Impact of small diameter and low level of emission laser coronary atherectomy in patients with acute myocardial infarction.

Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, ß-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022-0.959, p = 0.045; OR, 0.077, 95% CI, 0.007-0.805, p = 0.032; OR, 6.494, 95% CI, 1.228-34.34, p = 0.028; OR, 0.890, 95% CI, 0.828-0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era.

Excimer laser coronary atherectomy prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions.

This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest-incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)-were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan-Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614-8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.

Comparison of 0.9-mm and 1.4-mm catheters in excimer laser coronary angioplasty for acute myocardial infarction.

Excimer laser coronary angioplasty (ELCA) is a unique revascularization modality that can vaporize plaque and thrombus. Compared to thrombus aspiration therapy, ELCA is reported to provide better microcirculation and reduced peripheral embolism in treatment for acute coronary syndrome. Excimer laser catheters come in various sizes, and we sought to compare the 0.9- and 1.4-mm-diameter catheters. We retrospectively enrolled 90 acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention with excimer laser from August 2013 to March 2017 in our hospital. Patients were grouped by diameter of catheter that had been used, the 0.9 mm group (n = 51) and 1.4 mm group (n = 39). We evaluated myocardial perfusion, procedural success rate, short-term outcome, lesion crossability, and complications between the two groups. The percentage of patients whose final thrombolysis in myocardial infarction (TIMI) grade was 3 (0.9 mm 86.3% vs 1.4 mm 89.7% p = 0.75) and final myocardial blush grade (MBG) was 3 (0.9 mm 72.5% vs 1.4 mm 69.2% p = 0.82) was similarly high for both groups. Procedural success rate, in-hospital major adverse cardiac events (MACE), lesion crossability, and complications were also similar. This study showed that efficacy of 0.9 and 1.4 mm excimer laser catheter was equivalent in ELCA for AMI patients. If one takes into account lesion crossability, debulking effects, and the stunned platelets phenomenon, the 0.9 mm excimer laser catheter is sufficient for ELCA in AMI patients.

Optical Frequency Domain Imaging of Very Late Stent Thrombosis Following Bare-Metal Stent Implantation for Acute Myocardial Infarction.

A 43-year-old man was admitted to our hospital with ST-segment elevation acute coronary syndrome. He had experienced myocardial infarction 19 months previously, and a bare-metal stent (BMS) had been implanted in the culprit distal right coronary artery at another hospital. Emergency coronary angiography showed thrombotic in-stent occlusion of the BMS. Intravascular ultrasound revealed an undersized stent compared with the size of the vessel and late stent malapposition (LSM) with abundant thrombi. The lesion was successfully recanalized via thrombectomy and plain old balloon angioplasty. Optical frequency domain imaging performed at follow-up coronary angiography confirmed the improvement of the LSM and incomplete neointimal stent coverage. This report illustrates the importance of imaging modalities in elucidating the mechanism of BMS-related very late stent thrombosis.

Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization.

BACKGROUND: Sodium bicarbonate and ascorbic acid have been proposed to prevent contrast-induced nephropathy (CIN). The present study evaluated the effect of their combined use on CIN incidence.Methods and Results:We prospectively enrolled 429 patients with chronic kidney disease (CKD: baseline estimated glomerular filtration rate <60 mL/min/1.73 m2) prior to elective coronary catheterization. CIN was defined as absolute (≥0.5 mg/dL) or relative (≥25%) increase in serum creatinine within 72 h. In the saline hydration (n=218) and combined sodium bicarbonate+ascorbic acid (n=211) groups, a total of 1,500-2,500 mL 0.9% saline was given before and after the procedure. In addition, the combination group received 20 mEq sodium bicarbonate and 3 g ascorbic acid i.v. before the procedure, followed by 2 g ascorbic acid after the procedure and a further 2 g after 12 h. There were no significant differences between the basic characteristics and contrast volume in the 2 groups. CIN occurred in 19 patients (8.7%) in the saline group, and in 6 patients (2.8%) in the combined treatment group (P=0.008). CONCLUSIONS: Combined sodium bicarbonate and ascorbic acid could prevent CIN following catheterization in CKD patients.

Transcatheter aspiration of a thrombus and percutaneous transluminal coronary recanalization for ST-segment elevation myocardial infarction related to coronavirus disease 2019.

Although the novel coronavirus disease 2019 (COVID-19) causes severe viral pneumonia, it has also been reported, in some cases, to co-exist with ST-segment elevation myocardial infarction. Here, we describe the case of a patient with COVID-19 and coronary risk factors for hypertension, including smoking and obesity, who developed acute myocardial infarction due to primary coronary artery thrombosis and was treated with transcatheter thrombus aspiration and percutaneous transluminal coronary recanalization (PTCR) with intracoronary urokinase administration. A large volume of thrombus was collected and thrombolysis in myocardial infarction flow grade 3 was obtained after the procedures. PTCR with or without transcatheter thrombus aspiration may be a useful treatment option. .

