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Papers by Saeko Takahashi
Circulation, 2007
We thank Dr Rundek and her coauthors for their contribution on this very important issue. As plaq... more We thank Dr Rundek and her coauthors for their contribution on this very important issue. As plaque formation represents a later stage of atherosclerosis than diffuse intima-media thickening, it is likely that plaque formation is more predictive for vascular events than intima-media thickness (IMT), although formal comparisons between the 2 measurements in terms of risk relations are limited. For example, van der Meer et al 1 indicated that plaques show a somewhat higher risk estimate than IMT, but the differences are small. In addition, one should bear in mind that in several studies, IMT is used as a marker of generalized risk and not necessarily of local atherosclerosis, and with that reasoning inclusion of thicker segments or plaques in the carotid IMT measurement is not a relevant issue. Ultrasound assessment of carotid plaque bears a number of problems, some of which are listed here. From a pathoanatomical point of view, an atherosclerotic plaque (a Stary type [III-] IV-V lesion) is defined as focal thickening of the arterial wall with protrusion into the lumen and the presence of lipid-laden macrophages, extracellular lipid accumulation, and a fibrous cap. 2 The latter criterion is not reliably identifiable with ultrasound, despite some efforts that have been made. In studies based on high-resolution B-mode ultrasound, the definition of plaque relies on the first criterion of this definition. Unfortunately, no uniform definition of plaque assessment with the use of ultrasound has prevailed so far; the definition of a recent consensus paper 3 has not yet widely been implemented in current studies and also uses an arbitrary definition of plaque. Naturally, the prevalence of plaque is highly dependent on the definition used. Even when uniform criteria are used, the application of the criterion of a focal lesion remains subjective to a certain degree. This is reflected in a lower reproducibility of the plaque measurements as compared with the carotid IMT measurement. Furthermore, studies that assess carotid plaques are highly inhomogeneous in terms of the classification of subjects. Continuous parameters that reflect the plaque burden are statistically most powerful, 4 followed by ordinal plaque scores. Plaque scores that count the number of carotid segments affected are most frequently used. However, these scores imply that the predictivity of plaques is independent of their localization, which is unlikely. And although we do acknowledge that plaques are an important manifestation of atherosclerosis, IMT measurements are particularly relevant in areas of research where plaques have not yet developed (ie, among younger age groups). These and further issues are highly relevant in the review of the literature on carotid plaque and clinical vascular end points, which may justify greater expenditure than just an aspect secondary to IMT. A recent review considered most of these points, 5 but some of the resulting questions can only be answered on the basis of an individual data meta-analysis. We strongly advocate such an analysis in cooperation with all relevant study groups. Disclosures None.
P O S T E R S results often show increased localized haziness at the treated segment that is attr... more P O S T E R S results often show increased localized haziness at the treated segment that is attributable to multiple intimal flaps, dissection and atheromatous tissues. We analyzed the safety, focused on the rates of acute thrombosis after DCB in de-novo lesions without additional stenting (the so called drug-eluting balloon only strategy) in a clinical setting. Methods: A retrospective review was done of 191 consecutive patients who underwent percutaneous coronary intervention procedure with the paclitaxel eluting balloon SeQuent Please at a high-volume Heart Center in Potsdam. DCB was used for the treatment of de-novo lesions in 85 patients (male n1⁄461, age 67.1 10.9 years) in 102 interventions. Interventions included small coronary arteries, long lesions, ostial lesions and bifurcation lesions. All patients were pretreated with aspirin and clopidogrel/prasugrel (DAPT), which was continued for at least 4 weeks. Results: A localized haziness at the treated segment was found in 17...
Journal of Cardiology
A 43-year-old woman had undergone patch closure operation for atrial septal defect 27 years ago. ... more A 43-year-old woman had undergone patch closure operation for atrial septal defect 27 years ago. She was referred to our hospital for evaluation of frequent palpitations since 1 year ago. Electrophysiological study was performed with recording of the coronary sinus, His bundle, and low lateral right free wall electrography utilizing a steerable duo-decapolar electrode catheter(Livewire, Daig). Supraventricular tachycardia with cycle length alternation of 300 and 320 msec similar to atrial flutter was reproducibly provoked by burst pacing from the coronary sinus. During the supraventricular tachycardia, abnormal atrial potentials occurred in the low lateral right free wall region with very low amplitude and splitting potentials. The cycle length alternation of the supraventricular tachycardia depended on the occurrence of the splitting potentials, that is, the splitting potentials were present during the supraventricular tachycardia with a long cycle and the splitting potentials were...
