Fukuoka Wajiro Hospital

Fukuoka-shi, Japan

Fukuoka Wajiro Hospital

Fukuoka-shi, Japan
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Otsuka Y.,Fukuoka Wajiro Hospital | Nakamura M.,Sapporo Medical University | Kokubu N.,Sapporo Medical University | Tonooka A.,Sapporo Medical University | And 2 more authors.
Heart and Vessels | Year: 2012

The use of drug-eluting stents (DES) reduces the risk of repeat revascularization without increase of death and myocardial infarction compared to standard bare metal stents. However, in-stent restenosis (ISR) after DES implantation still occurs. Here, we report a rare case with a diffuse ISR after CYPHER® stent implantation because of chronic inflammation and hypersensitivity reactions, confirmed by pathohistological findings. © 2011 Springer.

Otsuka Y.,Japan National Cardiovascular Center Research Institute | Otsuka Y.,Fukuoka Wajiro Hospital | Ishiwata S.,Toranomon Hospital | Inada T.,Red Cross | And 5 more authors.
European Heart Journal | Year: 2011

Aims Long-term outcomes after sirolimus-eluting stent (SES) implantation in haemodialysis (HD) patients have remained controversial. We investigated the impact of HD on outcomes after SES implantation. Methods and resultsWe analysed the data on 2050 patients who underwent SES implantation in a multi-centre prospective registry in Japan. Three-year clinical outcomes were compared between the HD group (n 106) and the non-haemodialysis (NH) group (n 1944). At the 3-year clinical follow-up, the rates of unadjusted cardiac mortality (HD: 16.3 vs. NH: 2.3) and target-lesion revascularization (TLR) (HD: 19.4 vs. NH: 6.6) were significantly higher in the HD group than the NH group (P < 0.001). Although HD group had a numerically higher stent thrombosis rate, the difference in stent thrombosis between the two groups (HD: 2.0 vs. NH: 0.7) did not reach statistical significance. Using Coxs proportional-hazard models with propensity score adjustment for baseline differences, the HD group had higher risks of TLR [HD: 16.3 vs. NH: 6.1; hazard ratio, 2.83; 95 confidence interval (CI): 1.624.93, P 0.0003] and cardiac death (HD: 12.3 vs. NH: 2.3; hazard ratio, 5.51; 95 CI: 2.5811.78, P < 0.0001). The consistent results of analyses, whether unadjusted or adjusted for other baseline clinical and procedural differences, identify HD as an independent risk factor for cardiac death and TLR. ConclusionsPercutaneous coronary intervention with SES in HD patients has a higher incidence of repeat revascularization and mortality compared with those in NH patients. Haemodialysis appears to be strongly associated with mortality and repeat revascularization even after SES implantation. © 2011 The Author.

Otsuka Y.,Japan National Cardiovascular Center Research Institute | Otsuka Y.,Fukuoka Wajiro Hospital | Saito S.,Shonan Kamakura General Hospital | Nakamura M.,Toho University | And 2 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Objectives: The aim of this study was to compare the pharmacokinetics of the four limus-eluting stents used in Japanese patients. Background: There are presently no reports comparing human pharmacokinetics among drug-eluting stents (DESs). Methods: We retrospectively analyzed data from pharmacokinetic studies of patients implanted with an 18-mm DES: Cypher stent (sirolimus, n = 10), Endeavor stent (zotarolimus, n = 7), Xience V stent (everolimus, n = 6), and Nobori stent (biolimus A9, n = 10), in multicenter trials of Japan. Total drug doses of the Cypher stent, Endeavor stent, Xience V stent, and Nobori stent were 150, 180, 88, and 293 μg, respectively. Drug concentrations were measured in serial whole blood samples after implantation and the pharmacokinetics were analyzed. Results: Mean peak drug levels were 0.86 ng mL -1 for Cypher, 1.80 ng mL -1 for Endeavor, 0.50 ng mL -1 for Xience V, and 0.09 ng mL -1 for Nobori. After adjustment for the loaded dose, mean peak drug levels of the Cypher and Xience V stents were similar (0.0057 ng mL -1 μg -1 each) while the Endeavor (0.0100 ng mL -1 μg -1) was higher, and the Nobori (0.0003 ng mL -1 μg -1) was lower, compared with the Cypher and Xience V stents. The other pharmacokinetic parameters of four DESs differed according to characteristics of the coated drug. The systemic exposure of biolimus A9 was much lower than that of the other DESs studied. Conclusions: In Japanese patients, systemic exposure was low, regardless of the type of limus drug eluted from the stents; but specific pharmacokinetic activities were varied according to the drug characteristics, concentration, and DES design. © 2011 Wiley Periodicals, Inc.

