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ABSTRACT: The characteristics of coronary artery calcium responsible for vulnerable plaque remain incompletely elucidated. We used optical coherence tomography to investigate the characteristics of coronary calcium in acute myocardial infarction (AMI), unstable angina pectoris (UAP), and stable angina pectoris (SAP). We evaluated calcium deposits in the culprit lesions (30-mm segment) using optical coherence tomography in 187 patients with AMI (n = 44), UAP (n = 73), or SAP (n = 70). The arc, area, and length of calcium were significantly smaller in those with AMI and UAP than in those with SAP (p <0.001). The number of spotty calcium deposits (with an arc of <90°) per patient was significantly larger in the AMI and UAP groups than in the SAP group (p <0.001). The number of large calcium deposits (with an arc of >90°) per patient was significantly lower in the AMI and UAP groups than in the SAP group (p <0.001). The minimum distance between the inner edge of the calcium and the luminal surface was significantly shorter in the AMI and UAP groups than in the SAP group (p <0.001). Plaque rupture frequency correlated positively with the number of spotty calcium deposits (r = 0.479, p <0.001) and inversely with the number of large calcium deposits (r = -0.219, p = 0.003). In conclusion, calcium was very spotty and more superficial in the culprit lesions of AMI and UAP. These characteristics of calcium might play an important role in the pathogenesis of plaque vulnerability.
The American journal of cardiology 03/2013; · 3.58 Impact Factor
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Yasushi Ino,
Takashi Kubo,
Hironori Kitabata,
Kohei Ishibashi,
Takashi Tanimoto,
Yoshiki Matsuo,
Kunihiro Shimamura,
Yasutsugu Shiono,
Makoto Orii,
Kenichi Komukai,
Takashi Yamano,
Tomoyuki Yamaguchi,
Kumiko Hirata,
Atsushi Tanaka,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
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ABSTRACT: Late in-stent restenosis (ISR) is an important clinical issue in the drug-eluting stent era. Autopsy studies have reported different underlying mechanisms between early ISR and late ISR. The aim of the present study was to compare the neointimal tissue appearance between early ISR (<1 year) and late ISR (>1 year) after sirolimus-eluting stent (SES) implantation using optical coherence tomography (OCT).
We examined the neointimal tissue appearance in 48 ISR lesions after SES implantation [30 early ISR lesions (8±1 months after stenting) and 18 late ISR lesions (34±14 months after stenting)] by OCT. ISR was defined as percent diameter stenosis more than 50% within the stented segment in angiography. Lipid-rich neointima was characterized by signal-poor regions with diffuse borders. Thin-cap fibroatheroma (TCFA)-like neointima was defined by lipid-rich neointima with cap thickness 65 μm or less.
In the OCT findings, heterogeneous neointima was more often observed in the late ISR group compared with the early ISR group (89 vs. 43%, P=0.002). Although the frequency of intraluminal thrombus was not different between the two groups (P=0.085), the frequency of lipid-rich neointima (83 vs. 27%, P<0.001), TCFA-like neointima (39 vs. 10%, P=0.028), microchannels within neointima (67 vs. 27%, P=0.007), and neointimal disruption (33 vs. 3%, P=0.008) was significantly higher in the late ISR group.
In the present OCT study, it was found that atherosclerotic progression of neointima, such as lipid-rich neointima, TCFA-like neointima, microchannels, and neointimal disruption, was more often observed in late ISR lesions after SES implantation compared with early ISR ones.