Journal of the American College of Cardiology, 2014
Journal of the American College of Cardiology, 2012
The American Journal of Cardiology, 2013
Coronary artery dominance influences the amount and anatomic location of myocardium that is perfu... more Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, it is unknown whether coronary artery dominance also influences the distribution of coronary blood flow volume. The aim of this study was to evaluate volumetric coronary blood flow in 1,322 vessels from 496 patients in the Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Wall Morphology (PREDICTION) study. Patients were divided into 2 groups (right-dominant and left-dominant or balanced circulation). Coronary blood flow volume was calculated by coronary segment volume measurement using angiography and intravascular ultrasound and the contrast transit time through the segment. Coronary blood flow in the left circumflex coronary artery was significantly higher in left-dominant or balanced circulation than in right-dominant circulation (113 ± 43 vs 72 ± 37 ml/min, p <0.001), whereas flow in the right coronary artery was significantly lower in left-dominant or balanced circulation than in right-dominant circulation (56 ± 40 vs 113 ± 49 ml/min, p = 0.003). There was no significant difference in the left anterior descending coronary artery. In conclusion, coronary artery dominance has an impact on coronary blood flow volume in the left circumflex and right coronary arteries but not in the left anterior descending coronary artery. These findings suggest that the extent of myocardial perfusion area is associated with coronary blood flow volume.
Circulation. Cardiovascular interventions, 2011
We recently developed a 4F child catheter that can be inserted into 6F or larger conventional gui... more We recently developed a 4F child catheter that can be inserted into 6F or larger conventional guiding catheters. The use of 4F mother-child technique may improve the delivery of coronary stents to complex lesions. Accordingly, we sought to determine the potential of using a 4F mother-child technique to treat complex coronary lesions. The support power and the trackability of the mother-child technique of 4-in-6 were evaluated using a coronary artery tree model. In addition, the results of 51 lesions treated by using a 4F child catheter were retrospectively analyzed. The in vitro experiment demonstrated that backup support of the 4-in-6 system was increased when the child catheter was advanced into the coronary tree ≥5 cm (P≤0.01); further, the 4F child catheter was associated with superior trackability as compared with a 5F child catheter (15.0 cm [15.0 to 15.0] versus 13.0 cm [12.8 to 13.0], P<0.005). A total of 51 lesions, in which conventional techniques had been unsuccessful,...
Journal of Arrhythmia, 2005
ABSTRACT Objective: The purpose of this study was to provide detailed information as to the modif... more ABSTRACT Objective: The purpose of this study was to provide detailed information as to the modification of electrophysiological properties of pulmonary veins (PVs) and adjacent left atrial (LA) tissue caused by circumferential ablation (ABL) of superior and inferior pulmonary vein ostia using a novel radio-frequency balloon catheter (RBC), and to correlate such changes with recurrence or non-recurrence of atrial fibrillation (AF). Background: Although isolation of the triggering foci in PVs using conventional ABL techniques is useful in the treatment of AF, ABL of PVs per se is time consuming and tends to be associated with high AF recurrence rate. Methods and Results: Forty-nine patients with AF refractory to antiarrhythmic medication underwent circumferential ablation of PV-LA junction by RBC. Post ablation changes in electrophysiological properties around the PV ostia were studied with a basket catheter and were correlated with AF recurrence in 34 (1st study) early cases (ablating 68 superior PVs) and 15 (2nd study) later cases (53 superior and inferior PVs). Total elimination of PV potentials or PV-LA dissociation was achieved in 93% (63/68 PVs) and 93% (49/53 PVs), respectively. During mean follow-up periods of 24.1 ± 4.1 and 13.3 ± 1.7 months, AF recurred in 38% (13/34 cases) and 13% (2/15) in early and later groups, respectively, but no case developed severe PV stenosis. Although the amplitude of PV and periostial LA potentials were decreased (p < 0.0001) in all patients, the remaining PV potentials in 34 non-recurrence cases were definitely smaller than those in 15 recurrence cases (p <0.0001). When a cut-off level of less than 0.4 mV in receiver operating characteristic curves was used, its negative predictive value for non-recurrence of AF was 93% and specificity was 95%. Conclusions: Circumferential ablation around the PV ostia using the RBC is effective in the treatment of AF even in a single session, and AF recurrence may well be predicted by precisely measuring the amplitude of remaining PV-LA potentials.
