Takashi Matsukage - Academia.edu (original) (raw)
Papers by Takashi Matsukage
PJ-282 Pravastatin-Induced Reduction of Blood Leukocyte Count Is Associated with Coronary Plaque Regression : Possible Role of Non-Lipid Lowering Effects of Statins(Infection/Inflammation/Immunity 3 (H) : PJ47)(Poster Session (Japanese))
Circulation Journal Official Journal of the Japanese Circulation Society, Mar 1, 2004
PJ-083 Randomized Comparison of Immediate PCI with Conservative Management in Patients with Successful Thrombolysis after Acute Myocardial Infarction(Thromboembolism/Thrombolysis 2 (IHD) : PJ14)(Poster Session (Japanese))
Circulation Journal Official Journal of the Japanese Circulation Society, Mar 1, 2004
Angiographic evaluation of right upper-limb arterial anomalies: implications for transradial coronary interventions
The Journal of Invasive Cardiology, Nov 1, 2010
Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. T... more Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. These anomalies may contribute to procedural failure or to vascular complications, and are a major reason why many operators tend to avoid transradial procedures. We investigated the frequency of right upperlimb arterial anomalies using antegrade arteriography in patients undergoing transbrachial coronary angiography or intervention, and discuss the potential impact of these anomalies on the transradial procedure. We prospectively studied 163 consecutive patients who underwent right transbrachial coronary angiography or intervention for the first time during the period from May 2007 to December 2007. Following the transbrachial procedure, we performed antegrade transbrachial arteriography of right upper-limb arteries in these patients and investigated the frequency and anatomy of arterial anomalies. A total of 40 upper-limb arterial anomalies were observed in 38 patients (23.3%). These included 8 abnormal origins (4.9%), 2 radio-ulnar loops (1.2%), 25 tortuosities (15.3%), 4 stenoses (2.5%) and 1 loop (0.6%). In patients with congenital lesions (8 patients; 4.9%), abnormal origin of the radial artery was the most common anomaly encountered, and in the acquired group (25 patients; 15.3%), tortuosity was the most common abnormality. Even with a 23.3% incidence of right upper-limb arterial abnormalities, 98.8% of patients were acceptable for transradial coronary intervention except for 1.2% of radio-ulnar loops.
Analysis of Right Radial Artery for Transradial Catheterization by Quantitative Angiography — Anatomical Consideration of Optimal Radial Puncture Point
The Journal of Invasive Cardiology, Aug 1, 2010
To determine the optimal radial puncture point, we analyzed the anatomy and luminal diameter of t... more To determine the optimal radial puncture point, we analyzed the anatomy and luminal diameter of the right radial artery (RA) by quantitative angiography. Difficulty of radial puncture has impeded the establishment of the transradial approach as the standard procedure for cardiac catheterization. Antegrade angiography was performed from the right brachial artery in 135 patients who underwent coronary angiography. Presence and location of a bifurcation in the area of the RA puncture were analyzed. Furthermore, inner luminal diameter of the RA was quantitatively measured. We used the line between the styloid process and the ulnar styloid process (R-U line) as an anatomical reference point. Radial arterial bifurcation with a superficial palmar branch was angiographically observed in 66 patients (48.9%). The inner luminal diameter was significantly larger at the proximal point to the point of bifurcation. The bifurcation level was located at a median of -3.33 mm (interquartile range: -5.60 to 4.69 mm) below the R-U line. Radial puncture at 10 mm proximal to the R-U line could avoid bifurcation in 91.9% of all cases. Mean radial, ulnar and brachial arterial inner diameters were 2.94 +/- 0.52 mm, 2.51 +/- 0.49 mm and 4.53 +/- 0.62 mm. The RA size within 10-60 mm above the R-U line was nearly invariable throughout the range. CONCLUSION The radial puncture level should be proximal to the radial bifurcation because of its lumen size. The ideal puncture point was found to be at least 10 mm proximal to the R-U line.
Abstract 1794: Evaluation of Usefulness and Efficacy of a "Segmental Perfusion Abnormality Index": A Novel Diagnostic Approach with Conventional Enhanced Computed Tomography for the Differentiation of Acute Coronary Syndrome in Patients with Acute Onset of Chest or Back Pain
Circulation, Oct 31, 2007
Safety and feasibility of the new 5 Fr Glidesheath Slender
Cardiovascular Intervention and Therapeutics, 2015
The aim of this study was to evaluate the safety and feasibility of the new 5 Fr Glidesheath Slen... more The aim of this study was to evaluate the safety and feasibility of the new 5 Fr Glidesheath Slender (GSS). The transradial (TR) approach has become popular because of several advantages, such as a reduced rate of vascular access site complications. However, because the radial artery is narrow, a limitation of TR access is the potential for artery spasm or occlusion. Studies of radial artery size demonstrate that 5 Fr sheaths are too wide for more than 10 % of patients. The GSS (Terumo, Tokyo, Japan) is a new radial sheath with a thinner wall and a hydrophilic coating. It has an inner diameter that is compatible with a 5 Fr guiding catheter, while the outer diameter is similar to that of a 4 Fr sheath. A total of 21 consecutive patients undergoing transradial angiography and/or transradial percutaneous coronary intervention with the 5 Fr GSS were included, and safety and feasibility of the device were assessed. Transradial angiography was performed in 10 patients, and transradial intervention in 11 patients. All procedures were successful, without the need for conversion to the transfemoral approach. The radial artery occlusion rate was 0 %, including a patient who had experienced six previous radial artery punctures. There were no cases of artery spasm, hematoma, major bleeding or functional disorders. One coronary artery perforation caused by a guidewire was reported, but it was unrelated to the sheath introducer. The new 5 Fr GSS was safe and feasible for transradial angiography and transradial intervention.
