Pub Date : 2019-01-01DOI: 10.7793/jcad.25.19-00006
Shohei Mitta, Ryutaro Kimata, H. Ogura, Etsuji Umeda, N. Ishida, K. Shimabukuro, K. Doi
On hospital day 2, she complained of difficulty in speaking. She underwent brain magnetic resonance imaging (MRI) that re-Case Coronary stent infection is extremely rare and difficult to identify. Delay in definite diagnosis often leads to death. We describe a case of stent infection that occurred 8 years after implantation. A 66-year-old woman was admitted to our hospital with high-grade fever. She underwent placement of a bare-metal stent to the right coronary artery at 59 years of age. She also underwent kidney transplantation at 58 years of age and had been taking multiple immunosuppressants. Although whole-body computed tomography (CT) scan at the time of admission found no source of bacterial infection, blood cultures grew Staphylococcus aureus . Brain magnetic resonance imaging revealed multiple cerebral infarctions. Infective endocarditis (IE) was suspected but transthoracic and transesophageal echocardiogram found no evidence of IE. The patient became afebrile after administration of intravenous antibiotics and intravenous immunoglobulin, and blood cultures were negative. However, echocardiogram revealed a decline in left ventricle function, and thereafter, the patient developed acute inferior wall myocardial infarction. Urgent coronary angiography exhibited a large coronary artery aneurysm at the origin of the right coronary artery where a previous coronary stent was implanted, and repeat CT also confirmed a very rapidly developing coronary aneurysm. We performed emergent removal of the mycotic aneurysm along with the infected stent. However, the right heart had been severely damaged prior to surgery. She underwent four days of veno-arterial extracorporeal membrane oxygenation but developed bacterial pneumonia and expired on postoperative day 15. This case highlights the long-term risk of coronary stent infection several years after implantation.
{"title":"Coronary Stent Implantation Poses Lifelong Risk of Severe Infection or Even Death","authors":"Shohei Mitta, Ryutaro Kimata, H. Ogura, Etsuji Umeda, N. Ishida, K. Shimabukuro, K. Doi","doi":"10.7793/jcad.25.19-00006","DOIUrl":"https://doi.org/10.7793/jcad.25.19-00006","url":null,"abstract":"On hospital day 2, she complained of difficulty in speaking. She underwent brain magnetic resonance imaging (MRI) that re-Case Coronary stent infection is extremely rare and difficult to identify. Delay in definite diagnosis often leads to death. We describe a case of stent infection that occurred 8 years after implantation. A 66-year-old woman was admitted to our hospital with high-grade fever. She underwent placement of a bare-metal stent to the right coronary artery at 59 years of age. She also underwent kidney transplantation at 58 years of age and had been taking multiple immunosuppressants. Although whole-body computed tomography (CT) scan at the time of admission found no source of bacterial infection, blood cultures grew Staphylococcus aureus . Brain magnetic resonance imaging revealed multiple cerebral infarctions. Infective endocarditis (IE) was suspected but transthoracic and transesophageal echocardiogram found no evidence of IE. The patient became afebrile after administration of intravenous antibiotics and intravenous immunoglobulin, and blood cultures were negative. However, echocardiogram revealed a decline in left ventricle function, and thereafter, the patient developed acute inferior wall myocardial infarction. Urgent coronary angiography exhibited a large coronary artery aneurysm at the origin of the right coronary artery where a previous coronary stent was implanted, and repeat CT also confirmed a very rapidly developing coronary aneurysm. We performed emergent removal of the mycotic aneurysm along with the infected stent. However, the right heart had been severely damaged prior to surgery. She underwent four days of veno-arterial extracorporeal membrane oxygenation but developed bacterial pneumonia and expired on postoperative day 15. This case highlights the long-term risk of coronary stent infection several years after implantation.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7793/jcad.25.19-00006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.7793/jcad.25.19-00013
R. Fukui, Yuzo Yamamoto, K. Tanigaki, Shigeru Suzuki
and Objective : We assessed coronary motion artifacts at various heart rates (HRs) using coronary computed tomography angiography (CCTA) and a phantom; the resulting data were reconstructed using half-scan reconstruction algorithms (HSRA), multi-sector reconstruction algorithms (MSRA), and a novel vendor-specific motion correction algorithm (MCA) introduced to eliminate coronary motion artifacts. Materials and Methods : Using retrospective electrocardiographic (ECG)-gated helical CCTA scans of a cardiac phantom that included branching coronary artery models filled with iodine contrast medium and pulsating at HRs of 50 to 100 beats per minute (bpm), we reconstructed images using HSRA, MSRA, and HSRA combined with MCA during both systole and diastole. On axial images, 2 readers graded image quality focused on coronary motion artifacts at 50 to 100 bpm in 9 segments of the models using a scale from 1 (poor) to 5 (excellent). We then compared the average scores among the 3 algorithms using Kruskal-Wallis and post-hoc tests. Results : At 50 to 60 bpm, there were no significant differences in image quality among the 3 algorithms ( P > 0.05). At 70 to 100 bpm, the image quality using MSRA was comparable or better than that of HSRA, and HSRA combined with MCA provided a comparable or better image quality compared with the other 2 algorithms. Conclusion : Coronary motion artifacts are comparable or significantly reduced using HSRA combined with MCA, compared with MSRA.