Journal of the American College of Cardiology, 2015
Current Management and Treatment, 2012
ABSTRACT Local endothelial shear stress (ESS) triggers vascular phenomena which synergistically e... more ABSTRACT Local endothelial shear stress (ESS) triggers vascular phenomena which synergistically exacerbate atherosclerosis toward an unstable phenotype. Specifically, low ESS augments lipid uptake and catabolism, induces plaque inflammation and oxidation, downregulates the production and upregulates the degradation of extracellular matrix, and increases cellular apoptosis ultimately leading to thin-cap fibroatheromas and/or endothelial erosions. Increases in blood thrombogenicity that result from either high or low ESS, also contribute to plaque destabilization. A destabilized plaque manifests clinically as either abrupt luminal occlusion and acute coronary syndrome, or accelerated atherosclerosis progression via repeated cycles of subclinical partial luminal occlusion and healing which causes worsening ischemia.
The Journal of invasive cardiology, 2007
We report the first case in the literature of successful coronary intervention in a totally occlu... more We report the first case in the literature of successful coronary intervention in a totally occluded anomalous right coronary artery originating from the left sinus of Valsalva using several techniques, including the retrograde approach via a collateral vessel, the anchoring technique and the five-in-six system.
Journal of the American College of Cardiology, 2015
Journal of the American College of Cardiology, 2014
Background: Long-term results of self-expandable stent implantation to chronic total occlusion (C... more Background: Long-term results of self-expandable stent implantation to chronic total occlusion (CTO) in supericial femoral artery (SFA) of TASC (TransAtlantic Inter-Society Consensus) D remains unknown.
Circulation, 2007
We thank Dr Rundek and her coauthors for their contribution on this very important issue. As plaq... more We thank Dr Rundek and her coauthors for their contribution on this very important issue. As plaque formation represents a later stage of atherosclerosis than diffuse intima-media thickening, it is likely that plaque formation is more predictive for vascular events than intima-media thickness (IMT), although formal comparisons between the 2 measurements in terms of risk relations are limited. For example, van der Meer et al 1 indicated that plaques show a somewhat higher risk estimate than IMT, but the differences are small. In addition, one should bear in mind that in several studies, IMT is used as a marker of generalized risk and not necessarily of local atherosclerosis, and with that reasoning inclusion of thicker segments or plaques in the carotid IMT measurement is not a relevant issue. Ultrasound assessment of carotid plaque bears a number of problems, some of which are listed here. From a pathoanatomical point of view, an atherosclerotic plaque (a Stary type [III-] IV-V lesion) is defined as focal thickening of the arterial wall with protrusion into the lumen and the presence of lipid-laden macrophages, extracellular lipid accumulation, and a fibrous cap. 2 The latter criterion is not reliably identifiable with ultrasound, despite some efforts that have been made. In studies based on high-resolution B-mode ultrasound, the definition of plaque relies on the first criterion of this definition. Unfortunately, no uniform definition of plaque assessment with the use of ultrasound has prevailed so far; the definition of a recent consensus paper 3 has not yet widely been implemented in current studies and also uses an arbitrary definition of plaque. Naturally, the prevalence of plaque is highly dependent on the definition used. Even when uniform criteria are used, the application of the criterion of a focal lesion remains subjective to a certain degree. This is reflected in a lower reproducibility of the plaque measurements as compared with the carotid IMT measurement. Furthermore, studies that assess carotid plaques are highly inhomogeneous in terms of the classification of subjects. Continuous parameters that reflect the plaque burden are statistically most powerful, 4 followed by ordinal plaque scores. Plaque scores that count the number of carotid segments affected are most frequently used. However, these scores imply that the predictivity of plaques is independent of their localization, which is unlikely. And although we do acknowledge that plaques are an important manifestation of atherosclerosis, IMT measurements are particularly relevant in areas of research where plaques have not yet developed (ie, among younger age groups). These and further issues are highly relevant in the review of the literature on carotid plaque and clinical vascular end points, which may justify greater expenditure than just an aspect secondary to IMT. A recent review considered most of these points, 5 but some of the resulting questions can only be answered on the basis of an individual data meta-analysis. We strongly advocate such an analysis in cooperation with all relevant study groups. Disclosures None.
