桑原 政成

This study aimed to identify the clinical characteristics associated with spontaneous isolated dissection of superior mesenteric artery/celiac artery (SIDSMA/SIDCA). This observational study, conducted at Toranomon Hospital, Japan between 2009 and 2020, analyzed consecutive SIDSMA/SIDCA cases based on radiology data. The study compared clinical characteristics between symptomatic and asymptomatic patients with SIDSMA/SIDCA and investigated factors related to future vessel dilatation. Among 57 cases (44 SIDSMA, 17 SIDCA, and 4 both), the majority were male (87.7%), nearly half having hypertension (43.9%) and smokers (48.9%). Of those, 17 cases (29.8%) were symptomatic; abdominal pain (94.1%), back pain (23.5%), nausea (17.6%) and fever (5.9%). The symptomatic group was younger (52.6 ± 9.4 versus 67.2 ± 7.9 years, P < 0.001), had higher systolic and mean blood pressure (142.6 ± 20.0 versus 129.5 ± 16.5 mmHg, P = 0.017; 96.1 ± 14.6 versus 88.2 ± 17.7 mmHg, P = 0.038), a higher white blood cell count (9975 ± 5032 versus 6268 ± 1991 /µL, P = 0.012), and a higher LDL cholesterol level at diagnosis (129.7 ± 21.7 versus 87.2 ± 25.6 mg/dL, P = 0.002) than the asymptomatic group. The factors associated with future vessel dilatation included the presence of pseudo-lumen flow in the dissection vessel (73.9% versus 41.4%, p = 0.019) and a larger vessel diameter (13.5 ± 2.4 mm versus 11.5 ± 2.1 mm, p = 0.005) at diagnosis after multiple adjustments, pseudo-lumen flow was a predictor of future vessel dilatation (odds ratio, 4.80; 95% confidence interval, 1.11-20.75; p = 0.036). The study revealed that only 30% of SIDSMA/SIDCA cases were symptomatic. Symptomatic cases were generally younger and exhibited higher blood pressure and elevated white blood cell counts. These findings offer valuable insights for the acute diagnosis of SIDSMA/SIDCA.

Intravascular ultrasound (IVUS) has become a standard procedure for performing coronary intervention, but its impact on peripheral endovascular therapy (EVT) remains unclear. To assess the usefulness of IVUS during EVT, this study analyzed over 2000 consecutive patients from the TOkyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry with peripheral arterial disease (PAD) in Japan. The primary outcome was chronic limb events (a composite of clinically driven target lesion revascularization (cTLR) and major amputation) during a two-year follow-up period. The secondary outcomes included the procedural success rate, in-hospital major adverse limb events (MALE), and major cardiac and cerebrovascular events (MACCE). Patients with and without IVUS were compared using propensity score matching. Among the 2227 eligible cases enrolled, with a median follow-up period of 10.4 months, there were no significant differences in limb events between IVUS (784 patients) and non-IVUS (1443 patients) groups during the follow-up period (15.4% vs. 14.4%, P = 0.53, unadjusted; 14.8% vs. 15.4%, P = 0.77, adjusted). In contrast, the IVUS group had higher procedural success rates (98.7% vs. 96.7%, P = 0.02) and lower in-hospital MALE (1.6% vs. 4.1%, P = 0.01), even after multiple adjustments. Additionally, there was no significant difference in the MACCE incidence (10.9% vs. 12.2%, P = 0.47) between the groups. This study demonstrated that IVUS usage did not reduce the occurrence of limb events among EVT patients in the chronic phase, but IVUS may improve in-hospital outcomes. Further research is necessary to verify these findings.