Novel dual guiding catheter technique for kissing balloon inflation in percutaneous coronary intervention for bifurcated chronic total occlusive lesion.

Traditionally, two bigger-sized guiding catheters (GCs) via the femoral artery have been used in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, those GCs are associated with an increased incidence of bleeding. Therefore, the use of smaller GCs (e.g., 5-Fr) may lessen the invasiveness of this procedure. However, the use of 5-Fr GCs in PCI is complicated by device limitations. A novel technique was developed to overcome the challenges with regard to kissing balloon inflation. This approach involves simultaneous balloon inflation through a dual 5-Fr GC technique for CTO-PCI. In our hospital, this technique was successfully performed in 9 cases of CTO with 10 bifurcated lesions (including four left main-related bifurcations). During the study period, there was no requirement for an additional invasive procedure or occurrence of complications related to the PCI procedure. This technique may be a good option for performing KBI during CTO-PCI through the use of two 5-Fr GCs.

Effect of high-dose strong statin for preventing periprocedural ischemic complications of carotid artery stenting.

Statin therapy has been shown to induce carotid atherosclerotic plaque regression and reduce the periprocedural ischemic complications of carotid artery stenting (CAS). This study assessed the safety and usefulness of pretreatment using a high-dose strong statin (HDSS) to reduce the periprocedural ischemic complications of CAS. We analyzed 117 carotid lesions treated by CAS that were evaluated with magnetic resonance imaging (MRI) within 48 h after the procedure. For 67 lesions, an HDSS (rosuvastatin 20 mg or atorvastatin 40 mg daily) were prescribed from at least 14 days before CAS to at least 14 days after procedure (HDSS group). Clinical and angiographic data, as well as in-hospital outcomes, of the HDSS group were retrospectively compared with 50 lesions with conventional treatment without an HDSS (non-HDSS group). There were no significant differences in the baseline clinical and procedural characteristics between the two groups. There was no side effect related to the HDSS. Stroke rates were similar between the two groups (3.0% in HDSS group vs 8.0% in non-HDSS group, p = 0.22). All were minor strokes. Compared to the non-HDSS group, the HDSS group had a lower frequency of new lesions on diffusion-weighted imaging (DWI) with MRI (25.4% vs 44.0%, p = 0.0345). New ipsilateral DWI-positive rate in the HDSS group was significantly lower than in the non-HDSS group (16.4% vs 34.0%, p = 0.0275). Nonipsilateral (contralateral or posterior circulation) DWI-positive rates were similar between the two groups (13.4% vs 20.0%, p = 0.34). Pretreatment with an HDSS might reduce the periprocedural ischemic complications of CAS.

Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt.

A 56-year-old woman was diagnosed as atrial septal defect (ASD) with pulmonary hypertension; pulmonary blood flow/systemic blood flow (Qp/Qs) of 2.3, pulmonary artery pressure (PAP) of 71/23(39) mmHg and diastolic dysfunction of left ventricle. PAP was improved after medical therapy; therefore, transcatheter ASD closure was performed. Seven days later, left-sided heart failure occurred, however, the improvement of Qp/Qs (1.7) and PAP of 51/21(32) was confirmed. Diuretic therapy was introduced which led to further decrease of PAP 40/12(25) and Qp/Qs (1.1). Because of gradual decrease of Qp/Qs, this patient appeared to be protected from acute pulmonary edema.

A novel percutaneous coronary intervention technique for chronic total occlusion: Contralateral angiography with a single guiding catheter.

We report two successful cases with a new percutaneous coronary intervention (PCI) technique to treat chronic total occlusion (CTO) by using contra-lateral coronary angiography with a single guiding catheter (GC) safely. Firstly, a GC was inserted into the coronary artery supplying collaterals and a microcatheter was inserted into the distal side of the coronary artery. Then, the GC was retroflexed and engaged in the targeted coronary artery with CTO. While the contra-lateral coronary artery was visualized by injection through a microcatheter, a guide wire was controlled and passed through the CTO lesion. Two sheaths insertion were necessary to perform contra-lateral angiography in CTO PCI. This new technique makes it possible to perform safe contra-lateral angiography with a single sheath and a single GC. It could reduce vascular access complication rates. © 2015 Wiley Periodicals, Inc.

Coronary angiographic characteristics that influence fractional flow reserve.