P O S T E R S results often show increased localized haziness at the treated segment that is attr... more P O S T E R S results often show increased localized haziness at the treated segment that is attributable to multiple intimal flaps, dissection and atheromatous tissues. We analyzed the safety, focused on the rates of acute thrombosis after DCB in de-novo lesions without additional stenting (the so called drug-eluting balloon only strategy) in a clinical setting. Methods: A retrospective review was done of 191 consecutive patients who underwent percutaneous coronary intervention procedure with the paclitaxel eluting balloon SeQuent Please at a high-volume Heart Center in Potsdam. DCB was used for the treatment of de-novo lesions in 85 patients (male n1⁄461, age 67.1 10.9 years) in 102 interventions. Interventions included small coronary arteries, long lesions, ostial lesions and bifurcation lesions. All patients were pretreated with aspirin and clopidogrel/prasugrel (DAPT), which was continued for at least 4 weeks. Results: A localized haziness at the treated segment was found in 17...
Journal of Cardiology
A 43-year-old woman had undergone patch closure operation for atrial septal defect 27 years ago. ... more A 43-year-old woman had undergone patch closure operation for atrial septal defect 27 years ago. She was referred to our hospital for evaluation of frequent palpitations since 1 year ago. Electrophysiological study was performed with recording of the coronary sinus, His bundle, and low lateral right free wall electrography utilizing a steerable duo-decapolar electrode catheter(Livewire, Daig). Supraventricular tachycardia with cycle length alternation of 300 and 320 msec similar to atrial flutter was reproducibly provoked by burst pacing from the coronary sinus. During the supraventricular tachycardia, abnormal atrial potentials occurred in the low lateral right free wall region with very low amplitude and splitting potentials. The cycle length alternation of the supraventricular tachycardia depended on the occurrence of the splitting potentials, that is, the splitting potentials were present during the supraventricular tachycardia with a long cycle and the splitting potentials were...
Journal of the American College of Cardiology, 2014
Journal of the American College of Cardiology, 2012
The American Journal of Cardiology, 2013
Coronary artery dominance influences the amount and anatomic location of myocardium that is perfu... more Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, it is unknown whether coronary artery dominance also influences the distribution of coronary blood flow volume. The aim of this study was to evaluate volumetric coronary blood flow in 1,322 vessels from 496 patients in the Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Wall Morphology (PREDICTION) study. Patients were divided into 2 groups (right-dominant and left-dominant or balanced circulation). Coronary blood flow volume was calculated by coronary segment volume measurement using angiography and intravascular ultrasound and the contrast transit time through the segment. Coronary blood flow in the left circumflex coronary artery was significantly higher in left-dominant or balanced circulation than in right-dominant circulation (113 ± 43 vs 72 ± 37 ml/min, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), whereas flow in the right coronary artery was significantly lower in left-dominant or balanced circulation than in right-dominant circulation (56 ± 40 vs 113 ± 49 ml/min, p = 0.003). There was no significant difference in the left anterior descending coronary artery. In conclusion, coronary artery dominance has an impact on coronary blood flow volume in the left circumflex and right coronary arteries but not in the left anterior descending coronary artery. These findings suggest that the extent of myocardial perfusion area is associated with coronary blood flow volume.
