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Coronary debulking devices are essential in obtaining optimal results in percutaneous coronary intervention (PCI) for severely calcified lesions. However, since the introduction of these devices in Japan, the presence of full-time cardiovascular surgeons in their own facilities has been an essential condition (on-site surgical back-up) as the facility criteria for their use. The criteria were revised in April 2020, making their implementation possible at our hospital. Between May 2020 and January 2022, we administered PCIs using rotational atherectomy (RA) for 33 lesions in 28 patients and orbital atherectomy system (OAS) for 36 lesions in 27 patients. The most preferred strategy in our hospital is OAS via the distal radial approach using a 6Fr Glide sheath or RA via the femoral approach using a 7Fr sheath. The percentages of usable imaging modality as an initial device without lesion modification were 57.1 and 66.7% in the RA and OAS groups, respectively. In the RA procedure, 1.5- and 2.0-mm Rota burrs were more frequently adopted for the initial and second sessions, respectively. In the OAS procedure, the debulking was always initiated at a low speed. Nineteen of the 27 patients underwent additional high-speed debulking. Pre-procedural quantitative coronary angiographic analysis revealed that the minimal lumen diameter was significantly smaller in the RA than in the OAS group. Debulking procedures were successful in all patients excluding two instances of procedure-related complications in the RA group, one of which was coronary perforation safely treated via covered stent deployment without any resulting hemodynamic instability. Our early experience with coronary debulking devices with off-site surgical back-up clearly reveals the safety and feasibility of this procedure in a newcomer facility.

This study modeled deposition processes using statistical ensemble and feature-scale voxel methods to predict the coverage and film properties on a large-scale pattern for the first time. Certain new concepts, such as the use of probabilities to express physical and chemical phenomena occurring on the surface, interaction among voxels, and super particles for fast calculations, were introduced. Further, the model was used to analyze the experimental characteristic variation between the morphology and film density of SiN in low-temperature plasma-enhanced chemical vapor deposition using a SiH4/NH3/N2 gas mixture with different SiH4 flow rates, which has not been found in SiO2 films. The simulation results demonstrated the effect of the precursor mass in the gas phase on surface migration and morphology formation. In addition, a short residence time was required to prevent the generation of large and heavy precursors to realize good SiN coverage and film properties at a low temperature.

Sheet resistance ( ${R_{sheet}}$ ) reduction of a-few-layered molybdenum disulfide (MoS2) film using sputtering is investigated in this study. To enhance the carrier density, chlorine (Cl2) gas excited by inductively coupled plasma is introduced as a substitute for sulfur. To electrically activate the Cl dopants and simultaneously prevent out-diffusion of sulfur, a furnace annealing was performed in sulfur-vapor ambient. Consequently, the ${R_{sheet}}$ in the MoS2 film with the Cl2 plasma treatment remarkably reduced by one order lower than that without one, because of the activation of Cl dopants in the MoS2 film.

Patient: Female, 76 Final Diagnosis: Right ventricular free wall rupture Symptoms: Chest pain Medication: — Clinical Procedure: Echocardiography Specialty: Cardiology Objective: Rare disease Background: Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). Case Report: A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. Conclusions: A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.

Key Clinical Message Neoatherosclerosis is emerging as a stent‐associated problem that has not yet been fully resolved. Because in‐stent restenosis with a neoatherosclerotic etiology is associated with a high risk of acute coronary syndrome and a poor survival prognosis, it is essential to precisely identify patients at risk using advanced imaging modalities.

Background Vascular closure devices have been widely used to achieve rapid hemostasis after percutaneous catheterization procedures via the common femoral artery. The EXOSEAL vascular closure device is a device that can deliver a bioabsorbable polyglycolic acid plug to fill the subcutaneous puncture route at the groin for rapid hemostasis, and this device has a lower risk of arterial occlusion than other vascular closure devices. Case presentation An 83-year-old Japanese man underwent percutaneous coronary intervention for a proximal stenosis in his left circumflex artery through a 7-Fr sheath from his right common femoral artery. We encountered acute popliteal artery occlusion associated with EXOSEAL vascular closure device. We detected the plug material of this device at the occluded lesion by intravascular ultrasound, and performed successful bailout stenting after pulling the embolus with an inflated balloon catheter up to the superficial femoral artery from the popliteal artery. Conclusion Acute limb ischemia caused by an EXOSEAL vascular closure device is a very rare complication. Balloon angioplasty and stenting are considered to be effective options to deal with the plug dislodgement of an EXOSEAL vascular closure device. We must be prepared for every rare complication during endovascular treatment.

