坂倉 建一

BACKGROUND: There is a substantial risk of slow flow during percutaneous coronary intervention (PCI) for the culprit lesion in acute myocardial infarction (AMI), which can lead to adverse outcomes. We hypothesized that single-step long balloon inflation during stent deployment was associated with a more favorable final Thrombolysis in Myocardial Infarction (TIMI) flow grade. This retrospective study aimed to compare both the final TIMI flow grade and the delta TIMI flow grade in intravascular ultrasound (IVUS)-guided PCI for AMI between patients with long balloon inflation and those with conventional inflation. METHODS AND RESULTS: Long inflation was defined as single-step inflation ≥60 s at stent deployment. The primary endpoints were achievement of the final TIMI flow grade 3 and the delta TIMI flow grade, defined as the difference between the initial and final grades. We analyzed 336 AMI patients with attenuation plaque on IVUS, dividing them into a long inflation group (n=50) and a conventional inflation group (n=286). Despite a significantly higher TIMI thrombus grade in the long inflation group (P<0.001), the rate of the final TIMI 3 flow was similar (90% vs. 88.5%; P=1.00). However, the delta TIMI flow grade was significantly greater in the long inflation group (P=0.028). CONCLUSIONS: Single-step long balloon inflation may be a simple and feasible method to achieve optimal final TIMI flow in IVUS-guided PCI for AMI.

BACKGROUND: Primary percutaneous coronary intervention (PCI) has improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, radiation skin damage is one of serious complications in primary PCI. The purpose of this study was to identify the determinants of the excess radiation dose in primary PCI. METHODS: We included 1126 patients with STEMI and divided them into an excess radiation group (n = 61; peak skin dose ≥2 Gy) and a standard radiation group (n = 1065; peak skin dose <2 Gy). Univariate and multivariate logistic regression analyses were performed to find patient or procedural factors associated with excess radiation. RESULTS: In patient factors, body mass index (BMI) was significantly associated with excess radiation [odds ratio (OR) 1.09, 95 % confidence interval (CI) 1.01-1.18, P = 0.022] after controlling for confounding factors. In procedural factors, use of intra-aortic balloon pumping (OR 2.12, 95 % CI 1.05-4.27, P = 0.035), number of used guidewire (OR 1.70, 95 % CI 1.26-2.31, P < 0.001), number of used balloon (OR 1.50, 95 % CI 1.18-1.92, P = 0.001), total length of stents (OR 1.25, 95 % CI 1.09-1.44, P = 0.002), use of microcatheters (OR 2.18, 95 % CI 1.13-4.21, P = 0.02) and thrombus aspiration (OR 3.86, 95 % CI 2.07-7.20, P < 0.001) were significantly associated with excess radiation after controlling for confounding factors. CONCLUSIONS: In primary PCI for STEMI, high BMI and using many devices were significantly associated with excess radiation. We should pay special attention to patients with high BMI and complex lesions which require many devices to prevent excess skin radiation.

The KCB01 (KIZASHI™) is a novel cutting balloon catheter with blades integrally formed with the balloon. It is designed to overcome the drawbacks of conventional cutting balloons in terms of lesion delivery, crossability and procedural complications while maintaining the same dilation capacity. To evaluate the efficacy and safety of the KCB01, a prospective, open-label, single-arm study was conducted at nine sites in Japan on percutaneous coronary intervention-eligible patients with stenotic lesions that exhibited residual indentation even after conventional balloon dilation at nominal pressure. Seventy-six patients were enrolled between November 2022 and June 2023, and 73 eligible patients were included in the primary analysis. The mean age was 73.5 ± 7.4 years, and 79.5% of the patients were male. The target lesion characteristics included bifurcation lesions (42.5%), in-stent restenosis lesions (20.5%), and severely calcified lesions (54.8%). The primary endpoint was procedural success, defined as the KCB01 crossing the target lesion, no residual indentation, and < 50% residual stenosis rate after KCB01 dilation (assessed using quantitative coronary angiography). The angiographic images obtained during the procedure were evaluated in a core laboratory. The procedural success rate was 87.7% (95% confidence interval [CI]: 77.9-94.2), with the lower limit of the 95% CI (77.9%) exceeding the performance goal of 76.5%. Clinical success rate was achieved in 94.5% of cases (95% CI: 86.6-98.5%), with no major adverse cardiac events reported until discharge. Furthermore, no device deficiencies related to the KCB01 were observed. These results suggest the safety and efficacy of the KCB01.

Purpose To evaluate the prognostic value of the periaortic fat attenuation index (FAI), which noninvasively captures vascular inflammation on noncontrast CT images, in managing uncomplicated type B aortic dissection (TBAD). Materials and Methods In this retrospective multicenter study (January 2011-December 2022), an automated machine learning algorithm measured periaortic FAI of the descending thoracic aorta at noncontrast CT. Patients who underwent CT for chest or back pain were included to compare FAI between those with acute aortic dissection, including both type A and B, and those without. Further, prognostic evaluation of patients with uncomplicated TBAD was conducted using multivariable Cox proportional hazards regression. Results A total of 688 patients (median age, 69 years [IQR, 56-79]; 400 male patients), including 380 with acute aortic dissection and 308 without, were analyzed for the diagnostic characteristics of FAI, and 135 patients with uncomplicated TBAD (median age, 70 years [IQR, 59-79]; 90 male patients) were followed up for prognosis. FAI values at initial presentation were higher in patients with acute aortic dissection than in those without (median, -74.5 vs -78.7 HU; P < .001). In patients with uncomplicated TBAD, FAI values peaked on the 6th day after onset. These patients were divided into two groups according to the median peak FAI value of -64 HU. During a median follow up of 529 days, those with higher peak FAI values (≥-64 HU) had higher rates of all-cause death and aortic events (log-rank P < .001). High peak FAI independently predicted these events (adjusted hazard ratio, 4.54 [95% CI: 1.69, 12.21]; P = .003). Conclusion A higher peak FAI value was an independent risk factor for adverse events in patients with uncomplicated TBAD. Keywords: Acute Aortic Dissection, Fat Attenuation Index, Noncontrast CT, Perivascular Adipose Tissue, Prognosis UMIN Clinical Trials Registry (AIDFAI study no. UMIN000053435). Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.