Fluorescein angiography (FA) images of the eye with reversal of no-reflow obtained 3 days (left) and 1 month (right) after treatment (intra-arterial thrombolysis).

<p>The macular area in the eye with central retinal artery occlusion shows capillary dropout (nonperfusion) at 3 days (FA image obtained 7 min after intravenous fluorescein injection) and demonstrates reversal of no-reflow at 1 month (FA image obtained 4 min and 30 s after fluorescein injection).</p

Structural changes in the retina over time in the reflow (left) and no-reflow (right) eyes for central retinal artery occlusion (CRAO).

<p>An optical coherence tomography (OCT) image of the no-reflow eye shows loss of layer-by-layer structure in the inner retina and remarkable macular thickening. In contrast, the reflow eye shows a relatively preserved layered retinal structure at baseline (top) and 1 (middle) and 6 months (bottom) later. Furthermore, the no-reflow eye shows more remarkable retinal thinning than the reflow eye and loss of an organized layered retinal structure in the macula.</p

Anatomical and visual outcomes of eyes with and without the no-reflow phenomenon.

<p>(A) Temporal patterns of central macular thickness (CMT) and (B) 1-month and final changes in CMT in eyes with central retinal artery occlusion (CRAO). No-reflow eyes show a greater CMT at baseline but a lesser CMT at the final visit compared with reflow eyes. CMT changes at 1-month and final visits are significantly greater in no-reflow eyes. (C) Temporal patterns of best-corrected visual acuities (BCVAs) and (D) 1-month and final changes in BCVA in patients with reflow and no-reflow for CRAO. No-reflow eyes show worse visual function at baseline, 1 month, and the final visit. At the 1-month and final visits, BCVA changes from baseline are greater in the reflow eyes than in the no-reflow eyes. Error bars denote the upper boundary of 95% confidence intervals. *Statistical significance (P < 0.05).</p

Incidence of the no-reflow phenomenon and its reversal in patients with central retinal artery occlusion (CRAO).

<p>The no-reflow phenomenon was defined as the lack of tissue (capillary) reperfusion after successful arterial recanalization in this study. Among the 102 enrolled patients whose arterial recanalization was confirmed by fluorescein angiography (FA) images, 39 showed tissue (capillary) nonperfusion, resulting in a 38.2% incidence of the no-reflow phenomenon. Its reversal could be evaluated in 29 patients, 7 (24.1%) of whom showed reversal of no-reflow.</p

Comparison of clinical and retinal structural characteristics between patients with and without no-reflow phenomenon.

<p>P values were obtained by Student’s t test for continuous variables and by Fisher’s exact test or Chi-square test for dichotomous or ordinary variables.</p><p>Comparison of clinical and retinal structural characteristics between patients with and without no-reflow phenomenon.</p

Fundus photographs (Fd) and fluorescein angiography (FA) images of no-reflow (left) and reflow (right) eyes with central retinal artery occlusion.

<p>FA images (obtained 30 s after intravenous fluorescein injection) show improved arterial perfusion following intra-arterial thrombolysis (IAT) in both eyes, although a round area (yellow arrowheads) exhibiting capillary nonperfusion (and consequently retinal tissue nonperfusion) in the macula is observed only in the no-reflow eye.</p

Baseline characteristics of study patients.

<p>Baseline characteristics of study patients.</p

The causes of death.

*<p>Percentage of the cause of death among patients without WRN.</p>†<p>Percentage of the cause of death among patients with WRN.</p

Intravascular Ultrasound and Angiographic Predictors of In-Stent Restenosis of Chronic Total Occlusion Lesions

<div><p>Despite the benefits of successful percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO) lesions, PCIs of CTO lesions still carry a high rate of adverse events, including in-stent restenosis (ISR). Because previous reports have not specifically investigated the intravascular ultrasound (IVUS) predictors of ISR in CTO lesions, we focused on these predictors. We included 126 patients who underwent successful PCIs, using drug-eluting stents, and post-PCI IVUS of CTO lesions. Patient and lesion characteristics were analyzed to elucidate the ISR predictors. In each lesion, an average of 1.7 ± 0.7 (mean length, 46.4 ± 20.3 mm) stents were used. At 9 months follow-up, 14 (11%) patients demonstrated ISR, and 8 (6.3%) underwent target lesion revascularization. Multivariate logistic regression analysis showed that the independent predictors of ISR were the post-PCI minimal luminal diameter (MLD) and the stent expansion ratio (SER; minimal stent cross-sectional area (CSA) over the nominal CSA of the implanted stent), measured using quantitative coronary angiography (QCA) and IVUS, respectively. A receiver operating characteristic analysis indicated that the best post-PCI MLD and SER cut-off values for predicting ISR were 2.4 mm (area under the curve [AUC], 0.762; 95% confidence interval (CI), 0.639–0.885) and 70% (AUC, 0.714; 95% CI, 0.577–0.852), respectively. Lesions with post-PCI MLD and SER values less than these threshold values were at a higher risk of ISR, with an odds ratio of 23.3 (95% CI, 2.74–198.08), compared with lesions having larger MLD and SER values. Thus, the potential predictors of ISR, after PCI of CTO lesions, are the post-PCI MLD and SER values. The ISR rate was highest in lesions with a post-PCI MLD ≤2.4 mm and an SER ≤70%.</p></div

Subjective discomfort assessed by visual analogue scale.

<p>Subjective discomfort assessed by visual analogue scale.</p