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High lipoprotein (a) [Lp (a)] levels are associated with worse long-term outcomes in patients undergoing percutaneous coronary intervention (PCI). However, there are limited studies investigating association between Lp (a) levels and long-term outcomes in the era of new generation drug-eluting stents (DES).A total of 495 patients with available data on Lp (a) who underwent PCI for de novo lesions with new generation DES were enrolled between 2013 and 2017. The primary endpoint was the major adverse cardiovascular event (MACE), which was defined as a composite of cardiac death, myocardial infarction, stent thrombosis, clinically driven target lesion revascularization, and revascularization for new lesions during 3 years. Patients were divided into 2 groups according to the Lp (a) level: high Lp (a) group (≥30 mg/dL: n = 109) and low Lp (a) group (30 mg/dL: n = 386). Multivariate Cox regression analysis was performed to identify the predictors for 3-year MACE.The incidence of 3-year MACE was significantly higher in high Lp (a) group than low Lp (a) group (33.0% vs. 15.9%, p 0.001). Multivariable analysis showed that Lp (a) level of ≥30 mg/dL was an independent predictor for 3-year MACE (HR 2.01, 95%CI 1.30-3.11, p = 0.002).High Lp (a) level was associated with worse long-term outcome even in the era of new generation DES.

Lipoprotein(a) [Lp(a)] is a risk factor for peripheral artery disease (PAD). However, the relationship between Lp(a) levels and clinical events after endovascular therapy (EVT) for the femoropopliteal artery in PAD patients remains unclear. Thus, this study aimed to assess the impact of Lp(a) levels on primary patency after EVT for de novo femoropopliteal lesions in PAD patients. A retrospective analysis was conducted on 109 patients who underwent EVT for de novo femoropopliteal lesions, and Lp(a) levels were measured before EVT between June 2016 and December 2019. Patients were divided into low Lp(a) [Lp(a) 30 mg/dL; 78 patients] and high Lp(a) [Lp(a) ≥ 30 mg/dL; 31 patients] groups. The main outcome was primary patency following EVT. Loss of primary patency was defined as a peak systolic velocity ratio 2.4 on a duplex scan or 50% stenosis on angiography. Cox proportional hazards analysis was performed to determine whether high Lp(a) levels were independently associated with loss of primary patency. The mean follow-up duration was 28 months. The rates of primary patency were 83 and 76% at 1 year and 75 and 58% at 2 years in the low and high Lp(a) groups, respectively (P = 0.02). After multivariate analysis, High Lp(a)[Lp(a) ≥ 30 mg/dL] (hazard ratio 2.44; 95% CI 1.10-5.44; P = 0.03) and female sex (hazard ratio 2.65; 95% CI 1.27-5.51; P 0.01) were independent predictors of loss of primary patency. Lp(a) levels might be associated with primary patency after EVT for de novo femoropopliteal lesions.

Aim: High levels of lipoprotein(a) [Lp(a)] are a risk factor for peripheral artery disease (PAD). However, the relationship between Lp(a) levels and the severity of femoropopliteal lesions in patients with PAD has not been systematically studied. This study aimed to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD. Methods: We retrospectively analyzed a single-center database including 108 patients who underwent endovascular therapy for de novo femoropopliteal lesions and measured the Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [Lp(a) ＜30 mg/dL; 77 patients] and high Lp(a) [Lp(a) ≥ 30 mg/dL; 31 patients] groups. Trans-Atlantic Inter-Society Consensus (TASC) II classification, calcification [referring to the peripheral arterial calcium scoring system (PACSS) classification], and lesion length were compared between the groups. Results: The prevalence of TASC II class D (13% vs 38%, P ＜0.01) and severe calcification (PACSS 4) (6% vs 23%, P =0.02) was significantly higher and the lesion length longer (123±88 mm vs 175±102 mm, P ＜0.01) in the high Lp(a) group than in the low Lp(a) group. In multivariate analysis, Lp(a) ≥ 30 was an independent predictor for the prevalence of TASC II class D (HR=3.67, 95% CI 1.27–10.6, P =0.02) and PACSS 4 (HR=4.97, 95% CI 1.27–19.4, P =0.02). Conclusion: The prevalence of TASC II class D and severe calcification of femoropopliteal lesions was higher in patients with high Lp(a) than those with low Lp(a).

