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Recent retrospective investigations have suggested that optical coherence tomography (OCT) enables the diagnosis of underlying acute coronary syndrome (ACS) causes such as plaque rupture, plaque erosion, and calcified nodule. The relationships of these etiologies with clinical outcomes, and the clinical utility of OCT-guided primary percutaneous coronary intervention (PCI) are not systematically studied in real-world ACS treatment settings. The TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 21 hospitals in Japan. A total of 700 patients with ACS (symptom onset within 24 h) undergoing OCT-guided primary PCI will be enrolled. The primary endpoint of the study is to identify the underlying causes of ACS using OCT-defined morphological assessment of the culprit lesion. The key secondary clinical endpoints are hazard ratios of the composite of cardiovascular death, non-fatal myocardial infarction, heart failure, or ischemia-driven revascularization in patients with underlying etiologies at the 12- and 24-month follow-ups. The feasibility of OCT-guided primary PCI for ACS will be assessed by the achievement rates of optimal post-procedural results and safety endpoints. The TACTICS registry will provide an overview of the underlying causes of ACS using OCT, and will reveal any difference in clinical outcomes depending on the underlying causes. The registry will also inform on the feasibility of OCT-guided primary PCI for patients with ACS. The TACTICS (Tokyo, Kanagawa, Chiba, Shizuoka, and Ibaraki active OCT applications for ACS) registry. ACS, acute coronary syndrome; OCT, optical coherence tomography; PCI, percutaneous coronary intervention. [Display omitted] • TACTICS is an investigator-initiated prospective multicenter observational study. • Optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) will be performed. • The primary endpoint is to identify the underlying causes of acute coronary syndrome (ACS). • Clinical outcomes and feasibility of OCT-guided PCI will be clarified. [ABSTRACT FROM AUTHOR]

Background and Aims: Peripheral artery disease (PAD), intermittent claudication, and impaired mobility contribute to the loss of skeletal muscle. This study investigated the impact of endovascular treatment (EVT) in patients suffering from PAD above the knee and its relation to baseline glycemic control.Methods and Results: Mid-thigh muscle volume was measured before EVT, 3 months after EVT and 6 months after EVT. Mid-thigh muscle volumes of ipsilateral PAD patients with ischemic and non-ischemic legs were compared. Correlations between total thigh muscle volume and clinical characteristics were analyzed using univariable and multivariable analysis. Overall, thigh muscle volume increased after EVT. The mid-thigh muscle volume was significantly lower in patients with ipsilateral lesions and in those with ischemic lower limbs. The thigh muscle volume of those with ischemic lower limbs increased after EVT. Baseline glycated hemoglobin was the only factor that was negatively correlated with changes in the muscle volume after EVT. Muscle volume significantly increased in normoglycemic HbA1c<6.5% (47 mmol/mol) patients. There was no significant alteration in the muscle volume of hyperglycemic HbA1c ≥ 6.5% patients.Conclusion: Ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for a large-scale trial to investigate whether EVT can protect or delay skeletal muscle loss. [ABSTRACT FROM AUTHOR]

Background: Sleep disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease, although it is not clear whether SDB has any link to coronary atherosclerotic burden in patients with stable coronary artery disease (CAD). This study sought to analyze the links between SDB, coronary atherosclerotic burden, and cardiac biomarkers in stable CAD patients. Methods and results: We studied 83 consecutive patients who underwent coronary angiography or scheduled percutaneous coronary intervention. SDB was evaluated by an ambulatory polysomnographic monitoring device. Coronary atherosclerotic burden was evaluated by the Gensini score, and myocardial stress/injury were assessed by measuring plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT). Patients with an apnea hypopnea index (AHI)> 15events/h (n = 32) showed significantly higher Gensini score (35.7 ±38.0 vs 20.1 ± 19.7, p = 0.033) than those with AH1 < 15. The higher AH I group showed significantly higher NT-proBNP (275.8 ± 402.6 pg/ml vs 131.9 ± 146.3 pg/ml, p = 0.047) and hs-TnT levels (0.011 ± 0.005 ng/ml vs 0.008 ±0.003 ng/ml, p = 0.015). Furthermore it was revealed that AHI significantly correlated with the Gensini score (r = 0.253, p = 0.036), NT-proBNP (r=0.266, p = 0.027), and hs-TnT (r=0.274, p = 0.023), and multiple stepwise linear regression analysis revealed that AHI (β = 0.257, p = 0.029) and history of smoking (β = 0.244, p = 0.038) were independently correlated with Gensini score among clinical and SDB-related parameters. Conclusions: Severity of SDB has a significant link to the severity of coronary atherosclerotic burden, which also reflected elevated NT-proBNP and hs-TnT as silent myocardial ischemia and minute myocardial injury even in stable CAD patients. [ABSTRACT FROM AUTHOR]