BACKGROUND: Percutaneous coronary intervention (PCI) guided with fractional flow reserve (FFR) has been shown to improve clinical outcome. Although coronary angiography is the standard method for PCI guidance, the visual severity of stenosis is not always correlated with functional severity, suggesting that there are additional angiographic factors that affect functional ischemia. METHODS AND RESULTS: To evaluate angiographic predictors of positive FFR in stenotic lesions, angiographic characteristics of 260 consecutive patients (362 lesions) who underwent FFR testing from April 2009 to September 2012 were analyzed. A scoring system (STABLED score) using these predictors was developed and compared with quantitative coronary angiography (QCA). %Diameter stenosis >50% (OR, 8.43; P<0.0001), tandem lesion (OR, 4.00; P<0.0001), true bifurcation (OR, 2.42; P=0.028), lesion length >20 mm (OR, 5.40; P=0.0002), and distance from ostium <20 mm (OR, 1.94; P=0.028) were determined as independent predictors of positive FFR. Area under the ROC curve for probability of positive FFR using the STABLED score (Stenosis 2 points, TAndem lesion 1 point, Bifurcation 1 point, LEsion length 1 point, Distance from ostium 1 point) was 0.85, higher than that for QCA stenosis alone (0.76). STABLED score ≥3 had 72.3% sensitivity and 83.6% specificity for predicting positive FFR, and PPV was 76.7%. CONCLUSIONS: Specific angiographic features are applicable for predicting functional ischemia. STABLED score correlates well with FFR.

Simultaneous Intravascular Ultrasound Usage Overcomes Misinterpretation When Evaluating Lipid-Rich Plaques With Optical Frequency Domain Imaging--Ex Vivo Study.

BACKGROUND: The aim of this study was to investigate the accuracy of optical frequency domain imaging (OFDI) in lipid-rich plaque detection and determine the causes of "misinterpretation," and evaluate whether these limitations can be overcome with intravascular ultrasound (IVUS) using ex-vivo human coronaries. METHODS AND RESULTS: The OFDI images and corresponding 218 histological segments were evaluated. Segments with a poor signal and diffuse borders on OFDI, classified as lipid-rich plaques, were compared with the histological segments and IVUS images. Using histological images as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of OFDI for the detection of lipid-rich plaques were 93%, 93%, 85%, and 97%, respectively. The causes of false-positive diagnosis of lipid-rich plaque (11 segments) were superficial macrophage infiltration causing signal attenuation (8/11 segments, 73%) and tangential signal dropout of light (3/11 segments, 27%), whereas the cause of false-negative diagnosis was thickening of the fibrous cap (5 segments, 100%). Simultaneous IVUS helped to correct the misinterpretation of OFDI results and improved the diagnostic accuracy; the sensitivity, specificity, positive predictive value, and negative predictive value of OFDI with adjunct use of IVUS were 96%, 99%, 99%, and 98%, respectively. CONCLUSIONS: OFDI occasionally over- or underestimates the existence of lipid-rich plaques, which may be overcome with adjunctive usage of IVUS.

Diagnostic accuracy of Global Registry of Acute Coronary Events (GRACE) risk score in ST-elevation myocardial infarction for in-hospital and 360-day mortality in Japanese patients.

BACKGROUND: The purpose of the present study was to confirm the diagnostic accuracy of Global Registry of Acute Coronary Events (GRACE) risk score 1.0 (GRACE 1.0) and updated GRACE 1.0 (GRACE 2.0) for in-hospital and 360-day mortality in ST-elevation myocardial infarction (STEMI) in Japanese patients. GRACE 1.0 and GRACE 2.0 are the established predictive models in acute coronary syndrome, but their application to Japanese patients has not been fully verified. METHODS AND RESULTS: The present study retrospectively analyzed 412 consecutive STEMI patients who had undergone primary percutaneous coronary intervention from January 2006 to September 2011. All causes of death during hospitalization were examined to confirm the diagnostic accuracy of GRACE 1.0 on receiver operating characteristic (ROC) analysis. Similarly, all causes of death during the 360 days after hospitalization were analyzed to confirm the diagnostic accuracy of GRACE 2.0. The average GRACE 1.0 score was 175.8±50.9. In-hospital and 360-day mortality were 13.1% and 15.5%, respectively. Area under the ROC curve, which describes the diagnostic accuracy of the GRACE 1.0 predicted in-hospital mortality and the GRACE 2.0 predicted 360-day mortality, was as high as 0.95 and 0.92, respectively. CONCLUSIONS: Both GRACE 1.0 and GRACE 2.0 had a high diagnostic accuracy for prediction of in-hospital and 360-day mortality in Japanese STEMI patients.

Impact of renal function on adverse bleeding events associated with dual antiplatelet therapy in patients with acute coronary syndrome.

