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Kōbe-shi, Japan

Takahashi A.,Sakurakai Takahashi Hospital
The Journal of invasive cardiology | Year: 2012

Crush stenting mandates a final kissing-balloon technique (KBT) for a better clinical outcome; however, recrossing the 2 overlapping stent struts with the balloon catheter is technically challenging. The efficacy of the buddy-balloon technique for facilitating completion of the final KBT during crush stenting of the left main coronary artery (LMCA) was evaluated. The records of 38 consecutive patients who underwent crush stenting for a lesion in the distal LMCA from January 2005 to December 2009 were retrospectively reviewed. In 23 of the 38 patients, recrossing the balloon catheter to the left circumflex artery (LCX) was difficult, even with appropriate backup support from the guiding catheter. To enhance recrossing of the balloon catheter, the buddy-balloon technique was used, which resulted in the successful completion of the final KBT in 21 patients (91.3%). For the 2 patients in whom the technique was unsuccessful, the final KBT was subsequently achieved by performing the buddy-balloon technique in the LCX using a 1.5 mm balloon catheter. The overall success rate of the final KBT was 100%. One year after the procedure, target lesion revascularization (TLR) rate of these 23 cases showed no significant difference when compared with the TLR rate of patients for whom this technique was not needed. The buddy-balloon technique is a suitable option when used in the context of crush stenting in patients with lesions of the distal LMCA.

Taniguchi N.,Sakurakai Takahashi Hospital | Nakamura T.,Kyoto Prefectural University of Medicine | Sawada T.,Kyoto Prefectural University of Medicine | Matsubara K.,Kyoto City Hospital | And 5 more authors.
Circulation Journal | Year: 2010

Background: Erythropoietin (EPO) enhances re-endothelialization and anti-apoptotic action. Larger clinical studies to examine the effects of high-dose EPO are in progress in patients with acute myocardial infarction (AMI). Methods and Results: The aim of this multi-center pilot study was to investigate the effect of 'low-dose EPO' (6,000 IU during percutaneous coronary intervention (PCI), 24 h and 48 h) in 35 patients with a first ST-elevated AMI undergoing PCI who was randomly assigned to EPO or placebo (saline) treatment. Neointimal volume, cardiac function and infarct size were examined in the acute phase and 6 months later (ClinicalTrials.gov identifier: NCT00423020). No significant regression in in-stent neointimal volume was observed, whereas left ventricular (LV) ejection fraction was significantly improved (49.2% to 55.7%, P=0.003) and LV end-systolic volume was decreased in the EPO group (47.7 ml to 39.0 ml, P=0.036). LV end-diastolic volume tended to be reduced from 90.2% to 84.5% (P=0.159), whereas in the control group it was inversely increased (91.7% to 93.7%, P=0.385). Infarction sizes were significantly reduced by 38.5% (P=0.003) but not in the control group (23.7%, P=0.051). Hemoglobin, peak creatine kinase values, and CD34+/CD133+/CD45 dim endothelial progenitors showed no significant changes. No adverse events were observed during study periods. Conclusions: This is a first study demonstrating that short-term 'low-dose' EPO to PCI-treated AMI patients did not prevent neointimal hyperplasia but rather improved cardiac function and infarct size without any clinical adverse effects.

Stone P.H.,Harvard University | Saito S.,Shonan Kamakura General Hospital | Takahashi S.,Harvard University | Makita Y.,Hakodate Municipal Hospital | And 19 more authors.
Circulation | Year: 2012

BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.

Yamada T.,Sakurakai Takahashi Hospital | Takahashi A.,Sakurakai Takahashi Hospital
Catheterization and Cardiovascular Interventions | Year: 2013

Two patients who underwent simultaneous kissing stenting with sirolimus-eluting stents in the left main coronary artery were investigated with optical coherence tomography (OCT) at just more than 1 year postoperatively. In both cases, follow-up angiogram indicated complete coverage of the new metal carina with a membranous diaphragm, yet OCT showed varying tissue-coverage patterns transitioning from stent inflow to stent outflow. These patterns included single-strut coverage, bridge-like membrane formation between more than 1 strut, and end-to-end coverage of the carina; no uncovered stent struts were detected. OCT also demonstrated mixed patterns of tissue characteristics on the metal carina, ranging from poor endothelialization to modest neointima formation. These varying tissue characteristics suggest that the process of tissue coverage in the metal carina is different from that occurring on the vessel wall; this may indicate delayed healing in the carina. © 2013 Wiley Periodicals, Inc.

Yamada T.,Sakurakai Takahashi Hospital | Takahashi A.,Sakurakai Takahashi Hospital
Acta Cardiologica Sinica | Year: 2015

A 91-year-old man was admitted to our hospital with dyspnea and chest pain. His electrocardiogram showed ST-segment elevation in the V1-4 leads, and an emergency coronary angiogram revealed subtotal occlusion in the left descending coronary artery. A successful primary percutaneous coronary intervention was subsequently performed using aspiration thrombectomy and bare metal stent implantation. However, his hemodynamic condition deteriorated with severe pulmonary congestion. Administration of inotropes with diuretics and mechanical ventilation were not effective, and an echocardiogram showed coexisting severe aortic stenosis. As a bailout procedure, we performed balloon aortic valvuloplasty (BAV) with a 12- and 14-mm balloon on the next day. After BAV, the patient's condition improved, and he was weaned from the ventilator. It is commonly understood that onset of acute myocardial infarction may trigger worsening of heart failure in patients with compensated aortic stenosis. However, emergency balloon aortic valvuloplasty, when timely administered, is considered a simple and effective procedure for such patients, and can lead to substantial clinical improvement.

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