BACKGROUND Patients with non-ST-elevation myocardial infarction (NSTEMI) have worse long-term prognoses than those with ST-elevation myocardial infarction (STEMI). HYPOTHESIS It may be attributable to more extended coronary atherosclerotic disease burden in patients with NSTEMI. METHODS This study consisted of consecutive 231 patients who underwent coronary intervention for myocardial infarction (MI). To assess the extent and severity of atherosclerotic disease burden of non-culprit coronary arteries, two scoring systems (Gensini score and synergy between percutaneous coronary intervention with Taxus and cardiac surgery [SYNTAX] score) were modified by subtracting the score of the culprit lesion: the non-culprit Gensini score and the non-culprit SYNTAX score. RESULTS Patients with NSTEMI had more multi-vessel disease, initial thrombolysis in myocardial infarction (TIMI) flow grade 2/3, and final TIMI flow grade 3 than those with STEMI. As compared to STEMI, patients with NSTEMI had significantly higher non-culprit Gensini score (16.3 ± 19.8 vs. 31.2 ± 25.4, p

Background The relationship between long-term outcome in patients with lower extremity artery disease (LEAD) and left ventricular (LV) diastolic dysfunction has not been systematically studied. The aim of this study was to assess the impact of LV diastolic dysfunction on the long-term outcome in patients with LEAD. Methods Two hundred LEAD patients (male 66 %, mean age 76 ± 9 years) with preserved LV systolic function assessed by echocardiography (ejection fraction ≥50 %) were enrolled from a single center database between January 2013 and May 2015. We divided the patients into two groups on the basis of LV diastolic dysfunction, which was diagnosed based on the American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. The 3-year cumulative incidence of the primary endpoint was compared between LEAD patients with LV diastolic dysfunction and those without. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE: death, hospitalization for heart failure, myocardial infarction, and stroke). Multivariate analysis was performed to determine whether LV diastolic dysfunction was independently associated with the MACCE. Results LV diastolic dysfunction was identified in 31 % of LEAD patients. The mean observation period was 32 ± 21 months. The 3-year cumulative incidence of MACCE occurred more frequently in patients with LV diastolic dysfunction than those without (35 % vs 23 %, p = 0.01). In multivariate analysis, LV diastolic dysfunction (HR = 1.96, 95 % CI 1.09–3.55, p = 0.03) and critical limb ischemia (HR = 2.52, 95 % CI 1.24–5.10, p = 0.01) were an independent predictor for MACCE. Conclusion LV diastolic dysfunction increased the risk for MACCE in patients with LEAD.

Purpose: To identify intravascular ultrasound (IVUS) findings that predict midterm stent patency in femoropopliteal (FP) lesions. Materials and Methods: A retrospective analysis was undertaken of 335 de novo FP lesions in 274 consecutive patients (mean age 72.4±8.2 years; 210 men) who had IVUS assessment before and after successful stent implantation. The mean lesion length was 13.2±9.8 cm. The primary outcome was primary patency at 24 months, defined as freedom from major adverse limb event (MALE) and in-stent restenosis (ISR). MALE was defined as major amputation or any target lesion revascularization (TLR). ISR was defined by a peak systolic velocity ratio >2.4 by duplex ultrasonography. Logistic regression analyses were performed to identify independent predictors of stent patency at 24 months; the results are presented as the odds ratio (OR) and 95% confidence interval (CI). Receiver operator characteristic (ROC) curve analysis was performed to determine the optimal threshold for prediction of stent patency at 24 months. Results: Over the 24-month follow-up, 18 (7%) patients died and 43 (15%) of 286 lesions were responsible for MALE (42 TLRs and 1 major amputation). Primary patency was estimated at 82.5% (95% CI 78.1% to 86.9%) at 12 months and 73.2% (95% CI 67.9% to 78.5%) at 24 months. Multivariable analysis revealed that longer lesion length (OR 0.89, 95% CI 0.82 to 0.97, p2 as the optimal cut-point for prediction of 24-month stent patency (area under the ROC curve 0.764). Kaplan-Meier estimates of 24-month primary patency were 83.7% (95% CI 78.3% to 89.2%) in lesions with a distal EEM area >29.0 mm2 vs 53.1% (95% CI 42.9% to 63.3%) in those with a distal EEM area ≤29.0 mm2 (p

