Long-term follow-up of a rare calcified cardiac tumor: a case report

We describe a case of cardiac masses (high- and iso-echoic mass) which were detected by echocardiography in a 57-year-old man with cerebral infarction. Because he refused both biopsy and surgery, the patient was treated with an anticoagulant and antibiotic in our outpatient clinic. During 3-year follow-up, the iso-echoic mass disappeared and the high-echoic mass did not change. Thus, we considered the iso-echoic mass a thrombus and the high-echoic mass a benign tumor. Cardiac computed tomography revealed that the high-echoic mass had extensive calcifications like phleboliths, and magnetic resonance imaging pattern coincided with that of hemangiomas. We conclude that the benign tumor/high-echoic mass might be a vascular malformation.

Initial findings of impact of strut width on stent coverage and apposition of sirolimus-eluting stents assessed by optical coherence tomography

OBJECTIVES

We investigate the influence of stent design on stent coverage at 6-9 months after sirolimus eluting stent (SES) implantation using optical coherence tomography (OCT).

BACKGROUND

Although some reports suggest that stent design may correlate with stent coverage of stent struts, there were few detailed data whether stent design impact on stent coverage in the same drug-eluting stent.

METHODS

A total of 21 SESs (15 patients), who had implanted 2.5, 2.75, and 3.0 mm stents, underwent OCT at 6-9 months after stent implantation. SES is constructed by two different strut width-components; narrow strut width parts (59 μm) and wide strut width parts (115 μm). Thus, we divided stent struts of SESs into two groups: narrow strut width parts (narrow group) and wide ones (wide group). We compared the incidence of incomplete apposed struts, uncovered struts, and neointimal hyperplasia (NIH) thickness between the two groups.

RESULTS

We could detect 2,948 struts (narrow group consisted of 1,132 struts and wide group consisted of 1,816 struts). Incidence of uncovered struts in the narrow group was significantly lower than in the wide group (30.2% vs. 40.8%, P < 0.001), and NIH thickness in the narrow group was significantly greater than in the wide group (127.5 ± 93.4 μm vs. 118.6 ± 81.4 μm, P = 0.03).

CONCLUSIONS

Stent design, especially strut width, affects stent coverage of SES. The narrow strut may avoid the absence of stent coverage in SES, which correlates with stent thrombosis.

Comparison of angioscopic findings and three-year cardiac events between sirolimus-eluting stent and bare-metal stent in acute myocardial infarction

The safety of sirolimus-eluting stents (SESs) in acute myocardial infarction (AMI) remains controversial. We compared long-term neointimal coverage after stent implantation for AMI evaluated by coronary angioscopy and 3-year clinical events between SESs and bare-metal stents (BMSs). Eighty-seven consecutive patients who received SESs or BMSs for AMI were enrolled. At 8 months after AMI coronary angiography with angioscopy was performed. Using angioscopy we evaluated maximum and minimum grades of neointimal coverage using an angioscopic score (0 to 3). We calculated the heterogeneity score as the maximum grade minus the minimum grade. We compared angioscopic parameters including minimum grade and heterogeneity score of neointimal coverage, thrombi and plaque color, serum parameters, and major adverse cardiac events for 3 years between the 2 groups. The restenosis rate of the SES group (n = 56) was significantly lower than that of the BMS group (n = 31, 9% vs 31%, p = 0.015). The SES group had a lower minimum grade of neointimal coverage and higher heterogeneity score and prevalence of thrombi than the BMS group, but from 8 months to 3 years after stent implantation there were no significant differences in major adverse cardiac events between the 2 groups. In conclusion, a lower minimum grade and greater heterogeneity of neointimal coverage and thrombi were shown for SESs compared to BMSs at 8 months after AMI. However, these findings did not correlate with cardiac events over a period of 3 years in our patients.

Serial angioscopic evaluation of neointimal coverage and incidence of thrombus formation after Paclitaxel-eluting stent implantation: comparison between 6- and 18-month follow-up

BACKGROUND

Long-term serial angioscopic follow-up data after paclitaxel-eluting stent (PES) implantation has not previously been published. The aim of this study is to compare the angioscopic parameters such as neointimal coverage grade and prevalence of red mural thrombus at 6- and 18-month follow-up after PES implantation.

HYPOTHESIS

Neointimal formation continues to grow and prevalence of angioscopic thrombus formation becomes low over time after PES implantation.

