坂倉 建一

Different vascular beds show different tissue characteristics. The mechanism of progression at the culprit site in femoropopliteal arteries remains unclear. This study aims to assess the causes of significant stenosis at culprit lesions in femoropopliteal arteries using optical frequency domain imaging. Femoropopliteal arteries were evaluated in 54 legs from 44 patients with lower extremity artery disease undergoing optical frequency domain imaging-guided endovascular therapy. The causes of stenosis at the culprit sites were evaluated, and the types of acute thrombus were assessed. Multivariate logistic regression analysis was used to find the factors significantly associated with acute thrombus and healed plaque at the culprit sites. Acute thrombus (48%) and healed plaque (46%) were 2 major causes at the culprit sites. Among the types of acute thrombus at the culprit sites, eruptive calcified nodule was the most frequent (66%), erosion (24%) was second, and rupture (10%) was third. Dual antiplatelet therapy before admission to endovascular therapy and low run-off number (0, 1, and 2) were significantly related to acute thrombus, whereas the factors significantly associated with healed plaque were run-off number 0, lipidic plaque, and longer lesions. In conclusion, regardless of acute thrombus or healed plaque, the mechanisms of lower extremity artery disease at culprit sites were associated with thrombus. The prevalence of types of acute thrombus in femoropopliteal arteries was in order of eruptive calcified nodule, erosion, and rupture.

BACKGROUND: Acute myocardial infarction (AMI) is a fatal cardiovascular disease with varying prognosis. Recent studies suggest a close relationship between cardiovascular disease and metabolic dysfunction-associated fatty liver disease (MAFLD), but because the prognostic value of MAFLD in patients with AMI remains unclear, we investigated the relationship between MAFLD and clinical outcomes in patients with AMI. METHODS AND RESULTS: This retrospective study included 1,142 patients with AMI who underwent percutaneous coronary intervention (PCI) to the culprit lesion of AMI and were classified as MAFLD (n=231) and non-MAFLD (n=911). Hepatic steatosis was diagnosed by a liver-to-spleen attenuation (L/S) ratio <1 on computed tomography. The primary outcome was major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal MI, and readmission for heart failure. Over a median follow-up of 609 days, MACE was less frequently observed in the MAFLD group than in the non-MAFLD group (P=0.015). However, the multivariate Cox hazard analysis showed that MAFLD was not associated with MACE (hazard ratio 0.80, 95% confidence interval 0.564-1.140, P=0.219) after controlling for confounding factors. CONCLUSIONS: We could not show a significant association between MAFLD and MACE in patients with AMI, suggesting the absence of strong association between MAFLD and long-term clinical outcomes in these patients.

The Task Force on Rotational Atherectomy of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed the expert consensus document to summarize the techniques and evidence regarding rotational atherectomy (RA) in 2020, which was updated in 2023. Because the revascularization strategy to severely calcified lesions has been the hottest topic in contemporary percutaneous coronary intervention (PCI), many literatures related to RA have been published since 2023. Latest advancements have been incorporated in this updated expert consensus document.

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.