Purpose Optical frequency domain imaging (OFDI) is widely used to characterize lipidic-atherosclerotic plaques, shown as signal-poor regions with diffuse borders, in clinical setting. Given that lipid components are common to both fibroatheroma (FA) and pathological intimal thickening (PIT), it is unclear whether OFDI can be used to accurately distinguish between FA and PIT. This study evaluated the differences in OFDI findings between FA and PIT in comparison with histopathology. Methods A total of 631 histological cross-sections from 14 autopsy hearts were analyzed for the comparison between OFDI and histological images. Of those, 190 (30%) sections were diagnosed with PIT and 120 (19%) with FA. All OFDI images were matched with histology and the OFDI signal attenuation rate was calculated from an exponential. The lipid length was measured longitudinally, and the lipid arc was measured with a protractor centered in the center of the lumen. Results There was no significant difference in the OFDI signal attenuation rate between FA and PIT (3.09 ± 1.04 versus 2.79 ± 1.20, p = 0.13). However, the lipid length was significantly longer and the maximum lipid arc was significantly larger in FA than in PIT (7.5 [4.3–10.3] mm versus 4.3 [2.7–5.8] mm, p < 0.0001, and 125 [101–174]° versus 96 [74–131]°, p < 0.0001, respectively). Conclusions OFDI may be capable of discriminating advanced lipid plaques from early stage atherosclerosis based on the longitudinal and circumferential extent of signal-poor region.

Background High lipoprotein(a) [Lp(a)] levels are a risk factor for peripheral artery disease (PAD). However, the association between Lp(a) levels and angiographic severity of PAD has not been systematically studied. Purpose The aim of this study was to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD. Methods We retrospectively analyzed a single-center database including 108 patients (74±8 years, 69% male) who underwent endovascular therapy for de novo femoropopliteal lesions and measured Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [LP(a) Results Median Lp(a) was 16 (7–31) mg/dL.The prevalence of TASC II class D (13% vs 38%, P Conclusion Lp(a) was associated with angiographic severity of femoropopliteal lesions in patients with PAD. Comparison of angiographic severity Funding Acknowledgement Type of funding source: None

BACKGROUND Although self-expanding drug-eluting stents (DES) have recently shown superior outcomes for superficial femoral artery (SFA) lesions, optimal sizing of DES diameter in SFA intervention is unclear.Methods and Results:A total of 40 de novo SFA lesions were randomized 1:1 to receive self-expanding DES with either a 1-mm or 2-mm larger diameter than the reference vessel diameter. Follow-up optical coherence tomography (OCT) was scheduled 6 months after DES implantation to evaluate the vascular response to the stents. Volume index (VI) was defined as volume divided by stent length. The primary endpoint was neointimal VI at 6 months. Baseline reference vessel diameter was similar between the 1-mm larger diameter group and the 2-mm larger diameter group (5.0±0.8 mm vs. 4.7±0.9 mm, P=0.35). Stent diameter was 6.3±0.6 mm in the 1-mm larger group and 7.1±0.6 mm in the 2-mm larger group (P

In-stent restenosis (ISR) remains a tough problem after percutaneous coronary intervention (PCI) despite advances in technology of drug-eluting stents (DES). A 63-year-old man undergoing hemodialysis was diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS). An emergency coronary angiography (CAG) revealed severe stenosis in the middle left circumflex artery (LCx). After pre-dilatation with non-compliant balloon, primary PCI was successfully performed with DES implantation. Four months after, CAG was performed again and verified ISR of LCx under diagnosis of recurrent NSTE-ACS. Subsequently multimodality intravascular imaging assessment was performed for the ISR lesion. Optical frequency domain imaging showed the eccentric protruding mass with irregular surface with high-backscatter, whereas angioscopy revealed the in-stent bump with yellow color. The ISR lesion was successfully treated by drug-coated balloon angioplasty. However, he suffered recurrent NSTE-ACS five months later. CAG revealed de novo stenotic lesions not only in re-restenosis of LCx but also in proximal left anterior descending artery and ostium of right coronary artery. He was scheduled to undergo coronary artery bypass grafting for three-vessel disease. Multimodality assessment is useful to diagnose the recurrent restenosis lesion with calcified nodule. .