Circulation. Cardiovascular interventions, 2011
We recently developed a 4F child catheter that can be inserted into 6F or larger conventional gui... more We recently developed a 4F child catheter that can be inserted into 6F or larger conventional guiding catheters. The use of 4F mother-child technique may improve the delivery of coronary stents to complex lesions. Accordingly, we sought to determine the potential of using a 4F mother-child technique to treat complex coronary lesions. The support power and the trackability of the mother-child technique of 4-in-6 were evaluated using a coronary artery tree model. In addition, the results of 51 lesions treated by using a 4F child catheter were retrospectively analyzed. The in vitro experiment demonstrated that backup support of the 4-in-6 system was increased when the child catheter was advanced into the coronary tree ≥5 cm (P≤0.01); further, the 4F child catheter was associated with superior trackability as compared with a 5F child catheter (15.0 cm [15.0 to 15.0] versus 13.0 cm [12.8 to 13.0], P<0.005). A total of 51 lesions, in which conventional techniques had been unsuccessful,...
Journal of Arrhythmia, 2005
ABSTRACT Objective: The purpose of this study was to provide detailed information as to the modif... more ABSTRACT Objective: The purpose of this study was to provide detailed information as to the modification of electrophysiological properties of pulmonary veins (PVs) and adjacent left atrial (LA) tissue caused by circumferential ablation (ABL) of superior and inferior pulmonary vein ostia using a novel radio-frequency balloon catheter (RBC), and to correlate such changes with recurrence or non-recurrence of atrial fibrillation (AF). Background: Although isolation of the triggering foci in PVs using conventional ABL techniques is useful in the treatment of AF, ABL of PVs per se is time consuming and tends to be associated with high AF recurrence rate. Methods and Results: Forty-nine patients with AF refractory to antiarrhythmic medication underwent circumferential ablation of PV-LA junction by RBC. Post ablation changes in electrophysiological properties around the PV ostia were studied with a basket catheter and were correlated with AF recurrence in 34 (1st study) early cases (ablating 68 superior PVs) and 15 (2nd study) later cases (53 superior and inferior PVs). Total elimination of PV potentials or PV-LA dissociation was achieved in 93% (63/68 PVs) and 93% (49/53 PVs), respectively. During mean follow-up periods of 24.1 ± 4.1 and 13.3 ± 1.7 months, AF recurred in 38% (13/34 cases) and 13% (2/15) in early and later groups, respectively, but no case developed severe PV stenosis. Although the amplitude of PV and periostial LA potentials were decreased (p < 0.0001) in all patients, the remaining PV potentials in 34 non-recurrence cases were definitely smaller than those in 15 recurrence cases (p <0.0001). When a cut-off level of less than 0.4 mV in receiver operating characteristic curves was used, its negative predictive value for non-recurrence of AF was 93% and specificity was 95%. Conclusions: Circumferential ablation around the PV ostia using the RBC is effective in the treatment of AF even in a single session, and AF recurrence may well be predicted by precisely measuring the amplitude of remaining PV-LA potentials.
Journal of the American College of Cardiology, 2015
Current Management and Treatment, 2012
ABSTRACT Local endothelial shear stress (ESS) triggers vascular phenomena which synergistically e... more ABSTRACT Local endothelial shear stress (ESS) triggers vascular phenomena which synergistically exacerbate atherosclerosis toward an unstable phenotype. Specifically, low ESS augments lipid uptake and catabolism, induces plaque inflammation and oxidation, downregulates the production and upregulates the degradation of extracellular matrix, and increases cellular apoptosis ultimately leading to thin-cap fibroatheromas and/or endothelial erosions. Increases in blood thrombogenicity that result from either high or low ESS, also contribute to plaque destabilization. A destabilized plaque manifests clinically as either abrupt luminal occlusion and acute coronary syndrome, or accelerated atherosclerosis progression via repeated cycles of subclinical partial luminal occlusion and healing which causes worsening ischemia.
The Journal of invasive cardiology, 2007
We report the first case in the literature of successful coronary intervention in a totally occlu... more We report the first case in the literature of successful coronary intervention in a totally occluded anomalous right coronary artery originating from the left sinus of Valsalva using several techniques, including the retrograde approach via a collateral vessel, the anchoring technique and the five-in-six system.
Journal of the American College of Cardiology, 2015
Journal of the American College of Cardiology, 2014
Background: Long-term results of self-expandable stent implantation to chronic total occlusion (C... more Background: Long-term results of self-expandable stent implantation to chronic total occlusion (CTO) in supericial femoral artery (SFA) of TASC (TransAtlantic Inter-Society Consensus) D remains unknown.