{"title":"Effects of using Different Reconstruction Algorithms on Coronary Motion Artifacts at Various Heart Rates during Coronary CT Angiography","authors":"R. Fukui, Yuzo Yamamoto, K. Tanigaki, Shigeru Suzuki","doi":"10.7793/jcad.25.19-00013","DOIUrl":"https://doi.org/10.7793/jcad.25.19-00013","url":null,"abstract":"and Objective : We assessed coronary motion artifacts at various heart rates (HRs) using coronary computed tomography angiography (CCTA) and a phantom; the resulting data were reconstructed using half-scan reconstruction algorithms (HSRA), multi-sector reconstruction algorithms (MSRA), and a novel vendor-specific motion correction algorithm (MCA) introduced to eliminate coronary motion artifacts. Materials and Methods : Using retrospective electrocardiographic (ECG)-gated helical CCTA scans of a cardiac phantom that included branching coronary artery models filled with iodine contrast medium and pulsating at HRs of 50 to 100 beats per minute (bpm), we reconstructed images using HSRA, MSRA, and HSRA combined with MCA during both systole and diastole. On axial images, 2 readers graded image quality focused on coronary motion artifacts at 50 to 100 bpm in 9 segments of the models using a scale from 1 (poor) to 5 (excellent). We then compared the average scores among the 3 algorithms using Kruskal-Wallis and post-hoc tests. Results : At 50 to 60 bpm, there were no significant differences in image quality among the 3 algorithms ( P > 0.05). At 70 to 100 bpm, the image quality using MSRA was comparable or better than that of HSRA, and HSRA combined with MCA provided a comparable or better image quality compared with the other 2 algorithms. Conclusion : Coronary motion artifacts are comparable or significantly reduced using HSRA combined with MCA, compared with MSRA.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"155 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Terazawa, Y. Narita, K. Fujimoto, M. Mutsuga, Y. Tokuda, Hideki Ito, W. Uchida, A. Usui
to dementia 8) . Clinicians can diagnose the symptoms of dementia based on the standard criteria of the fifth Coronary artery bypass grafting (CABG) is strategy for complex coronary artery disease (CAD) practiced worldwide that has become to be performed in relatively elderly patients in recent years, regarding to the development of off-pump CABG. As the population of elderly patients with cognitive disorders increases, a certain proportion of CABG candidates are likely to have some degree of cognitive impairment, especially dementia. The discussions about the CABG candidates with dementia are still insufficient, although several reports have suggested that 9.6%–20% of CABG candidates may have preoperative dementia. An analysis indicated higher rate of hospital mortality and delirium in dementia patients, but ideal strategies for managing such patients remain controversial. An estimated 20%–35% of CABG patients may have preoperative mild cognitive impairment (MCI), which is associated with an increased risk of morbidity and poor physical recovery after CABG. This preoperative cognitive decline was identified as a predictive factor for post-operative cognitive decline (POCD). Several randomized control trial have compared the cognitive outcomes between elderly high-risk patients after CABG with or without cardiopulmonary bypass, finding no significant cognitive differences between on- and off-pump treatments at 3 to 12 months after CABG. In addition, any late cognitive decline is likely associated with the progression of underlying cerebrovascular disease rather than surgical procedure itself or cardiopulmonary bypass. Preoperative evaluations of the cognitive function may contribute to appropriate postoperative management, reduce the incidence of delirium and improve the overall surgical outcome.