Background Presence of severe stenosis in non-infarct related arteries, i.e. multi-vessel disease (MVD), is associated with poor outcomes after acute myocardial infarction (AMI). However, impact of mild to moderate stenosis in non-culprit lesions remains unclear.Gensini score is an angiographic application grading the extent of coronary artery lesions including mild to moderate stenosis. Purpose To evaluate whether the extent of non-culprit lesion is related to one-year outcomes after AMI. Methods This study consisted of consecutive 168 patients who underwent primary percutaneous coronary intervention (PPCI) for AMI between 2015 and 2017. Patients with coronary bypass grafts were excluded from the analysis. To assess the extent of non-culprit lesions, we used “non-culprit Gensini score”, which is calculated by excluding score of the culprit lesion from the original Gensini score. Patients were divided into 2 groups by the median ofnon-culprit Gensini score: low score (0–14, n=84) and high score (>15, n=84). Major adverse cardiac events (MACE) included all cause of deaths, non-fatal MI, stroke and ischemia driven coronary revascularization during one-year follow-up period. Results MVDwas more frequent in patients with high score than those in those with low score (90% vs 25%, P Multivariable analyses Univariable analyses Multivariable analyses HR (95% CI) P-value HR (95% CI) P-value Age 1.03 (1.01, 1.06) 15) 3.37 (1.79, 6.78) Kaplan-Meier curves Conclusion These findings suggested that extent of mild to moderate stenosis in non-culprit lesions might affect the prognosis after AMI in patients undergoing PPCI. Non-culprit Gensini score may be useful to predict outcomes of patients with AMI. Acknowledgement/Funding None

Background and aim: It has been known that bifurcation angles of common iliac artery (CIA) are not always bilateral symmetry. Previous study reported that mechanical stress initiate calcification in aortic valve. The aim of this study was to investigate the impact of CIA anatomical features on lesion characteristic of CIA. Methods and results: This study enrolled 72 patients with intermittent claudication who had undergone endovascular-therapy (EVT) for de novo CIA atherosclerotic lesions in our hospital during April 2012 to March 2017. Anatomical analysis of CIA bifurcation was assessed by frontal view of initial angiography at EVT. We calculated the bilateral CIA angles between axis of terminal aorta and axis of proximal CIA, and bilateral symmetry was expressed as absolute value of the difference between both CIA angles (Δangle). The patients were divided into 2 groups: symmetry group (Δangle≦10 degrees, n=40) and asymmetry group (Δangle>10 degrees, n=32), according to the mean of Δangle. Distribution characteristics were classified into 2 patterns: bilateral lesions pattern and unilateral lesion pattern, furthermore we assessed calcified nodule of CIA lesion using intravascular ultrasound. There was no difference between 2 groups about patient characteristics. Unilateral lesion was observed in asymmetry group much more than symmetry group (63% vs 22%, P Conclusions: These findings suggested that asymmetric bifurcation angle of CIA was associated with unilateral lesion and calcified nodule lesion. Asymmetry of CIA bifurcation might be predictor of unilateral calcified nodule lesion of CIA.