Use of slender catheters for transradial angiography and intervions
Indian Heart Journal
Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are... more Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are 0.014 inch-compatible. The size of common guiding catheters is 6-F or 7-F. However, PCI requires oral administration of antiplatelet agents, and punctured-site complications such as hemorrhage and hematoma occur more frequently with use of a 6-F or 7-F guiding catheter compared to a 5-F guiding catheter. Moreover, 6-F or larger guiding catheters may cause radial arterial occlusion, although the transradial approach causes less punctured-site complications compared to the transfemoral approach. Recently, 0.010-inch guidewires applicable for the Kissing Balloon Technique (KBT) using a 5-F guiding catheter and 0.010-inch guidewire-compatible balloons have been developed in Japan, and a 3-F angiography catheter has also been developed. We refer to these devices as the "Slender System", and we have used this system for active treatment of bifurcation lesions and chronic total occlusion (CTO). In this report, we describe angiography using a 3-F catheter, the KBT using a 5-F guiding catheter and 0.010-inch guidewires, and treatment of CTO using a 5-F catheter and 0.010-inch guidewires. For CTO treated using the Slender System at our facility, the transradial arterial approach was used in 96% of cases, treatment using the Slender System alone succeeded in 68%, and the overall success rate was 89%. Therefore, our results show that complex lesions may be treatable using the Slender System, and that not all complex lesions require a 6-F or larger guiding catheters, a femoral arterial approach, or bilateral guiding catheters.
Backup force of guiding catheters for the right coronary artery in transfemoral and transradial interventions
The Journal of invasive cardiology
We sought to clarify the mechanisms of backup force for right coronary artery intervention. Backu... more We sought to clarify the mechanisms of backup force for right coronary artery intervention. Backup force of a guiding catheter is important for successful percutaneous coronary intervention (PCI); however, little attention has been given to its mechanism. Backup force of guiding catheters was measured in an arterial tree model. Judkins R, Amplatz L and Ikari R had greater backup force in the transfemoral intervention (TFI) than the transradial intervention (TRI). The primary attachment site of the catheter was the aortic arch in TFI, but it was the brachiocephalic artery in right TRI. This may be a major reason for the different backup force because generation of backup force is governed by the mechanics of the catheter at the attachment site. The Amplatz L and Ikari R had stronger backup force than the Judkins R both in TFI and in TRI because a slight backward motion of the catheter due to device advancement changed the primary attachment site to the reverse side of the aorta or sinus of Valsalva. The primary attachment site of the Ikari L at the power position was the reverse side of the aorta both in TFI and TRI, which was different from other catheters. The primary attachment site of the catheter had great impact on the backup force in right coronary interventions. An understanding of the mechanism by which the guiding catheter works in TRI and TFI may help in choosing an appropriate approach site.
Simultaneous triple-balloon inflation technique within a 6 Fr guiding catheter for a trifurcation lesion
The Journal of invasive cardiology
We report two cases of trifurcation lesions that were successfully treated with simultaneous trip... more We report two cases of trifurcation lesions that were successfully treated with simultaneous triple-balloon inflation. One of the potential limitations with using simultaneous triple-balloon inflation has been the requirement for a larger guiding catheter (8 Fr or larger). This limitation was overcome by using 0.010 inch guidewires and 0.010 inch guidewire compatible balloon catheters with a 6 Fr guiding catheter via a transradial approach (The King Ghidorah Technique). The other advantage of the simultaneous triple-balloon inflation was to obtain an almost complete round circle (symmetry index 0.9) at the left main coronary artery by intravascular ultrasound imaging.
