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Hara H, Kubo S, Nakajima Y, Matsumoto T, Kondo Y, Sugane H, Okubo K, Nakagawa K, Nagatomo D, Hachinohe D, Kusa S, Goya M, Nanasato M, Arita T, Yamasaki H, Kuwabara K, Yoshiyama T, Tanaka N, Masuda M, Sakamoto T, Nakashima M, Ohno Y, Saito S, Fukunaga M. Initial results of transcatheter modification of left atrial appendage by obliteration with device in patients with nonvalvular atrial fibrillation: Real-world data from the TERMINATOR registry. J Cardiol 2024; 83:298-305. [PMID: 37802202 DOI: 10.1016/j.jjcc.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Percutaneous left atrial appendage closure (LAAC) has increased for those who need alternative to long-term anticoagulation with non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS From September 2019, after initiating WATCHMAN (Boston Scientific, Maple Grove, MN, USA) device implantation, we established Transcatheter Modification of Left Atrial Appendage by Obliteration with Device in Patients from the NVAF (TERMINATOR) registry. Utilizing 729 patients' data until January 2022, we analyzed percutaneous LAAC data regarding this real-world multicenter prospective registry. A total of 729 patients were enrolled. Average age was 74.9 years and 28.5 % were female. Paroxysmal AF was 37.9 % with average CHADS2 3.2, CHA2DS2-VASc 4.7, and HAS-BLED score of 3.4. WATCHMAN implantation was successful in 99.0 %. All-cause deaths were 3.2 %, and 1.2 % cardiovascular or unexplained deaths occurred during follow-up [median 222, interquartile range (IQR: 93-464) days]. Stroke occurred in 2.2 %, and the composite endpoint which included cardiovascular or unexplained death, stroke, and systemic embolism were counted as 3.4 % [median 221, (IQR: 93-464) days]. Major bleeding defined as BARC type 3 or 5 was seen in 3.7 %, and there was 8.6 % of all bleeding events in total [median 219, (IQR: 93-464) days]. CONCLUSIONS These preliminary data demonstrated percutaneous LAAC with WATCHMAN device might have a potential to reduce stroke and bleeding events for patients with NVAF. Further investigation is mandatory to confirm the long-term results of this strategy using this transcatheter local therapy instead of life-long systemic anticoagulation.
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Affiliation(s)
- Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Takashi Matsumoto
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroki Sugane
- Division of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kenji Okubo
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
| | - Daisuke Nagatomo
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Takeshi Arita
- Division of Cardiovascular Medicine, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Hiro Yamasaki
- Department of Cardiology, University of Tsukuba, Tsukuba, Japan
| | - Kensuke Kuwabara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Nobuaki Tanaka
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tomohiro Sakamoto
- Cardiovascular Center Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Hioki H, Watanabe Y, Kataoka A, Kozuma K, Shirai S, Naganuma T, Yamawaki M, Enta Y, Mizuno S, Ueno H, Ohno Y, Nakajima Y, Izumo M, Bouta H, Kodama K, Yamaguchi J, Kubo S, Amaki M, Asami M, Saji M, Mizutani K, Okazaki S, Hachinohe D, Otsuka T, Adachi Y, Yamamoto M, Hayashida K. Impact of Gender on Mortality After Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation. Am J Cardiol 2023; 205:12-19. [PMID: 37579655 DOI: 10.1016/j.amjcard.2023.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/16/2023]
Abstract
Recent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between men and women. However, the gender-specific prognostic difference in the long-term follow-up after TEER is still unknown. To evaluate the impact of gender on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. We retrospectively analyzed 1,233 patients (male 60.3%) who underwent TEER for FMR at 24 centers. The impact of gender on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. During the 2-year follow-up, 207 all-cause death and 263 hospitalizations for HF were observed after TEER for FMR. Men had a significantly higher incidence of all-cause death than women (18.6% vs 14.1%, log-rank p = 0.03). After adjustment by multivariate Cox regression and PS matching, the male gender was significantly associated with a higher incidence of all-cause mortality after TEER than the female gender (hazard ratio 2.11, 95% confidence interval 1.42 to 3.14 in multivariate Cox regression; hazard ratio 1.89, 95% confidence interval 1.03 to 3.48 in PS matching). The gender-specific prognostic difference was even more pronounced after 1-year of TEER. On the contrary, there was no gender-related difference in hospitalization for HF after TEER. In conclusion, women with FMR had a better prognosis after TEER than men, whereas this was not observed in hospitalization for HF. This result might indicate that women with FMR are more likely to benefit from TEER.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan.
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yusuke Enta
- Department of Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
| | - Shingo Mizuno
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanmakura, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St, Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Bouta
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuhisa Kodama
- Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | | | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Morita Y, Kashima Y, Yasuda Y, Kanno D, Hachinohe D, Sugie T, Endo A, Fujita T, Tanabe K. Burr entrapment in a percutaneous coronary intervention during rotational atherectomy: An experience with 3195 cases. J Invasive Cardiol 2023; 35. [PMID: 37984323 DOI: 10.25270/jic/23.00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Burr entrapment is a potentially life-threatening complication of rotational atherectomy (RA). However, owing to its infrequency, there have been no major reports on burr entrapment. This study aimed to evaluate the incidence, treatment, and outcomes of burr entrapment. METHODS This multicenter retrospective study analyzed patients who had undergone percutaneous coronary interventions (PCIs) and were treated by RA between May 2013 and March 2022. RESULTS Of the 22 640 PCI procedures, RA was performed in 3195 patients (14.1%), among whom burr entrapment occurred in 22 patients (0.69%). The mean patient age was 78 ± 8.7 years; 64% were male, and 32% were on dialysis. The entrapped burr size was 1.7 ± 0.2 mm, and the burr/artery ratio was 0.6 ± 0.1. In 20 patients (91%), the burr was extracted by strong manual pullback. The other patients underwent balloon angioplasty at the site of the entrapped burr, which might have provided space for successful burr withdrawal. Major adverse cardiac events occurred in 23% of patients. Tamponade requiring pericardiocentesis occurred in two patients (9%). No patients required emergency surgery or suffered an in-hospital death. CONCLUSIONS Burr entrapment occurred in 0.69% of patients who had undergone RA. Most burrs were extracted by a strong manual pullback. None required emergency surgery, and there were no in-hospital deaths. The results provide a treatment approach and prognosis for burr stuck in the use of RA.