Coronary artery disease 03/2013; 24(2):95-101. · 1.56 Impact Factor
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Kohei Ishibashi,
Atsushi Tanaka,
Hironori Kitabata,
Takashi Kubo,
Manabu Kashiwagi,
Kenichi Komukai, Yasushi Ino,
Takashi Tanimoto,
Kazushi Takemoto,
Shigeho Takarada,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
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ABSTRACT: Previous intravascular ultrasound studies have shown that echolucent neointimal hyperplasia occasionally appears after bare-metal stent (BMS) or sirolimus-eluting stent (SES) implantation. Optical coherence tomography (OCT) studies have also demonstrated that paclitaxel-eluting stent (PES) restenosis exhibited similar images showing low signal intensity areas (LSIA) surrounding stent struts and three-layer appearance (TLA). The aim of the present study was to investigate the clinical significance of LSIA on OCT images in various types of stents. Fifty nine consecutive patients who underwent scheduled follow-up coronary angiography and OCT were enrolled. There was no significant difference in the prevalence of LSIA among the 3 stent groups (BMS 30%, SES 19%, PES 28%, P = 0.70). LSIA thickness was larger in the PES group than in the other stent groups (BMS 0.51 ± 0.21 mm, SES 0.35 ± 0.06 mm, PES 0.87 ± 0.19 mm, P < 0.01). The ratio of LSIA thickness to the neointimal thickness was also larger in PES compared with other stents (BMS 53 ± 9 %, SES 57 ± 8 %, PES 77 ± 5 %, P < 0.01). Also, LSIA thickness in patients with in-stent restenosis (ISR) was significantly larger than in those without ISR (0.37 ± 0.37 mm versus 0.12 ± 0.26 mm, P = 0.048). Our results suggest that LSIA might be involved in excessive neointimal formation, and that the healing response after PES implantation might be different from BMS or SES.
International Heart Journal 01/2013; 54(1):7-10. · 1.16 Impact Factor
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ABSTRACT: The retrograde approach, a new technique of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), allows coronary interventionalists to improve the success rate. However, this technique occasionally has serious complications. We report a case with the occlusion of left main coronary artery (LMCA) during PCI for CTO in the proximal LCX with retrograde approach because of backward spiral dissection formed by retrograde wire. We could perform bail-out stenting for LMCA. In PCI for CTO in the proximal site of left coronary artery with retrograde approach, we should keep in mind a backward dissection to LMCA formed by retrograde wire.
Cardiovascular intervention and therapeutics. 08/2012;
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ABSTRACT: Background: Elevated blood glucose on admission may worsen outcome after acute myocardial infarction (AMI). No relationship has been identified between admission blood glucose level and myocardial salvage in patients with AMI. Methods and Results: This study assessed 150 consecutive patients with a first AMI who underwent percutaneous coronary intervention within 24h from onset of symptoms. Plasma blood glucose was measured on admission. Stress hyperglycemia was defined as blood glucose ≥10mmol/L (180mg/dl). The extent of myocardial salvage 7 days after AMI was evaluated on cardiovascular magnetic resonance imaging (CMRI) as the difference between areas of myocardium at risk (T2-weighted hyperintense lesion) and areas of late gadolinium enhancement. The association between stress hyperglycemia and myocardial salvage index (MSI) was investigated in patients with and without diabetes. Among non-diabetic patients, MSI was lower in those with stress hyperglycemia than in those without. No significant difference in MSI was noted between diabetes patients with or without stress hyperglycemia. On multivariate analysis, stress hyperglycemia in patients without diabetes was an independent predictor of MSI. Conclusions: Stress hyperglycemia affects MSI, indicating that the manipulation of glucose levels could be a potential therapeutic target for salvaging ischemic damage. (Circ J 2012; 76: 2690-2696).
Circulation Journal 08/2012; 76(11):2690-6. · 3.77 Impact Factor
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ABSTRACT: Optical coherence tomography (OCT) is a high resolution imaging technique that offers microscopic visualization of the coronary artery. The fast scanning speed and simple imaging procedure of new-generation frequency-domain OCT make this technology easy to use in the clinical setting. The OCT examination is useful for guidance and risk stratification of percutaneous coronary intervention (PCI). OCT-derived thin-cap fibroatheroma, which is characterized by large lipid-core and thin fibrous cap <65μm, is a predictor of peri-PCI complications, such as angiographic no-reflow, microvascular obstruction, and post-PCI cardiac troponin I elevation. Stent malapposition, tissue protrusion, and stent edge dissection are assessed in more detail by OCT than with conventional intravascular imaging modalities. Neointimal coverage at strut level assessed by OCT could be a surrogate endpoint for quickly scrutinizing safety after drug-eluting stent implantation. The OCT findings of in-stent neoatherosclerosis, such as lipid-rich neointima, microvascular proliferation, and neointimal plaque rupture, are associated with very late stent failure, including thrombosis and restenosis. With its excellent ability to assess coronary atherosclerosis and to guide PCI, OCT provides new insights into interventional cardiology. (Circ J 2012; 76: 2076-2083).