Delayed bleeding complication due to internal mammary artery injury after ultrasound-guided percutaneous catheter drainage for liver cyst infection.

BACKGROUND: Ultrasound-guided percutaneous catheter drainage (PCD) is widely accepted as a primary treatment for pyogenic liver abscess. Severe PCD-related complications have been reported; however, delayed bleeding complications due to internal mammary artery injury are unknown. CASE PRESENTATION: An 84-year-old man undergoing hemodialysis owing to chronic kidney disease due to focal segmental glomerulosclerosis was admitted to our hospital for liver cyst infection. Ultrasound-guided PCD was carried out through the normal liver at the upper abdominal midline at the level of the sixth intercostal space. Two days later, an abdominal hematoma occurred at the puncture site. Contrast-enhanced computed tomography revealed extravasation of the distal right internal mammary artery, which was successfully treated with percutaneous coil embolization. CONCLUSION: Internal mammary artery injury should be considered as a differential diagnosis when a progressing hematoma develops after PCD.

Rotational Atherectomy for Ablation of Multiple Channel Structure Observed by Optical Frequency Domain Imaging.

BACKGROUND Previous case reports have shown that regardless of the etiology, multiple channel structures can be treated successfully by routine percutaneous coronary intervention. However, there are no general recommendations for intervention because multiple channel structures are complex and rarely diagnosed. CASE REPORT A 71-year-old male was admitted to our hospital due to bronchial pneumonia. After admission, the patient experienced acute decompensated heart failure. Coronary angiogram revealed 3 diseased vessels with heavy calcification. Although the patient's syntax score was high, we performed percutaneous coronary intervention (PCI) on each vessel based on his request and in consideration of his dementia. After PCI for the left circumflex and descending arteries, we performed PCI for the right coronary artery (RCA) using optical frequency domain imaging (OFDI). A multiple channel structure and calcified nodule were observed by OFDI. We performed rotational atherectomy (RA) on the RCA, and the 2 structures were ablated. After RA, we dilated the lesions with a scoring balloon and deployed a drug-eluting stent. CONCLUSIONS RA was effective in ablating partition walls of the multiple channel structure observed using OFDI.

Internal Mammary Artery Injury without Chest Wall Fractures after Cardiopulmonary Resuscitation: A Case Report.

High-quality cardiopulmonary resuscitation (CPR) is crucial for survival from cardiac arrest. However, various chest compression-associated injuries have been reported. Internal mammary artery (IMA) injury is one of the rare complications after CPR, and most of cases include rib and sternum fractures. In this report, we describe a rare case of IMA injury without chest wall fractures after CPR. An 85-year-old man with a history of acute myocardial infarction 2 weeks prior visited to our hospital for sustained ventricular tachycardia (VT). After admission, sustained VT requiring CPR occurred several times. Emergency coronary angiogram revealed 90% stenosis at the left anterior descending artery. Hence, emergency percutaneous coronary intervention (PCI) was performed. During the PCI, blood gas analysis showed decreasing serum hemoglobin levels. Contrast computed tomography revealed hemothorax and extravasation at the branch of the right IMA without chest wall fractures. The patient's deteriorating hemodynamic condition precluded thoracotomy or embolization to stop the bleeding. The patient died on the next day of hospitalization. IMA injury can occur after CPR, regardless of chest wall fractures and can be fatal without early diagnosis. For an emergency physician, IMA injury should be considered as a cause of unknown anemia after CPR.

Combination of drug-coated balloon angioplasty and excimer laser coronary angioplasty ablation for coronary restenosis of Kawasaki disease: A case report.

Coronary aneurysm is a well-known sequela of Kawasaki disease. Although ischemic heart disease often becomes problematic due to coronary aneurysm and severe calcification, there is no consensus on how to treat ischemic lesions in those with Kawasaki disease. We describe a case of successful percutaneous coronary intervention of the restenosis lesion within a coronary artery aneurysm accompanied by Kawasaki disease by using an excimer laser coronary angioplasty ablation technique followed by drug-coated balloon angioplasty. .

Isolated adrenocorticotropin deficiency associated with delirium and takotsubo cardiomyopathy.

We report a 65-year-old woman with isolated adrenocorticotropic hormone (ACTH) deficiency. The patient was transported to the emergency outpatient department by ambulance complaining of malaise and nausea. Because her laboratory data revealed hyponatremia, we performed endocrinological examinations and diagnosed isolated ACTH deficiency. After admission, she went into a delirious state and suffered from takotsubo cardiomyopathy due to adrenal insufficiency. Replacement therapy with hydrocortisone sufficiently improved her delirium and cardiomyopathy. We conclude that her unstable mental state and myocardial dysfunction were closely related to adrenal insufficiency and suggest that adrenal crisis may cause delirium and Takotsubo cardiomyopathy.