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Affiliation(s)
- Yusuke Morita
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan.
| | - Yoshifumi Kashima
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Yu Yasuda
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Daitaro Kanno
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuro Sugie
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tsutomu Fujita
- Cardiovascular Medicine, Sapporo Heart Centre, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
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Haraguchi T, Masanaga T, Fujita T, Otake R, Hachinohe D, Kaneko U, Kashima Y, Sato K. Comparative 2-year outcomes of the Misago stent versus other self-expandable nitinol stents for the endovascular treatment of aortoiliac disease. J Cardiovasc Surg (Torino) 2023:S0021-9509.23.12500-6. [PMID: 36897205 DOI: 10.23736/s0021-9509.23.12500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The Misago iliac stent has not been compared with other stents. This study aimed to evaluate the 2-year clinical outcomes between the Misago stent and other self-expandable nitinol stents for symptomatic chronic aortoiliac disease. METHODS This retrospective, single-center observational study enrolled 138 patients (180 limbs; Rutherford classification, between categories 2 and 6) treated with a Misago stent (N.=41) or self-expandable nitinol stent (N.=97) between January 2019 and December 2019. The primary endpoint was patency for up to 2 years. The secondary endpoints were technical success, procedure-related complications, freedom from target lesion revascularization, overall survival, and freedom from major adverse limb events. Multivariate Cox proportional hazards analysis was used to investigate predictors of restenosis. RESULTS The mean follow-up duration was 710±201 days. The 2-year primary patency rate was comparable between the groups (Misago, 89.6% and self-expandable nitinol stent, 91.0%, P=0.883). The technical success rate was 100% in both groups, and procedure-related complications were equivalent between the groups (1.7% and 2.4%, respectively; P=0.773). Freedom from target lesion revascularization was not significantly different between the groups (97.6% and 94.4%, respectively; P=0.890). The overall survival rate and freedom from major adverse limb events were not significantly different between the groups (77.2% and 70.8%, respectively, P=0.209; 66.9% and 58.4%, respectively, P=0.149). Statin therapy was positively associated with primary patency. CONCLUSIONS The Misago stent for aortoiliac lesions demonstrated comparable and acceptable clinical results of safety and efficacy for up to 2 years compared with other self-expandable stents. Statin use predicted the prevention of patency loss.
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Tadano Y, Kotani JI, Kanno D, Hachinohe D, Sugie T, Kaneko U, Kobayashi K, Kashima Y, Fujita T. Incidence, predictors, and clinical impact of the impeded-by-stent phenomenon after placing two-linked design new generation drug-eluting stents. Cardiovasc Revasc Med 2023; 51:10-17. [PMID: 36804303 DOI: 10.1016/j.carrev.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND When a catheter device is delivered during percutaneous coronary intervention, its passage can be disrupted by a deployed in a coronary artery. However, the condition and details of this phenomenon, that is impeded-by-stent phenomenon (ISP), remain unclear. METHODS We designed a prospective, open-label, single-center, observational study to clarify the incidence, predictors, and clinical impact of ISP in drug-eluting stents (DESs). Two independent operators observed and judged the occurrence of ISP, which was defined as all disturbances to a device delivery by deployed DESs. We consecutively used the Ultimaster™ (Terumo, Tokyo, Japan) DES for one month (109 patients, October 2018), followed by the Synergy™ (Boston Scientific Corporation, Marlborough, MA, USA) DES the next month (119 patients, November 2018). RESULTS DESs (2.5-4.0 mm in diameter) were implanted in 230 de novo coronary vessels. ISPs were observed in 17 of 239 stented segments (7.1 %). Multivariate analysis showed that bifurcation lesions (adjusted odds ratio [OR], 4.2; 95 % confidence interval [CI], 1.5-12.6; p = 0.008), predilatation balloon diameter (mm) (OR, 0.2; 95 % CI, 0.1-0.9; p = 0.03), and Ultimaster™ use (OR, 6.0; 95 % CI, 1.9-27.2; p = 0.002) were independent predictors of ISPs. During the 1.5-year follow-up period, no repeat revascularization or stent thrombosis occurred in patients with ISP. CONCLUSIONS ISP itself does not trigger notable clinical outcomes, including repeat revascularization and stent thrombosis. However, caution should be considered regarding the latent risk of procedural complications.
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Affiliation(s)
- Yutaka Tadano
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan.
| | - Jun-Ichi Kotani
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Daitaro Kanno
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Daisuke Hachinohe
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Takuro Sugie
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Umihiko Kaneko
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Ken Kobayashi
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Yoshifumi Kashima
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
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Morita J, Kondo Y, Hachinohe D, Kitai T, Fujita T. Retrieval of an infectious leadless pacemaker with vegetation. J Arrhythm 2023; 39:71-73. [PMID: 36733319 PMCID: PMC9885316 DOI: 10.1002/joa3.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/04/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
This case discusses the retrieval of a pacemaker with vegetation from a 78-year-old man. It suggests that grasping side of Micra body and pulling Micra into Agilis sheath is a possible technique for retrieval.
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Affiliation(s)
- Junji Morita
- Department of CardiologySapporo Cardiovascular ClinicSapporoJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | | | - Takayuki Kitai
- Department of CardiologySapporo Cardiovascular ClinicSapporoJapan
| | - Tsutomu Fujita
- Department of CardiologySapporo Cardiovascular ClinicSapporoJapan
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Morita Y, Kashima Y, Kanno D, Hachinohe D, Shitan H, Matsuna N, Horita R, Tsujimoto M, Fujita T, Tanabe K. Subintimal Tracking and Re-entry Technique for Stent-Jailed Side-Branch Occlusion. J Invasive Cardiol 2022; 34:E678-E682. [PMID: 35969840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effectiveness and outcomes of treatment with the subintimal tracking and re-entry technique for stent-jailed side branch (SB-STAR). SB occlusion is a serious complication of percutaneous coronary intervention (PCI). However, conventional strategies may fail to recanalize the stent-jailed SB. METHODS We retrospectively analyzed consecutive patients who underwent elective PCI and were treated with SB-STAR at the Sapporo Cardiovascular Clinic in Japan. SB was treated for severe stenosis, reduced thrombolysis in myocardial infarction flow grade, or ischemic signs after main vessel stenting. Technical success during the procedure and clinical and angiographic follow-up findings at 6 months were analyzed. RESULTS Of the 13,431 PCI procedures performed between January 2016 and June 2021, SB-STAR was performed in 10 patients. The angiographic success rate was 100%. At the 6-month follow-up, no deaths or target-vessel revascularizations had occurred. All patients underwent angiographic follow-up, and 8 of the 10 patients (80%) who underwent SB-STAR had confirmed patency. CONCLUSIONS SB-STAR can be a bailout strategy to improve the critical situation of stent-jailed SB occlusion. At 6-month follow-up, the SB-STAR had good patency as well as good clinical outcomes.
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Affiliation(s)
- Yusuke Morita
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, 8-1, Kita-49 Higashi-16, Higashiku, Sapporo, Japan 007-0849.
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Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Watanabe T, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K. The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR Endovasc 2021; 4:87. [PMID: 34905136 PMCID: PMC8671592 DOI: 10.1186/s42155-021-00276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion. Main text The “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1–2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention. Conclusions The DIOL fashion is a useful and effective method to facilitate CTO treatment.
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Affiliation(s)
- Takuya Haraguchi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan.