Background: Although very late stent thrombosis occurs several years after implantation of sirolimus-eluting stent (SES), the morphologic changes of the stent beyond 2 years have not yet been systematically studied in living patients. The late vascular response to SES was therefore evaluated by serial angioscopic studies at 2 and 5 years after stent implantation. Methods: A total of 17 patients with 17 SES underwent a repeated angioscopy procedure at 2 and 5 years. Neointimal stent coverage (NSC) was classified as follows: grade 0, presence of uncovered struts; grade 1, visible struts through a thin neointima; or grade 2, complete neointimal coverage without visible struts. For each patient, the minimum and maximum NSC grade and the existence of in-stent thrombus were recorded. Results: The minimum and maximum NSC grade did not increase between the 2 and 5 years (0.59 ± 0.51 vs 0.88 ± 0.70, P = .17, and 1.82 ± 0.39 vs 1.94 ± 0.24, P = .30, respectively). The prevalence of patients with uncovered struts did not significantly decrease from 2 to 5 years (41% vs 29%, P = .49). During the follow-up period, 3 of 6 thrombi disappeared, whereas new thrombus formation was found in 3 patients without any clinical symptoms. In-stent thrombus did not decrease (35% vs 35%, P > .99). Conclusions: The current serial angioscopic study suggests that incomplete NSC and the prevalence of latent thrombus within the SES segments did not decrease from 2 to 5 years. The risk of stent thrombosis related to incomplete healing of SES may continue for an extended period. [Copyright &y& Elsevier]

The article presents a study which examined the role of late vascular outcomes after insertion of drug-eluting stents in stent thrombosis, based on the result from the optical coherence tomography (OCT) modality. The methods used in subject selection, angiographic and OCT procedures and statistical analysis are described. The results showed that uncovered stent struts decreased and neointimal (NIT) increased without any complications.

Background: Delayed neointimal coverage after the implantation of a drug-eluting stent (DES) is thought to be related to their potential for developing late-stent thrombosis. However, few studies have shown which factor affects the neointimal coverage after DES implantation. We hypothesized that the extent of neointimal coverage after DES implantation is affected by the underlying lesion characteristics because arterial wall components are reported to determine the transport and distribution of the drugs. Methods: Thirty-seven coronary artery lesions treated with a single sirolimus-eluting stent (SES) were evaluated in 37 patients with stable coronary artery disease. Angioscopy was performed before, immediately after, and 6 months after stenting to examine the existence of yellow plaque, thrombus, complex plaque, and intramural hemorrhage and the degree of neointimal coverage at 6-month follow-up. This was classified either as a noncoverage group (stent struts were predominantly exposed or visible through a thin neointima) or as a coverage group (stent struts were predominantly covered by neointimal hyperplasia and thus invisible). Results: Twenty-one lesions were classified into the noncoverage group, and 16 lesions the coverage group. The frequency of preexistent yellow plaques was significantly higher in the noncoverage group than that in the coverage group (67% vs 19%, P = .007). A multivariate logistic regression analysis showed the preexistence of yellow plaque was the only independent factor behind less neointimal coverage at 6 months after SES implantation (odds ratio 19.5, 95% confidence interval 1.58-240.50, P = .020). Conclusions: The preexistence of yellow plaque may be associated with decreased neointimal coverage of SES. [Copyright &y& Elsevier]

The article discusses serial angiographic and angioscopic examinations of the feature inside bare-metal stent (BMS) implantation in native coronary arteries to validate the qualitative changes over an extended period of time after implantation. Findings suggests that white neointima of the BMS may often change into yellow plaque beyond four years after implantation and atherosclerotic progression inside the BMS may contribute to late luminal narrowing.