Intravascular ultrasound-guided percutaneous coronary interventions with minimum contrast volume for prevention of the radiocontrast-induced nephropathy: report of two cases
Cardiovascular Intervention and Therapeutics, 2010
Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous ... more Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous coronary interventions (PCI). The prevention of PCI-related CIN for chronic kidney disease (CKD) patients has not been established yet. The intravascular ultrasound (IVUS) is commonly used as an imaging device during PCI. We performed IVUS-guided PCI while only using fluoroscopic imaging and without administering any routine contrast dye injection during the procedures. All patients underwent a baseline coronary angiography prior to the elective PCI. During the PCI, all the following procedures were done with X-ray fluoroscopic imaging without or with a minimized contrast dye injection: the engagement of the guiding catheter, insertion of the coronary guidewire, insertion of the IVUS catheter, the stent deployment and the post-dilatation. The diameter and the length of the balloon and the stent were determined according to the pre-procedural IVUS findings, and the end point of the stent dilatation was also judged according to the acquired minimal cross-sectional area of the stent. Here we report our findings from two cases representative of IVUS-guided minimum contrast PCI in which the volumes of contrast dye during the procedure were 5 and 4 ml, respectively. No CIN occurred after either procedure. The IVUS-guided minimum contrast PCI could be a promising option for the prevention of CIN after PCI.
“Rising Sun”, Minimally Invasive TRI from Japan to the Rest of the World
Journal of Vascular Medicine & Surgery, 2013
Successful transradial intervention for two lesions with dual anomalous origins of coronary arteries
The Journal of invasive cardiology, 2011
A 76-year-old male was admitted to our hospital for effort angina pectoris. His coronary computed... more A 76-year-old male was admitted to our hospital for effort angina pectoris. His coronary computed tomography and coronary angiography revealed anomalous origins of the left anterior descending artery (LAD) from the proximal right coronary artery (RCA) and the left circumflex coronary artery (LCX) from the separate ostium in the right coronary cusp. Severe stenoses were present in the proximal segment of the LAD and in the middle segment of the LCX, which were successfully treated by 5 French (Fr) transradial approach intervention. Congenital coronary anomalies are relatively rare, with a prevalence of approximately 1.3% in a large-series study undergoing coronary angiography. Such anomalies occur in several anatomical arrangements, which have been classified in a number of research reports. Here we describe previously unreported dual anomalous origins of coronary arteries associated with significant atherosclerotic lesions, which were successfully treated by 5 Fr transradial approac...
Impact of transient or persistent slow flow and adjunctive distal protection on mortality in ST-segment elevation myocardial infarction
Cardiovascular intervention and therapeutics, Jan 2, 2014
Routine use of distal protection for ST-segment elevation myocardial infarction (STEMI) is not re... more Routine use of distal protection for ST-segment elevation myocardial infarction (STEMI) is not recommended. The purpose of this study was to analyze the impact of slow flow on mortality after STEMI, and the efficacy of adjunctive distal protection following primary thrombus aspiration. We retrospectively analyzed 414 STEMI patients who underwent primary PCI. Distal protection was used following primary thrombus aspiration only when the operator judged the patient to be at high risk of slow flow. Patients were divided into 3 groups: those receiving no thrombus aspiration (A- Group), thrombus aspiration without distal protection (A+/D- Group) or a combination of aspiration with distal protection (A+/D+ Group). Slow flow/no reflow was characterized as transient or persistent. The A-, A+/D-, and A+/D+ Groups consisted of 28.5 % (n = 118), 44.4 % (n = 184), and 27.1 % (n = 112) of patients, respectively. All-cause mortality at 180 days was 6.8 % without slow flow, 14.1 % with transient a...
A simple method preventing tangling of the guidewires during percutaneous coronary intervention for bifurcation lesions
Cardiovascular intervention and therapeutics, 2011
The aim was to examine the efficacy of the simple technique that reduces tangling of the guidewir... more The aim was to examine the efficacy of the simple technique that reduces tangling of the guidewires by utilizing wet gauze during percutaneous coronary intervention with multiple guidewires. We defined "Critical tangle of the guidewires" as occurring when it became impossible to insert balloon catheters into the bifurcation lesion due to tangling of the guidewires without withdrawing and reinserting one of the guidewires. We compared the rate of the critical tangle of the guidewires between the group taking no special tangle precaution ("NP Group"), and the group taking the tangle precaution with the wet gauze ("Gauze Group"). Eighty-four patients were enrolled in the study and randomly assigned to either NP Group (n = 43) or Gauze Group (n = 41). The kissing balloon technique success was 42/43 (97.7%) versus 40/41 (97.6%), in NP Group and Gauze Group, respectively. The rate of critical tangle of the guidewires was significantly lower in Gauze Group (27...
Cardiovascular intervention and therapeutics, 2011
Very late stent thrombosis (VLST) is a major unresolved problem of drug-eluting stent (DES) impla... more Very late stent thrombosis (VLST) is a major unresolved problem of drug-eluting stent (DES) implants. However, its actual incidence with respect to the distribution of DES-target vessel and accuracy of adjudicating stent thrombosis according to the ARC definition has not been yet adequately evaluated. We studied 720 patients who had completed over 1 year from elective DES implantation. In this cohort, we extracted patients who present acute coronary syndrome (ACS) (n = 3, 0.4%). The timing of ACS events was 17, 19, and 24 months after DES implantation. At the time of presentation, VLST was strongly suspected as the initial diagnosis, however, coronary angiography (CAG) confirmed the different culprit lesion from DES and clearly no thrombus within the DES. According to ARC definition, three probable stent thromboses in this cohort before CAG, however, no stent thrombosis was confirmed after the CAG. Thus, no stent thrombosis was confirmed among this study population. In the very late...