| | - Tsutomu Fujita
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Yoshifumi Kashima
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Masanaga Tsujimoto
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Tomohiko Watanabe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Takuro Sugie
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daisuke Hachinohe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Umihiko Kaneko
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Ken Kobayashi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daitaro Kanno
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Katsuhiko Sato
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
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Dong H, Hachinohe D, Nie Z, Kashima Y, Li G, Haraguchi T, Shitan H, Watanabe T, Tadano Y, Kaneko U, Sugie T, Kobayashi K, Kanno D, Enomoto M, Sato K, Fujita T. Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients. Ann Palliat Med 2021; 10:11308-11321. [PMID: 34670384 DOI: 10.21037/apm-21-1658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in hemodialysis patients with severely calcified and diffused lesions is associated with extremely high rates of major adverse cardiovascular events (MACE), even when facilitated by rotational atherectomy (ROTA). Potential risk factors for MACE with ROTA-facilitated PCI in hemodialysis patients should be identified. METHODS We retrospectively analyzed a consecutive cohort of patients from the Sapporo Cardiovascular Clinic database, who were on maintenance hemodialysis with severe calcified lesions and treated with ROTA-facilitated PCI. Clinical and interventional procedure characteristics were collected and compared between patients with and without MACE, defined as all-cause death, hospitalization due to heart failure, definite stent thrombosis, or target lesion revascularization (TLR) at 1-year follow-up. The individual outcomes of MACE and TLR in the cohort were presented as Kaplan-Meier percentages. Cox regression analyses were performed to identify independent predictors of MACE. RESULTS A total of 138 patients undergoing hemodialysis and followed up for 362.50 (243.75, 382.25) days. Sixty-one patients in the cohort had MACE, most of which were TLR (47.5%, 29/61). Cumulative all-cause death at 30-day and 1-year follow-up were 6.52% and 18.8%, respectively. Patients with right coronary artery (RCA) lesions, in-stent restenosis (ISR) lesions, and were more likely to have MACE, even with larger reference vessel diameter and greater acute gain after PCI. Cox regression analysis demonstrated that ISR lesion was positively associated with both MACE (HR 3.21, 95% CI: 1.59-6.48) and TLR (HR 5.08, 95% CI: 1.78-14.47), latter of which was also proved to be significantly related to greater acute gain (HR 1.95, 95% CI: 1.12-3.39). In subgroup analysis, RCA was found to be positively associated with MACE in de novo lesion (HR 2.83, 95% CI: 1.28-6.28). CONCLUSIONS We found that the overall prognosis of ROTA-facilitated PCI in hemodialysis patients was poor. ISR was a significant risk factor for MACE, especially TLR.
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Affiliation(s)
- Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Daisuke Hachinohe
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yoshifumi Kashima
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Takuya Haraguchi
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Hidemasa Shitan
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tomohiko Watanabe
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yutaka Tadano
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Umihiko Kaneko
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takuro Sugie
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Ken Kobayashi
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Daitaro Kanno
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Morio Enomoto
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Katsuhiko Sato
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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10
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Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Takeuchi T, Tadano Y, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K. The "Fracking" technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure. CVIR Endovasc 2021; 4:70. [PMID: 34570312 PMCID: PMC8476692 DOI: 10.1186/s42155-021-00258-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. Main text We propose a novel calcified plaque modification technique, named the “fracking technique” (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm2 on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm2 and 13.1-mm2, respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm2 without complications. Restenosis has not been detected for 2 years follow-up period. Conclusions The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-021-00258-y.
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Affiliation(s)
- Takuya Haraguchi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan.
| | - Tsutomu Fujita
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Yoshifumi Kashima
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Masanaga Tsujimoto
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Tsuyoshi Takeuchi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Yutaka Tadano
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daisuke Hachinohe
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Umihiko Kaneko
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Ken Kobayashi
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Daitaro Kanno
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
| | - Katsuhiko Sato
- Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, Sapporo, Hokkaido, 007-0849, Japan
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11
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Haraguchi T, Tsujimoto M, Kashima Y, Takeuchi T, Tadano Y, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K, Fujita T. The "Needle bypass" technique: Percutaneous anatomical bypass with needle rendezvous for patients with peripheral arterial disease that have no other surgical options. CVIR Endovasc 2021; 4:66. [PMID: 34436700 PMCID: PMC8390632 DOI: 10.1186/s42155-021-00254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ideal method for recanalization of complex peripheral lesions has not been determined, despite the use of the latest endovascular devices. We describe a novel method for a fully percutaneous anatomical bypass, named the "needle bypass" technique, for treatment of complex vascular lesions with failed previous surgical therapy. MAIN TEXT A 68-year-old male patient with chronic limb-threatening ischemia presented to our department. He previously had received surgical treatment 10 years prior that included the removal of the right distal common femoral artery and two surgical bypasses, an axillary-femoral bypass and an iliofemoral bypass, because he had repeated infections. He was referred to our center in order to have peripheral interventions. Since the previous conventional bridging/revascularization of the removed common femoral bifurcation had failed, the "needle bypass" technique was then used. With this novel technique, the tips of two percutaneous and bidirectional inserted needles were aligned ("needle rendezvous") for the externalization of a guidewire in a through-and-through manner. Once this was achieved, an endovascular stent graft and an interwoven stent were deployed to cover and connect the lesion. This new technique is a minimally invasive anatomical bypass that directly connects artery to artery without any disturbance of the venous flow, and this technique, as the only option available, was performed successfully in our no-option patient. CONCLUSIONS The "needle bypass" technique is an effective percutaneous treatment method in patients with no other surgical options.
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Affiliation(s)
- Takuya Haraguchi
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan. .,Department of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, 007-0849, Sapporo, Hokkaido, Japan.
| | | | | | | | - Yutaka Tadano
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | | | - Umihiko Kaneko
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Ken Kobayashi
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Daitaro Kanno
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Katsuhiko Sato
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
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12
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Dong H, Hachinohe D, Nie Z, Kashima Y, Luo J, Haraguchi T, Shitan H, Watanabe T, Tadano Y, Kaneko U, Sugie T, Kobayashi K, Kanno D, Enomoto M, Sato K, Fujita T. Comparison of Drug-Eluting Stent and Plain Old Balloon Angioplasty After Rotational Atherectomy in Severe Calcified and Large Coronary. Int Heart J 2021; 62:264-273. [PMID: 33731525 DOI: 10.1536/ihj.20-538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Drug-eluting stent (DES) is well known to be effective in severely calcified lesion after rotational atherectomy (ROTA). However, there are still some situations when stents should be avoided and plain old balloon angioplasty (POBA) should be the preferred option. The present study aims to explore whether POBA is comparably effective to DES in large and calcified coronary pretreated by ROTA in clinical outcomes.Consecutive patients treated for severely calcified lesions in the large (≥ 3 mm) coronary using ROTA + DES or ROTA + POBA were retrospectively analyzed. The major adverse cardiac events (MACE), including all-cause/cardiac death and target lesion revascularization (TLR) at 1 year and 2 years posttreatment, were compared between groups using the Cox regression analysis to identify independent predictors of TLR and MACE.The analysis included 285 cases in the ROTA + DES group and 47 cases in the ROTA + POBA group, without relevant differences in clinical baseline characteristics. Of note, lesion length was greater in the ROTA + DES group (37.2 versus 19.3 mm, P < 0.001); the ROTA + DES group had a higher rate of chronic total occlusion (CTO) lesions, with 8.4%, and the ROTA + POBA group had none. The inhospital/30-day mortality rate (5.3%, ROTA + DES; 6.4%, ROTA + POBA) and the 12- and 24-month all-cause/cardiac mortality rate (9.3%, ROTA + DES; 7.7%, ROTA + POBA) were not significantly different between the two groups. TLR rates were not significantly different between the two groups at 12 (4.6%, ROTA + DES; 4.3%, ROTA + POBA) and 24 (5.3%, ROTA + DES; 6.4%, ROTA + POBA) months.Outcomes were comparable for ROTA + DES and ROTA + POBA in severely calcified large coronary artery intervention with respect to midterm death or TLR rate, especially for short lesion of < 20 mm.