{"title":"Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society","authors":"S. Terazawa, Y. Narita, K. Fujimoto, M. Mutsuga, Y. Tokuda, Hideki Ito, W. Uchida, A. Usui","doi":"10.7793/jcad.25.010","DOIUrl":"https://doi.org/10.7793/jcad.25.010","url":null,"abstract":"to dementia 8) . Clinicians can diagnose the symptoms of dementia based on the standard criteria of the fifth Coronary artery bypass grafting (CABG) is strategy for complex coronary artery disease (CAD) practiced worldwide that has become to be performed in relatively elderly patients in recent years, regarding to the development of off-pump CABG. As the population of elderly patients with cognitive disorders increases, a certain proportion of CABG candidates are likely to have some degree of cognitive impairment, especially dementia. The discussions about the CABG candidates with dementia are still insufficient, although several reports have suggested that 9.6%–20% of CABG candidates may have preoperative dementia. An analysis indicated higher rate of hospital mortality and delirium in dementia patients, but ideal strategies for managing such patients remain controversial. An estimated 20%–35% of CABG patients may have preoperative mild cognitive impairment (MCI), which is associated with an increased risk of morbidity and poor physical recovery after CABG. This preoperative cognitive decline was identified as a predictive factor for post-operative cognitive decline (POCD). Several randomized control trial have compared the cognitive outcomes between elderly high-risk patients after CABG with or without cardiopulmonary bypass, finding no significant cognitive differences between on- and off-pump treatments at 3 to 12 months after CABG. In addition, any late cognitive decline is likely associated with the progression of underlying cerebrovascular disease rather than surgical procedure itself or cardiopulmonary bypass. Preoperative evaluations of the cognitive function may contribute to appropriate postoperative management, reduce the incidence of delirium and improve the overall surgical outcome.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary artery disease (CAD) is a disorder that causes myocardial ischemia, where the blood flow to the myocardium is inhibited by obstruction and stenosis of the coronary artery, and the balance of supply and demand of oxygen in the myocardium is disturbed. In general, it is used almost synonymous with ischemic heart disease. Based on the condition of ischemia, it is roughly classified into angina, silent myocardial ischemia (SMI), and myocardial infarction. The development of myocardial ischemia, whether silent or painful, represents the cumulative impact of a sequence of pathophysiologic events over time and this sequence of events can be termed the ischemic cascade (Fig. 1). Specifically, these events include diminished left ventricular compliance, decreased myocardial contractility, increased left ventricular end-diastolic pressure, ST-segment changes and, occasionally, angina pectoris. Cardiac rhythm disturbances and breathlessness as a consequence of ischemic left ventricular dysfunction may also be recognized. There are three types of mechanism causing ischemia in coronary artery ; obstruction of epicardial coronary artery, coronary microvascular dysfunction (MVA: microvascular angina), and coronary spasm (CSA: coronary spastic angina), but the mechanisms are often overlapped. II. Initial assessment
{"title":"Ischemia Testing for Stable Coronary Artery Disease","authors":"Y. Iwanaga","doi":"10.7793/JCAD.25.001","DOIUrl":"https://doi.org/10.7793/JCAD.25.001","url":null,"abstract":"Coronary artery disease (CAD) is a disorder that causes myocardial ischemia, where the blood flow to the myocardium is inhibited by obstruction and stenosis of the coronary artery, and the balance of supply and demand of oxygen in the myocardium is disturbed. In general, it is used almost synonymous with ischemic heart disease. Based on the condition of ischemia, it is roughly classified into angina, silent myocardial ischemia (SMI), and myocardial infarction. The development of myocardial ischemia, whether silent or painful, represents the cumulative impact of a sequence of pathophysiologic events over time and this sequence of events can be termed the ischemic cascade (Fig. 1). Specifically, these events include diminished left ventricular compliance, decreased myocardial contractility, increased left ventricular end-diastolic pressure, ST-segment changes and, occasionally, angina pectoris. Cardiac rhythm disturbances and breathlessness as a consequence of ischemic left ventricular dysfunction may also be recognized. There are three types of mechanism causing ischemia in coronary artery ; obstruction of epicardial coronary artery, coronary microvascular dysfunction (MVA: microvascular angina), and coronary spasm (CSA: coronary spastic angina), but the mechanisms are often overlapped. II. Initial assessment","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
mortality associated with CS may approach nearly 30% to 45% in the contemporary era. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may represent the final option for severe CS that is refractory to medical therapy. Peripheral VA-ECMO can be initiated percutaneously and promptly via femoral artery and femoral vein access, and is widely used for CS and CA in emergency situations. In this review, we describe the role and efficacy of peripheral VA-ECMO in treating CS and CA.
