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Optical coherence tomography (OCT) provides higher resolution intravascular imaging and allows detailed evaluations of stent implantation sites post-percutaneous coronary intervention (PCI). Coronary angioscopy (CAS) can evaluate the vascular response after drug-eluting stent (DES) implantation. The post-PCI OCT findings that are associated with the CAS 1-year vascular response have not been known. We enrolled 168 lesions from 119 patients who underwent OCT-guided PCI using DES and follow-up CAS observation at 1 ± 0.5 year from August 2012 to December 2019. Outcome measures were sufficient neointimal coverage (NIC) defined as stent struts embedded in the neointima, subclinical intrastent thrombus, and vulnerable stented segments defined as those with angioscopic yellow or intensive yellow color 1 year after PCI. We identified the post-PCI OCT findings associated with these CAS findings. Sufficient NIC, subclinical intrastent thrombus, and vulnerable stented segment were detected in 85 lesions (51%), 47 lesions (28%), and 54 lesions (32%), respectively. A multivariate analysis demonstrated that malapposed struts were negatively associated with sufficient NIC (odds ratio 0.87; 95% CI 0.76-0.99; p = 0.029). However, no specific OCT findings immediately after PCI were associated with subclinical intrastent thrombus or vulnerable stented segment. Malapposition immediately after PCI was negatively associated with sufficient NIC at 1 year even without associations between post-PCI OCT findings and subclinical intrastent thrombus or vulnerable stented segment.

BackgroundAtrial myocardial degeneration predisposes to atrial fibrillation (AF), ischemic stroke, and heart failure. Studies suggest the presence of sex differences in atrial myocardial degeneration. This study aimed to delineate sex differences in the prevalence, predictors, and prognostic impact of left atrial low-voltage areas (LVAs).MethodsThis observational study included 1,488 consecutive patients undergoing initial ablation for AF. Voltage mapping was performed after pulmonary vein isolation during sinus rhythm. LVAs were defined as regions where bipolar peak-to-peak voltage was < 0.50 mV. Results: LVA prevalence was higher in women (37.6%) than in men (16.0%). High age, persistent form of AF, diabetes mellitus, and a large left atrium were shown to be common predictors in both sex categories. Heart failure and history of stroke/thromboembolic events were men-specific predictors of LVA existence. Women experienced more AF recurrence than men (31.1% vs. 25.7%, p = 0.027). LVA existence was significantly associated with increased AF recurrence in each sex category, with a respective hazard ratio, 95% confidence interval and p value of 2.45, 1.87-3.22, and < 0.0001 in men and 1.82, 1.33-2.49, and < 0.0001 in women.ConclusionsLVA was more frequent in women than men, and predicted frequent AF recurrence irrespective of sex category.

Vessel preparation for endovascular treatment (EVT) is important but because the contributory factors for favorable outcomes are not yet known, we conducted the present study to elucidate the factors associated with sufficient vessel preparation for severely calcified femoropopliteal (FP) lesions.Methods and Results: This was a single-center retrospective observational study of 97 patients (mean age, 75±8 years, 76% male) with 106 de novo severely calcified FP lesions who underwent EVT under intravascular ultrasound (IVUS) evaluation. The lesion definition was 360° of superficial calcification on IVUS. The primary outcome measure was sufficient vessel preparation, which was defined as successful cracking of severely calcified lesions evaluated by IVUS after predilation. The mean lesion length was 200±103 mm, and chronic total occlusion was present in 38% of patients. According to the greater difference between the preballoon size and the lumen diameter of the severely calcified lesion, the frequency of sufficient vessel preparation increased (odds ratio, 4.68; 95% confidence interval, 2.09-10.49; P0.01). Balloon type (noncompliant, P=0.80; scoring: P=0.25) and pressure (P=0.27) were non-contributory.The difference between the lumen diameter at the severely calcified FP lesion site and the preballoon dilatation diameter was the sole factor contributing to sufficient vessel preparation.

Purpose: This study investigated the incidence of acute thrombotic occlusion (ATO) and its predictors after contemporary femoropopliteal (FP) endovascular therapy (EVT) for peripheral artery disease. Materials and Methods: We retrospectively examined 763 limbs (chronic limb-threatening ischemia [CLTI]: 44%, involving popliteal lesion: 44%) in 644 patients (mean age: 75±9 years, male: 71%, hemodialysis: 34%) who successfully underwent EVT with contemporary FP devices (drug-coated stent: n=220, stent graft: n=158, drug-eluting stent: n=150, drug-coated balloon [DCB]: n=235) from June 2012 to July 2020. The outcome measure was ATO defined as acute onset of claudication and/or signs of CLTI in combination with angiographic evidence of occlusive thrombus formation within the treated segment. Cox proportional hazards regression models were used to identify baseline characteristics associated with the incidence of ATO after EVT treated with scaffold. To determine the impact of ATO occurrence and creatine phosphokinase (CPK) elevation on the subsequent composite outcome of mortality or major amputation, we developed the Cox model in which the trichotomous variable (free from ATO, ATO without CPK elevation, and ATO with CPK elevation) was a time-dependent covariate. Results: The 24-month incidence of ATO in the overall population was 4.3%±0.8% (DCB: 1.0%±0.7% vs scaffold: 5.8%±1.1%, pConclusion: We found a substantial incidence of ATO after contemporary FP-EVT, particularly with scaffold. Hemodialysis and involving popliteal lesion were significantly associated with ATO risk in patients treated with scaffold. The occurrence of ATO, particularly with CPK elevation, was associated with an increased risk of a subsequent composite outcome of mortality or major amputation. The scaffold was safely used in patients without those risk factors of ATO, but a non-scaffolding strategy should be considered for patients with more risk factors. Clinical Impact The scaffold was safely used in patients without hemodialysis and involving popliteal lesion, but a non-scaffolding strategy should be considered for patients with those risk factors. The occurrence of ATO, particulary with CPK elevation, was of high risk of mortality or amputation.