Circulation Journal 07/2012; 76(9):2076-83. · 3.77 Impact Factor
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Yasutsugu Shiono,
Hironori Kitabata,
Takashi Kubo,
Tomizou Masuno,
Shingo Ohta,
Yuichi Ozaki,
Hiromichi Sougawa,
Makoto Orii,
Kunihiro Shimamura,
Kohei Ishibashi,
Kenichi Komukai,
Takashi Yamano,
Takashi Tanimoto, Yasushi Ino,
Tomoyuki Yamaguchi,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
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ABSTRACT: Background: For the identification of functionally significant coronary artery disease, there have not been any dedicated optical coherence tomography (OCT) studies reported previously, although OCT can clearly detect coronary vessel lumina at higher resolution than intravascular ultrasound (IVUS). Methods and Results: OCT and fractional flow reserve (FFR) measurements were performed in 62 intermediate coronary lesions in 59 patients. FFR was calculated as the ratio of distal coronary pressure divided by proximal coronary pressure during maximal hyperemia. FFR <0.75 was used as the threshold for diagnosing functionally significant stenosis. Minimal lumen area (MLA), minimal lumen diameter (MLD) and percent lumen area stenosis were measured by OCT. FFR values correlated significantly with OCT-derived MLA (r=0.75, P<0.01), MLD (r=0.76, P<0.01) and percent lumen area stenosis (r=-0.77, P<0.01). Receiver-operating characteristic curve suggested an OCT-derived MLA <1.91mm(2) (sensitivity 93.5%, specificity 77.4%), MLD <1.35mm (sensitivity 90.3%, specificity 80.6%) and percent lumen area stenosis >70.0% (sensitivity 96.8%, specificity 83.9%) as the best cutoff values for a FFR <0.75. Conclusions: Anatomical measurements of coronary stenosis obtained by OCT show significant correlation with FFR. OCT has the potential to predict functionally significant stenosis, although the present OCT-derived parameters were smaller than those reported in previous IVUS studies. (Circ J 2012; 76: 2218-2225).
Circulation Journal 06/2012; 76(9):2218-25. · 3.77 Impact Factor
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Yoshiki Matsuo,
Takashi Kubo,
Yasushi Okumoto,
Kohei Ishibashi,
Kenichi Komukai,
Takashi Tanimoto, Yasushi Ino,
Hironori Kitabata,
Kumiko Hirata,
Toshio Imanishi,
Hideharu Akagi,
Takashi Akasaka
[show abstract]
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ABSTRACT: AIMS: The importance of oxidized low-density lipoprotein (oxLDL) has been implicated in the process of plaque rupture. However, few previous studies demonstrated the relationship between plaque morphology and oxLDL. We evaluated the relationship between coronary plaque vulnerability assessed by optical coherence tomography (OCT) and circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL). METHODS AND RESULTS: OCT was used to determine plaque vulnerability in 102 patients with acute coronary syndrome (ACS; n = 53) and stable angina pectoris (SAP; n = 49). Circulating levels of MDA-LDL were measured by using enzyme-linked immunosorbent assay. Thin-cap fibroatheromas (TCFAs; defined as lipid-rich with plaque cap thickness <65 μm) were detected more frequently in ACS than in SAP (83% vs. 16%, P < 0.001). The circulating levels of MDA-LDL were significantly higher in patients with ACS compared with SAP (P = 0.008). The levels of MDA-LDL were significantly higher in SAP patients with TCFA than those with non-TCFA (P < 0.001). Although the levels of MDA-LDL were not significant between ACS patients with TCFA and those with non-TCFA, patients with ruptured TCFA had higher levels of MDA-LDL compared with those with morphologically intact TCFA (P = 0.023). MDA-LDL levels were associated with the presence of TCFA (odds ratio, 1.45 per 10-unit increment of MDA-LDL; 95% CI, 1.24-1.68; P< 0.001) in multivariable logistic regression analysis. CONCLUSION: Circulating MDA-LDL levels might be associated with the presence of TCFA in the culprit lesion.