It is believed, but not well established, that renal dysfunction increases the risk of adverse bleeding events associated with dual antiplatelet therapy (DAPT), especially in patients with acute coronary syndrome (ACS). The aim of this study is to estimate the impact of renal function on adverse bleeding events associated with DAPT in patients with ACS. A total of 1,264 ACS patients who received DAPT, clopidogrel (n = 530) or prasugrel (n = 734) in addition to aspirin, were assessed in a multicenter observational study. The relationship between renal function and bleeding event, defined as BARC 3 or 5, was determined using a marginal effect from the logit model and Royston-Parmar model. During an average 313.1 days of the observation period, defined as the duration of DAPT after admission until the implementation of a change in the regimen, bleeding events were observed in 7.4% of patients (n = 94). The estimated curves demonstrated that the probability of bleeding was positive correlated with renal dysfunction (6.0 to 8.6), regardless of the DAPT regimen used. This probability was consistently higher in clopidogrel (7.4 to 10.5) than in prasugrel (4.8 to 0.7). This trend was also shown in maintenance hemodialysis patients (6.7 vs. 10.3). Estimated cumulative incidences among individual stages of renal function were drawn. In conclusion, bleeding events increased with worsening renal function, and prasugrel is safer than clopidogrel as a component of DAPT throughout all levels of renal function, including hemodialysis patients after ACS.

Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study.

BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159.

Temporal variations in ischemic and bleeding event risks after acute coronary syndrome during dual antiplatelet therapy.

BACKGROUND: This study estimates the temporal risk variations of ischemic and bleeding events during dual antiplatelet therapy (DAPT) among patients stratified according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria, suggesting the optimal period for DAPT after acute coronary syndrome (ACS). METHODS: A total of 1264 ACS patients receiving either clopidogrel or prasugrel with aspirin were classified by ARC-HBR; HBR (n = 574) and non-HBR groups (n = 690). This study was designed as a multicenter observation to evaluate the primary endpoints of ischemic, including cardiovascular death, myocardial infarction, or ischemic stroke, and bleeding events, defined as Bleeding Academic Research Consortium type 3/5. The temporal risk variations were estimated using the Cox hazard and Royston-Parmar models. RESULTS: Ischemic and bleeding events were observed in 9.4% and 7.4%, respectively, during an average observation period of 313 days. The HBR group had a higher incidence of both events than the non-HBR group (15.3% vs. 4.5%, P < 0.01 for ischemic; 11.9% vs. 3.8%, P < 0.01 for bleeding). The estimated risk curves for both events revealed peaks and steep declines in the first few days, followed by constant declines. The peak of risk was higher for bleeding than for ischemic events, but this relationship reversed early, with ischemic events displaying a higher risk in both the HBR and non-HBR groups until at least 60 days. CONCLUSIONS: A 60-day period of DAPT is appropriate to balance the risks of adverse events after ACS, regardless of ARC-HBR criteria.

A Case of ST Segment Elevation Myocardial Infarction Within 24 h of a Third Dose of COVID-19 mRNA Vaccine.

Although coronavirus disease 2019 (COVID-19) vaccination is known to carry a slight risk of myocarditis and pericarditis, it remains unclear whether it has any impact on coronary artery disease. Here we present a case without particular thrombotic diathesis with a diagnosis of ST segment elevation acute myocardial infarction (STEMI) 19 h after a third dose of a COVID-19 mRNA vaccine. A primary percutaneous coronary intervention procedure for occluded right coronary artery with thrombus aspiration alone was successful in this patient. However, the relationship between STEMI and COVID-19 mRNA vaccination is uncertain, and additional studies to validate thrombogenetic effects of COVID-19 mRNA vaccines are needed. This case was helpful in distinguishing STEMI from myocarditis and pericarditis, which are recognized rare cardiac side effects of COVID-19 vaccination. It is important not to hesitate to perform coronary angiography procedures to rule out the possibility of STEMI occurrence, as in this case.

