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Background The advantage of using bioresorbable-polymer drug-eluting stent (BP-DES) compared with second-generation durable-polymer drug-eluting stent (2G DP-DES) still remains controversial in clinical situations. The purpose of this study to evaluate the degree of re-endothelialization and the prevalence of high-grade yellow-colored plaque (YCP), which might concern arterial healing after BP-DES and 2G DP-DES implantation using a high-resolution coronary angioscopy (CAS). Methods In total, 104 DESs (52: 2G DP-DES and 52: BP-DES) were prospectively observed using CAS 12 ± 1 months after coronary intervention. The grade of neointimal coverage (NIC) over the stent was scored on a 4-point scale from 0 (no coverage) to 3 (complete coverage). YCP grade was also scored on a 4-point scale as 0 (white) to 3 (intensive yellow). High-grade YCP was defined as maximum grade ≥2. Moreover, the prevalence of high-grade YCP and the incidence of thrombus were investigated. Results BP-DES revealed better dominant NIC grade and less NIC heterogeneity than 2G DP-DES (p = 0.0001 and p = 0.015, respectively). The prevalence of high-grade YCP was lower for BP-DES than for 2G DP-DES (p = 0.05). However, the incidence of thrombus was not significantly different (p = 0.41). Multivariate analysis identified that low-density lipoprotein cholesterol levels [odds ratio (OR), 1.03; 95% Confidence Interval (CI): 1.01–1.06, p = 0.01] and the usage of BP-DES [OR, 0.36; 95% CI: 0.14–0.91, p = 0.03] as independent predictors of high-grade YCP. Conclusions Compared with 2G DP-DES, BP-DES was less heterogeneous and well-covered NIC and less prevalence of the high-grade YCP implying optimal arterial healing.

A 40-year-old man with progressively worsening dyspnea was admitted to our hospital. On physical examination, pulse oximetry results demonstrated 80% oxygen saturation in room air. The lungs sounded clear, and both extremities appeared normal, without pitting edema. His echocardiography revealed a pressure overload in the right ventricle. Suspecting the presence of pulmonary thromboembolism, we performed an enhanced computed tomography (CT). CT results revealed systemic venous thromboembolism (VTE) involving the superior mesenteric vein, inferior vena cava (IVC), right common iliac vein and pulmonary arteries, as well as splenomegaly and edema of the small intestine with ascites. After insertion of a retrievable IVC filter, we prescribed 10 mg of apixaban twice daily for the first 7 days, followed by 5 mg twice daily as long-term therapy. Confirming no exacerbation of the VTE symptoms, we removed the IVC filter 14 days after admission. Additionally, hereditary antithrombin deficiency was unraveled as the etiology of systemic VTE. Although an enhanced CT at 6 months follow-up showed that almost all previous VTE had dissolved, we decided to prescribe apixaban indefinitely. Fortunately, he has not experienced a recurrence of VTE or any bleeding events to date.

Purpose The purpose of this study was to identify predictors of contrast-induced acute kidney injury (CI-AKI) and the effect of CI-AKI on cardiovascular outcomes after hospital discharge in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods and Materials We retrospectively reviewed 194 STEMI consecutive patients who underwent primary PCI to evaluate the predictors for CI-AKI and 187 survivors to examine all-cause mortality and cardiovascular events. Outcomes were compared between patients with CI-AKI and those without CI-AKI, which was defined as an increase >50% or >0.5mg/dl in serum creatinine concentration within 48hours after primary PCI. Results CI-AKI occurred in 23 patients (11.9%). Multivariate analysis identified pre-procedural renal insufficiency as a predictor of CI-AKI, and this predictor was independent from hemodynamic instability and excessive contrast volume. Receiver-operator characteristics analysis demonstrated that patients with an estimated glomerular filtration rate (eGFR) of ≤43.6ml/min per 1.73m 2 had the potential for CI-AKI. Patients who developed CI-AKI had higher mortality and cardiovascular events than did those without CI-AKI (27.8% vs. 4.7%; log-rank P =.0003, 27.8% vs. 11.2%; log-rank P =.0181, respectively). Cox proportional hazards model analysis identified CI-AKI as the independent predictor of mortality and cardiovascular events [hazard ratio [HR]=5.36; P =.0076, HR=3.10; P =.0250, respectively]. Conclusions The risk of CI-AKI is increased in patients with pre-procedural renal insufficiency, and eGFR is clinically useful in the emergent setting for CI-AKI risk stratification before primary PCI.

Tortuous coronary arteries frequently make percutaneous coronary intervention (PCI) difficult by causing less accessibility of guidewire toward the target lesion. After guidewire has been passed through the target lesion, it often assists a balloon catheter and stent system insertion along the stiff guidewire. However, artificial kinking and wrinkling might induce pseudo-narrowing of coronary arteries, which has been recognized as an "accordion phenomenon." We describe an educational case of an accordion phenomenon with ST-segment elevation of electrocardiogram and anginal chest pain when the stiff guidewire which had been withdrawn was advanced again into the distal site after deploying stents.

The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) is a good predictor of adverse cardiovascular events and mortality in patients with acute coronary syndrome (ACS). The utility of risk stratifying patients with ACS complicated by cardiogenic