Intravascular ultrasound-guided percutaneous coronary interventions with minimum contrast volume for prevention of the radiocontrast-induced nephropathy: report of two cases
Cardiovascular intervention and therapeutics, 2011
Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous ... more Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous coronary interventions (PCI). The prevention of PCI-related CIN for chronic kidney disease (CKD) patients has not been established yet. The intravascular ultrasound (IVUS) is commonly used as an imaging device during PCI. We performed IVUS-guided PCI while only using fluoroscopic imaging and without administering any routine contrast dye injection during the procedures. All patients underwent a baseline coronary angiography prior to the elective PCI. During the PCI, all the following procedures were done with X-ray fluoroscopic imaging without or with a minimized contrast dye injection: the engagement of the guiding catheter, insertion of the coronary guidewire, insertion of the IVUS catheter, the stent deployment and the post-dilatation. The diameter and the length of the balloon and the stent were determined according to the pre-procedural IVUS findings, and the end point of the stent ...
Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents
Cardiovascular intervention and therapeutics, 2011
Although sirolimus-eluting stent (SES) is effective to reduce restenosis, the effect of SES for p... more Although sirolimus-eluting stent (SES) is effective to reduce restenosis, the effect of SES for patients with chronic kidney disease (CKD) has been ambiguous. SES were exclusively implanted into 304 lesions in 195 patients. Forty-seven percent of the patients had diabetes. Patients were divided into three groups by estimated glomerular filtration rate, CKD stage 0-2: 156 patients, 239 lesions; CKD stage 3-4: 21 patients, 37 lesions; and CKD stage 5: 18 patients, 28 lesions. Clinical follow-up data were available in 97% at 616 ± 192 days. There was a statistically significant association between the stage of CKD and target lesion revascularization (TLR) (CKD 0-2: 2.7%, CKD 3-4: 5.3%, and CKD 5: 11.9%; P = 0.011), and late lumen loss at 8 months (CKD 0-2: 0.13 ± 0.25 mm, CKD 3-4: 0.27 ± 0.47 mm, and CKD 5: 0.37 ± 0.61 mm; P = 0.0032). The frequency of clinical adverse events was also higher according to stages of CKD. In conclusion, stages of CKD proportionally correlated with TLR, la...
Transradial and slender percutaneous coronary intervention: less invasive strategy in PCI
Cardiovascular intervention and therapeutics, 2010
Although there is a discussion on the outcome between percutaneous coronary intervention (PCI) an... more Although there is a discussion on the outcome between percutaneous coronary intervention (PCI) and bypass surgery, PCI is clearly superior to bypass surgery in terms of less invasiveness. One of the further less invasive strategy is transradial approach (TRI). There have been several limitations such as low backup force of guiding catheters. However, mechanics studies showed that the backup force does not relate to approach site but to catheter shape and size. The other strategy is slender PCI using a 5 Fr or less guiding catheter. The slender PCI has also several limitations, however, some of these limitations have been overcome using new slender devices and new slender specific techniques. In this article, current progress in this field using new devices is reviewed. The less invasive strategy such as TRI and slender PCI may be the future direction of PCI because they prevent complications and improve quality of life.
Feasibility of 6 Fr intra-aortic balloon pumping via the femoral or brachial approach
The Journal of invasive cardiology, 2012
To demonstrate safety and efficacy of new 6 Fr intra-aortic balloon pumping (IABP) system. Access... more To demonstrate safety and efficacy of new 6 Fr intra-aortic balloon pumping (IABP) system. Access-site complications have been reported to increase adverse events following PCI. Some reports have shown access-site complications in conventional 8-Fr compatible IABP system. The new 6 Fr IABP system may reduce the complication rate due to the smaller size. We extracted medical records for patients who underwent elective percutaneous coronary intervention under prophylactic 6 Fr or 8 Fr IABP assistance from January 2006 to December 2009 at Tokai University School of Medicine. The clinical outcomes were compared between 6 Fr and 8 Fr or between transfemoral and transbrachial IABP. A total of 42 cases were extracted, including 20 cases using 6 Fr IABP (47.6%) and 22 cases using 8 Fr IABP (52.4%). The 6 Fr IABP included 15 cases of transbrachial approach (75.0%) and 5 cases of transfemoral approach (25.0%). All cases of 8 Fr IABP were via transfemoral approach. The bedrest time was clearly...