European heart journal cardiovascular Imaging. 05/2012;
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Tomizo Masuno,
Kumiko Hirata,
Nozomi Wada,
Haruka Endo,
Kazushi Takemoto,
Tsuyoshi Nishiguchi,
Ikuko Teraguchi,
Naoki Maniwa,
Aiko Shimokado,
Manabu Kashiwagi, [......],
Hideyuki Ikejima,
Akio Kuroi,
Kohei Ishibashi,
Kenichi Komukai,
Takashi Tanimoto, Yasushi Ino,
Hironori Kitabata,
Keizo Kimura,
Toshio Imanishi,
Takashi Akasaka
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[hide abstract]
ABSTRACT: A 47-year-old woman was hospitalized for syncope. An electrocardiogram showed complete right bundle branch block and T-wave
inversion in leads III, aVF, and V2–4. Cardiac catheterization was performed since the echocardiogram demonstrated the existence
of a left ventricular apical aneurysm and apical thrombus. Coronary angiography revealed normal coronary arteries. An endomyocardial
biopsied specimen from the right ventricular apical wall demonstrated typical noncaseating granulomas with giant cells. There
was no evidence suggesting the involvement of other systemic organs. The patient was diagnosed as having cardiac sarcoidosis.
Cardiac sarcoidosis should be considered within a spectrum of diseases that cause left ventricular apical aneurysm.
KeywordsCardiac sarcoidosis-Left ventricular aneurysm-Left ventricular apical thrombus-Nonsustained ventricular tachycardia
Journal of Echocardiography 04/2012; 8(4):129-130.
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Hironori Kitabata,
Takashi Kubo,
Kenichi Komukai,
Kohei Ishibashi,
Takashi Tanimoto, Yasushi Ino,
Shigeho Takarada,
Yuichi Ozaki,
Manabu Kashiwagi,
Makoto Orii,
Yasutsugu Shiono,
Masatsugu Shiono,
Kunihiro Shimamura,
Kumiko Hirata,
Atsushi Tanaka,
Keizo Kimura,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
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ABSTRACT: Neointima inside the bare-metal stents (BMSs) can transform into atherosclerotic tissue during an extended follow-up because of a persistent inflammatory reaction to the metal. We sought to investigate whether strut thickness may impact on the atherosclerotic change in neointima 4 years or more after BMS implantation using optical coherence tomography.
Forty-six stented lesions of 41 patients with BMS ≥ 4 years after implantation who underwent optical coherence tomography were enrolled in the study. The strut was defined as thin when less than 100 μm and thick when ≥ 100 μm. According to these criteria, stents were divided into 2 groups (thin strut n = 19, thick strut n = 27). Neointimal tissue was categorized into normal neointima, characterized by a signal-rich band without signal attenuation, or lipid-laden intima, with marked signal attenuation and a diffuse border. Intimal disruption, thrombus, and neovascularization were also evaluated.
The mean period after implantation was 98.2 ± 25.8 months in the thin-strut group and 91.1 ± 22.8 months in the thick-strut group (P = .330). Lipid-laden intima (70% vs 32%, P = .016), thin-cap fibroatheroma-like intima (59% vs 16%, P = .0056), and intimal disruption (48% vs 16%, P = .031) were observed more frequently in the thick-strut group than in the thin-strut group, but no significant difference was observed in the frequency of thrombus. Although peristrut neovascularization was a common finding in both groups (thick vs thin 81% vs 79%, P = 1.000), the frequency of intraintima neovascularization tended to be higher in the thick-strut group (67% vs 42%, P = .135).
A thinner strut thickness may have favorable effects on neointimal atherosclerotic changes after BMS implantation.