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Affiliation(s)
- Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.,Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | | | - Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | | | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | | | | | | | - Yutaka Tadano
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | | | - Takuro Sugie
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Ken Kobayashi
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Daitaro Kanno
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
| | - Morio Enomoto
- Sapporo Heart Center, Sapporo Cardio Vascular Clinic
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13
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Hachinohe D, Shitan H, Kaneko U, Kobayashi K, Mitsube K, Kawamura T, Fujita T. Controlled Valve Slide-Over Using a Buddy Balloon: "Shoehorn Technique". Korean Circ J 2021; 51:187-188. [PMID: 33525076 PMCID: PMC7853888 DOI: 10.4070/kcj.2020.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Daisuke Hachinohe
- Division of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
| | - Hidemasa Shitan
- Division of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Umihiko Kaneko
- Division of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Ken Kobayashi
- Division of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Keijiro Mitsube
- Division of Cardiovascular Surgery, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takeshi Kawamura
- Division of Anesthesiology, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Division of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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14
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Kaneko U, Hachinohe D, Kobayashi K, Fujita T. Snare-Assisted Valve Delivery to Overcome a Severely Calcified Aortic Arch during Transcatheter Aortic Valve Replacement. Korean Circ J 2021; 51:185-186. [PMID: 33525075 PMCID: PMC7853898 DOI: 10.4070/kcj.2020.0384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/09/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan.
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
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15
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Kaneko U, Hachinohe D, Kobayashi K, Shitan H, Mitsube K, Furugen A, Kawamura T, Koshima R, Fujita T. Evolut Self-Expanding Transcatheter Aortic Valve Replacement in Patients with Extremely Horizontal Aorta (Aortic Root Angle ≥ 70°). Int Heart J 2020; 61:1059-1069. [PMID: 32921666 DOI: 10.1536/ihj.20-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.
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Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Hidemasa Shitan
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center
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Shitan H, Hachinohe D, Kashima Y, Fujita T. How to retrieve a ruptured micro-catheter tip stuck in a tight lesion? Cardiol J 2020; 27:91-92. [PMID: 32103483 DOI: 10.5603/cj.2020.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hidemasa Shitan
- Cardiology and Catheterization Laboratories, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan.
| | - Daisuke Hachinohe
- Cardiology and Catheterization Laboratories, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan
| | - Yoshifumi Kashima
- Cardiology and Catheterization Laboratories, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan
| | - Tsutomu Fujita
- Cardiology and Catheterization Laboratories, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan
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17
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Kaneko U, Kobayashi K, Hachinohe D, Mitsube K, Furugen A, Kawamura T, Koshima R, Fujita T. Successful Use of an eSheath for Failed Introduction of the Evolut R Valve during Transfemoral Transcatheter Aortic Valve Implantation. Korean Circ J 2019; 50:372-373. [PMID: 31960639 PMCID: PMC7067605 DOI: 10.4070/kcj.2019.0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan.
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
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18
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Kaneko U, Kobayashi K, Hachinohe D, Fujita T. Valsalva Sinus Perforation Following Valve Dislodgement During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:e119-e120. [PMID: 31255558 DOI: 10.1016/j.jcin.2019.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Umihiko Kaneko
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Hokkaido, Japan.
| | - Ken Kobayashi
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Hokkaido, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Hokkaido, Japan
| | - Tsutomu Fujita
- Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Hokkaido, Japan
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Azzalini L, Laricchia A, Regazzoli D, Mitomo S, Hachinohe D, Bellini B, Demir OM, Poletti E, Maccagni D, Colombo A. Ultra-Low Contrast Percutaneous Coronary Intervention to Minimize the Risk for Contrast-Induced Acute Kidney Injury in Patients With Severe Chronic Kidney Disease. J Invasive Cardiol 2019; 31:176-182. [PMID: 30865912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The incidence of contrast-induced acute kidney injury (CI-AKI) is particularly high in patients with severe chronic kidney disease (CKD). Novel contrast-sparing strategies are warranted to guarantee the benefit of revascularization in this challenging and growing patient population. We aimed to evaluate the feasibility of an ultra-low contrast volume percutaneous coronary intervention (ULC-PCI) protocol in patients with severe CKD. METHODS The ULC-PCI protocol is based on the prespecification of the maximum contrast volume to be administered, extensive intravascular ultrasound (IVUS) and/or dextran-based optical coherence tomography (OCT) guidance, and use of diluted contrast media. We created a retrospective registry to compare the outcomes of the ULC-PCI protocol vs conventional angiography-based PCI in patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m², applying no angiographic or procedural restriction criteria. RESULTS We included 111 patients (ULC-PCI group, n = 8; conventional group, n = 103). Baseline clinical and angiographic characteristics were similar between groups. Contrast volume (8.8 mL [interquartile range, 1.3-18.5] vs 90 mL [interquartile range, 58-140 mL]; P<.001) was markedly lower in the ULC-PCI group. Technical success was achieved in all ULC-PCI procedures; in 7 of the 8 cases (88%), the ULC-PCI protocol was also successful (contrast-volume-to-eGFR ratio <1). The incidence of CI-AKI was 0% vs 15.5% in the ULC-PCI and conventional groups, respectively (P=.28). Procedures in the ULC-PCI group included the use of rotational atherectomy, two-stent bifurcation PCI, and mechanically supported chronic total occlusion PCI. CONCLUSIONS An ULC-PCI protocol in patients with advanced CKD is feasible, appears to be safe, and has the potential to decrease the incidence of CI-AKI, compared with angiographic guidance alone.
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Affiliation(s)
- Lorenzo Azzalini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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Hachinohe D, Latib A, Laricchia A, Iannopollo G, Demir OM, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Azzalini L, Mitomo S, Chieffo A, Montorfano M, Carlino M, Colombo A. Long‐term follow‐up of covered stent implantation for various coronary artery diseases. Catheter Cardiovasc Interv 2019; 94:571-577. [DOI: 10.1002/ccd.28117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of Cardiology, Sapporo Heart CenterSapporo Cardio Vascular Clinic Sapporo Japan
| | - Azeem Latib
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of CardiologyMontefiore Medical Centre New York
| | | | | | - Ozan M. Demir
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
- Department of CardiologyHammersmith Hospital, Imperial College Hospital Healthcare NHS Trust London United Kingdom
| | - Marco B. Ancona
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Antonio Mangieri
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Damiano Regazzoli
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Francesco Giannini
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Lorenzo Azzalini
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Satoru Mitomo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
| | - Alaide Chieffo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Mauro Carlino
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
| | - Antonio Colombo
- Interventional Cardiology UnitSan Raffaele Scientific Institute Milan Italy
- Interventional Cardiology UnitEMO‐GVM Centro Cuore Columbus Milan Italy
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21
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Tadano Y, Kotani JI, Kashima Y, Hachinohe D, Watanabe T, Sugie T, Kaneko U, Kobayashi K, Kanno D, Fujita T. Predictors of clinical outcomes after coronary implantation of bioresorbable polymer sirolimus-eluting Ultimaster stents in all-comers: A report of 1,727 cases. Catheter Cardiovasc Interv 2019; 94:91-97. [PMID: 30636371 DOI: 10.1002/ccd.28076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/11/2018] [Accepted: 12/26/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bioresorbable polymer sirolimus-eluting Ultimaster stents (BP-SESs) are likely useful for percutaneous coronary interventions (PCIs), the clinical data from real-world cases are insufficient. Furthermore, the predictors of adverse clinical outcomes after BP-SES implantation have not been fully investigated. OBJECTIVES This study evaluated the 1-year clinical outcomes after BP-SES implantation in real-world PCI cases and identified the predictors of adverse outcomes. METHODS In this single-center, all-comers study, we consecutively implanted BP-SESs in all patients who required coronary stents between October 2015 and August 2016. We conducted a clinical follow-up assessment of these patients. RESULTS The sample comprised 1,727 patients; 67% were men, the mean age was 72 years, and 37% had diabetes. Of the 2,085 lesions detected, 88% were type B2/C lesions, 4% were chronic total occlusions (CTOs), and 23% were bifurcations. The cumulative incidences of target lesion revascularization (TLR) and target lesion failure (TLF) at 1-year were 2.4% and 5.2%, respectively. A multivariate analysis revealed that hemodialysis (HD) (hazard ratio [HR] 8.40) and CTO (HR 4.21) were independent predictors of TLR. Stent sizes ≤2.5 mm were not associated with either TLR or TLF. CONCLUSIONS The current study indicates that patients on HD and those with CTO were more likely to experience adverse clinical outcomes after BP-SES implantation. In contrast, small vessel diameter was not significantly related to adverse outcomes. The 1-year clinical outcomes after BP-SES implantation were found to be favorable among all-comer PCI cases, including patients receiving HD and those with in-stent restenosis.