{"title":"The Role and Efficacy of Peripheral Veno-arterial Extracorporeal Membrane Oxygenation in Treating Cardiogenic Shock and Cardiac Arrest","authors":"T. Tada, K. Kadota","doi":"10.7793/jcad.25.002","DOIUrl":"https://doi.org/10.7793/jcad.25.002","url":null,"abstract":"mortality associated with CS may approach nearly 30% to 45% in the contemporary era. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may represent the final option for severe CS that is refractory to medical therapy. Peripheral VA-ECMO can be initiated percutaneously and promptly via femoral artery and femoral vein access, and is widely used for CS and CA in emergency situations. In this review, we describe the role and efficacy of peripheral VA-ECMO in treating CS and CA.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. K. M. Khalifa, T. Kubo, Y. Ino, Masahiro Takahata, K. Shimamura, Y. Shiono, K. Terada, H. Emori, D. Higashioka, Y. Katayama, T. Akasaka
deliver balloon/stent the risk of in-stent (Fig. 1B) 6) . can accurately measure calcium thickness, calcium arc, and calcium length ; and accordingly can guide the selection of cutting balloon or rotational atherectomy. Also, OCT can accurately detects occurrence of calcium fracture following balloon angioplasty and thus predict adequate stent expansion. Maejima N. et al. concluded that the optimal thresholds for the prediction of calcium fracture Intravascular optical coherence tomography (OCT) is a recently developed technology that is becoming more and more increasingly available in the catheter laboratories. OCT is an easy and safe tool that can provide the operator with many valuable information aiding intervention and making the intervention safer and more predictable. OCT can guide all steps of intervention including target lesion assessment before intervention, stent selection, stent optimization, and post-stenting assessment. This review will summarize the role of OCT in guiding percutaneous coronary intervention.
{"title":"Role of Optical Coherence Tomography in Optimizing Percutaneous Coronary Intervention","authors":"A. K. M. Khalifa, T. Kubo, Y. Ino, Masahiro Takahata, K. Shimamura, Y. Shiono, K. Terada, H. Emori, D. Higashioka, Y. Katayama, T. Akasaka","doi":"10.7793/jcad.25.008","DOIUrl":"https://doi.org/10.7793/jcad.25.008","url":null,"abstract":"deliver balloon/stent the risk of in-stent (Fig. 1B) 6) . can accurately measure calcium thickness, calcium arc, and calcium length ; and accordingly can guide the selection of cutting balloon or rotational atherectomy. Also, OCT can accurately detects occurrence of calcium fracture following balloon angioplasty and thus predict adequate stent expansion. Maejima N. et al. concluded that the optimal thresholds for the prediction of calcium fracture Intravascular optical coherence tomography (OCT) is a recently developed technology that is becoming more and more increasingly available in the catheter laboratories. OCT is an easy and safe tool that can provide the operator with many valuable information aiding intervention and making the intervention safer and more predictable. OCT can guide all steps of intervention including target lesion assessment before intervention, stent selection, stent optimization, and post-stenting assessment. This review will summarize the role of OCT in guiding percutaneous coronary intervention.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.7793/JCAD.25.19-00004
K. Ueyama, Y. Ide, Kazuhisa Sakamoto, H. Kanemitsu, K. Yamazaki, T. Ikeda, K. Minatoya
Patients with antiphospholipid syndrome (APS) have an increased risk of atherothrombotic complications, such as cerebrovascular events and myocardial infarction. The case of a young adult patient of APS associated with systemic lupus erythematosus (SLE) who had severe stenosis of left anterior descending coronary artery (LAD) and total occlusion of right coronary artery (RCA) on angiography and was successfully treated with off pump coronary artery bypass grafting (OPCAB) is reported.