Previous studies have reported that long-term prognosis of non-ST-elevation myocardial infarction (NSTEMI) was worse than that of ST-elevation myocardial infarction (STEMI). We hypothesized that coronary artery disease (CAD) in non-culprit lesion is more severe in NSTEMI. We compared with the

This study sought to assess the impact of polyvascular disease on severity of coronary artery disease (CAD) and clinical outcome in patients undergoing percutaneous coronary intervention (PCI) for stable angina. We retrospectively analyzed a single-center database of 283 patients (male 75 %, mean

Peripheral artery disease (PAD) is often accompanied by heart failure with preserved ejection fraction (HFpEF). Left ventricular (LV) diastolic dysfunction is related to HFpEF. The aim of this study was to compare LV diastolic function between patients with or without PAD.One thousand one hundred twenty-one patients (male 56%, mean age 68±13 years) with available preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 and May 2015. PAD was defined as ankle brachial index0.9 or previous history of lower extremity bypass and/or endovascular therapy. Diagnosis of LV diastolic dysfunction was based on the American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The prevalence of LV diastolic dysfunction was compared between patients with PAD and those without PAD. Multivariate analysis was performed by logistic regression analyses to assess predictors of LV diastolic dysfunction.Two hundred patients (18%) had PAD. Patients with PAD had higher E/e' (15.3±7.4 vs 11.8±5.5, p0.01), tricuspid regurgitation velocity (2.37±0.33 vs 2.19±0.28m/s, p0.01), left atrial volume index (40.6±20.2 vs 32.1±13.6mL/mThe prevalence of LV diastolic dysfunction was higher in patients with PAD than patients without PAD.

Patient Initials or Identifier Number NH ### Relevant Clinical History and Physical Exam A 60-year-old male, treating on daily hemodialysis through the arteriovenous (AV) fistula in the left arm, presented with left arm swelling and ulcer with congestive dermatitis. He had a history of

Pseudoaneurysm of below-the-knee arteries after a high tibial osteotomy (HTO) is rare. A 69-year-old woman with history of right HTO a half year ago had performed a left HTO for osteoarthritis. Postoperatively, she had swelling and pain of the left lower leg. Computed tomography and echocardiography revealed the pseudoaneurysm of peroneal artery (PA). After the release of the covered stent graft, the pseudoaneurysm of the PA did not disappear, it was completely excluded in the completion angiogram.

Background The optimal sizing of self-expanding paclitaxel-eluting stents (PES) in the treatment for superficial femoral artery (SFA) lesions is unclear. This study sought to investigate the influence of PES diameter on stent patency in SFA lesions using optical frequency domain imaging (OFDI). Methods A total of 20 de novo SFA lesions were randomized 1:1 to receive either self-expanding PES with a nominal diameter of 6 mm or 8 mm. Follow-up angiography and OFDI was scheduled six months after stent implantation, and volumetric OFDI analysis was performed to evaluate vascular response to the stents. Volume index (VI) was defined as the volume divided by the stent length. The primary end point was lumen VI at the 6-month follow-up. Secondary end point was minimum lumen diameter (MLD) by quantitative vascular angiography (QVA) at the follow-up. Results Stent length was 78.0 ± 23.9 mm in the 6-mm group and 70.0 ± 23.6 mm in the 8-mm group ( p = 0.46). Baseline QVA data were also similar between the two groups. MLD immediately after stent implantation was similar between the two groups (4.2 ± 0.5 mm in the 6-mm group and 3.9 ± 0.5 mm in the 8-mm group, p = NS). At the 6-month follow-up, MLD was greater in the 8-mm group compared to the 6-mm group (4.0 ± 1.0 mm vs. 3.2 ± 0.4 mm, p 3 /mm vs. 22.2 ± 1.2 mm 3 /mm, p = 0.01). Neointimal VI was similar between the two groups (5.8 ± 2.9 mm 3 /mm vs. 5.2 ± 2.6 mm 3 /mm, p = 0.68). Lumen VI was greater in the 8-mm group (23.2 ± 7.6 mm 3 /mm vs. 17.3 ± 2.6 mm 3 /mm, p = 0.04). Conclusions Chronic stent enlargement resulted in greater lumen area after implantation of self-expanding PES with a large diameter at the mid-term follow-up. Stent diameter might be important for stent patency in procedure with PES for SFA lesions.

Although tiny vessel-size has been a consistent predictor for restenosis after self-expanding nitinol stents implantation in the superficial femoral artery (SFA), its predictive values in self-expanding bare-metal stents (BMS) and paclitaxel-eluting stents (PES) are still limited. Fifty de novo SFA