Comparison of Mortality Prediction by the GRACE Score, Multiple Biomarkers, and Their Combination in All-comer Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Objective This study examined the ability of a combination of biomarkers, including N-terminal pro-B-type natriuretic peptide (N-BNP) and high-sensitivity C-reactive protein (hs-CRP), to better predict mortality than the Global Registry of Acute Coronary Events (GRACE) score in acute myocardial infarction (AMI) patients who received primary percutaneous coronary intervention (PPCI). Methods The in-hospital mortality in 754 all-comer patients with AMI who underwent successful PPCI over 8 years was examined. A receiver operating characteristic (ROC) analysis was performed to determine the in-hospital mortality in a single center. A logistic regression analysis was used to compare the predictive accuracy of the GRACE score and biomarkers. The incremental predictive value of those biomarkers beyond the GRACE score was also examined. Results The mean age was 66±13 years old, and 609 patients with ST-elevated AMI (80.8%) were included. The in-hospital mortality was 6.8%. The GRACE score (in-hospital survivor/non-survivor: 106±33/161±32; p<0.05,) and N-BNP (in-hospital survivor/non-survivor: 2,458±7,058/8,880±1,1331 pg/mL; p<0.05) were significantly lower in survivors than in non-survivors. The area under the ROC curve (AUC) of in-hospital mortality of the GRACE score was significantly higher than that of the dual-biomarker combination (0.868/0.720; p<0.05). The AUC of the combination of the GRACE score and dual-biomarkers was not significantly higher than that of the GRACE score alone (0.870/0.868; p=0.747). Conclusion The measurement of representative cardiovascular biomarkers did not provide any additional benefit for mortality prediction beyond the GRACE score in AMI patients who received PPCI.

Estimation of adverse events associated with P2Y12 receptor inhibitors stratified by academic research consortium for high bleeding risk criteria in acute coronary syndrome.

BACKGROUND: The usefulness of the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in the selection of P2Y12 receptor inhibitors for acute coronary syndrome is unknown. This study investigated whether the selection of antiplatelet agents according to the ARC-HBR criteria could improve clinical outcomes. METHODS: This multicenter retrospective study included 1261 patients with acute coronary syndrome who received dual antiplatelet therapy, namely clopidogrel (75 mg, n = 529) or prasugrel (3.75 mg, n = 732) in addition to aspirin. The primary endpoint was net adverse clinical events (NACE) after hospital admission, including ischemic (death, myocardial infarction, ischemic stroke) and bleeding events (Bleeding Academic Research Consortium 3 or 5). Secondary outcomes were ischemic and bleeding events. For each patient, the observation period was defined as the duration of dual antiplatelet therapy after admission. RESULTS: During the observation period (average: 313 days), the rate of NACE was lower in the prasugrel group than the clopidogrel group (20.6% vs. 12.6%, respectively, P < 0.01). In patients who satisfied or did not satisfy the ARC-HBR criteria, prasugrel was associated with a 3.7% and 2.1% lower incidence of NACE, respectively, versus clopidogrel. Ischemic and bleeding events were less frequent in the prasugrel group than the clopidogrel group (11.5% vs. 7.9%, respectively, P = 0.03; 10.6% vs. 5.2%, respectively, P < 0.01). The estimated incidence models for NACE suggested that the difference between clopidogrel and prasugrel was greater in patients who satisfied the ARC-HBR criteria than in those who did not. CONCLUSIONS: Prasugrel is preferable to clopidogrel regardless of the ARC-HBR.

Histological evaluation of vascular changes after excimer laser angioplasty for neointimal formation after bare-metal stent implantation in rabbit iliac arteries.

BACKGROUND: Excimer laser is used to treat coronary artery disease, especially in case of lesions with thrombus and in-stent restenosis (ISR). However, there are no in vivo preclinical studies that have evaluated the pathological reactions of the vessel wall after excimer laser ablation. METHODS: Bare-metal stents were placed in the external iliac arteries of six healthy rabbits. Twenty-eight days later, excimer laser ablation was performed with low-power (45 (fluency)/25 (rate)) in one side, and high-power (60/40) in the opposite side, followed by optical coherence tomography (OCT) evaluation. Rabbits were sacrificed 15 min after the procedure, and histological assessment was performed. RESULTS: Morphometry analysis of OCT showed similar stent and lumen size between low-power and high-power group. Histological evaluation suggested endothelial cell loss, fibrin deposition, and tissue loss. The low-power group showed significantly less pathological changes compared with the high-power group: angle of endothelial cell loss, 32.4° vs. 191.7° (interquartile range, 8.8°-131.7° vs. 125.7°-279.5°; p < 0.01); fibrin deposition, 1.1° vs. 59.6° (0.0°-70.4° vs. 31.4°-178.4°; p = 0.03); and tissue loss 0.0° vs. 18.2° (0.0°-8.7° vs. 0.0°-42.7°; p = 0.03). CONCLUSIONS: The pathological changes in neointima were more prominent after high-power excimer laser ablation than after low-power excimer laser. To improve safety in clinical practice, understanding the pathological changes of tissues after excimer laser in lesions with ISR is essential.

Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina.