Patient: Male, 43 Final Diagnosis: Isolated idiopathic inferior mesenteric artery dissection Symptoms: Lower abdominal pain Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Rare disease Background: Isolated dissection of a mesenteric artery is very rare and usually presents with acute gastrointestinal symptoms. There have been previously published reports on the isolated dissection of the superior mesenteric artery. However, isolated dissection of the inferior mesenteric artery is rare. Case Report: A 43-year-old man presented with sudden onset of lower abdominal pain. Abdominal computed tomography (CT) imaging confirmed isolated dissection of the inferior mesenteric artery. To prevent exacerbation of the dissection, his systolic blood pressure was controlled to

Herein we report on the positive Seebeck coefficient S = 162 μV K−1 of niobium (Nb)-doped MoS2 films prepared by sputtering and activation of Nb atoms by sulfur vapor annealing. The p-type doping achieved via these processes is discussed based on changes in chemical bonding states and resistivity behavior in terms of annealing and measurement temperatures. The results of this study provide a new option for p-type doping of MoS2 films and are expected to contribute to the development of nanoelectronics and a smart society.

WS 2 pMISFETs are successfully demonstrated by radio-frequency magnetron sputtering and sulfur-vapor annealing with TiN/HfO 2 -top-gate-stack, TiN contact and ultra-thin body and box (UTBB). The WS 2 film with (002) plane was formed in parallel to a substrate surface. I-V characteristics with p-type operation are confirmed with the maximum field effect mobility of 0.69 cm2V−1s−1. This WS 2 film is expected for not only the CMOS circuits but also thermoelectric generators.

Patient: Female, 68-year-old Final Diagnosis: Vascular access venous hypertension Symptoms: Difficulties during hemodialysis Medication: — Clinical Procedure: — Specialty: Cardiology • Nephrology • Radiology Objective: Unusual clinical course Background: Vascular access (VA) venous hypertension is a major complication for patients with long-term arteriovenous access in the upper extremities. Endovascular treatment (EVT) is the first option for treating it. A possible cause of VA venous hypertension is stenosis at a site downstream of the arteriovenous fistula. We report a case of VA venous hypertension with complex venous drainage routes. Case Report: A 68-year-old woman had worsening VA venous hypertension that led to difficulties in the venous blood return during hemodialysis. The cephalic vein distal to the arteriovenous fistula branched into 3 routes. The most proximal branch was occluded just before the junction to the subclavian vein at the level of the first rib. The pressure gradient between the brachial artery and the VA vein was 30 mmHg. Therefore, we performed an EVT for the occlusion and deployed a 3.0-mm balloon-expandable bare-metal stent, achieving good vascular patency with favorable blood flow. When the outside of the implanted stent was stained with contrast media, the appearance suggested the formation of varices that could have lowered the pressure at that lesion. The pressure gradient between the brachial artery and the VA vein had increased to 80 mmHg, which indicated an improvement of the VA venous hypertension. Conclusions: EVT was effective for an occluded cephalic arch in a hemodialysis patient showing VA venous hypertension, despite the presence of collateral venous routes. VA venous hypertension can be life-threatening for hemodialysis patients. Therefore, it is essential that physicians who use vascular access interventional therapy should determine the cause of the VA venous hypertension and resolve it.

Background Although timely coronary intervention can result in markedly improved clinical outcomes of patients with acute coronary syndrome (ACS), non-ST-elevation (NSTE)-ACS is sometimes difficult to accurately diagnose. Case presentation A 52-year-old woman complained of acute chest pain with sudden onset. Both electrocardiography (ECG) and echocardiography showed normal results, and we urgently needed to make a differential diagnosis among critical illnesses such as acute coronary syndrome and nonischemic cardiovascular life-threatening diseases. Contrast-enhanced computed tomography (CT) without ECG synchronization showed evidence of neither aortic dissection nor pulmonary embolism, but regionally reduced contrast enhancement in the posterior myocardium, which were suggestive of myocardial ischemia. Emergency coronary angiography demonstrated severe stenosis of the left circumflex artery, and we achieved favorable revascularization with drug-eluting stent deployment. Conclusions We diagnosed a patient with NSTE-ACS in whom contrast-enhanced CT without ECG synchronization was effective for visualization of reduced myocardial perfusion, suggesting ischemic heart disease.