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Affiliation(s)
- Yutaka Tadano
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Jun-Ichi Kotani
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Yoshifumi Kashima
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Daisuke Hachinohe
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Tomohiko Watanabe
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Takuro Sugie
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Umihiko Kaneko
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Ken Kobayashi
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Daitaro Kanno
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
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22
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Hachinohe D, Ancona MB, Colombo A, Latib A. Severe aortic regurgitation due to a Lunderquist Extra-Stiff Wire Guide during transcatheter aortic valve implantation. Cardiol J 2018; 25:642-643. [PMID: 30394515 DOI: 10.5603/cj.2018.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daisuke Hachinohe
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; EMO-GVM Centro Cuore Columbus, Via Michelangelo Buonarroti, 48, 20145 Milan, Italy; Sapporo Heart Center, Sapporo Cardio Vascular Clinic, 8-1, Kita-49 Higashi-16, Higashiku, 0070849 Sapporo, Japan.
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23
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Azzalini L, Hachinohe D, Regazzoli D, Colombo A. Ultra-low contrast percutaneous coronary intervention in patients with severe chronic kidney disease. EUROINTERVENTION 2018; 14:896-897. [PMID: 29039309 DOI: 10.4244/eij-d-17-00774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Lorenzo Azzalini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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24
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Hachinohe D, Latib A, Laricchia A, Demir OM, Agricola E, Romano V, Del Sole PA, Leone PP, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Mitomo S, Monaco F, Buzzatti N, Montorfano M, Colombo A. Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation. Catheter Cardiovasc Interv 2018; 93:522-529. [PMID: 30286515 DOI: 10.1002/ccd.27827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. BACKGROUND Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. METHODS At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. RESULTS Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. CONCLUSIONS The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Division of Cardiology, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Hospital Healthcare NHS Trust, London, United Kingdom
| | - Eustachio Agricola
- Non-invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pier Pasquale Leone
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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25
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Kaneko U, Kobayashi K, Hachinohe D, Sumino S, Furugen A, Kawamura T, Doi H, Fujita T. Successful Direct Iliac Transcatheter Aortic Valve Implantation to Overcome Significant Tortuosity of the Thoracic Aorta. Korean Circ J 2018; 48:949-950. [PMID: 30238714 PMCID: PMC6158455 DOI: 10.4070/kcj.2018.0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan.
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Satoshi Sumino
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
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26
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Hachinohe D, Kashima Y, Hirata K, Kanno D, Kobayashi K, Kaneko U, Sugie T, Tadano Y, Watanabe T, Shitan H, Haraguchi T, Enomoto M, Sato K, Fujita T. Treatment for in-stent restenosis requiring rotational atherectomy. J Interv Cardiol 2018; 31:747-754. [DOI: 10.1111/joic.12558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daisuke Hachinohe
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Yoshifumi Kashima
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Kazuya Hirata
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Daitaro Kanno
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Ken Kobayashi
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Umihiko Kaneko
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Takuro Sugie
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Yutaka Tadano
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Tomohiko Watanabe
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Hidemasa Shitan
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Takuya Haraguchi
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Morio Enomoto
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Katsuhiko Sato
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
| | - Tsutomu Fujita
- The Sapporo Heart Center; Sapporo Cardio Vascular Clinic; Sapporo Japan
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27
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Azzalini L, Laricchia A, Regazzoli D, Bellini B, Hachinohe D, Mitomo S, Demir O, Poletti E, Maccagni D, Colombo A. TCT-595 Ultra-Low Contrast Percutaneous Coronary Intervention to Minimize the Risk for Contrast-Induced Acute Kidney Injury in Patients with Severe Chronic Kidney Disease. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Tadano Y, Kashima Y, Hachinohe D, Haraguchi T, Shitan H, Watanabe T, Sugie T, Kaneko U, Kobayashi K, Enomoto M, Kanno D, Sato K, Fujita T. TCT-254 Strut Impingement Phenomenon by a Bioresorbable Polymer Sirolimus-eluting Ultimaster Stent. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Hachinohe D, Mitomo S, Candilio L, Latib A. A Practical Approach to Assessing Stent Results with IVUS or OCT. Methodist Debakey Cardiovasc J 2018; 14:32-41. [PMID: 29623170 DOI: 10.14797/mdcj-14-1-32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronary angiography is routinely used to assess the extent and severity of coronary artery disease and for decision-making during percutaneous coronary interventions (PCI). However, it is sometimes inadequate for deciding a strategy and defining optimal stenting outcomes. In this review, we present a comprehensive and practical approach to PCI using intravascular ultrasound or optical coherence tomography to optimize stent deployment and assess procedural complications after stent implantation.
