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Shiraki T., Ichibori Y., Ohtani T., et al. Pathophysiological evaluations of initial plaque development after heart transplantation via serial multimodality imaging and cytokine assessments. Journal of Heart and Lung Transplantation 41, 877 (2022); https://doi.org/10.1016/j.healun.2022.03.007., Background: Detailed morphological characteristics of de novo and donor-transmitted plaques and the association of serum T-lymphocyte cytokine levels with plaque progression of coronary allograft vasculopathy within 1 year after heart transplantation are unknown. Methods: In this retrospective analysis of data in a prospectively maintained database, 40 heart transplant recipients were included. We performed serial 3 vessel optical coherence tomography and intravascular ultrasound analyses, at the 8 week (baseline) and 12 month post-transplantation follow-ups, and serum cytokine measurements (n = 23). The correlation between serum cytokines and Δplaque burden (between baseline and follow-up) was evaluated depending on plaque morphology. Results: Thirteen de novo plaques (maximum intimal thickness ≥0.5 mm at the 12 month follow-up without plaques at baseline) were identified in 8 recipients, and 31 donor-transmitted plaques (maximum intimal thickness ≥0.5 mm at baseline) were detected in 17 recipients. Compared with donor-transmitted plaques, the Δplaque burden in the de novo plaques, with mainly fibrous morphology, was high (38.8% [29.6%–41.2%] vs 8.7% [1.33%–13.6%], p < 0.001). Stratification of the morphology of donor-transmitted plaques revealed that the Δplaque burden in fibrous plaques (10.6% [7.0%–18.0%]) was similar to that in fibroatheroma (10.3% [8.7%–23.8%]). Serum interleukin-31 levels at baseline correlated with fibrous plaque proliferation (r = 0.73, p = 0.007) even under immunosuppressive conditions, whereas other cytokines (interleukin-1β, interleukin-17, and interferon-gamma) were mostly undetectable. Conclusions: Intimal fibrous proliferation contributed to the progression of donor-transmitted and de novo plaques. Serum interleukin-31 levels at baseline may contribute to intimal fibrous proliferation within 1 year after heart transplantation.

Purpose To examine the long-term clinical outcomes of patients with anti-centromere antibody (ACA)-positive critical limb-threatening ischemia (CLTI) who were treated with endovascular therapy (EVT). Materials and Methods This was a retrospective analysis using a database of 423 consecutive CLTI patients (543 limbs, Rutherford class 4–6) who underwent EVT between January 2011 and March 2013. The patients were divided into 2 groups: an ACA-positive group (10 limbs, 8 patients) and a control group (46 limbs, 43 patients). The control group was defined as female, non-dialysis, and those who were able to obtain a below-knee angiogram. Results None of the 8 ACA-positive CLTI patients had previously been diagnosed as ACA positive. No significant difference was observed in the below-the-knee lesion distribution and severity between the ACA-positive group and the control group. The median observational period was 51 months. The survival rate was 54% in the ACA-positive group and 76% in the control group at 5 years after EVT (P = .732). The freedom from major amputation rate was 60% in the ACA-positive group and 91% in the control group at 5 years after EVT (P = .029). The technical EVT success rate in the ACA-positive group was 70% (7/10). Of the successful EVT cases, 71% (5/7) of patients achieved complete wound healing or rest pain relief; however, 60% (3/5) had a recurrence of wounds. Conclusions In a series of ACA-positive patients with CLTI, successful EVT had acceptable outcomes with respect to wound healing with short-term results. However, the major amputation rate for ACA-positive patients was high in long-term follow-up.

