Impact of continuous deterioration of kidney function 6 to 8 months after percutaneous coronary intervention for acute coronary syndrome.

Preprocedural chronic kidney disease and contrast-induced acute kidney injury are predictors of in-hospital death and long-term mortality. However, neither the time course of kidney function after percutaneous coronary intervention (PCI) nor the relation between the time course of kidney function and prognosis has been adequately studied. We studied 531 patients who underwent PCI for acute coronary syndrome.

Dramatic response to low-dose rivaroxaban in an Asian patient with deep vein thrombosis and pulmonary embolism.

We report a case of deep venous thrombosis and pulmonary embolism treated with rivaroxaban due to warfarin allergy. The patient responded well to a low dose of 15 mg/day. There has been a report about treating patients with atrial fibrillation using a low dose of rivaroxaban in Japan, but no previous reports about deep vein thrombosis/pulmonary embolism.

Contents of second peak in the circadian variation of acute myocardial infarction in the Japanese population.

Background: Circadian variation has been accepted as a factor in acute myocardial infarction (AMI). An increased incidence of cardiac events in the morning has been reported for a long time. Recent reports have indicated that the onset of AMI shows two peaks, which occur in the morning and evening.

Absence of circadian variation of acute coronary syndrome onset in chronic kidney disease patients.

Background: Several studies have reported on the circadian variation in acute coronary syndrome (ACS) onset. The influence of morning blood pressure surge, platelet aggregation and sympathetic activity is believed to cause this circadian variation. At the same time, a high frequency of ACS and sympathetic nerve hyperactivity has been reported in chronic kidney disease (CKD).

Bilateral spontaneous renal artery dissection.

Spontaneous renal artery dissection is a rare condition that precedes renal infarction. We describe a 48-year-old, normotensive healthy woman presenting with left flank pain of sudden onset. Enhanced abdominal computed tomography demonstrated a dissecting intimal flap of the left renal artery complicating renal infarction.

Combined endovascular and open surgical approach for the management of subclavian artery occlusion due to thoracic outlet syndrome.

A 32-year-old male with arterial thoracic outlet syndrome (TOS) underwent endovascular treatment for the chronic total occlusive lesion from the subclavian to the brachial artery after resection of the first rib and cervical rib. A combined endovascular and surgical treatment represents an attractive alternative to the traditional surgical approach for the treatment of complicated arterial TOS. 

Higher body mass index at the time of acute myocardial infarction is associated with a favorable long-term prognosis (8-year follow-up).

Obesity is an important public health problem, especially among patients with cardiovascular disease. However, little is known about the impact of obesity on the long-term prognoses of patients with acute myocardial infarction (AMI). Major adverse cardiac and cerebrovascular events (MACCE) consist of all causes of death, stroke, target lesion revascularization, target vessel revascularization, non-fatal myocardial infarction, and hospitalization.

A slightly elevated level of N-terminal pro-brain natriuretic peptide can predict coronary artery disease in a population with normal left ventricular function.

The prognostic and diagnostic values of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in ischemic heart disease have already been investigated in many previous studies. Although NT-pro-BNP is affected by many factors, these previous studies did not strictly exclude them. This study included 110 patients who received coronary arteriography between November 2007 and September 2009.

Endovascular treatment of innominate artery stenosis via the bilateral brachial approach.

Endovascular treatment (stenting) has evolved as an effective and safe treatment modality for symptomatic subclavian and innominate artery disease. Most of these patients have comorbid conditions associated with atherosclerotic vascular disease, which is responsible for the access site and increased difficulty of procedure. We report a case of symptomatic innominate artery stenosis with concomitant atherosclerotic disease of the abdominal aorta successfully treated with using coronary devices and the pull-through technique via the bilateral brachial approach.

Aggressive statin therapy in multicenter and effectiveness for the reduction of intra-myocardial damage caused by non-ST elevation acute coronary syndrome: AMERICA study.

Background: While preprocedural statin treatment for acute coronary syndrome (ACS) is widely regarded as beneficial, there has been no prospective randomized multicenter trial of patients with non-ST elevation ACS in the Japanese population to examine the efficacy of preprocedural aggressive statin use. The aim of this study was to confirm this effect by prospective randomized multicenter design.

Methods: Fifty patients who presented with non-ST elevation ACS were enrolled, and randomly assigned to aggressive statin administration before percutaneous coronary intervention (PCI).

Stent deformation: an experimental study of coronary ostial stenting.

Objectives: To investigate stent deformation by torsional stress after implantation at the ostium of a model coronary artery.

Background: Little is known about coronary stent deformation, especially the association between stent design and deformation at the coronary ostium. Recent reports have suggested that mechanical factors are important for stent restenosis.

Anomalous coronary arteries in adults detected by multislice computed tomography: presentation of cases from multicenter registry and review of the literature.

Anomalous coronary arteries are a rare condition, but they may cause myocardial ischemia, heart failure, and sudden death. We evaluated the prevalence and multislice computed tomographic (MSCT) findings of anomalous coronary arteries in a large number of patients from the multicenter registry. At four institutes, 29 (0.

Impact of statin therapy on coronary intervention for non-ST elevation acute coronary syndrome with decreased low-density lipoprotein cholesterol.