[Case report; A case of Fabry's disease suspected based on echocardiographic findings]
Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine, Jan 10, 2011
PJ-282 Pravastatin-Induced Reduction of Blood Leukocyte Count Is Associated with Coronary Plaque Regression : Possible Role of Non-Lipid Lowering Effects of Statins(Infection/Inflammation/Immunity 3 (H) : PJ47)(Poster Session (Japanese))
Circulation Journal Official Journal of the Japanese Circulation Society, Mar 1, 2004
PJ-083 Randomized Comparison of Immediate PCI with Conservative Management in Patients with Successful Thrombolysis after Acute Myocardial Infarction(Thromboembolism/Thrombolysis 2 (IHD) : PJ14)(Poster Session (Japanese))
Circulation Journal Official Journal of the Japanese Circulation Society, Mar 1, 2004
Angiographic evaluation of right upper-limb arterial anomalies: implications for transradial coronary interventions
The Journal of Invasive Cardiology, Nov 1, 2010
Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. T... more Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. These anomalies may contribute to procedural failure or to vascular complications, and are a major reason why many operators tend to avoid transradial procedures. We investigated the frequency of right upperlimb arterial anomalies using antegrade arteriography in patients undergoing transbrachial coronary angiography or intervention, and discuss the potential impact of these anomalies on the transradial procedure. We prospectively studied 163 consecutive patients who underwent right transbrachial coronary angiography or intervention for the first time during the period from May 2007 to December 2007. Following the transbrachial procedure, we performed antegrade transbrachial arteriography of right upper-limb arteries in these patients and investigated the frequency and anatomy of arterial anomalies. A total of 40 upper-limb arterial anomalies were observed in 38 patients (23.3%). These included 8 abnormal origins (4.9%), 2 radio-ulnar loops (1.2%), 25 tortuosities (15.3%), 4 stenoses (2.5%) and 1 loop (0.6%). In patients with congenital lesions (8 patients; 4.9%), abnormal origin of the radial artery was the most common anomaly encountered, and in the acquired group (25 patients; 15.3%), tortuosity was the most common abnormality. Even with a 23.3% incidence of right upper-limb arterial abnormalities, 98.8% of patients were acceptable for transradial coronary intervention except for 1.2% of radio-ulnar loops.
Analysis of Right Radial Artery for Transradial Catheterization by Quantitative Angiography — Anatomical Consideration of Optimal Radial Puncture Point
The Journal of Invasive Cardiology, Aug 1, 2010
To determine the optimal radial puncture point, we analyzed the anatomy and luminal diameter of t... more To determine the optimal radial puncture point, we analyzed the anatomy and luminal diameter of the right radial artery (RA) by quantitative angiography. Difficulty of radial puncture has impeded the establishment of the transradial approach as the standard procedure for cardiac catheterization. Antegrade angiography was performed from the right brachial artery in 135 patients who underwent coronary angiography. Presence and location of a bifurcation in the area of the RA puncture were analyzed. Furthermore, inner luminal diameter of the RA was quantitatively measured. We used the line between the styloid process and the ulnar styloid process (R-U line) as an anatomical reference point. Radial arterial bifurcation with a superficial palmar branch was angiographically observed in 66 patients (48.9%). The inner luminal diameter was significantly larger at the proximal point to the point of bifurcation. The bifurcation level was located at a median of -3.33 mm (interquartile range: -5.60 to 4.69 mm) below the R-U line. Radial puncture at 10 mm proximal to the R-U line could avoid bifurcation in 91.9% of all cases. Mean radial, ulnar and brachial arterial inner diameters were 2.94 +/- 0.52 mm, 2.51 +/- 0.49 mm and 4.53 +/- 0.62 mm. The RA size within 10-60 mm above the R-U line was nearly invariable throughout the range. CONCLUSION The radial puncture level should be proximal to the radial bifurcation because of its lumen size. The ideal puncture point was found to be at least 10 mm proximal to the R-U line.
Abstract 1794: Evaluation of Usefulness and Efficacy of a "Segmental Perfusion Abnormality Index": A Novel Diagnostic Approach with Conventional Enhanced Computed Tomography for the Differentiation of Acute Coronary Syndrome in Patients with Acute Onset of Chest or Back Pain
Circulation, Oct 31, 2007
Safety and feasibility of the new 5 Fr Glidesheath Slender
Cardiovascular Intervention and Therapeutics, 2015
The aim of this study was to evaluate the safety and feasibility of the new 5 Fr Glidesheath Slen... more The aim of this study was to evaluate the safety and feasibility of the new 5 Fr Glidesheath Slender (GSS). The transradial (TR) approach has become popular because of several advantages, such as a reduced rate of vascular access site complications. However, because the radial artery is narrow, a limitation of TR access is the potential for artery spasm or occlusion. Studies of radial artery size demonstrate that 5 Fr sheaths are too wide for more than 10 % of patients. The GSS (Terumo, Tokyo, Japan) is a new radial sheath with a thinner wall and a hydrophilic coating. It has an inner diameter that is compatible with a 5 Fr guiding catheter, while the outer diameter is similar to that of a 4 Fr sheath. A total of 21 consecutive patients undergoing transradial angiography and/or transradial percutaneous coronary intervention with the 5 Fr GSS were included, and safety and feasibility of the device were assessed. Transradial angiography was performed in 10 patients, and transradial intervention in 11 patients. All procedures were successful, without the need for conversion to the transfemoral approach. The radial artery occlusion rate was 0 %, including a patient who had experienced six previous radial artery punctures. There were no cases of artery spasm, hematoma, major bleeding or functional disorders. One coronary artery perforation caused by a guidewire was reported, but it was unrelated to the sheath introducer. The new 5 Fr GSS was safe and feasible for transradial angiography and transradial intervention.