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Affiliation(s)
- Daisuke Hachinohe
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Satoru Mitomo
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Luciano Candilio
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY.,cHAMMERSMITH HOSPITAL, IMPERIAL COLLEGE LONDON, UNITED KINGDOM
| | - Azeem Latib
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
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30
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Hachinohe D, Latib A, Mitomo S, Montorfano M, Colombo A. Usefulness of Buddy Wire Technique During Transcatheter Transseptal Mitral Valve Implantation in Degenerated Mitral Bioprosthesis. Circ J 2018; 83:243-244. [PMID: 29937464 DOI: 10.1253/circj.cj-18-0413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus
| | - Satoru Mitomo
- Interventional Cardiology Unit, San Raffaele Scientific Institute.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus
| | | | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus
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31
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Hachinohe D, Latib A, Montorfano M, Colombo A. Transcatheter mitral valve implantation in rigid mitral annuloplasty rings: Potential differences between complete and incomplete rings. Catheter Cardiovasc Interv 2018; 93:E71-E74. [PMID: 29774982 DOI: 10.1002/ccd.27658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/25/2018] [Accepted: 04/15/2018] [Indexed: 11/07/2022]
Abstract
Transcatheter mitral valve implantation (TMVI) has been performed in high-risk and inoperable patients for degenerated mitral bioprostheses (TMVIinV) and failed annuloplasty rings (TMVIinR). TMVIinR is more challenging compared to TMVIinV because of the differences in dimensions, shapes, and contours between rings and valves. In this report, we present two clinical cases of TMVIinR that were treated by trans-septal implantation of a balloon-expandable prosthesis. In TMVI cases with an incomplete ring, the ring will be stretched out toward its anterior and commissural side, and the open side of the ring will increase in width. The ring may not transform in line with the shape of the transcatheter heart valve (THV) and an interspace can develop between the THV and the ring at the commissural side, resulting in significant paravalvular regurgitation. Our experience suggests that the circumferential completeness of the rings may be an important factor to consider when planning a TMVIinR.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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32
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Hachinohe D, Kashima Y, Shitan H, Watanabe T, Sugie T, Tadano Y, Kaneko U, Kobayashi K, Kanno D, Enomoto M, Fujita T. TCTAP A-030 Rotational Atherectomy and New-generation Drug-eluting Stent Implantation in De Novo Lesion. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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33
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Azzalini L, Mitomo S, Hachinohe D, Regazzoli D, Colombo A. Zero-Contrast Percutaneous Coronary Intervention Guided by Dextran-Based Optical Coherence Tomography. Can J Cardiol 2018; 34:342.e1-342.e3. [DOI: 10.1016/j.cjca.2017.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022] Open
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34
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Ancona MB, Hachinohe D, Giannini F, Del Sole PA, Regazzoli D, Mangieri A, Romano V, Latib A, Ancona F, Monaco F, Castiglioni A, Esposito A, Montorfano M, Colombo A. Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:e29-e30. [PMID: 29471959 DOI: 10.1016/j.jcin.2017.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo A Del Sole
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Echocardiography Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Anesthesiology Unit; San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Esposito
- Radiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Hachinohe D, Latib A, Agricola E, Colombo A. Repeat MitraClip for early recurrent mitral regurgitation. Catheter Cardiovasc Interv 2017; 92:611-616. [PMID: 29280535 DOI: 10.1002/ccd.27460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/19/2017] [Accepted: 11/26/2017] [Indexed: 11/06/2022]
Abstract
Treatment for recurrent mitral regurgitation (MR) after MitraClip therapy remains a challenging issue. This study reports the efficacy of repeat MitraClip therapy for recurrent MR during the early phase after the index MitraClip procedure. We present a case series of four consecutive patients who underwent repeat MitraClip procedures for severe recurrent MR during the early phase. Partial clip detachment (PCD) was the suspected cause of recurrent MR in these cases. All patients received additional clip(s). PCD could be stabilized and MR grade improved in all cases compared with that before the second procedure. Repeat MitraClip procedures for recurrent MR due to PCD are feasible during the early phase. However, patients having PCD with paracommissural MR may not be good candidates for repeat MitraClip.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Eustachio Agricola
- Non-invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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36
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Mitomo S, Giannini F, Candilio L, Mangieri A, Hachinohe D, Latib A, Colombo A. Intrastent Hematoma After Pre-Dilatation for 17-Month Restenosis of Polytetrafluoroethylene-Covered Stent: Insights From Intravascular Imaging. JACC Cardiovasc Interv 2017; 10:e213-e215. [PMID: 29217015 DOI: 10.1016/j.jcin.2017.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Cardiology, The Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daisuke Hachinohe
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Hachinohe D, Kashima Y, Kanno D, Kobayashi K, Sugie T, Kaneko U, Tadano Y, Watanabe T, Shitan H, Fujita T. Rotational atherectomy and new-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2017; 91:1026-1034. [PMID: 29205743 DOI: 10.1002/ccd.27446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical outcomes of rotational atherectomy (RA) followed by new-generation drug-eluting stent (DES) implantation in patients with an extensive amount of calcified and fibrotic plaque. BACKGROUND RA followed by new-generation DES implantation for complex lesions has not been thoroughly evaluated. METHODS A total of 744 consecutive patients (770 lesions) treated with new-generation DES implantation following RA for de novo lesions between January 2013 and November 2015 were retrospectively identified using our institutional database. Clinical outcomes at 12 months were evaluated and the independent predictors of all-cause death and target vessel failure (TVF) were assessed using Cox regression models. RESULTS Target lesion revascularization occurred in 22 lesions (2.9%) and TVF occurred in 51 lesions (6.6%). In a multivariate analysis, hemodialysis, non-ST-segment elevation acute coronary syndrome, low ejection fraction, and HbA1c ≧ 7% were associated with 12-month mortality. Hemodialysis and right coronary artery were identified as independent predictors of TVF (hazard ratio (HR) 4.107, 95% confidence interval (CI) 2.194-7.685, P < .001; HR 2.491, 95% CI 1.023-6.062, P = .044, respectively). CONCLUSIONS A good debulking with RA followed by new-generation DES implantation is recommended for patients with an excessive amount of calcified and fibrotic plaque, as this will likely improve the clinical outcomes.
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Affiliation(s)
- Daisuke Hachinohe
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yoshifumi Kashima
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Daitaro Kanno
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Ken Kobayashi
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Takuro Sugie
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Umihiko Kaneko
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yutaka Tadano
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tomohiko Watanabe
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Hidemasa Shitan
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
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38
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Hachinohe D, Kobayashi K, Furugen A, Koshima R. Left Ventricular Outflow Tract Migration of a Balloon-Expandable Prosthesis During Transcatheter Aortic Valve Implantation. Int Heart J 2017; 58:290-293. [PMID: 28321026 DOI: 10.1536/ihj.16-288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Valve migration into the left ventricular outflow tract (LVOT) during transcatheter aortic valve implantation (TAVI) is a life-threatening complication. An 89-year-old female patient was admitted for TAVI due to severe symptomatic aortic stenosis. After deployment of a balloon-expandable prosthesis, the prosthesis had migrated into the LVOT. The prosthesis was reimpacted to the aortic annulus by a balloon-assisted recapture procedure. Immediately after recapturing the prosthesis with an oversized balloon, the patient's vital signs deteriorated due to acute aortic regurgitation (AR), and a prompt valve-in-valve (V-in-V) procedure allowed us to stabilize the patient's condition. This is the first reported case of a V-in-V procedure using an oversized balloon and a larger prosthesis to treat migration of the initial prosthesis into the LVOT. Balloon recapture and V-in-V procedure using an oversized balloon and larger prosthesis for a migrated balloonexpandable prosthesis into the LVOT is feasible, but hemodynamic support should be prepared before recapture and Vin-V because overdilatation of the first prosthesis might cause hemodynamic collapse due to severe AR.
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39
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Yamanaka F, Shishido K, Ochiai T, Moriyama N, Tobita K, Tani T, Furuhashi K, Sugitatsu K, Hachinohe D, Wada T, Mizuno S, Suenaga H, Tanaka Y, Murakami M, Matsumi J, Takahashi S, Akasaka T, Tanaka S, Saito S. Diagnostic performance of 320-slice computed tomography coronary angiography for symptomatic patients in clinical practice. Eur J Intern Med 2017; 39:57-62. [PMID: 27693027 DOI: 10.1016/j.ejim.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/01/2016] [Accepted: 09/14/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Multi-slice computed tomography (MSCT) coronary angiography has been reported as an effective alternative to invasive conventional coronary angiography (CCA) for the diagnosis of coronary artery disease (CAD). However, in previous reports, the diagnostic accuracy of MSCT has not been significant enough to be of benefit in symptomatic patients. The aim of this study was to identify the usefulness of 320-slice computed tomography coronary angiography (320-CTA) for symptomatic patients in terms of the diagnostic accuracy of 320-CTA and the prevalence of vasospastic angina pectoris (VSAP) within the study cohort. METHODS We retrospectively analyzed 513 consecutive symptomatic patients with suspected CAD who had undergone 320-CTA and CCA. We determined the diagnostic accuracy of 320-CTA using CCA as the reference standard. Ergonovine provocation tests were performed on patients without significant coronary artery stenosis on CCA. RESULTS Of the total cohort of 513 symptomatic patients, 39% had obstructive CAD. The patient based analysis of the accuracy of 320-CTA showed a sensitivity of 91.0%, a specificity of 71.0%, a positive predictive value of 66.5%, and a negative predictive value of 92.5%. Of the 314 symptomatic patients who did not have significant coronary artery stenosis on CCA, 58 (18%) were diagnosed with VSAP using ergonovine provocation tests. DISCUSSION The negative and positive predictive values indicate that 320-CTA cannot replace CCA for symptomatic patients. Indeed, a combination of CCA and ergonovine provocation tests should be taken into consideration for symptomatic patients.
