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Kobayashi N, Hirano K, Nakano M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Yamawaki M, Araki M, Takimura H, Sakamoto Y. Development and validation of a new scoring system to predict wound healing after endovascular therapy in critical limb ischemia with tissue loss. J Endovasc Ther 2016; 22:48-56. [PMID: 25775680 DOI: 10.1177/1526602814564370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop a scoring system to predict wound healing in critical limb ischemia (CLI) patients treated with endovascular therapy (EVT). METHODS Between July 2007 and January 2013, 184 patients (118 men; mean age 73.0 years) with CLI (217 limbs) and tissue loss underwent EVT. From this cohort 236 separate wounds were divided into development (n = 118) and validation (n = 118) groups. Predictors of wound healing were identified using multivariable analysis. Each predictor was assigned a score based on its regression coefficient, and total scores were calculated, ranging from 0 to 1 for low risk up to ≥ 4 for high risk of a nonhealing wound. The performance of the scoring system in the prediction of wound healing was evaluated by calculating the area under the receiver operating characteristics (ROC) curve. RESULTS By multivariable analysis, a University of Texas grade ≥ 2 (HR 0.524, 95% CI 0.288-0.951, p = 0.034), an infected wound (HR 0.497, 95% CI 0.276-0.894, p = 0.020), dependence on hemodialysis (HR 0.459, 95% CI 0.259-0.814, p = 0.008), no visible blood flow to the wound (HR 0.343, 95% CI 0.146-0.802, p = 0.014), and major tissue loss (HR 0.322, 95% CI 0.165-0.630, p = 0.001) predicted a non-healing wound. The 1-year rates of wound healing in the low-, intermediate-, and high-risk groups were 94.6%, 67.6%, and 9.1%, respectively, in the development group (p < 0.001) and 92.3%, 70.5%, and 31.3%, respectively, in the validation sample (p < 0.001). The area under the ROC curve was 0.922 in the development group and 0.808 in the validation sample. CONCLUSION This scoring system reliably predicts wound healing in CLI patients after endovascular revascularization and is potentially helpful in deciding if additional adjuncts or revascularization should be considered.
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Tokuda T, Yamawaki M, Mori S, Takimura H, Sakamoto Y, Kobayashi N, Araki M, Hirano K, Ito Y. Risk Factors and Clinical Impacts of Peri-Stent Contrast Staining After Second-Generation Drug-Eluting Stent Implantation. J Interv Cardiol 2016; 29:179-87. [PMID: 26822952 DOI: 10.1111/joic.12282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation is associated with target lesion revascularization (TLR) and very late stent thrombosis. However, the risk factors and clinical sequelae of PSS after second-generation DES implantation remain unclear. METHODS AND RESULTS This study comprised 2,090 patients with 2,883 lesions treated with second-generation DES from April 2009 to February 2013. Angiographic findings and clinical outcomes were compared between PSS and non-PSS groups. Follow-up angiography was available for 2,411 lesions. PSS was observed in 23 lesions: 4 in biolimus-eluting stents, 4 in zotarolimus-eluting stents (ZES), and 15 in everolimus-eluting stents (EES). Right coronary artery lesions, chronic total occlusion (CTO), and lesions with severe angulation (>90°) were more frequent in the PSS group compared with the non-PSS group. Lesions were longer and the cumulative TLR incidence at 3 years was higher in the PSS group than those in the non-PSS group (27.9 mm vs. 19.4 mm, P < 0.0001; 27.4% vs. 8.6%, P = 0.0002). There was no significant difference in stent thrombosis between the two groups. Multivariable analysis identified CTO [odds ratio (OR) 3.75, 95%CI 1.52-8.88, P = 0.005] as an independent predictor of PSS. CONCLUSIONS PSS after second-generation DES implantation was associated with an increased risk of subsequent TLR. CTO was the independent predictor of PSS.