Use of slender catheters for transradial angiography and intervions
Indian Heart Journal
Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are... more Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are 0.014 inch-compatible. The size of common guiding catheters is 6-F or 7-F. However, PCI requires oral administration of antiplatelet agents, and punctured-site complications such as hemorrhage and hematoma occur more frequently with use of a 6-F or 7-F guiding catheter compared to a 5-F guiding catheter. Moreover, 6-F or larger guiding catheters may cause radial arterial occlusion, although the transradial approach causes less punctured-site complications compared to the transfemoral approach. Recently, 0.010-inch guidewires applicable for the Kissing Balloon Technique (KBT) using a 5-F guiding catheter and 0.010-inch guidewire-compatible balloons have been developed in Japan, and a 3-F angiography catheter has also been developed. We refer to these devices as the "Slender System", and we have used this system for active treatment of bifurcation lesions and chronic total occlusion (CTO). In this report, we describe angiography using a 3-F catheter, the KBT using a 5-F guiding catheter and 0.010-inch guidewires, and treatment of CTO using a 5-F catheter and 0.010-inch guidewires. For CTO treated using the Slender System at our facility, the transradial arterial approach was used in 96% of cases, treatment using the Slender System alone succeeded in 68%, and the overall success rate was 89%. Therefore, our results show that complex lesions may be treatable using the Slender System, and that not all complex lesions require a 6-F or larger guiding catheters, a femoral arterial approach, or bilateral guiding catheters.
Backup force of guiding catheters for the right coronary artery in transfemoral and transradial interventions
The Journal of invasive cardiology
We sought to clarify the mechanisms of backup force for right coronary artery intervention. Backu... more We sought to clarify the mechanisms of backup force for right coronary artery intervention. Backup force of a guiding catheter is important for successful percutaneous coronary intervention (PCI); however, little attention has been given to its mechanism. Backup force of guiding catheters was measured in an arterial tree model. Judkins R, Amplatz L and Ikari R had greater backup force in the transfemoral intervention (TFI) than the transradial intervention (TRI). The primary attachment site of the catheter was the aortic arch in TFI, but it was the brachiocephalic artery in right TRI. This may be a major reason for the different backup force because generation of backup force is governed by the mechanics of the catheter at the attachment site. The Amplatz L and Ikari R had stronger backup force than the Judkins R both in TFI and in TRI because a slight backward motion of the catheter due to device advancement changed the primary attachment site to the reverse side of the aorta or sinus of Valsalva. The primary attachment site of the Ikari L at the power position was the reverse side of the aorta both in TFI and TRI, which was different from other catheters. The primary attachment site of the catheter had great impact on the backup force in right coronary interventions. An understanding of the mechanism by which the guiding catheter works in TRI and TFI may help in choosing an appropriate approach site.
Simultaneous triple-balloon inflation technique within a 6 Fr guiding catheter for a trifurcation lesion
The Journal of invasive cardiology
We report two cases of trifurcation lesions that were successfully treated with simultaneous trip... more We report two cases of trifurcation lesions that were successfully treated with simultaneous triple-balloon inflation. One of the potential limitations with using simultaneous triple-balloon inflation has been the requirement for a larger guiding catheter (8 Fr or larger). This limitation was overcome by using 0.010 inch guidewires and 0.010 inch guidewire compatible balloon catheters with a 6 Fr guiding catheter via a transradial approach (The King Ghidorah Technique). The other advantage of the simultaneous triple-balloon inflation was to obtain an almost complete round circle (symmetry index 0.9) at the left main coronary artery by intravascular ultrasound imaging.