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Affiliation(s)
- Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Tomoyuki Tani
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Kyosuke Furuhashi
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Kazuya Sugitatsu
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Daisuke Hachinohe
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Tadashi Wada
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Hidetaka Suenaga
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Junya Matsumi
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Takeshi Akasaka
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Shinji Tanaka
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan
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40
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Ochiai T, Tanaka Y, Aso K, Shishido K, Hachinohe D, Sugitatsu K, Yamanaka F, Saito S. Rapid diagnosis of prosthetic valve endocarditis from Janeway lesions in a transcatheter aortic valve implantation patient. J Cardiol Cases 2015; 13:63-66. [PMID: 30524558 DOI: 10.1016/j.jccase.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/17/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022] Open
Abstract
Percutaneous transcatheter aortic valve implantation (TAVI), first introduced in 2002, is a viable solution for previously inoperable or high-risk patients with aortic stenosis, providing the benefit of valve replacement without the associated risks of surgery. When these patients develop prosthetic valve endocarditis (PVE), management is complicated, owing to their often, atypical presentations and baseline comorbidities. Moreover, it is often difficult to detect vegetations in such patients, even with transesophageal echocardiography. Here, we describe a case of post-TAVI PVE that was successfully treated medically after a rapid diagnosis was made based on physical examination. Our experience shows that physical examination continues to be important for rapid diagnosis of infective endocarditis, even in the era of structural heart disease intervention. <Learning objective: Diagnosis of endocarditis in transcatheter aortic valve implantation patients can be difficult and may be delayed, as echocardiography is often inconclusive because of the unique physiology of these patients. We should maintain a low threshold for investigation of infective endocarditis in these patients, and more emphasis should be placed on physical examination to ensure rapid diagnosis and favorable clinical outcome.>.
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Affiliation(s)
- Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Keiko Aso
- Clinical Research Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Kazuya Sugitatsu
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.,Heart Center of Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Hachinohe D, Jeong MH, Saito S, Kim MC, Cho KH, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ. Comparison of drug-eluting stents in acute myocardial infarction patients with chronic kidney disease. Korean J Intern Med 2012; 27:397-406. [PMID: 23269880 PMCID: PMC3529238 DOI: 10.3904/kjim.2012.27.4.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/12/2011] [Accepted: 01/09/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). METHODS This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) calculated by the modification of diet in renal disease method. RESULTS At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). CONCLUSIONS Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
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Affiliation(s)
- Daisuke Hachinohe
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Internal Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Shigeru Saito
- Department of Internal Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Min Chol Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Khurshid Ahmed
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hwan Hwang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Hyun Kim
- Department of Internal Medicine, Pusan Hanseo Hospital, Busan, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Seung Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - In Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Taek Jong Hong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Donghoon Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Ki Bae Seung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Wook Sung Chung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yang Soo Jang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jang Ho Bae
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Seung Jung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hachinohe D, Jeong MH, Saito S, Kim MC, Cho KH, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ. Clinical impact of thrombus aspiration during primary percutaneous coronary intervention: Results from Korea Acute Myocardial Infarction Registry. J Cardiol 2012; 59:249-57. [DOI: 10.1016/j.jjcc.2011.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 12/09/2011] [Accepted: 12/16/2011] [Indexed: 12/27/2022]
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Ahmed K, Jeong MH, Chakraborty R, Cho KH, Sim DS, Hong YJ, Ahn Y, Hachinohe D, Cho MC, Kim CJ, Kim YJ. Prognostic impact of baseline high-sensitivity C-reactive protein in patients with acute myocardial infarction undergoing percutaneous coronary intervention based on body mass index. Korean Circ J 2012; 42:164-72. [PMID: 22493611 PMCID: PMC3318088 DOI: 10.4070/kcj.2012.42.3.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/02/2011] [Accepted: 10/17/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Serum high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and may lead to the development of atherosclerosis, adversely affecting mortality. The aim of this study was to evaluate the relationship between baseline hs-CRP level and 12-month clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) according to their body mass index (BMI) status. SUBJECTS AND METHODS Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to September 2008, a total of 8174 consecutive AMI patients were studied. Cox proportional hazard model revealed that higher baseline levels of hs-CRP was associated with 12-month all-cause mortality (p=0.045). To further understand this association, patients were divided into 3 groups based on their body mass index: 1) overweight/obese, 2) normal weight, and 3) underweight patients. Then each group was stratified into quartiles based on their hs-CRP. RESULTS In overweight/obese patients, Cox model showed significant association of hs-CRP with 12-month mortality when adjusted for age and gender (p<0.001), however, after adjustment with multiple covariates, mortality was highest in the 4th quartile {HR 2.382, (1.079-5.259), p=0.032} though statistically insignificant (p=0.172). We observed no significant association of serum hs-CRP with 12-month mortality in normal weight (p=0.681) and underweight (p=0.760) patients. CONCLUSION Higher baseline hs-CRP level (≥4.08 mg/dL) in overweight/obese AMI patients showed significant association with 12-month all-cause mortality independent of other prognostic markers.
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Affiliation(s)
- Khurshid Ahmed
- Department of Cardiovascular Medicine, Chonnam National University College of Medicine, Gwangju, Korea
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Ahmed K, Jeong MH, Chakraborty R, Hong YJ, Oh MS, Cho KH, Kim MC, Hachinohe D, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Ahn Y, Kang JC. Clinical Impact of Non-High Density Lipoprotein-Cholesterol and Apolipoprotein B on Clinical Outcomes in Metabolic Syndrome Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Korean Circ J 2012; 42:319-28. [PMID: 22701134 PMCID: PMC3369963 DOI: 10.4070/kcj.2012.42.5.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 09/23/2011] [Accepted: 11/22/2011] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Subjects and Methods Results Conclusion
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Affiliation(s)
- Khurshid Ahmed
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
- Apollo Gleneagles Hospital, Kolkata, India
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | | | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Mi Sook Oh
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Kyung Hoon Cho
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Min Chol Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Daisuke Hachinohe
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Seung Hwan Hwang
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Min Goo Lee
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Keun Ho Park
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Hachinohe D, Jeong MH, Kim MC, Cho KH, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC. Drug-eluting stent as an option for intractable in-stent coronary restenosis. Korean Circ J 2011; 41:677-80. [PMID: 22194765 PMCID: PMC3242025 DOI: 10.4070/kcj.2011.41.11.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/09/2011] [Accepted: 02/16/2011] [Indexed: 11/16/2022] Open
Abstract
A 51-year-old man was admitted due to an acute anterior ST-segment elevation myocardial infarction. After thrombolytic therapy using recombinant tissue plasminogen activator, stent implantation was performed from the proximal left anterior descending artery (LAD) to the mid LAD using a bare-metal stent (BMS). Since then, the patient suffered five repeated episodes of in-stent restenosis (ISR). At the first ISR, he was treated with plain old balloon angioplasty (POBA). At the second ISR, he was treated with brachytherapy, and at the third ISR, he was treated with POBA and one more BMS distal to the previously implanted stent. At the forth, only POBA was performed, and finally, at the fifth ISR, a sirolimus-eluting stent was implanted. Following that, the patient remained asymptomatic and follow-up coronary angiography showed no ISR.