This study investigated the correlation between vascular flow reserve (VFR) values and wound healing rate in patients with critical limb ischemia.Peripheral VFR may be useful for predicting complete wound healing after endovascular therapy (EVT). However, published reports included small numbers of patients from single centers and long-term outcomes remain unknown.This was a prospective multicenter study that consecutively enrolled 104 patients (115 limbs) who received EVT for ischemic ulcerations. All lesions were treated with conventional balloon angioplasty. After EVT, VFR was measured using a pressure/temperature guidewire. The study endpoints were correlation between VFR values and wound healing rate at 3 months and 1 year.The median VFR was 2.9. A total of 110 and 104 limbs completed the 3-month and 1-year follow-up, respectively. The 3-month and 1-year wound healing rates were 49% and 76%, respectively. VFR was significantly associated with the 3-month and 1-year wound healing (p 0.001 for both). The crude hazard ratios of VFR (per 2-fold increase) for the 3-month and 1-year wound healing were 2.6 (1.7 to 3.9) and 2.9 (2.0 to 4.2), respectively. The estimated median time to wound healing was 5.0 (3.2 to 7.2) months, 3.3 (2.8 to 4.9) months, and 2.5 (2.0 to 3.0) months, when the VFR value was 2.4, 2.9, and 3.9, respectively.Post-procedure VFR is significantly associated with wound healing. VFR, measured in the catheterization laboratory, is useful in clinical risk stratification for patients with critical limb ischemia after EVT. (Predictor of Wound Healing in Patients with Critical Limb Ischemia-Multicenter Prospective Study; UMIN000012746).

During percutaneous coronary intervention (PCI) procedures, there are cases in which different types of guiding catheters (GCs) are needed depending on different approach sites. However, it is not clear how the approach site affects GC engagement. At our hospital it is possible to perform

Despite widespread use of endovascular therapy with bare-metal stent (BMS) implantation in patients with peripheral artery disease (PAD), arterial healing has not been well examined in this setting. An 84-year-old man with PAD received BMS implantation at the right external iliac artery (EIA, Epic 8.0 mm × 100 mm) and superficial femoral artery (SFA, SMART Control 8.0 mm × 150 mm). However, he died of lobar pneumonia 81 days later. Pathological evaluation was conducted at BMS implantation sites. At the distal part of Epic site in the EIA, neointimal formation was seldom observed. A small amount of fibrin deposition was seen around stent struts without apparent smooth muscle cell proliferation or surface endothelial cell coverage. In contrast, at the middle part of distal SMART site in the SFA, most of the stent struts were completely covered with moderate amount of neointima which was composed of a lot of smooth muscle cells and extracellular matrix on the plaque-free wall. However, on the contralateral calcified plaque site, a lot of fibrin components were still observed over the surface of thin neointima and only rough smooth muscle cells were scatteringly infiltrated. Furthermore, incomplete endothelial cell coverage was seen on the surface. Arterial repair after BMS implantation in peripheral arteries was extremely delayed.

ObjectiveThe latest guideline points to life expectancy of 75 years (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.10-2.85), nonambulatory status (HR, 5.32; 95% CI, 2.96-9.56), regular dialysis (HR, 1.90; 95% CI, 1.10-3.26), and ejection fraction 75 years, nonambulatory status, regular dialysis, and ejection fraction

Although endovascular therapy (EVT) is recommended in patients with peripheral artery disease presenting TASC II A-C femoropopliteal (FP) arterial lesions, restenosis following bare-metal stents (BMS) remains a clinical concern. Recently, Zilver PTX drug-eluting stent (DES) has shown favorable

In patients with left ventricular diastolic dysfunction, an elevated left atrial pressure would increase the atrial arrhythmogenic substrate. Recently, diastolic wall strain (DWS) has been reported to indicate left ventricular distensibility as a novel and simple echocardiographic index. The

The impacts of severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) have not been systematically studied. We retrospectively analyzed 622 patients with PAD (intermittent claudication [IC]: n=446

Patient initials or identifier number N.S ### Relevant clinical history and physical exam 85 years old male was admitted to our hospital for treatment of juxtarenal aorticaneurysm with saccular type. Because he had several comorbidities, we selected endovascularaneurysm repair. Pre

We here report a case of successful endovascular therapy for penile gangrene in a patient with calciphylaxis and a long history of diabetes mellitus and end-stage renal disease on dialysis. The internal iliac artery, with 75% stenosis, was treated with balloon-expandable bare metal stent implantation, whereas the inferior gluteal artery, 75% stenosis, was treated with balloon dilatation. After endovascular therapy, the intractable penile pain immediately resolved, and penile salvage with complete wound healing was achieved 6 months after the procedure.