Intravascular ultrasound-guided percutaneous coronary interventions with minimum contrast volume for prevention of the radiocontrast-induced nephropathy: report of two cases
Cardiovascular Intervention and Therapeutics, 2010
Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous ... more Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous coronary interventions (PCI). The prevention of PCI-related CIN for chronic kidney disease (CKD) patients has not been established yet. The intravascular ultrasound (IVUS) is commonly used as an imaging device during PCI. We performed IVUS-guided PCI while only using fluoroscopic imaging and without administering any routine contrast dye injection during the procedures. All patients underwent a baseline coronary angiography prior to the elective PCI. During the PCI, all the following procedures were done with X-ray fluoroscopic imaging without or with a minimized contrast dye injection: the engagement of the guiding catheter, insertion of the coronary guidewire, insertion of the IVUS catheter, the stent deployment and the post-dilatation. The diameter and the length of the balloon and the stent were determined according to the pre-procedural IVUS findings, and the end point of the stent dilatation was also judged according to the acquired minimal cross-sectional area of the stent. Here we report our findings from two cases representative of IVUS-guided minimum contrast PCI in which the volumes of contrast dye during the procedure were 5 and 4 ml, respectively. No CIN occurred after either procedure. The IVUS-guided minimum contrast PCI could be a promising option for the prevention of CIN after PCI.
“Rising Sun”, Minimally Invasive TRI from Japan to the Rest of the World
Journal of Vascular Medicine & Surgery, 2013
Successful transradial intervention for two lesions with dual anomalous origins of coronary arteries
The Journal of invasive cardiology, 2011
A 76-year-old male was admitted to our hospital for effort angina pectoris. His coronary computed... more A 76-year-old male was admitted to our hospital for effort angina pectoris. His coronary computed tomography and coronary angiography revealed anomalous origins of the left anterior descending artery (LAD) from the proximal right coronary artery (RCA) and the left circumflex coronary artery (LCX) from the separate ostium in the right coronary cusp. Severe stenoses were present in the proximal segment of the LAD and in the middle segment of the LCX, which were successfully treated by 5 French (Fr) transradial approach intervention. Congenital coronary anomalies are relatively rare, with a prevalence of approximately 1.3% in a large-series study undergoing coronary angiography. Such anomalies occur in several anatomical arrangements, which have been classified in a number of research reports. Here we describe previously unreported dual anomalous origins of coronary arteries associated with significant atherosclerotic lesions, which were successfully treated by 5 Fr transradial approac...
Impact of transient or persistent slow flow and adjunctive distal protection on mortality in ST-segment elevation myocardial infarction
Cardiovascular intervention and therapeutics, Jan 2, 2014
Routine use of distal protection for ST-segment elevation myocardial infarction (STEMI) is not re... more Routine use of distal protection for ST-segment elevation myocardial infarction (STEMI) is not recommended. The purpose of this study was to analyze the impact of slow flow on mortality after STEMI, and the efficacy of adjunctive distal protection following primary thrombus aspiration. We retrospectively analyzed 414 STEMI patients who underwent primary PCI. Distal protection was used following primary thrombus aspiration only when the operator judged the patient to be at high risk of slow flow. Patients were divided into 3 groups: those receiving no thrombus aspiration (A- Group), thrombus aspiration without distal protection (A+/D- Group) or a combination of aspiration with distal protection (A+/D+ Group). Slow flow/no reflow was characterized as transient or persistent. The A-, A+/D-, and A+/D+ Groups consisted of 28.5 % (n = 118), 44.4 % (n = 184), and 27.1 % (n = 112) of patients, respectively. All-cause mortality at 180 days was 6.8 % without slow flow, 14.1 % with transient a...
A simple method preventing tangling of the guidewires during percutaneous coronary intervention for bifurcation lesions
Cardiovascular intervention and therapeutics, 2011
The aim was to examine the efficacy of the simple technique that reduces tangling of the guidewir... more The aim was to examine the efficacy of the simple technique that reduces tangling of the guidewires by utilizing wet gauze during percutaneous coronary intervention with multiple guidewires. We defined "Critical tangle of the guidewires" as occurring when it became impossible to insert balloon catheters into the bifurcation lesion due to tangling of the guidewires without withdrawing and reinserting one of the guidewires. We compared the rate of the critical tangle of the guidewires between the group taking no special tangle precaution ("NP Group"), and the group taking the tangle precaution with the wet gauze ("Gauze Group"). Eighty-four patients were enrolled in the study and randomly assigned to either NP Group (n = 43) or Gauze Group (n = 41). The kissing balloon technique success was 42/43 (97.7%) versus 40/41 (97.6%), in NP Group and Gauze Group, respectively. The rate of critical tangle of the guidewires was significantly lower in Gauze Group (27...
Cardiovascular intervention and therapeutics, 2011
Very late stent thrombosis (VLST) is a major unresolved problem of drug-eluting stent (DES) impla... more Very late stent thrombosis (VLST) is a major unresolved problem of drug-eluting stent (DES) implants. However, its actual incidence with respect to the distribution of DES-target vessel and accuracy of adjudicating stent thrombosis according to the ARC definition has not been yet adequately evaluated. We studied 720 patients who had completed over 1 year from elective DES implantation. In this cohort, we extracted patients who present acute coronary syndrome (ACS) (n = 3, 0.4%). The timing of ACS events was 17, 19, and 24 months after DES implantation. At the time of presentation, VLST was strongly suspected as the initial diagnosis, however, coronary angiography (CAG) confirmed the different culprit lesion from DES and clearly no thrombus within the DES. According to ARC definition, three probable stent thromboses in this cohort before CAG, however, no stent thrombosis was confirmed after the CAG. Thus, no stent thrombosis was confirmed among this study population. In the very late...
