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Nishino M, Egami Y, Nakamura H, Abe M, Ohsuga M, Nohara H, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M. Clinical Impact of Perfusion Balloon for ST-Segment Elevated Myocardial Infarction: RYUSEI Study. Am J Cardiol 2024; 223:43-51. [PMID: 38734400 DOI: 10.1016/j.amjcard.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Drug-eluting stents have significantly contributed to reducing mortality in patients with ST-segment elevation myocardial infarctions (STEMIs), but slow-flow/no-reflow phenomenon (SFNR) and in-stent restenosis are still clinical problems. In contrast, perfusion balloons (PBs) can compress thrombi and ruptured plaque for long inflation without ischemia and can be used as a delivery device for infusion of nitroprusside to distal risk area during ballooning. We conducted a Reduction of risk bY perfUsion balloon for ST-segment Elevated myocardial Infarction (RYUSEI) study to evaluate whether PBs before stenting are more effective than conventional stenting for STEMIs. We divided consecutive patients with STEMIs who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention into PB group who were treated with PBs (Ryusei; Kaneka Medix Corporation, Osaka, Japan) before stenting and the conventional percutaneous coronary intervention (CP) group. We compared clinical results including SFNR, OCT findings, and clinical events between the 2 groups. We finally analyzed 34 patients in PB group and 90 in CP group. After propensity score-matching, PB and CP groups consisted of 23 patients, respectively. In the propensity score-matched cohort, SFNR and maximum protrusion area detected by OCT were significantly lower (p = 0.047 and p = 0.019), and thrombolysis in myocardial infarction flow grade 3 was higher (p = 0.022) in the PB group than CP group. Kaplan-Meier analysis revealed a significantly better clinical outcome in PB group than CP group (p = 0.038). In conclusion, the RYUSEI study revealed a pre-stent lesion modification in addition to nitroprusside infusion using PB is useful to achieve better clinical courses in STEMI patients.
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Affiliation(s)
- Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan.
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Masaru Abe
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Mizuki Ohsuga
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Nagasonecho, Kita-ku, Sakai, Osaka, Japan
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Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, Morino Y, Okura H, Ikari Y, Kozuma K, Honye J. CVIT 2023 clinical expert consensus document on intravascular ultrasound. Cardiovasc Interv Ther 2024; 39:1-14. [PMID: 37656339 PMCID: PMC10764584 DOI: 10.1007/s12928-023-00957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
Intravascular ultrasound (IVUS) provides precise anatomic information in coronary arteries including quantitative measurements and morphological assessment. To standardize the IVUS analysis in the current era, this updated expert consensus document summarizes the methods of measurements and assessment of IVUS images and the clinical evidence of IVUS use in percutaneous coronary intervention.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Kenichi Fujii
- Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Yahaba, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Junko Honye
- Department of Cardiovascular Medicine, Kikuna Memorial Hospital, Yokohama, Japan
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Wu X, Wu M, Huang H, Wang L, Liu Z, Cai J, Huang H. Comparative Clinical Implications of Calcified versus Non-Calcified Tissue Protrusion After Coronary Stent Implantation. Int J Gen Med 2023; 16:5935-5946. [PMID: 38115967 PMCID: PMC10729605 DOI: 10.2147/ijgm.s445493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
Purpose The prognostic implications of calcified versus non-calcified tissue protrusions (TPs) following stent implantation remain undetermined. This study aimed to evaluate the differential clinical outcomes associated with calcified and non-calcified TP morphologies. Patients and Methods Employing intravascular ultrasound (IVUS), we identified calcified TPs as calcium fragment extrusions permeating the stent struts, while non-calcified TPs were characterized as plaque and/or thrombus extensions through the stent into the arterial lumen. The primary endpoint encompassed target lesion failure (TLF), comprising cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization (TLR), or stent thrombosis, assessed in patients with a follow-up period exceeding one year. Results Of 1033 patients subjected to pre- and post-intervention IVUS, 62 exhibited calcified TPs (6.0%), and 279 presented non-calcified TPs (27.0%), forming the basis of this analysis. Multivariable linear regression indicated calcified nodules as a significant predictor of calcified TP [Odds Ratio (OR) 2.47; 95% Confidence Interval (CI) 2.33 to 2.62; P <0.001], with ST-segment elevation myocardial infarction emerging as an inverse correlate [OR 0.82; 95% CI 0.73 to 0.93; P = 0.004]. Two-year data revealed a higher incidence of TLF in patients with calcified TPs versus their non-calcified counterparts (11.3% vs 2.2%, P <0.001), and a marked increase in clinically driven TLR (9.7% vs 1.4%, P <0.001). Calcified TPs were independently correlated with increased TLF risk in the adjusted model [Hazard Ratio (HR) 2.47; 95% CI 1.17 to 5.16; P = 0.027]. Conclusion After drug-eluting stent implantation, IVUS-identified calcified TPs correlate with adverse clinical outcomes compared to non-calcified TP formations.
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Affiliation(s)
- Xi Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Lei Wang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Zhe Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - Jie Cai
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
| | - He Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, 411100, People’s Republic of China
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Watanabe S, Usui M. Efficacy of Long Inflation Balloon Angioplasty for Acute Myocardial Infarction Due to Thrombotic Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:249-252. [PMID: 33309041 DOI: 10.1016/j.carrev.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Distal embolism is a frequent complication in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) due to thrombotic lesions. Distal embolism causes no reflow phenomenon, which leads to worse patient prognosis after AMI. There is no established treatment to prevent distal embolism in PCI for thrombotic lesions. The aim of this study is to investigate the usefulness of long inflation balloon angioplasty (LIBA) with perfusion balloon in PCI for AMI due to thrombotic lesions. METHODS AND RESULTS This is a case series study. We investigated 10 cases treated with LIBA for cases with massive thrombus remaining after thrombus aspiration therapy in primary PCI for acute myocardial infarction. We investigated the success rate of the procedure, residual stenosis rate, TIMI flow grade, TIMI frame count, and myocardial blush score in 10 cases of primary PCI with LIBA at our hospital. In all 10 cases, distal embolism was not observed by angiogram after LIBA. In 9 cases, residual stenosis was improved to less than 25% and the procedure was completed without a stent. Before PCI, all cases had TIMI flow grade 0, but in all 10 cases, TIMI flow grade 3 was obtained after PCI. The mean TIMI frame count was 19.6 ± 2.50 for RCA lesions and 27.5 ± 1.5 for LAD lesions. Regarding myocardial blush score, grade 3 was obtained in 8 cases and grade 2 was obtained in 2 cases. CONCLUSION LIBA using a perfusion balloon is a useful technique in thrombus lesion to prevent distal embolism.
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Affiliation(s)
- Shingo Watanabe
- The Department of Cardiology, Tokyo Yamate Medical Center, 3-22-1 Hyakunincho, Shinjuku-ward, Tokyo 169-0063, Japan.
| | - Michio Usui
- The Department of Cardiology, Tokyo Yamate Medical Center, 3-22-1 Hyakunincho, Shinjuku-ward, Tokyo 169-0063, Japan
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