Patient: Female, 74-year-old Final Diagnosis: Arteriosclerosis obliterans Symptoms: Skin ulcers Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Unusual or unexpected effect of treatment Background: In practical settings of endovascular treatment (EVT) for below-the-knee arteries, we often encounter cases of severe calcification. To overcome problems regarding device uncrossing due to severe calcifications, a bidirectional approach and subsequent guidewire externalization is one of critical methods. Case Report: A 74-year-old female with refractory skin ulcers on the lower frontal thigh and necrotic toes on the left side showed occlusion in both the anterior tibial artery (ATA) and tibio-peroneal trunk. Both occluded vessels were accompanied with dense calcification. In the process of EVT targeting the occluded ATA, the retrograde guide-wire successfully passed the occlusion and was advanced into the antegrade guide sheath. Next, we attempted guidewire externalization, but severe calcification of the ATA hampered the procedure. Therefore, we introduced a guide extension catheter and a balloon catheter in an antegrade fashion to establish a system of trapping the retrograde guidewire between these devices. Then, we pulled the system back outside the guide sheath, which completed guidewire externalization. We performed prolonged balloon dilatation and finally achieved favorable revascularization of the ATA. Conclusions: Our novel method led to successful retrograde guidewire externalization, overcoming severely calcified lesions. It is generally essential for clinicians to increase their expertise regarding EVT procedures to attain better outcomes.

A high Seebeck coefficient of 1.17 × 103 μV K−1 was achieved using an on-chip thermoelectric device for a WS2 atomic-layer film, which was synthesized by ultra-high vacuum RF magnetron sputtering as a function of sputtering power. A layered structure in parallel to the SiO2/Si substrate was confirmed from the transmission electron microscopy and X-ray diffraction spectra. The grain size and peak intensities of the Raman spectra increase with a decrease in the sputtering power. Accordingly, the resistivity and activation energy also increase. The WS2 film can be used in thermoelectric generators, such as energy harvesters in LSIs and wearable devices.

This paper reviews reaction control in the dry etching of insulating films. High ion fluxes are required for high-speed SiO2 processing. However, because atomic F generation due to excessive fluorocarbon gas dissociation causes reduced selectivity, the number of electron collisions should be reduced by using short residence times. The C–F-based polymer thickness formed during processing varies based on the oxygen content of the material to be etched. To achieve high etch selectivity, the incident flux balance must be adjusted quantitatively to ensure that the polymer becomes thinner during etching and thicker as the underlying material is exposed. Even under high selectivity conditions, incident ions cause damage at the moment the underlying material is exposed. To suppress this damage, the ion penetration depth, which depends on both ion energy distribution and ion composition, must be reduced. Recently, atomic layer etching combined with C–F polymer deposition and removal using Ar ion irradiation has been studied. To improve the accuracy of such cyclic etching processes, it is important to understand and control the transient states of both plasma and surface reactions quantitatively.

BACKGROUND As primary percutaneous coronary intervention (PCI) has been commonly performed for acute myocardial infarction (AMI), we rarely encounter ventricular septal rupture (VSR), which is one of the mechanical complications of AMI. However, the associated mortality rate is still very high unless treated appropriately. CASE REPORT We encountered a very rare case of VSR that was considered to have occurred during primary PCI for AMI. The manifestation of sudden coronary flow disturbance may correspond with the emergence of VSR. We introduced a veno-arterial extracorporeal membrane oxygenation (ECMO) system for sudden hemodynamic instability. As a result, the existence of VSR under the operation of the ECMO system led to unusual hemodynamics in the heart, but the vital signs were stabilized by ECMO. VSR was surgically treated and the patient fully recovered without any neurological or physical sequelae. CONCLUSIONS Although we now encounter markedly fewer mechanical complications of AMI in this era of primary PCI, we should always be conscious of its possibility in the acute phase of myocardial infarction.

Patient: Male, 69 Final Diagnosis: Atherosclerotic renal artery stenosis Symptoms: None Medication: — Clinical Procedure: — Specialty: Radiology Objective: Unusual setting of medical care Background: The GuideLiner catheter extension device is a monorail-type “Child” support catheter that facilitates coaxial alignment with the guide catheter and provides an appropriate back-up force. This device has been developed in the field of coronary intervention, and now is becoming widely applied in the field of endovascular treatment. However, there has been no report on the effectiveness of the guide catheter extension device in percutaneous transluminal renal angioplasty (PTRA). Case Report: We encountered a case of atherosclerotic subtotal occlusion at the ostium of the left renal artery. Due to the severely calcified orifice and weaker back-up force provided by a JR4 guide catheter, we could not pass any guide-wires through the target lesion. Therefore, we introduced a guide catheter extension device, the GuideLiner catheter, through the guide catheter and achieved good guidewire maneuverability. We finally deployed 2 balloon-expandable stents and successfully performed all PTRA procedures. Conclusions: The guide catheter extension device can be effective in PTRA for severely calcified subtotal occlusion.

Key Clinical Message Catheter‐induced coronary dissection involving left main bifurcation is a rare complication during cardiac catheterization but can become lethal unless it is treated appropriately. Interventional cardiologists always have to pay attention to the risk of complications related to cardiac catheterization and prepare for determining the best bailout strategy for the situation.

