Percutaneous coronary intervention for a healed erosion with excimer laser coronary angioplasty and drug-coated balloon angioplasty: a case report

BackgroundHealed plaque, characterized by distinct layers of organizing thrombus and collagen, is the hallmark of tissue self-repair. However, the efficacy of excimer laser coronary angioplasty (ELCA) followed by drug-coated balloon (DCB) angioplasty in patients with healed plaques is not fully understood.Case summaryA 42-year-old woman with a history of anxiety disorder was admitted to our institution with worsening chest pain and subsequently diagnosed with anterior non-ST-elevation myocardial infarction. Coronary angiography revealed severe stenosis in the proximal left anterior descending artery (LAD) despite Thrombolysis in Myocardial Infarction (TIMI) grade 3. Optical coherence tomography (OCT) showed healed plaques with partial macrophage accumulation and no fresh thrombus. Plaque disruption and thin-cap fibrous atheroma were not identified in the culprit lesions. Intravascular ultrasound (IVUS) confirmed high-intensity marginal irregular masses at the culprit site, suggesting that the thrombus was formed by plaque erosion rather than lipid plaque or necrotic tissue. With lesion modification using ELCA prior to DCB angioplasty, OCT examination of the LAD after ELCA showed a significant reduction in plaque burden and preserved lumen size. Post-percutaneous coronary intervention angiography revealed no stenosis with TIMI grade 3. A follow-up coronary computed tomography scan showed no angiographic restenosis, and the patient remained symptom-free.ConclusionsHere we describe a case in which OCT and IVUS evaluation suggested organizing thrombus due to erosion healing, and a favorable outcome was achieved with the combination of ELCA and DCB. The combination use of ELCA and DCB might be a potential strategy for acute coronary syndrome patients with organizing thrombus

Impact of Native Coronary Artery Calcification on Lesion Outcome Following Drug-Coated Balloon Angioplasty for Treatment of In-Stent Restenosis

This study aimed to clarify whether native coronary artery（CA） calcification before index percutaneous coronary intervention（PCI） has an impact on the effectiveness of drug-coated balloon（DCB） angioplasty for the treatment of in-stent restenosis（ISR）. 100consecutive patients with 166ISR lesions underwent quantitative coronary angiography（QCA） before and after index PCI and before and after DCB angioplasty for ISR. CA calcification before index PCI was assessed by angiography and results were analyzed to reveal the predictive values for target lesion revascularization（TLR） and major adverse cardiac events（MACE）. During 1.03±1.03years of follow-up, TLR occurred in 44lesions（26.5%） and MACE in 33 patients（33%）. On multivariate analysis, CA calcification before index PCI（p=0.016）, and % diameter of stenosis（%DS）≥73%（p=0.023） and minimal lumen diameter（MLD）<0.65mm（p=0.001） before DCB angioplasty were independent predictors for TLR after DCB angioplasty. MACE was also associated with CA calcification before index PCI（p=0.01）, and %DS≥73%（p=0.001） and MLD<0.65mm（p=0.01） before DCB angioplasty, but only %DS≥73% before DCB angioplasty was an independent predictor for MACE after DCB angioplasty（p=0.039）. The combination of CA calcification before index PCI and these QCA factors before DCB angioplasty was an independent and more powerful predictor for MACE than the QCA factors alone（p<0.001）. Thereafter, the combination of CA calcification and %DS≥73% before DCB angioplasty stratified the risk of MACE after DCB angioplasty（p<0.05）. CA calcification before index PCI, as well as anatomical information at ISR, have an impact on outcome after DCB angioplasty for ISR

Effect of Implantable Cardioverter-defibrillator Therapy for Ventricular Fibrillation Patients with Out-of-hospital Cardiac Arrest