Cutting balloons are commonly used to treat patients with coronary artery disease (CAD) presenting with calcified lesions, but the efficacy of cutting balloons has not been elucidated. We aimed to investigate the impact of novel cutting balloons (Wolverine™) relative to conventional balloons on post-interventional stent expansion for coronary calcified lesions. This study was a single-center, retrospective, observational study. We analyzed 636 lesions from 543 patients with moderate-to-severely calcified CAD lesions undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention using cutting balloons or conventional balloons prior to drug-eluting stent implantation. The primary outcome was post-interventional minimum stent area (MSA) evaluated by IVUS. Propensity score matching was performed to adjust for baseline characteristics. The interaction effects between balloon type and baseline characteristics were also assessed in MSA 5.5 mm

Purpose: The current study sought to investigate the impact of cardiac condition on loss of patency after endovascular therapy (EVT) using new-generation devices for femoropopliteal (FP) lesions. Materials and Methods: We retrospectively studied 547 lesions (chronic limb-threatening ischemia: 44%, TASC II C/D lesion: 61%, chronic total occlusion: 37%, in-stent restenosis: 13%, involving popliteal arterial lesion: 45%) belonging to 416 patients (average age: 75±9 years, male: 69%, diabetes mellitus: 62%, hemodialysis: 33%) who underwent EVT with new-generation FP-specific devices (polymer-free paclitaxel-eluting stent, n=186; stent graft, n=119; fluoropolymer-based paclitaxel-eluting stent, n=29; interwoven stent, n=17; drug-coated balloon, n=196) from June 2012 to May 2019. Cardiac function was evaluated using echocardiography. The primary outcome measure was primary patency, which was defined as free from peak systolic velocity ratio (PSVR) >2.5 assessed by duplex ultrasound. Predictors for loss of patency were evaluated using Cox proportional hazards regression analysis. Results: Overall 12 primary patency were 80.0±1.8%. After the multivariate analysis, reduced stroke volume evaluated by echocardiography (hazard ratio [HR]=0.99, 95% confidence interval [CI]=0.97-0.99, p=0.03), chronic heart failure (HR=1.76, 95% CI=1.05-2.97, p=0.03), and a smaller distal reference vessel diameter (HR=0.73, 95% CI=0.55-0.97, p=0.03) were significantly associated with loss of 12-month primary patency, whereas lesion length (HR=1.01, 95% CI=0.99–1.03, p=0.33) and presence of chronic total occlusion (CTO; HR=0.92, 95% CI=0.61-1.40, p=0.70) were not statistically significant. Conclusion: The current study revealed that cardiac function represented by reduced stroke volume and presence of chronic heart failure as well as a smaller distal reference vessel diameter were significantly associated with loss of 12-month primary patency in patients with peripheral artery disease (PAD) presenting FP lesions endovascularly treated with new-generation devices.

BACKGROUND AND AIMS: The achievement of a target low-density lipoprotein cholesterol (LDL-C) level in clinical settings is often insufficient. A hospital lipid-lowering protocol (HLP) could be effective for providing the optimal lipid-lowering therapy. Herein we determined the effectiveness of a HLP for acute coronary syndrome (ACS) patients. METHODS: We retrospectively analyzed 1,497 patients who underwent successful percutaneous coronary intervention for ACS at our hospital (November 2011 to May 2020). In December 2018, we introduced a HLP that included the prescription of the maximum tolerated dose of statin, ezetimibe, and eicosapentaenoic acid. We compared the lipid profile and clinical outcomes at 12 months between before (Control group: 1,219 patients) and after the HLP's introduction (HLP group: 278 patients). The primary outcome was the achievement rate of LDL-C

Global Limb Anatomic Staging System (GLASS) proposed by Global vascular guideline can anatomically stratify infrapopliteal (IP) lesions in patients with chronic limb-threatening ischemia (CLTI). This study investigated the prognostic impact of IP anatomic severity on delayed wound healing (WH) in