observed in most patients after coronary angioplasty. Largeintimal splits were seen in one third of patients. Stents wereinserted in 10 patients who were revealed to have a large flap orprotruding split to the inner lumen. Thrombolytic agents wereadministered in 2 patients with large thrombi. Additionaltreatments were required in 32% of patients. No acutemyocardial infarction or unstable angina occurred in patientsduring hospitalization. Thus, angioscopy of the coronary lumenenables clinicians to determine the most appropriate and leastrisky coronary intervention strategy. In patients with acutemyocardial infarction, angioscopy revealed occlusive or protrudingthrombi in 34 of 35 patients. The protruding thrombi disappearedafter stenting. The frequency of large intimal flaps increasedafter predilatation with balloon, but these disappeared afterstenting. The present angioscopic study demonstrates that thecoronary stent compresses the occlusive or protruding thrombi andcovers the ruptured thrombogenic plaque Consequently,smooth-surfaced and wide vessel lumen are obtained.

DOI： 10.1155/dte.7.15

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担当区分：筆頭著者  

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担当区分：筆頭著者  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（公募）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：シンポジウム・ワークショップ パネル（公募）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（公募）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：口頭発表（招待・特別）  

researchmap

会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

researchmap

会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

researchmap

会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：シンポジウム・ワークショップ パネル（指名）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（招待・特別）  

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会議種別：口頭発表（一般）  

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