METHODS

We retrospectively enrolled 17 patients with 19 stents who underwent both 6- and 18-month follow-up coronary angioscopy after PES implantation. We evaluated the minimum and maximum neointimal coverage grade within 1 stent using coronary angioscopy by classifying neointimal coverage grade into 4 categories. Neointimal coverage grade and incidence of angioscopic red mural thrombus were compared between 6- and 18-month follow-up groups.

RESULTS

Minimum neointimal coverage grade at 18 months become lower than that at the 6-month follow-up (0.95 ± 0.62 at 6 mo vs 0.58 ± 0.51 at 18 mo, P = 0.035), whereas maximum grade was not significantly different (2.16 ± 0.83 at 6 mo vs 2.37 ± 0.76 at 18 mo, P = 0.248). High incidence of angioscopic red mural thrombus at 6 months was maintained even at 18-month follow-up (68% at 6 mo vs 84% at 18 mo, P = 0.224).

CONCLUSIONS

Long-term serial angioscopic follow-up demonstrated persistent high incidence of red mural thrombus formation at 18 months after PES implantation.

Two cases of quadricuspid aortic valve

Quadricuspid aortic valve (QAV) is a rare congenital aortic valve anomaly. We present two cases of QAV diagnosed by using echocardiography including transesophageal echocardiography (TEE) and cardiac computed tomography (CT). The first case, QAV with four equal-sized cusps, was identified in a 58-year-old man. The second case, QAV with a small accessory cusp between the right coronary and non-coronary cusp, was identified in a 42-year-old man. TEE and cardiac CT could lead to accurate diagnosis of QAV. QAV in these two patients could be diagnosed before indication for surgery but it is necessary to continue careful follow-up.

Vulnerable disease may induce neointimal coverage after sirolimus-eluting stent implantation

BACKGROUND

Neointimal formation can protect against thrombosis after sirolimus-eluting stent (SES) implantation; however, promoters of neointimal formation are unknown.

METHODS

Six-month follow-up angioscopy was performed in 141 consecutive patients with SES implantation. All patients received aspirin (100 mg) and ticlopidine (200 mg) daily until angioscopy. We defined 2 grades of neointimal coverage as follows: insufficient coverage including no or partial neointimal coverage of stent struts, and sufficient coverage. The possible promoters of neointimal formation that were evaluated in this study were the condition of coronary artery disease (stable angina or acute coronary syndrome); angioscopic markers, including visible thrombus and plaque color (white or yellow); serum markers, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, hemoglobin A(1c), high-sensitive C-reactive protein, and fibrinogen; blood pressure and smoking; intervention markers, including stent size and length and intravascular ultrasound measurements; and medication, including statins, anticoagulants, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, calcium antagonists, and β-blockers.

RESULTS

Univariate analysis revealed that high-sensitive C-reactive protein, plaque color, and the condition of coronary artery disease were significantly correlated with the grade of neointimal coverage. Multivariate analysis using these 3 parameters revealed that only acute coronary syndrome (vulnerable disease) significantly promoted neointimal coverage.

CONCLUSION

Vulnerable disease may promote neointimal coverage after SES implantation.

High incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: angioscopic comparison with sirolimus-eluting stent

BACKGROUND

Difference of neointimal formational pattern and incidence of thrombus formation between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) at 18 months after stent implantation has not previously been reported.

METHODS

We retrospectively enrolled 35 event-free patients who received SES (15 patients, 18 stents) or PES (20 patients, 23 stents) implantation with 18-month follow-up coronary angioscopy. We divided our patients into SES or PES groups and compared neointimal coverage pattern and incidence of red mural thrombus formation between the 2 groups. Neointimal coverage grades were classified into 4 categories. Minimum neointimal coverage grade, maximum grade, and heterogeneity score were assessed in each stent. Heterogeneity score was calculated by subtracting minimum from maximum grade within one stent.

RESULTS

Minimum neointimal coverage grade of PES was significantly lower than that of SES (0.70 +/- 0.64 vs 1.33 +/- 0.69, P = .005), whereas maximum grade was not significantly different (2.48 +/- 0.73 vs 2.22 +/- 0.73, P = .218). Heterogeneity score and incidence of red mural thrombus of PES were higher than those of SES (1.78 +/- 0.80 vs 0.89 +/- 0.76, P = .002 and 70% vs 11%, P < .001).

CONCLUSIONS

The present study revealed that PES shows more heterogeneous neointimal coverage and higher incidence of thrombus formation as compared with SES at 18 months after stent implantation.