{"title":"Off Pump Coronary Artery Bypass Grafting for a Young Adult Patient with Antiphospholipid Syndrome","authors":"K. Ueyama, Y. Ide, Kazuhisa Sakamoto, H. Kanemitsu, K. Yamazaki, T. Ikeda, K. Minatoya","doi":"10.7793/JCAD.25.19-00004","DOIUrl":"https://doi.org/10.7793/JCAD.25.19-00004","url":null,"abstract":"Patients with antiphospholipid syndrome (APS) have an increased risk of atherothrombotic complications, such as cerebrovascular events and myocardial infarction. The case of a young adult patient of APS associated with systemic lupus erythematosus (SLE) who had severe stenosis of left anterior descending coronary artery (LAD) and total occlusion of right coronary artery (RCA) on angiography and was successfully treated with off pump coronary artery bypass grafting (OPCAB) is reported.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Komatsu, S. Takahashi, C. Yutani, T. Ohara, M. Takewa, A. Hirayama, K. Kodama
Spatial and temporal resolution of NOGA are superior to CTA and transesophageal echocardiography. NOGA provides direct images of both intimal and subintimal images. Aortic angioscopy using non-obstructive general angioscopy (NOGA) is a novel, video-based technique that allows visualization of the inner aorta. Dual infusion method improves the visual field and the use of an Ikari-L guiding catheter allows easy access to the aorta, enabling NOGA of not only the coronary artery but also aorta. Imaging techniques such as computed tomography angiography (CTA), magnetic resonance, and transesophageal echocardiography have been used to evaluate the aorta and the findings are usually confirmed based on pathology. NOGA has a spatial and temporal resolution superior to these techniques, detecting various types of spontaneous ruptured aortic plaques (SRAPs) and injuries. SRAPs detected using NOGA are not comparable to those detected using CTA. NOGA can also demonstrate subintimal changes and blood flow through the aortic wall. Although aortic angioscopy is yet at its dawn, several case reports have showed its ability to decode aortic dissection pathogenesis and to evaluate the merits and demerits of stent graft implantation. NOGA is a unique invasive modality to visualize the inner aorta and to sample SRAPs. NOGA is an epoch-making modality that can be used to simultaneously evaluate the arterial and venous systems.