Survivors of ventricular fibrillation out-of-hospital cardiac arrest（VF-OHCA）due to potentially reversible causes such as acute coronary syndrome（ACS）, vasospastic angina and electrolyte abnormalities are considered low risk for recurrent arrhythmia. Accordingly, implantable cardioverter-defibrillator therapy is not routinely recommended in such patients. We investigated the risk of mortality and the value of ICD therapy for VF-OHCA. Among 2,248 cardiopulmonary arrest patients presenting at our hospital, we retrospectively investigated 110 patients with VF-OHCA who were admitted for treatment. We divided the patients based on ICD（n＝71） or No-ICD status（n＝39）, and on reversible cause（n＝70） or irreversible cause（n＝40）. The groups were compared for baseline characteristics, mortality and ICD therapies. Patients with a reversible cause had a significantly lower rate of ICD implantation than those with an irreversible cause（P＝0.03）. Males in the ICD group presented more frequently than those in the No-ICD group, and cardiac mortality in patients with acute coronary syndrome was significantly lower with ICD therapy than without ICD（P＝0.04）. The rate of appropriate ICD therapies with a reversible cause was 28％, and the first ICD therapy was highest within 1 year post-implantation. Patients with VF-OHCA due to a reversible cause remain at high risk of recurrent ventricular arrhythmias, suggesting that ICD implantation is a reasonable approach in such cases

Epicardial Adipose Tissue in the Right Atrium Is Associated with Progression of Atrial Fibrillation and Recurrence after Pulmonary Vein Catheter Ablation in Patients with Atrial Fibrillation

An increase in epicardial adipose tissue（EAT）in the left atrium（LA）predicts the progression of atrial fibrillation（AF）and AF recurrence after pulmonary vein catheter ablation（CA）. We hypothesized that EAT in the right atrium（RA）is also associated with the progression of AF and post-CA AF recurrence. Using 128-slice multidetector computed tomography, EAT volume and atrial volume were measured 3-dimensionally before CA in 68 patients who had proven AF（paroxysmal AF, 42; persistent AF, 26; mean age, 65±11 years; 42.6％ female）with successful CA and 21 volunteers with sinus rhythm（age, 63±13 years; 52.3％ female）. In both atria, EAT and atrial volumes were largest in patients with persistent AF, followed, in order, by those with paroxysmal AF, and then healthy volunteers（P＜0.001）. Increased EAT and atrial volumes in both atria predicted persistent AF（P＜0.001）. Fifteen patients had AF recurrence（22.1％）during the 2-year period after CA. Increased EAT volume in both atria were independent predictors for AF recurrence, and a RA EAT volume≥6.2ml was an independent predictor, with a hazard ratio of 5.47（95％ confidence interval, 1.2-24.3; P=0.03）. The combination of EAT and atrial volume in both atria was a more powerful independent prognostic factor, with a hazard ratio of 4.8（95％ confidence interval, 1.7-3.7; P=0.003）, and a sensitivity of 60％ in 9 of 15 patients, and specificity of 81.1％ in 43 of 53 patients,（P=0.003）. RA EAT is associated with the progression of AF and post-CA AF recurrence

Conversion of Alkyl Azides to Diazo Compounds and the Azide-Site Selectivity: One-Pot Phosphine-Mediated Transient Protection of Azido Groups and Deprotective Transformation to Diazo Groups

A one-pot conversion of alkyl azides to diazo compounds is outlined. After azido group protection of α-azidocarbonyl compounds, treatment of the resulting phosphazides with silica gel in a wet solvent afforded α-diazo carbonyl products by azide-deprotective conversion. Competitive reactions of α-azido amides with alkyl and aryl azides demonstrate azide-site selectivity. Azide-site selective click functionalization by this one-pot sequence is also demonstrated with diazido compounds

Determinants of Resting Oxidative Stress in Middle-Aged and Elderly Men and Women: WASEDA’S Health Study