American heart journal 04/2012; 163(4):608-16. · 4.65 Impact Factor
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Yuichi Ozaki,
Toshio Imanishi,
Takashi Tanimoto,
Manabu Kashiwagi,
Hiroto Tsujioka,
Hiromichi Sougawa,
Makoto Orii,
Yasutsugu Shiono,
Kunihiro Shimamura,
Kohei Ishibashi,
Kenichi Komukai, Yasushi Ino,
Hironori Kitabata,
Takashi Akasaka
[show abstract]
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ABSTRACT: It remains unclear whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) have fully delivered the expected reduction in cardiovascular diseases. We investigated the effects of adding the direct renin inhibitor (DRI), aliskiren, to an ACEI or an ARB on monocyte subsets and myocardial salvage in patients with primary acute myocardial infarction (AMI).
Twenty-one consecutive patients were treated with an ACEI or an ARB (non-DRI group), and another 21 consecutive patients received aliskiren combined with an ACEI or an ARB (DRI group). Two monocyte subsets (CD14(+)CD16(-) and CD14(+)CD16(+)) were measured by flow cytometry. The extent of myocardial salvage 7 days after AMI was evaluated by cardiac magnetic resonance imaging. Both plasma renin activity and aldosterone levels were significantly lower in the DRI group than in the non-DRI group. Peak levels of CD14(+)CD16(-) monocyte number and ratio were also significantly lower in the DRI group. The extent of myocardial salvage was significantly higher in the DRI group than in the non-DRI group (44.8 [41.2-53.1] vs. 36.0 [28.5-42.6], P=0.001).
A DRI combined with an ACEI or an ARB can better improve the extent of myocardial salvage after AMI than an ACEI or an ARB alone in association with the decrease in circulating CD14(+)CD16(-) monocytes.
Circulation Journal 03/2012; 76(6):1461-8. · 3.77 Impact Factor
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Manabu Kashiwagi,
Toshio Imanishi,
Yuichi Ozaki,
Keisuke Satogami,
Tomizo Masuno,
Teruaki Wada,
Yoshihiro Nakatani,
Kohei Ishibashi,
Kenichi Komukai,
Takashi Tanimoto, Yasushi Ino,
Hironori Kitabata,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: To investigate the involvement of Toll-like receptor 4 (TLR4) expression on two monocyte subsets in the pathologic processes related to acute coronary syndrome. How monocytes, which have recently been shown to comprise two distinct subsets, mediate the process of coronary plaque rupture remains to be fully elucidated. Recent studies have shown that TLR4 is involved in monocyte activation of patients with accelerated forms of atherosclerosis.
We enrolled 65 patients with acute myocardial infarction (AMI, n=22), unstable angina pectoris (UAP, n=16), and stable angina pectoris (SAP, n=27) who underwent coronary angiography and 15 healthy controls. The expression of TLR4 on two monocyte subsets (CD14(+)CD16(-) and CD14(+)CD16(+)) was measured by flow cytometry.
In patients with AMI, TLR4 was more expressed on circulating CD14(+)CD16(+) monocytes than on CD14(+)CD16(-) monocytes (p<0.001). The expression levels of TLR4 on CD14(+)CD16(+) monocytes were significantly elevated in patients with AMI compared with other 3 groups. TLR4 expression levels on CD14(+)CD16(+) monocytes were significantly elevated at the culprit site compared with the systemic level (p=0.044). The up-regulation of TLR4 on admission was remarkably decreased 12 days after AMI (p<0.001). In addition, plasma levels of tumor necrosis factor-α were positively correlated with TLR4 expression levels on monocytes in patients with AMI (r=0.47, p=0.027).
TLR overexpression on CD14(+)CD16(+) monocytes in AMI, as demonstrated both in the circulation and at the coronary culprit site, might be associated with the pathogenesis of AMI.
Atherosclerosis 03/2012; 221(1):249-53. · 3.79 Impact Factor
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Yuichi Ozaki,
Hironori Kitabata,
Hiroto Tsujioka,
Seiki Hosokawa,
Manabu Kashiwagi,
Kohei Ishibashi,
Kenichi Komukai,
Takashi Tanimoto, Yasushi Ino,
Shigeho Takarada,
Takashi Kubo,
Keizo Kimura,
Atsushi Tanaka,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: Although an intracoronary frequency-domain optical coherence tomography (FD-OCT) system overcomes several limitations of the time-domain OCT (TD-OCT) system, the former requires injection of contrast media for image acquisition. The increased total amount of contrast media for FD-OCT image acquisition may lead to the impairment of renal function. The safety and usefulness of the non-occlusion method with low-molecular-weight dextran L (LMD-L) via a guiding catheter for TD-OCT image acquisition have been reported previously. The aim of the present study was to compare the image quality and quantitative measurements between contrast media and LMD-L for FD-OCT image acquisition in coronary stented lesions.