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Kobayashi N, Ito Y, Nakano M, Araki M, Hirano K, Yamawaki M, Takimura H, Sakamoto Y, Tsukahara R, Muramatsu T. Incidence and Characteristics of Late Catch-Up Phenomenon Between Sirolimus-Eluting Stent and Everolimus-Eluting Stent: A Propensity Matched Study. J Interv Cardiol 2015; 28:551-62. [DOI: 10.1111/joic.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Takimura H, Hirano K, Muramatsu T, Tsukahara R, Ito Y, Sakai T, Ishimori H, Nakano M, Yamawaki M, Araki M, Kato T, Kobayashi N, Sakamoto Y, Ishii A, Takama T, Tokuda T. Vascular elastography: a novel method to characterize occluded lower limb arteries prior to endovascular therapy. J Endovasc Ther 2015; 21:654-61. [PMID: 25290793 DOI: 10.1583/13-4487mr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine the effectiveness of vascular elastography (VE) for the assessment of totally occluded lower limb arteries prior to endovascular treatment (EVT). METHODS Of 812 consecutive patients who underwent EVT between April 2010 and April 2012, VE was used to evaluate the hardness of chronic total occlusions of the femoropopliteal segment prior to EVT in 65 consecutive patients (48 men; mean 73.9 years, range 63-86). Elastograms of the CTOs proximally and distally were scored using a 5-point scale, and outcomes in limbs with hard lesions (VE score 0-2) were compared to those with soft lesions (VE score 3-4) according to lesion length. The interventionists who performed the endovascular procedures were not informed of the VE score results. RESULTS CTO characteristics could be evaluated in all cases. A VE score ≤2 was found in 14 of the 23 lesions <150 mm in length. A flexible guidewire was sufficient for recanalization in more of the soft lesions than in the hard lesions [6/9 vs. 2/14, respectively]. In 39 lesions >150 mm, a VE score of 3 was recorded in most lesions proximally, while lesions distally were hard in many cases (VE score 1 or 2). A flexible guidewire alone was sufficient in many soft CTOs (8/13, p<0.01). In 16 cases, hard calcified plaque was indicated by difficulty in penetrating the lesion even with a stiff guidewire; all these cases had a VE score of 1 or 2. A retrograde approach was required only in hard CTOs (p<0.01). The procedure time was significantly longer for the hard lesion group (152.9±63.2 vs. 87.0±29.8 minutes, p=0.001). In 11 in-stent occlusions, only VE scores of 3 (n=4) or 4 (n=7) were recorded, indicating soft thrombus, which was aspirated under distal protection in 7 cases. CONCLUSION VE may be a useful method for determining the hardness of CTO lesions noninvasively before endovascular therapy, providing information that can help plan the procedure.
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Honda Y, Muramatsu T, Ito Y, Sakai T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mouri S, Tsutumi M, Takama T, Takafuji H, Tokuda T, Makino K. Impact of ultra-long second-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2015; 87:E44-53. [DOI: 10.1002/ccd.26010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 11/06/2022]
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Tokuda T, Muramatsu T, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H, Takama T, Honda Y. TCTAP A-058 The Changes and Clinical Outcomes of Peri-Contrast Staining (PSS) in First Generation DES Era to Second Generation DES Era. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.03.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsutsumi M, Muramatsu T, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Takama T, Takafuji H, Honda Y, Tokuda T. TCTAP A-149 Clinical Outcome of Drug-Eluting Stent Implantation for Isolated Left Circumflex Ostial Stenosis. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.03.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tokuda T, Hirano K, Muramatsu T, Ishimori H, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H, Takama T, Honda Y. TCTAP A-098 The Clinical Outcomes of EVT for Restenosis of Superficial Femoral Artery Stent with Jailed Deep Femoral Artery. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.03.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tokuda T, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Tsutsumi M, Takafuji H, Takama T. THE RELEVANCE TO CLINICAL OUTCOMES AND RISK FACTORS OF PERI-CONTRAST STAINING (PSS) AFTER SECOND GENERATION DES DEPLOYMENT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kobayashi N, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Takimura H, Sakamoto Y. Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation. Heart Vessels 2014; 31:330-40. [PMID: 25523891 DOI: 10.1007/s00380-014-0615-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.