Fujita H.,Kurume University | Fujita H.,Fukuoka Wajiro Hospital
Surgery Today | Year: 2014

I would herein like to look back upon surgery for esophageal cancer, particularly on lymphadenectomy, and to speculate a little on the future prospects for esophageal surgery. There are two schools of thought on lymphadenectomy in esophageal cancer: one believes in en bloc esophagectomy, which is commonly performed in Western countries; the other believes in three-field lymphadenectomy, which is commonly performed in Japan. We esophageal surgeons at Kurume University have contributed to some advances in three-field lymphadenectomy. For example, we initiated functional mediastinal dissection to ensure patient safety, and we proposed the lymph node compartment theory to assess the clinical importance of regional nodes. Oncological surgery has progressed in terms of its safety, radicality and functional preservation, leading to improved quality-of-life for patients after surgery. This then evolved to the current development of multimodal and individualized tailor-made treatments. I believe that surgery for esophageal cancer will become bipolarized in the future. One strand will evolve as salvage surgery for residual or recurrent tumors, which non-surgical therapies have failed to cure, and the other strand will evolve as less invasive surgery, adjuvant surgery, for cancers at the relatively early stage, for which micro-metastasis can be cured by non-surgical therapies. © 2014 Springer Japan.

Yanagita Y.,Fukuoka Wajiro Hospital | Noda K.,Kumamoto Central Hospital
Cardiovascular Intervention and Therapeutics | Year: 2011

To evaluate vascular complications associated with endovascular treatment (EVT) of peripheral arterial disease (PAD) through the popliteal artery and to identify the risk factors for these complications. Between November 2005 and January 2009, 63 patients with PAD received EVT via the popliteal artery. Retrograde (n = 58) and antegrade (n = 5) transpopliteal procedures were performed to target 77 lesions, including 12 distal to the trifurcation. Thirty-five punctures were performed under ultrasound guidance and 7 under angiographic guidance; 21 punctures were performed without any guidance. Vascular complications were evaluated by physical examination and duplex ultrasonography. Vascular complications at the popliteal puncture site occurred in 8 patients (12. 7%): 6 hematomas and 2 arteriovenous fistulas (AVF). Seven of 24 patients receiving hemodialysis (HD) (29%) had significantly higher complications (P = 0. 004) compared with 1 of 39 patients not receiving hemodialysis (non-HD) (2. 6%). HD alone was also a significant risk factor for hematoma (P = 0. 010). Both AVF occurred in HD patients (P = 0. 141), and one occurred despite ultrasound-guided puncture. Ultrasound-guided puncture showed no significant improvement in reducing both complications. The combination of antiplatelet and anticoagulant therapy showed no statistical significance in overall complications. In non-HD patients, the transpopliteal approach in the EVT of PAD seems to be safe. More attention should be paid to HD patients when using the transpopliteal approach due to a higher complication rate. © 2011 Japanese Association of Cardiovascular Intervention and Therapeutics.

Shimabukuro M.,Tokushima University | Saito T.,Tokushima University | Saito T.,Fukuoka Wajiro Hospital | Higa T.,Fukuoka Wajiro Hospital | And 3 more authors.
Circulation Journal | Year: 2015

Background: Patients with type 2 diabetes mellitus (T2DM) show a greater risk for coronary artery disease (CAD), but the risk stratification in asymptomatic CAD patients has not been established. This study investigated the prevalence and severity for asymptomatic CAD and predictors in T2DM patients. Methods and Results: In a multiclinic group, diabetic patients (320 men, 186 women) without known symptoms suggestive of CAD were recruited for multidetector computed tomography (MDCT). Patients were categorized according to severity of coronary atherosclerosis: Grade 1 (normal findings), Grade 2 (mild atherosclerosis without significant stenosis), Grade 3 (moderate stenosis/atherosclerosis, 50–74% stenosis), Grade 4 (moderate stenosis/ atherosclerosis, 75–89% stenosis), Grade 5 (severe stenosis/atherosclerosis, ≥90% stenosis). The trend for severity grade of CAD was slightly higher in men than women (P=0.054). For critical lesions (combined Grades 3–5), the prevalence was almost equal (men 44% vs. women 37%; P=0.113). Multivariate models showed that in men, HbA1c ≥7.4%, dyslipidemia, duration of diabetes, retinopathy, and other type of cardiovascular diseases were predictors of critical lesions and in women, duration of diabetes and retinopathy were predictors. Conclusions: The prevalence and severity of asymptomatic CAD are comparably high in men and women with T2DM. Risk stratification by using MDCT might be useful to predict asymptomatic coronary lesions requiring coronary revascularization. © 2015, Japanese Circulation Society. All rights reserved.