Objectives: The benefits of treating patients with acute coronary syndrome (ACS) with statins are well established. This study investigated the effects of statins on patients who presented with low levels of low-density lipoprotein (LDL) cholesterol, were diagnosed with non-ST elevation ACS, and subsequently underwent percutaneous coronary interventions (PCI).

Methods: From 2000 to 2003, 87 patients(mean age 68 +/- 10 years, 69 males, 18 females) underwent PCI because of non-ST elevation ACS, and had low LDL cholesterol on presentation.

MDCT detection of double right coronary artery arising from a single ostium in the right sinus of Valsalva: report of 2 cases.

Double right coronary artery arising from a single ostium in the right sinus of Valsalva is an extremely rare coronary artery variation. Differentiating this variation from high take off of a large right ventricular branch is often difficult in conventional coronary angiography. In two cases, multidetector-row computed tomography (MDCT) identified double right coronary artery.

Absence of the right coronary artery detected by 64-detector-row multislice computed tomography.

The absence of the right coronary artery is an extremely rare variety of single coronary artery. We report a patient in whom the right coronary artery arose from the distal left circumflex artery. This is the first report describing images of this anomaly obtained by multislice computed tomography.

Chronic stent recoil plays an important role in restenosis of the right coronary ostium.

Objective: The efficacy of coronary stenting of aorto-ostial atherosclerotic lesions is still unclear. We investigated the frequency and mechanism of stent restenosis at this particular lesion.

Methods: Fifty-five consecutive patients with 64 native aorto-ostial lesions in the right coronary artery (RCA, n = 38) and the left main trunk (LM, n = 26) were treated by conventional stenting.

Insulin resistance in nondiabetic patients is associated with expansive remodeling in coronary arterial lesions.

Objective: Insulin resistance has been implicated as an important initiating factor in coronary atherosclerosis. However, associations between insulin resistance and specific morphologic features of atherosclerotic coronary arteries remain unclear. We ultrasonographically evaluated the morphologic features of atherosclerotic coronary arteries in nondiabetic patients with insulin resistance.

Insulin-treated diabetes mellitus and predictors of mid-term clinical outcome after percutaneous coronary interventions with stent implantation.

Background: Patients with type II, insulin-dependent diabetes mellitus have a high risk of death and repeat revascularization following successful percutaneous coronary interventions. The predictors of outcome in such patients after coronary stenting have not been clarified.

Methods: We studied 133 consecutive patients with type II, insulin-dependent diabetes mellitus who underwent coronary stenting from November 1992 to May 2001.

Sirolimus-eluting stents: a review of experimental and clinical findings.

Sirolimus (rapamycin), a macrolide antibiotic with known potent immunosuppressive properties, acts in the first phase (G1) of the cell cycle, blocking its further progression to the phase of DNA synthesis (S). In experimental models, rapamycin is effective in inhibiting smooth muscle cell proliferation and migration after vessel wall injury with balloon angioplasty. These results lead to the clinical application of sirolimus-eluting stents in 45 patients in Sao Paulo and Rotterdam (FIM Registry) and 238 patients in a randomized, European multicenter trial (RAVEL).

Percutaneous bare Z-stent implantation as an alternative to surgery for acute aortic dissection with visceral ischemia.

We describe a case of Stanford type B acute aortic dissection causing visceral ischemia. An aortogram showed an hourglass-like narrowing of the true lumen at the diaphragm with a 60 mm Hg pressure gradient. Placement of a self-expanding metallic Z-stent under intravascular ultrasound guidance restored blood flow to the viscera.

A new dedicated stent and delivery system for the treatment of bifurcation lesions: preliminary experience.

We report the first clinical experience in eight patients with a new stent and delivery system specifically designed for the treatment of bifurcational lesions. The device (AST SLK-View system) consists of a premounted stent and a delivery system. The stent has a side aperture, which orients toward the ostium of the side branch.

Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery.

Background: The safety and efficacy of percutaneous coronary intervention of de novo lesions in unprotected left main coronary arteries remains an unresolved issue.

Methods And Results: We analyzed 67 consecutive patients treated with the following devices: 39 with stents, 12 with rotational atherectomy plus stents, 13 with directional coronary atherectomy plus stents (a total of 64 patients were treated with stents), and 3 patients with directional coronary atherectomy only. The reference vessel size was 3.

Effective plaque removal with a new 8 French-compatible atherectomy catheter.

The purpose of this study was to evaluate the safety and efficacy of the new 8 Fr guide catheter-compatible Flexicut directional atherectomy device and to compare it with the conventional Atherocath GTO catheter. The 6 Fr Flexicut catheter has a larger cutting window and a titanium nitride-coated cutter to effect more tissue removal as well as treat mildly calcified lesions. A group of 143 lesions in 117 consecutive patients treated with the Flexicut catheter in four centers were compared with a control group of 277 lesions in 212 consecutive patients treated with the GTO device.

Directional atherectomy of a calcified lesion using a new atherectomy device.

We report on a case of directional atherectomy performed on a calcified coronary lesion using a novel device with a hardened titanium cutter. The successful removal of calcified plaque was documented by intravascular ultrasound assessment and confirmed by histopathological analysis of the obtained plaque specimen.