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Takama T, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Nakano M, Hirano K, Araki M, Yamawaki M, Kobayashi N, Mori S, Takafuji H, Tsutsumi M, Takimura H, Sakamoto Y, Tokuda T. TCT-392 Relation Between Malapposition And Thrombus In ST-segment Elevation Myocardial Infarction using Optical Coherence Tomography. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tokuda T, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H. TCT-651 The Relevance to Clinical Outcomes of Stent Fracture after Second Generation DES deployment. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mori S, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Tsutsumi M, Takama T, Takafuji H, Honda Y, Tokuda T, Makino K. TCT-544 Post-Procedural Intravascular Ultrasound Findings on Short-Term Outcomes of Drug-Eluting Stent Implantation for Femoropopliteal Lesions. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tsutsumi M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Takafuji H, Takama T, Honda Y, Tokuda T. TCT-543 Middle-Term Clinical Outcome of Femoropopliteal Stenting with Drug-Eluting Stent for Diabetic Patients. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tokuda T, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H. TCT-88 The Clinical Outcomes of Peri-contrast Staining (PSS) after Second Generation DES Implantation. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsutsumi M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kato T, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Takafuji H, Tokuda T, Kenji M. TCTAP A-104 Real World Clinical Outcome of Drug-eluting Stent Implantation in Femoropopliteal Lesions. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kobayashi N, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kato T, Inoue Y, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H, Tokuda T, Kenji M. TCTAP A-099 Predictors of Wound Healing in Patients with Critical Limb Ischemia with Tissue Loss Following Successful Endovascular Treatment. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mori S, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kato T, Kobayashi N, Takimura H, Sakamoto Y, Tsutsumi M, Takafuji H, Tokuda T, Kenji M. TCTAP A-073 Angiographic and Clinical Outcome of Drug-eluting Stent Implantation for Right Coronary Ostial Lesion. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kenji M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kato T, Kobayashi N, Inoue Y, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H, Tokuda T. TCTAP A-017 The Clinical Result of Percutaneous Coronary Intervention for Acute Myocardial Infarction with Cardio-pulmonary Arrest. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Takimura H, Muramatsu T, Tsukahara R, Ito Y, Sakai T, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Kato T, Kobayashi N, Sakamoto Y, Mori S, Tsutsumi M, Takafuji H, Tokuda T, Kenji M. TCTAP A-101 Efficacy of the Preoperative Assessment with Ultrasonography “Vascular Elastograph” in Endovascular Therapy. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Takafuji H, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kato T, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Tsutsumi M, Takama T, Tokuda T, Makino K. TCTAP A-022 Comparison of PCI Procedure and Outcomes in Patients with STEMI (Differences in TIMI Risk Score). J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Takimura H, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kato T, Kobayashi N, Sakamoto Y, Mori S, Tsutsumi M, Takama T, Takafuji H, Tokuda T. TCT-552 Nitinol Selfexpanding Paclitaxel-eluting Stent is Useful in Endovascular Therapy for In-stent Restenosis after Superficial Femoral Artery Stenting. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Takimura H, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kato T, Kobayashi N, Sakamoto Y, Mori S, Tsutsumi M, Takama T, Takafuji H, Tokuda T. TCT-485 Paclitaxel Prevented the Intimal Proliferation after Percutaneous Coronary Intervention for Patients with Renal Insufficiency. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tsutsumi M, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kato T, Kobayashi N, Takimura H, Sakamoto Y, Mori S, Takama T, Takafuji H, Tokuda T. TCT-201 The middle-term outcome of small-vessel stenting with the second-generation drug-eluting stents. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Takimura H, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Araki M, Kobayashi N, Kato T, Sakamoto Y, Mori S, Tsutsumi M, Takama T, Takafuji H, Tokuda T. TCT-551 Efficacy of the Preoperative Assessment with a Ultrasonography "Vascular Elastography" in Endovascular Therapy. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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