Twenty-two patients with 25 coronary stented lesions were enrolled in this study. FD-OCT was performed with the continuous-flushing method via a guiding catheter. Both contrast media and LMD-L were infused at a rate of 4 ml/s by an autoinjector. With regard to image quality, the prevalence of clear image segments was comparable between contrast media and LMD-L (97.9% vs. 96.5%, P=0.90). Furthermore, excellent correlations were observed between both flushing solutions in terms of minimum lumen area, mean lumen area, and mean stent area. The total volumes of contrast media and of LMD-L needed for OCT image acquisition were similar.
FD-OCT image acquisition with LMD-L has the potential to reduce the total amount of contrast media without loss of image quality.
Circulation Journal 02/2012; 76(4):922-7. · 3.77 Impact Factor
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Manabu Kashiwagi,
Atsushi Tanaka,
Hironori Kitabata, Yasushi Ino,
Hiroto Tsujioka,
Kenichi Komukai,
Yuichi Ozaki,
Kohei Ishibashi,
Takashi Tanimoto,
Shigeho Takarada,
Takashi Kubo,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
JACC. Cardiovascular imaging 02/2012; 5(2):232-3. · 14.29 Impact Factor
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Yuichi Ozaki,
Atsushi Tanaka,
Takashi Tanimoto,
Hironori Kitabata,
Manabu Kashiwagi,
Takashi Kubo,
Shigeho Takarada,
Kohei Ishibashi,
Kenichi Komukai, Yasushi Ino,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO after PCI in patients with ACS.
We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59), a nonrupture with TCFA group (n=21), and a nonrupture and non-TCFA group (n=35), according to optical coherence tomography findings of the culprit lesion. Using contrast-enhanced MRI, we assessed MVO. There were no statistically significant differences in patient characteristics. The nonrupture with TCFA group more frequently presented MVO (ruptured plaque, 27%; versus nonrupture with TCFA, 43%; versus non-TCFA and nonrupture, 9%; P=0.012). The prevalence of MVO increases as cap thickness decreases.
TCFA is more frequently associated with MVO after PCI. TCFA is a high-risk plaque for MVO after PCI in patients with ACS.
Circulation Cardiovascular Imaging 09/2011; 4(6):620-7. · 5.94 Impact Factor
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Takashi Kubo,
Yoshiki Matsuo, Yasushi Ino,
Hironori Kitabata,
Takashi Tanimoto,
Kohei Ishibashi,
Yasushi Okumoto,
Kenji Nakamura,
Kenichi Komukai,
Shigeho Takarada,
Atsushi Tanaka,
Toshio Imanishi,
Hideharu Akagi,
Takashi Akasaka
JACC. Cardiovascular imaging 09/2011; 4(9):1040-3. · 14.29 Impact Factor
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Yasushi Ino,
Takashi Kubo,
Hironori Kitabata,
Kunihiro Shimamura,
Yasutsugu Shiono,
Makoto Orii,
Keishi Okochi,
Hiromichi Sougawa,
Takashi Tanimoto,
Kenichi Komukai,
Kohei Ishibashi,
Shigeho Takarada,
Hiroko Nakanishi,
Atsushi Tanaka,
Keizo Kimura,
Kumiko Hirata,
Masato Mizukoshi,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: A tortuous lesion with hinge motion is reportedly a risk factor for in-stent restenosis (ISR) after bare metal stent implantation. Sirolimus-eluting stents (SESs) implantation has dramatically reduced ISR. However, SES is a closed-cell design stent, which has low conformability and flexibility. Several studies have reported a relationship between tortuous lesions and stent fracture, which is one of the causes of ISR. The efficacy of SES in a tortuous lesion with hinge motion has not been fully evaluated. The aim of this study was to investigate the relationship between tortuous lesions and ISR after SES implantation.