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Affiliation(s)
- Daisuke Hachinohe
- The Heart Center of Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Hong YJ, Jeong MH, Song SJ, Sim DS, Kim JH, Lim KS, Hachinohe D, Ahmed K, Hwang SH, Lee MG, Ko JS, Park KH, Yoon HJ, Yoon NS, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Cho DL, Park JC, Kang JC. Effects of ramiprilat-coated stents on neointimal hyperplasia, inflammation, and arterial healing in a porcine coronary restenosis model. Korean Circ J 2011; 41:535-41. [PMID: 22022329 PMCID: PMC3193045 DOI: 10.4070/kcj.2011.41.9.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/14/2011] [Accepted: 02/22/2011] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neointimal hyperplasia, and a role for angiotensin II in the migration and proliferation of vascular smooth muscle cells in restenotic lesions has been proposed. The aim of this study was to determine the anti-proliferative and anti-inflammatory effects of ramiprilat-coated stents in a porcine coronary overstretch restenosis model. Subjects and Methods Pigs were randomized into two groups in which the coronary arteries {16 pigs (16 coronaries in each group)} had a 3.0×17 mm ramiprilat-coated MAC stent or a 3.0×17 mm control MAC stent (AMG, Munich, Germany) implanted with oversizing (stent-to-artery ratio, 1.3 : 1) in porcine coronary arteries, and histopathologic analysis was assessed 28 days after stenting. Results There were no significant differences in the injury and inflammation scores between the two groups (1.20±0.43 vs. 1.23±0.57, p=0.8; and 1.21±0.39 vs. 1.25±0.49, p=0.6, respectively). Within the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations existed between inflammatory cell counts and the neointima areas (r=0.567, p<0.001), and between inflammatory cell counts and the percent area stenosis (r=0.478, p<0.001). There was no significant difference in the inflammatory cell counts normalized to the injury (110±89 vs. 123±83, p=0.4) and fibrin scores (0.15±0.06 vs. 0.17±0.07, p=0.8) between the 2 groups. There were trends toward a smaller neointima area (1.06±0.51 mm2 vs. 1.28±0.35 mm2, p=0.083) and a smaller percent area stenosis (18.9±8.7% vs. 21.8±7.2%, p=0.088) in the ramiprilat-coated stent group. Conclusion Although the ramiprilat-coated stent did not show significant inhibitory effects on neointimal hyperplasia, the ramiprilat-coated stent showed good effects on the inflammatory reaction and arterial healing similar to the control stent in a porcine coronary restenosis model.
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Affiliation(s)
- Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Ahmed K, Jeong MH, Chakraborty R, Ahn Y, Sim DS, Park K, Hong YJ, Kim JH, Cho KH, Kim MC, Hachinohe D, Hwang SH, Lee MG, Cho MC, Kim CJ, Kim YJ, Park JC, Kang JC. Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol 2011; 108:8-14. [PMID: 21529735 DOI: 10.1016/j.amjcard.2011.02.339] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 11/25/2022]
Abstract
Stent thrombosis and restenosis remain drawbacks of drug-eluting stents in patients with acute myocardial infarction (AMI). Intravascular ultrasound (IVUS) guidance for stent deployment helps optimize its results in stable patients. The aim of this study was to examine the utility of routine IVUS guidance in patients with AMI undergoing percutaneous coronary intervention (PCI). Employing data from Korea Acute Myocardial Infarction Registry (KAMIR), we analyzed 14,329 patients with AMI from April 2006 through September 2010. Patients with cardiogenic shock and rescue PCI after thrombolysis were excluded. Clinical outcomes of 2,127 patients who underwent IVUS-guided PCI were compared to those of 8,235 patients who did not. Mean age was 63.6 ± 13.5 years and 72.3% were men. Patients undergoing IVUS-guided PCI were younger, more often men, more hyperlipemic, and had increased body mass index and left ventricular ejection fraction. Number of treated vessels and stents used, stent length, and stent diameter were increased in the IVUS-guided group. Multivessel involvement was less frequent and American College of Cardiology/American Heart Association type C lesion was more frequent in the IVUS-guided group. Drug-eluting stents were more frequently used compared to bare-metal stents in the IVUS group. There was no significant relation of stent thrombosis between the 2 groups. Twelve-month all-cause death was lower in the IVUS group. After multivariate analysis and propensity score adjustment, IVUS guidance was not an independent predictor for 12-month all-cause death (hazard ratio 0.212, 0.026 to 1.73, p = 0.148). In conclusion, this study does not support routine use of IVUS guidance for stent deployment in patients who present with AMI and undergo PCI.
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Lim KS, Hong YJ, Hachinohe D, Ahmed K, Jeong MH, Kim JH, Sim DS, Lee MG, Park KH, Kim JH, Ahn Y, Cho JG, Park JC, Song SJ, Jung KW, Cho DL, Kang JC. Effect of a dual drug-coated stent with abciximab and alpha-lipoic Acid in a porcine coronary restenosis model. Korean Circ J 2011; 41:241-7. [PMID: 21731564 PMCID: PMC3116101 DOI: 10.4070/kcj.2011.41.5.241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 08/20/2010] [Accepted: 09/06/2010] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives The aim of this study was to examine the anti-proliferative and anti-inflammatory effects of a stent coated with abciximab and alpha-lipoic acid (ALA) in a porcine coronary overstretch restenosis model. Materials and Methods A total of 10 pigs were randomized into two groups (10 pigs, 10 coronaries in each group) in which the coronary arteries were stented with a dual-coated stent and a bare metal stent (control) by randomization. Stents were deployed with oversizing (stent/artery ratio 1.3 : 1) in the porcine coronary arteries, and histopathology was assessed 28 days after stenting. Results There was no significant difference in the injury score between the two groups. In the neointima, the lymphohistiocyte count was significantly lower in dual-coat stent group compared with the control stent group (120±85 cells vs. 159±80 cells, p=0.048). There was no significant difference in the fibrin score between the two groups (0.16±0.34 in the dual-coated stent group vs. 0.25±0.48 in the control stent group, p=0.446). The neointima area was not significantly different between both groups (1.55±0.8 mm2 in dual-coated stent group vs. 1.40±0.86 mm2 in the control stent group, p=0.447). Conclusion Although the dual-coated stent with abciximab and ALA showed no significant difference in inhibition of neointimal hyperplasia when compared with the bare metal stent, it was associated with a reduced inflammatory reaction when compared with the control stent in a porcine coronary restenosis model.
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Affiliation(s)
- Kyung Seob Lim
- The Heart Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
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Hong YJ, Jeong MH, Hachinohe D, Ahmed K, Choi YH, Kim AR, Hwang SH, Lee MG, Park KH, Sim DS, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. AS-236 Microalbuminuria at the Time of Presentation is Associated with Coronary Plaque Components: Virtual Histology-Intravascular Ultrasound Analysis. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ahmed K, Jeong MH, Cho KH, Kim MC, Hachinohe D, Hwang SH, Lee MG, Sim DS, Park KH, Hong YJ, Kim JH, Ahn Y, Kang JC. AS-064 Role of Intravascular Ultrasound in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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