{"title":"Spontaneous Ruptured Aortic Plaques and Injuries Detected using Non-obstructive General Angioscopy","authors":"S. Komatsu, S. Takahashi, C. Yutani, T. Ohara, M. Takewa, A. Hirayama, K. Kodama","doi":"10.7793/jcad.25.009","DOIUrl":"https://doi.org/10.7793/jcad.25.009","url":null,"abstract":"Spatial and temporal resolution of NOGA are superior to CTA and transesophageal echocardiography. NOGA provides direct images of both intimal and subintimal images. Aortic angioscopy using non-obstructive general angioscopy (NOGA) is a novel, video-based technique that allows visualization of the inner aorta. Dual infusion method improves the visual field and the use of an Ikari-L guiding catheter allows easy access to the aorta, enabling NOGA of not only the coronary artery but also aorta. Imaging techniques such as computed tomography angiography (CTA), magnetic resonance, and transesophageal echocardiography have been used to evaluate the aorta and the findings are usually confirmed based on pathology. NOGA has a spatial and temporal resolution superior to these techniques, detecting various types of spontaneous ruptured aortic plaques (SRAPs) and injuries. SRAPs detected using NOGA are not comparable to those detected using CTA. NOGA can also demonstrate subintimal changes and blood flow through the aortic wall. Although aortic angioscopy is yet at its dawn, several case reports have showed its ability to decode aortic dissection pathogenesis and to evaluate the merits and demerits of stent graft implantation. NOGA is a unique invasive modality to visualize the inner aorta and to sample SRAPs. NOGA is an epoch-making modality that can be used to simultaneously evaluate the arterial and venous systems.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.7793/jcad.27.21-00007
S. Sueda, Tomoki Sakaue
Focal Objectives: We retrospectively analyzed the clinical and angiographical characteristics between variant angina and non-variant angina. Methods : We diagnosed 902 patients with coronary spastic angina from Jan 1991 to Mar 2019. Variant angina was observed in 105 patients, while the remaining 797 patients had non-variant angina. Acetylcholine was injected in incremental doses of 20/50/100/200 μg into the left coronary artery (LCA) and 20/50/80 μg into the right coronary artery (RCA), whereas 64 μg ergonovine was administered into the LCA and 40 μg into the RCA. Positive spasm was defined as > 90% stenosis and usual chest pain or ischemic ECG changes. Clinical outcomes under medications were investigated during 1462±960 days of follow-up. Results : There were no differences regarding the clinical characteristics between the two groups. Significant organic stenosis was frequently observed in patients with variant angina compared with non-variant angina. Although the administration of two types of calcium channel blocker (CCB)s, nitrates, and aspirin was markedly higher in patients with variant angina than in those with non-variant angina, the number of clinical outcomes including sudden cardiac death, acute coronary syndrome, ventricular fibrillation, and percutaneous coronary intervention was significantly higher in patients with variant angina than in those with non-variant angina. Clinical outcomes in patients with variant angina and organic stenosis was markedly worse than other 3 groups: variant angina with nonorganic stenosis, non-variant angina with organic stenosis, and non-variant angina and nonorganic stenosis. Conclusions : Clinical outcomes in patients with variant angina was unfavorable compared with those with non-variant angina. Variant angina requires more percutaneous coronary intervention therapy compared with non-variant angina.
{"title":"Clinical Characteristics and Outcomes in Patients with Variant Angina","authors":"S. Sueda, Tomoki Sakaue","doi":"10.7793/jcad.27.21-00007","DOIUrl":"https://doi.org/10.7793/jcad.27.21-00007","url":null,"abstract":"Focal Objectives: We retrospectively analyzed the clinical and angiographical characteristics between variant angina and non-variant angina. Methods : We diagnosed 902 patients with coronary spastic angina from Jan 1991 to Mar 2019. Variant angina was observed in 105 patients, while the remaining 797 patients had non-variant angina. Acetylcholine was injected in incremental doses of 20/50/100/200 μg into the left coronary artery (LCA) and 20/50/80 μg into the right coronary artery (RCA), whereas 64 μg ergonovine was administered into the LCA and 40 μg into the RCA. Positive spasm was defined as > 90% stenosis and usual chest pain or ischemic ECG changes. Clinical outcomes under medications were investigated during 1462±960 days of follow-up. Results : There were no differences regarding the clinical characteristics between the two groups. Significant organic stenosis was frequently observed in patients with variant angina compared with non-variant angina. Although the administration of two types of calcium channel blocker (CCB)s, nitrates, and aspirin was markedly higher in patients with variant angina than in those with non-variant angina, the number of clinical outcomes including sudden cardiac death, acute coronary syndrome, ventricular fibrillation, and percutaneous coronary intervention was significantly higher in patients with variant angina than in those with non-variant angina. Clinical outcomes in patients with variant angina and organic stenosis was markedly worse than other 3 groups: variant angina with nonorganic stenosis, non-variant angina with organic stenosis, and non-variant angina and nonorganic stenosis. Conclusions : Clinical outcomes in patients with variant angina was unfavorable compared with those with non-variant angina. Variant angina requires more percutaneous coronary intervention therapy compared with non-variant angina.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71176220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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