Recently, there have been increasing opportunities to treat patients with peripheral arterial disease. Of those patients, both pathological conditions, such as acute limb ischemia (ALI) and chronic critical limb ischemia (CLI), are closely associated with high risks of major amputation, disability and death. We encountered a very rare case of CLI subsequent to ALI. An 83-year-old male showed the sudden onset of ALI, probably due to thromboembolism from an abdominal aortic aneurysm during an operation for gastric cancer. The patient was referred to another hospital for Fogarty thrombectomy. About 1 month after ALI onset, necrosis of the left first toe gradually progressed. On angiography of the left lower limb, we noted occlusions of both anterior and posterior tibial arteries. Then, we successfully conducted balloon angioplasty for the below-the-knee arteries. Thereby, favorable blood flow was achieved, which led to successful wound healing without amputations.

The MoS2 film for chip-size area was synthesized by two step processes consisting of MoS2-compound sputtering and post sulfurization. We intentionally revealed that the crystallinity of sulfurized MoS2 film depends on that of just-after-sputtered film. Therefore, a crystallinity improvement just-after sputtering is mandatory to achieve an excellent quality MoS2 film after sulfur-vapor annealing for thin film transistor, sensor and human interface device applications.

We encountered a case of blow-out type coronary perforation at the calcified stenosis of left anterior descending artery. First, we started immediate balloon tamponade through the initial guiding catheter (GC) with a GuideLiner® catheter. Next, we introduced a second GC with a GuideLiner® catheter and successfully deployed a covered stent. Two sets of the GC with GuideLiner® catheter facilitated us to simultaneously perform temporary hemostasis with balloon tamponade and rapid delivery of a covered stent. To alternately manipulate the GuideLiner® catheters, back and forth with seesaw-like motion enabled us to minimize the interruption of balloon tamponade.

A 77-year-old Japanese woman underwent bioprosthetic aortic valve replacement (AVR) and the Maze procedure for severe aortic valve disease and paroxysmal atrial fibrillation (AF), and one year after the AVR, she also underwent a permanent pacemaker implantation for sick sinus syndrome. At two postoperative years, a large mural mass happened to be detected in her left atrium on routine trans-thoracic echocardiography. The cardiac rhythm records produced by the implanted pacemaker demonstrated the recurrence of AF. As anticoagulant therapy was not effective at reducing the size of the mass, surgery was performed and organized thrombus was detected on the ablation line made at the Maze procedure.

Objectives This study aimed to investigate the practical usefulness of dual lumen catheter-facilitated reverse wire technique. Background We sometimes encounter difficulty in introducing a guidewire to the highly angulated side branch. In those cases, the reverse wire technique is considered as a last resort to overcome the situation. Methods Between January 2013 and June 2015, we performed the reverse wire technique for guidewire crossing into an extremely angulated side branch in consecutive seven cases with true bifurcated lesions. We retrospectively evaluated patients’ backgrounds, lesion characteristics, and details of the percutaneous coronary intervention (PCI) procedures. Results Three interventional cardiologists with various levels of experience in coronary intervention performed this technique. A polymer-jacket hydrophilic-coated guidewire was used for the reverse wire system excluding in one case, and we adopted a sharp curve for the tip shape in all cases. After crossing the reverse wire into a highly angulated side branch, we usually deliver a flexible micro catheter over the guidewire for the purpose of guidewire exchange. We deployed a stent in the side branch in three cases. We successfully performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. Conclusions We could safely and effectively perform the reverse wire technique for guidewire crossing into a markedly angulated side branch. We recommend a polymer-jacket hydrophilic-coated guidewire with a sharp curve in the tip shape for this technique. All interventional cardiologists should acquire knowledge and skills regarding this guidewire manipulation technique. (J Interven Cardiol 2015;28:544–550)

Currently, there are more opportunities to treat patients complicated with critical limb ischemia (CLI), which is a very dismal medical condition associated with a high risk of major amputation, disability and death. Because CLI is usually caused by multi-level occlusive atherosclerotic disease, the condition of CLI induced by aorto-iliac occlusive disease (AIOD) alone is thought to be a rare pathological entity. We encountered a patient with severe CLI caused by solitary AIOD. Three vascular access routes were established and stiff guidewires retrogradely passed the occluded arteries on both sides. We deployed two self-expandable bare metal stents and complete revascularization led to wound healing. Recent improvements of catheter devices and procedural techniques related to endovascular treatment (EVT) have enabled us to safely recanalize complex vascular lesions of the lower extremities. Therefore, an EVT strategy is one of the favorable treatment options for CLI patients who are contraindicated for surgical treatments.