Sakurakai Takahashi Hospital

Kōbe-shi, Japan

Sakurakai Takahashi Hospital

Kōbe-shi, Japan
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Sakamoto S.,Sakurakai Takahashi Hospital | Taniguchi N.,Sakurakai Takahashi Hospital | Nakajima S.,Sakurakai Takahashi Hospital | Takahashi A.,Sakurakai Takahashi Hospital
Annals of Thoracic Surgery | Year: 2012

Background: Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients. Methods: The investigation was a single-center, retrospective cohort study of 98 ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment. Results: Circulatory status before ECLS introduction was cardiogenic shock in 34, ventricular fibrillation or pulseless ventricular tachycardia in 23, and asystole or pulseless electrical activity in 41. Ninety-four patients (95.9%) underwent emergency revascularization, including 92 who received percutaneous coronary intervention and 2 who received isolated coronary artery bypass grafting. Successful angioplasty was achieved in 65 of 92 patients (70.7%). Fifty-four patients (55.1%) were weaned from ECLS, and ECLS-related complications occurred in 35 (35.7%). All-cause in-hospital mortality rate was 67.3%, and the survival rate to hospital discharge was 32.7%. Multivariate analysis revealed that independent predictors of in-hospital mortality were unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications. Conclusions: Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality. © 2012 The Society of Thoracic Surgeons.

Sakamoto S.,Sakurakai Takahashi Hospital | Taniguchi N.,Sakurakai Takahashi Hospital | Mizuguchi Y.,Sakurakai Takahashi Hospital | Yamada T.,Sakurakai Takahashi Hospital | And 3 more authors.
Catheterization and Cardiovascular Interventions | Year: 2014

Objective: The purpose of this study was to examine the efficacy and safety of method for retrieval of entrapped guidewire in stent-jailed side branch using a balloon catheter.Background: Guidewire entrapment in the side branch after main vessel stenting is an infrequent but potentially serious complication of bifurcation lesion treatment. Entrapped wire retrieval with device advancement over the wire is a previously reported bail-out method, but its efficacy and impact on the proximal edge of the stent are unknown.Methods: We conducted a single-center, prospective study to evaluate the outcome of 28 consecutive patients who developed guidewire entrapment in a stent-jailed side branch after drug-eluting stent implantation, and underwent retrieval of entrapped wire using a balloon catheter. The primary objective was cumulative 12-month major adverse cardiac events including death, non-fatal myocardial infarction, target lesion revascularization, and stent thrombosis. Secondary objectives included binary restenosis and late lumen loss, evaluated in-stent, 5-mm proximal edge, and 5-mm distal edge sites at 9-month angiographic follow-up.Results: Entrapped guidewire retrieval was successfully achieved in all patients. Cumulative 12-month major adverse cardiac events were not observed in any patient. At angiographic follow-up, no significant differences were observed in late lumen loss between in-stent, 5-mm proximal edge, and 5-mm distal edge sites (0.12±0.38 mm vs. 0.09±0.27 mm vs. 0.03±0.3 mm, P=0.57). None of the patients had binary in-stent or in-segment restenosis.Conclusion: Although the decision to apply the present method for entrapped guidewire retrieval should be made with careful consideration, it appears effective for bail-out. © 2013 Wiley Periodicals, Inc.

Taniguchi N.,Sakurakai Takahashi Hospital | Takahashi A.,Sakurakai Takahashi Hospital | Sakamoto S.,Sakurakai Takahashi Hospital
Journal of Invasive Cardiology | Year: 2011

Guiding catheter-induced coronary artery dissection is a rare, but hazardous complication of percutaneous coronary intervention (PCI) and is associated with the potential risk of impairment of coronary blood flow. Therefore, occurrence of this complication mandates a prompt revascularization procedure. A 68-year-old female patient with acute myocardial infarction caused by total occlusion of the proximal right coronary artery (RCA) underwent PCI. After revascularization by thrombus aspiration, catheter-induced dissection of the ostium of the right coronary artery (RCA) occurred when the guiding catheter and guidewire were accidentally removed. An attempt to engage the guiding catheter and guidewire into the true lumen failed because of total occlusion of the right coronary ostium. A chronic total occlusion (CTO)-dedicated guidewire was then used to create a fenestration of the intimal flap, and after it penetrated into the distal true lumen, a low-profile balloon catheter was dilated, and coronary flow from the false to the true lumen was established. After balloon dilatation, stents were deployed at both the dissection site and in the distal lesion. The final angiogram revealed restoration of coronary blood flow. We propose that application of a CTO-dedicated guidewire to create a fenestration of the intimal flap in the region of the coronary dissection is a feasible and effective alternative to conventional procedures. © 2011 HMP Communications.

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.

Taniguchi N.,Sakurakai Takahashi Hospital | Mizuguchi Y.,Sakurakai Takahashi Hospital | Takahashi A.,Sakurakai Takahashi Hospital
Cardiovascular Revascularization Medicine | Year: 2015

A 72-year-old man underwent primary percutaneous coronary intervention for a subtotal occlusion in the mid-portion of the left anterior descending artery involving a large diagonal branch. After successful stenting with a 3.0/24. mm bare metal stent, during which, the diagonal branch was protected with a coronary guidewire, conventional retrieval of the jailed guide wire was impossible. Subsequently, several attempts at a strong retraction of the wire with the support of a balloon catheter enabled retrieval of the trapped wire. Optical coherence tomography performed after post-dilatation, revealed that the stent was elongated to the left main coronary artery, and the structure of the strut had become coarse in the proximal portion. The stent was believed to have become entangled with the balloon catheter when the guidewire was being pulled. This case suggests that retrieving the jailed guidewire with a balloon catheter carries a potential risk of entrapment in the deformed stent. © 2014 Elsevier Inc.

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 ( 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.

Takahashi A.,Sakurakai Takahashi Hospital | Taniguchi N.,Sakurakai Takahashi Hospital
Catheterization and Cardiovascular Interventions | Year: 2011

Intra-aortic balloon pump (IABP) counterpulsation is a useful hemodynamic assist device during complex percutaneous coronary intervention (PCI) in patients with poor left ventricular function; however, the presence of an abdominal aortic aneurysm poses a problem, because insertion via the femoral artery may cause distal embolism and aneurysm rupture. A 92-year-old man with unstable angina was admitted to our hospital. Coronary angiography revealed chronic total occlusion of the proximal left anterior descending artery and severe stenosis of the left circumflex artery (LCX). The left ventricular ejection fraction was 36%. He also had an infrarenal abdominal aortic aneurysm with a diameter of 55 mm. Supported PCI was performed for the management of the LCX lesion. A novel 6-Fr IABP catheter was inserted via the left brachial artery. The lesion was successfully dilated, and a 3.0 × 13 mm Cypher® stent was placed. After the PCI procedure, the IABP catheter was retrieved in the catheter laboratory, and the patient was discharged after 7 days. When a femoral approach is contraindicated in PCI, 6-Fr IABP catheter insertion via the brachial artery is feasible and effective. Copyright © 2011 Wiley-Liss, Inc.

Stone P.H.,Harvard University | Saito S.,Shonan Kamakura General Hospital | Takahashi S.,Harvard University | Takahashi S.,Shonan Kamakura General Hospital | And 23 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.// Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.

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