Conventional radial access (cRA) for percutaneous coronary intervention (PCI) has become the current standard due to low bleeding complications, although recently, distal radial access (dRA) has attracted attention as an alternative. Here, the usefulness of dRA is shown in a case in whom neither side could be used for cRA. The patient was a woman in her 70 s diagnosed with unstable angina pectoris at another hospital. Although ad hoc PCI was attempted via her right forearm radial artery, her hemodynamics deteriorated and the procedure was abandoned. After an intra-aortic balloon pumping device was inserted via the left femoral approach and hemostasis was established with a dedicated device, the patient was transferred to our hospital. Her right radial artery was being used for hemostasis and her left radial artery was poorly palpable. Because her right distal radial artery was palpable, access via that location was attempted after confirming sufficient blood vessel diameter and blood flow by ultrasound. A 6Fr sheath was inserted and PCI was safely accomplished. Hemostasis on dRA was completed without complications using a hemostasis device. Thus, dRA may be an option as an alternative access site in an emergency. .

Effect of Cardiac Rehabilitation on Glomerular Filtration Rate Using Serum Cystatin C Concentration in Patients With Cardiovascular Disease and Renal Dysfunction.

PURPOSE: Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD. METHODS: We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.73 m2) who participated in our CR program for cardiovascular disease. First, the patients were divided into three groups according to the baseline severity of the eGFRcys: G3a, G3b, and G4 groups. We compared the eGFRcys before and after the CR in each group. Second, to determine the association of baseline eGFRcys with the effect of CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome. RESULTS: Of the 203 patients, 122 were in G3a, 60 were in G3b, and 21 were in G4 groups. The mean improvement of eGFRcys in each group was 1.3, 3.1, and 4.8 mL/min/1.73 m2, respectively. The %ΔeGFRcys was larger among patients with lower baseline eGFRcys (0.47% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.23-0.72%). This association remained significant after adjustment for potential confounders (0.63% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.35-0.91%). CONCLUSIONS: The effect of CR on renal function was greater in patients with worse renal dysfunction measured by eGFRcys. A CR program could be useful for patients with severe renal dysfunction and it might have a beneficial effect on their renal function.

Simple percutaneous coronary intervention strategy with a novel guide extension catheter through a 5-Fr guiding catheter for a tortuous coronary artery.

A 78-year-old female diagnosed with effort angina underwent coronary angiography. The findings revealed subtotal occlusion in the tortuous circumflex. The lesion was initially treated with a drug-coated balloon alone; however, restenosis occurred after 2 months. Thus, percutaneous coronary intervention was performed again using a drug-eluting stent (DES) through a 5-Fr guiding catheter to minimize invasiveness. However, it was not possible to pass the lesion with the DES; thus, a novel guide extension catheter with a rapid exchange system was passed under balloon anchoring against the tortuous artery. The use of this guide extension catheter resulted in the successful delivery and implantation of the DES. This approach, using a novel guide extension catheter with a rapid exchange system through a 5-Fr guiding catheter, may facilitate the implantation of devices. Learning objective: Smaller guiding catheter (GC) using a 5-Fr contributes less invasive percutaneous coronary intervention (PCI) procedure for patients. However, sometimes GC stability and device pushability become insufficient in using 5-Fr GC. Hence, we report a case of PCI procedure through a 5-Fr GC with novel guide extension catheter, and it may be an alternative option when GC stability and device pushability are insufficient. It is meaningful to share this method of PCI procedure for all physicians.

Coronary orbital atherectomy using a five-French guiding catheter.

Recently, the efficacy was demonstrated of the Diamondback 360® Coronary Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St. Paul, MN, USA) for treating calcified coronary lesions in percutaneous coronary intervention (PCI). The safety and feasibility of OAS application through a 5-Fr guiding catheter (GC) which is less invasive and reduces access site complications were validated. This sequential, retrospective, observational study was conducted in a single center from September 2018 to May 2020. The primary endpoint was a successful PCI with the OAS. Secondary endpoints were major adverse complications related to PCI with the OAS, including coronary dissection, perforation, side branch loss, need for an unexpected cardiac assist device, access site complications, and major adverse cardiac and cerebrovascular events. 33 PCIs in 30 patients (mean age 72 ± 11 years; male, 83.3%) were surveyed. All PCIs were successfully completed with OAS application through a 5-Fr GC. Coronary perforation after the OAS procedure occurred in one case (3.0%). Severe coronary dissection occurred in three cases (9.1%), and procedural myocardial infarction in two cases (6.1%). Regarding PCIs performed with the 5-Fr GC, the OAS is a safe and feasible strategy for calcified plaque modification.