Harada K.,Fukuoka Wajiro Hospital | Kakumoto K.,Fukuoka Wajiro Hospital | Morioka J.,Fukuoka Shinmizumaki Hospital | Saito T.,Fukuoka Wajiro Hospital | Fukuyama K.,Fukuoka Wajiro Hospital
Annals of Vascular Surgery | Year: 2014

Background: Carotid artery stenting (CAS) with distal filter protection allows continuous cerebral perfusion, although it is associated with a greater risk of cerebral ischemic complications than other protection systems. To reduce cerebral ischemic complications, CAS was performed under combined cerebral protection using both flow reversal (FR) and a distal filter. Methods: Fifty-six stenoses of 52 patients were treated with CAS using the combined protection of FR and a distal filter, with intermittent occlusion of both the common carotid artery (CCA) and the external carotid artery. The blood flow was reversed into the guiding catheter to the central venous system via an external filter, which collected the debris. Clinical outcomes, the rates of capturing visible debris, and new ischemic signals on diffusion-weighted magnetic resonance imaging (DWI-MRI) were evaluated. Results: The overall technical success rate was 92.9% (52/56). Successful stent deployment was achieved in 100% (56/56) of the cases. No procedural-related emboli causing a neurologic deficit were observed. In 38.5% (20/52) of the cases, visible debris were captured by only the external filter, and in 17.3% (9/52), visible debris were captured by both external and distal filters. In no case was visible debris noted in only the distal filter. New ischemic signals on DWI-MRI were detected in 9.6% (5/52). The 30-day myocardial infarction, stroke, and death rates were 0%. Conclusions: The additional use of a distal filter captures emboli in 17.3% of cases, and because the occlusion is only intermittent, the procedure is potentially applicable even in those who cannot tolerate prolonged balloon occlusion of the CCA. © 2014 Elsevier Inc. All rights reserved.

Left ventricular free wall rupture is a rare, but occasionally lethal, complication after acute myocardial infarction (AMI). This case report describes a patient who presented with cardiogenic shock due to oozing-type rupture secondary to AMI and successfully underwent percutaneous intrapericardial fibrin-glue injection therapy. Cardiac magnetic resonance imaging demonstrated the thin layer of fibrin that covered the ruptured infarct myocardium immediately after fibrin-glue injection and its disappearance without any complications at 6 months.

Harada K.,Fukuoka Wajiro Hospital | Kakumoto K.,Fukuoka Wajiro Hospital
Interventional Neuroradiology | Year: 2015

In embolization of a cavernous sinus (CS) by transvenous embolization (TVE) for a CS dural arteriovenous fistula (DAVF), selection of embolization coils is difficult owing to the complex anatomical structure of the CS. Moreover, overpacking of the CS with embolization coils may cause permanent cranial nerve palsies. The ED coil-10 (EDC-10) infini is an extremely soft platinum coil without shape-memory that has excellent conformability with surrounding structures. The goal of this study was to evaluate use of the EDC-10 infini coil for embolization of a CS DAVF. Six patients with a CS DAVF were treated with TVE. Refluxing cerebral and ophthalmic veins were embolized with shapememory type coils other than EDC-10 infini, and CSs were embolized with the EDC-10 infini coils. In five cases, CSs were loosely embolized with EDC-10 infini coils. In one case, reflux of the cerebral vein worsened from the CS during the procedure, and embolization of the CS tightly using three-dimensional shape-memory type coils other than EDC-10 infini. Overall, three to 19 (average 7.3) coils were used fozr each CS and the total coil volume was 33-284 (average 95.1) mm3 in each CS. Postoperative transient abducens palsy occurred in two cases, but both patients recovered completely. There was no case of recurrence. The EDC-10 infini coil showed excellent conformability with the complex inner structure of the CS and excellent safety without postoperative permanent cranial nerve palsy. © The Author(s) 2015.

Otsuka Y.,Fukuoka Wajiro Hospital | Nakamura K.,Fukuoka Wajiro Hospital | Saito T.,Fukuoka Wajiro Hospital
Journal of Invasive Cardiology | Year: 2012

Percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO) is one of the most technically challenging areas of interventional cardiology. When CTO is combined with angulation and tortuosity of the coronary artery, the technical complexity of PCI for CTO is magnified. In this report, we describe a case of successful revascularization of a CTO lesion in the complex circumflex anatomy using a novel microcatheter (the Corsair catheter) along with an antegrade approach to facilitate guidewire passage through a proximal steep angulation and to cross the circumflex CTO lesion that was unresponsive with conventional microcatheters.

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