The article presents a study which investigated the relationship between angiographic late loss and the presence of thrombus based on angioscopic findings within paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES). Quantitative coronary angiography was used to measure late loss. Results showed that the prevalence of patients with uncovered struts did not differ and in-stent thrombus was found more frequently in PES than in SES.

Summary: Neointimal proliferation after sirolimus-eluting stent (SES) implantation is generally inhibited by the pharmacological effects of sirolimus in comparison to bare metal stent (BMS). Neointimal hyperplasia after BMS implantation is mainly composed of vascular smooth muscle cells, and is usually observed as a white mass by angioscopy and as a layer of uniform signal intensity without attenuation on optical coherence tomography (OCT). In this case, angioscopic color of the neointima covering the SES was obviously yellow and OCT signal patterns of the neointima showed rapid attenuation similar to lipid tissues in atherosclerotic lesions. These findings suggest that neointima within the SES is quite different from that of the BMS and may contain atherosclerotic components. [Copyright &y& Elsevier]

The article provides information on a study which examined the history of thin-cap fibroatheromas (TCFA). A small lumen area and presence of TCFA at a nonculprit lesion are associated with future major adverse cardiovascular events, based on an investigation made. It also features the case of a 69-year-old man with stable angina who underwent successful drug-eluting stent implantation in the left anterior descending coronary artery.

Abstract: A 67-year-old male was admitted because of acute myocardial infarction (AMI). An emergent coronary angiography showed a total occlusion in the left anterior descending artery, and a stent was deployed. Moderate lesion stenosis was found in the right coronary artery (RCA). Fractional flow reserve indicated 0.96, and percutaneous coronary intervention was not performed. Six months later, the patient visited an emergency room due to AMI. Angiograms showed a patency of the previous stent and progressed stenosis with filling delay of the RCA. Protruding red thrombi and plaque disruption of thin-cap fibroatheroma (TCFA) were identified by optical coherence tomography. Mild to moderate lesions are physiologically benign but morphologically malignant in cases of TCFA. [Copyright &y& Elsevier]

Summary: We present the case of a 48-year-old man with unstable angina who underwent drug-eluting stent (DES) implantation for the left circumflex artery (LCx). Red thrombi within the stent were clearly found by coronary angioscopy. Dual antiplatelet therapy was orally given before the stenting. Twenty-two months after the procedure, the patient visited because of severe chest pain. The patient had stopped taking all prescriptions including antiplatelet drugs for the previous 18 months. The occurrence of late stent thrombosis (LST) derived from previously implanted DES in the LCx was strongly suspected. Unexpectedly, the left coronary angiograms showed neither in-stent restenosis nor thrombotic occlusion. Angioscopic images for the DES segment showed that there were no uncovered stent struts without neointimal coverage. Notably, red thrombi identified immediately after stenting by angioscopy had completely disappeared. Mural red thrombi at the first observation completely disappeared despite premature cessation of dual antiplatelet therapy. Early neointimal coverage may occasionally occur even under the condition of acute coronary syndrome. The leading cause of LST was not only the cessation of dual-antiplatelet therapy and multiple factors contribute to LST of DES. Relatively early and adequate neointimal stent coverage may reduce the risk of thrombus formation including LST even though anti-platelet therapy was discontinued prematurely. [ABSTRACT FROM AUTHOR]

Summary: Very late stent thrombosis (VLST) after implantation of a drug-eluting stent (DES) is a rare but catastrophic complication and the mechanisms are not completely understood. We describe a 76-year-old patient with recurrent VLST of DES that developed at 13 and 23 months after the initial catheter procedure of DES implantation under the cessation of dual antiplatelet therapy. Optical coherence tomography (OCT) observation revealed small stent area of a DES. Based on the OCT findings, balloon angioplasty for expansion of the DES was performed and angiographic Thrombolysis In Myocardial Infarction grade 3 flow was subsequently obtained. Small stent area is considered a significant factor in acute or subacute stent thrombosis according to previous reports. The present report shows that small stent area of DES may be regarded as a key factor in recurrent VLST as well as cessation of dual antiplatelet therapy. [ABSTRACT FROM AUTHOR]