Intravascular ultrasound-guided percutaneous coronary interventions with minimum contrast volume for prevention of the radiocontrast-induced nephropathy: report of two cases
Cardiovascular intervention and therapeutics, 2011
Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous ... more Radiocontrast-induced nephropathy (CIN) is one of the most serious complications of percutaneous coronary interventions (PCI). The prevention of PCI-related CIN for chronic kidney disease (CKD) patients has not been established yet. The intravascular ultrasound (IVUS) is commonly used as an imaging device during PCI. We performed IVUS-guided PCI while only using fluoroscopic imaging and without administering any routine contrast dye injection during the procedures. All patients underwent a baseline coronary angiography prior to the elective PCI. During the PCI, all the following procedures were done with X-ray fluoroscopic imaging without or with a minimized contrast dye injection: the engagement of the guiding catheter, insertion of the coronary guidewire, insertion of the IVUS catheter, the stent deployment and the post-dilatation. The diameter and the length of the balloon and the stent were determined according to the pre-procedural IVUS findings, and the end point of the stent ...
Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents
Cardiovascular intervention and therapeutics, 2011
Although sirolimus-eluting stent (SES) is effective to reduce restenosis, the effect of SES for p... more Although sirolimus-eluting stent (SES) is effective to reduce restenosis, the effect of SES for patients with chronic kidney disease (CKD) has been ambiguous. SES were exclusively implanted into 304 lesions in 195 patients. Forty-seven percent of the patients had diabetes. Patients were divided into three groups by estimated glomerular filtration rate, CKD stage 0-2: 156 patients, 239 lesions; CKD stage 3-4: 21 patients, 37 lesions; and CKD stage 5: 18 patients, 28 lesions. Clinical follow-up data were available in 97% at 616 ± 192 days. There was a statistically significant association between the stage of CKD and target lesion revascularization (TLR) (CKD 0-2: 2.7%, CKD 3-4: 5.3%, and CKD 5: 11.9%; P = 0.011), and late lumen loss at 8 months (CKD 0-2: 0.13 ± 0.25 mm, CKD 3-4: 0.27 ± 0.47 mm, and CKD 5: 0.37 ± 0.61 mm; P = 0.0032). The frequency of clinical adverse events was also higher according to stages of CKD. In conclusion, stages of CKD proportionally correlated with TLR, la...
Transradial and slender percutaneous coronary intervention: less invasive strategy in PCI
Cardiovascular intervention and therapeutics, 2010
Although there is a discussion on the outcome between percutaneous coronary intervention (PCI) an... more Although there is a discussion on the outcome between percutaneous coronary intervention (PCI) and bypass surgery, PCI is clearly superior to bypass surgery in terms of less invasiveness. One of the further less invasive strategy is transradial approach (TRI). There have been several limitations such as low backup force of guiding catheters. However, mechanics studies showed that the backup force does not relate to approach site but to catheter shape and size. The other strategy is slender PCI using a 5 Fr or less guiding catheter. The slender PCI has also several limitations, however, some of these limitations have been overcome using new slender devices and new slender specific techniques. In this article, current progress in this field using new devices is reviewed. The less invasive strategy such as TRI and slender PCI may be the future direction of PCI because they prevent complications and improve quality of life.
Feasibility of 6 Fr intra-aortic balloon pumping via the femoral or brachial approach
The Journal of invasive cardiology, 2012
To demonstrate safety and efficacy of new 6 Fr intra-aortic balloon pumping (IABP) system. Access... more To demonstrate safety and efficacy of new 6 Fr intra-aortic balloon pumping (IABP) system. Access-site complications have been reported to increase adverse events following PCI. Some reports have shown access-site complications in conventional 8-Fr compatible IABP system. The new 6 Fr IABP system may reduce the complication rate due to the smaller size. We extracted medical records for patients who underwent elective percutaneous coronary intervention under prophylactic 6 Fr or 8 Fr IABP assistance from January 2006 to December 2009 at Tokai University School of Medicine. The clinical outcomes were compared between 6 Fr and 8 Fr or between transfemoral and transbrachial IABP. A total of 42 cases were extracted, including 20 cases using 6 Fr IABP (47.6%) and 22 cases using 8 Fr IABP (52.4%). The 6 Fr IABP included 15 cases of transbrachial approach (75.0%) and 5 cases of transfemoral approach (25.0%). All cases of 8 Fr IABP were via transfemoral approach. The bedrest time was clearly...
[Case report; A case of Fabry's disease suspected based on echocardiographic findings]
Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine, Jan 10, 2011