Previous studies have not investigated the determinants of resting oxidative stress, including physical fitness, as it relates to redox regulation. The present study therefore was aimed at identifying lifestyle and biological factors that determine resting oxidative stress, including objectively measured physical fitness. In 873 middle-aged and elderly men and women, age and anthropometric parameters, lifestyle-related parameters, medication and supplementation status, physical fitness, biochemical parameters, and nutritional intake status, as well as three plasma oxidative stress markers: protein carbonyl (PC), F2-isoprostane (F2-IsoP), and thiobarbituric acid reactive substances (TBARS), were surveyed and measured. The determinants of PC, F2-IsoP, and TBARS in all participants were investigated using stepwise multiple regression analysis. In PC, age (β=−0.11, P=0.002), leg extension power (β=−0.12, P=0.008), BMI (β=0.12, P=0.004), and HDL-C (β=0.08, P=0.040) were included in the regression model (adjusted R2=0.018). In the F2-IsoP, smoking status (β=0.07, P=0.060), BMI (β=0.07, P=0.054), and HbA1c (β=−0.06, P=0.089) were included in the regression model (adjusted R2=0.006). In TBARS, glucose (β=0.18, P<0.001), CRF (β=0.16, P<0.001), age (β=0.15, P<0.001), TG (β=0.11, P=0.001), antioxidant supplementation (β=0.10, P=0.002), and HbA1c (β=−0.13, P=0.004) were included in the regression model (adjusted R2=0.071). In conclusion, the present study showed that age, anthropometric index, lifestyle-related parameters, medication and supplementation status, objectively measured physical fitness, biochemical parameters, and nutritional intake status explain less than 10% of oxidative stress at rest

Rapid three-dimensional quantification of high-intensity plaques from coronary atherosclerosis T1-weighted characterization to predict periprocedural myocardial injury

High-intensity plaque (HIP) on magnetic resonance imaging (MRI) has been documented as a powerful predictor of periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI). Despite the recent proposal of three-dimensional HIP quantification to enhance the predictive capability, the conventional pulse sequence, which necessitates the separate acquisition of anatomical reference images, hinders accurate three-dimensional segmentation along the coronary vasculature. Coronary atherosclerosis T1-weighted characterization (CATCH) enables the simultaneous acquisition of inherently coregistered dark-blood plaque and bright-blood coronary artery images. We aimed to develop a novel HIP quantification approach using CATCH and to ascertain its superior predictive performance compared to the conventional two-dimensional assessment based on plaque-to-myocardium signal intensity ratio (PMR). In this prospective study, CATCH MRI was conducted before elective stent implantation in 137 lesions from 125 patients. On CATCH images, dedicated software automatically generated tubular three-dimensional volumes of interest on the dark-blood plaque images along the coronary vasculature, based on the precisely matched bright-blood coronary artery images, and subsequently computed PMR and HIP volume (HIPvol). Specifically, HIPvol was calculated as the volume of voxels with signal intensity exceeding that of the myocardium, weighted by their respective signal intensities. PMI was defined as post-PCI cardiac troponin-T &gt;5× the upper reference limit. The entire analysis process was completed within 3minutes per lesion. PMI occurred in 44 lesions. Based on the receiver operating characteristic curve analysis, HIPvol outperformed PMR for predicting PMI (C-statistics, 0.870 [95% CI, 0.805-0.936] vs. 0.787 [95% CI, 0.706-0.868]; p = 0.001). This result was primarily driven by the higher sensitivity HIPvol offered: 0.886 (95% CI, 0.754-0.962) vs. 0.750 for PMR (95% CI, 0.597-0.868; p = 0.034). Multivariable analysis identified HIPvol as an independent predictor of PMI (odds ratio, 1.15 per 10-μL increase; 95% CI, 1.01-1.30, p = 0.035). Our semi-automated method of analyzing coronary plaque using CATCH MRI provided rapid HIP quantification. Three-dimensional assessment using this approach had a better ability to predict PMI than conventional two-dimensional assessment