Three year clinical follow-up data after SES implantation, including 6-9 month scheduled follow-up coronary angiography in 399 consecutive patients with 537 lesions, were obtained. Δangle was defined as the difference in the angle of the target lesion between the diastole and systole before the procedure. The incidence of ISR was 8.2%. The mean maximal angle and Δangle were larger in the ISR group (47 ± 22° vs. 37 ± 21°, P=0.004 and 20 ± 13° vs. 13 ± 10°, P < 0.0001, respectively). Independent predictors of ISR were Δangle, hemodialysis, aortic ostium stenting, and diabetes mellitus. Hinge motion-associated ISR (Δangle ≥ 16°) occurred in 28 lesions: stent fracture in 9, stent recoil in 6, edge injury in 10, and others in 3.
The amount of hinge motion in tortuous lesions should be considered in the selection of drug eluting stent types.
Circulation Journal 05/2011; 75(8):1878-84. · 3.77 Impact Factor
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ABSTRACT: Optical coherence tomography (OCT) is a high-resolution imaging technique that offers microscopic visualization of coronary plaques. The clear and detailed images of OCT generate an intense interest in adopting this technique for both clinical and research purposes. Recent studies have shown that OCT is useful for the assessment of coronary atherosclerotic plaques, in particular the assessment of plaque rupture, erosion, and intracoronary thrombus in patients with acute coronary syndrome. In addition, OCT may enable identifying thin-cap fibroatheroma, the proliferation of vasa vasorum, and the distribution of macrophages surrounding vulnerable plaques. With its ability to view atherosclerotic lesions in vivo with such high resolution, OCT provides cardiologists with the tool they need to better understand the thrombosis-prone vulnerable plaques and acute coronary syndromes. This paper reviews the possibility of OCT for identification of vulnerable plaques in vivo.
Cardiology research and practice. 01/2011; 2011:312978.
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Takashi Kubo,
Yoshiki Matsuo, Yasushi Ino,
Takashi Tanimoto,
Kohei Ishibashi,
Kenichi Komukai,
Hironori Kitabata,
Atsushi Tanaka,
Keizo Kimura,
Toshio Imanishi,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: Background. Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such "attenuated plaque" may be an IVUS characteristic of unstable lesion. Methods. We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque. Results. IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%, P < 0.001), thin-cap fibroatheroma (48% versus 16%, P < 0.001), plaque rupture (44% versus 11%, P < 0.001), and intracoronary thrombus (54% versus 17%, P < 0.001) were more often seen in IVUS-detected attenuated plaques compared with nonattenuated plaques. Conclusions. IVUS-detected attenuated plaque has many characteristics of unstable coronary lesion. The presence of attended plaque might be an important marker of lesion instability.
Cardiology research and practice. 01/2011; 2011:687515.
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Takashi Kubo,
Nobuo Nakamura,
Yoshiki Matsuo,
Yasushi Okumoto,
Xiaofan Wu,
So-Yeon Choi,
Kenichi Komukai,
Takashi Tanimoto, Yasushi Ino,
Hironori Kitabata,
Keizo Kimura,
Masato Mizukoshi,
Toshio Imanishi,
Hideharu Akagi,
Tadao Yamamoto,
Takashi Akasaka
[show abstract]
[hide abstract]
ABSTRACT: Virtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a high-resolution imaging method, which might be a promising technique to identify thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study was to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT.We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a plaque with a fibrous cap of < 65 µm. VH-IVUS correctly identified 16 TCFA and 67 non-TCFA but misclassified 2 TCFA and 11 non-TCFA as determined by OCT. The sensitivity, specificity, and positive and negative predictive values of VH-IVUS to identify TCFA as determined by OCT were 89%, 86%, 59%, and 97%, respectively.VH-IVUS showed an acceptable sensitivity and specificity to identify TCFA as determined by OCT. Although the positive predictive value was low reflecting a high number of false positives, the negative predictive value was notably high. Our results suggest a potential role for VH-IVUS to exclude high risk lesions for future coronary events.
International Heart Journal 01/2011; 52(3):175-9. · 1.16 Impact Factor
