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Discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) occurs in approximately 20 % of cases. However, no studies have reported the discordance in patients with severe aortic stenosis (AS). We aimed to evaluate the diagnostic discordance between FFR and iFR in patients with severe AS.We examined 140 consecutive patients with severe AS (164 intermediate coronary artery stenosis vessels). FFR and iFR were calculated in four quadrants based on threshold FFR and iFR values of ≤0.8 and ≤0.89, respectively (Group 1: iFR0.89, FFR0.80; Group 2: iFR ≤0.89, FFR0.80; Group 3: iFR0.89, FFR ≤0.80; and Group 4: iFR ≤0.89, FFR ≤0.80). Concordant groups were Groups 1 and 4, and discordant groups were Groups 2 and 3. Positive and negative discordant groups were Groups 3 and 2, respectively.The median (Q1, Q3) FFR and iFR were 0.84 (0.76, 0.88) and 0.85 (0.76, 0.91), respectively. Discordance was observed in 48 vessels (29.3 %). In the discordant group, negative discordance (Group 2: iFR ≤0.89 and FFR0.80) was predominant (45 cases, 93.6 %). Multivariate analysis showed that the left anterior descending artery [odds ratio (OR), 3.88; 95 % confidence interval (CI): 1.54-9.79, p = 0.004] and peak velocity ≥5.0 m/s (OR, 3.21; 95%CI: 1.36-7.57, p = 0.008) were independently associated with negative discordance (FFR0.8 and iFR ≤0.89).In patients with severe AS, discordance between FFR and iFR was predominantly negative and observed in 29.3 % of vessels. The left anterior descending artery and peak velocity ≥5.0 m/s were independently associated with negative discordance.

BACKGROUND/PURPOSE Data on the feasibility of coronary access (CA) through above or outside of the cylindrical shaped-transcatheter heart valve (THV) are very limited. The aims of the present study were to assess the feasibility of CA after transcatheter aortic valve replacement (TAVR) with the LOTUS using multi detector computed tomography (MDCT) and the reliability of algorithm detecting unfavorable CA. METHODS/MATERIALS Post-TAVR MDCT of 41 patients with 82 coronary arteries were evaluated. The relationship and distance between the THV flame and sinotubular junction (STJ) and coronary ostia were assessed. Unfavorable CA was defined as the valve-to-STJ distance < 2-mm or the valve-to-coronary ostia distance < 2-mm if the THV flame was above STJ or coronary ostia. RESULTS MDCT-identified unfavorable CA was observed in 29.3% for the left coronary artery and 41.5% for the right coronary artery. In total, 53.7% of patients had at least one unfavorable CA and 14.6% of those had unfavorable CA for both left and right coronary artery. While patients underwent coronary angiography after TAVR, the success rates of selective coronary cannulation were significantly lower in patients with MDCT-identified unfavorable CA in comparison to those with favorable CA for left (20.0% vs. 100%, P = 0.002) and right coronary artery (0% vs. 100%, P < 0.001). CONCLUSIONS Future CA through above or outside of a cylindrical shaped THV may be challenging with a significant probability. Our algorithm identifying unfavorable CA using post-MDCT seems to be useful for estimating the risk of unsuccessful selective cannulation.

Although a distal radial artery (DRA) approach has recently been used in patients undergoing cardiac catheterization, no studies have so far investigated the safety and feasibility of DRA in patients undergoing hemodialysis (HD). We aimed to investigate the incidence of conventional radial artery (CRA) occlusion and puncture site complications after DRA puncture in patients undergoing HD.We retrospectively analyzed the data of 117 consecutive patients with HD who underwent coronary angiography or percutaneous coronary intervention via a DRA approach at our institution from September 2017 to December 2019. The primary endpoint was the incidence of CRA occlusion after DRA puncture, as assessed via vascular ultrasonography. Secondary endpoints included difficulty achieving hemostasis, DRA occlusion, aneurysm, arteriovenous shunt, and acute ischemia.The DRA puncture was successful in 106 patients (success rate: 90.5%). Because 21 patients lacked postprocedural vascular ultrasonography data, the primary endpoint was evaluated in 85 patients. CRA occlusion occurred in three patients (3.5%) following DRA puncture. DRA occlusion and aneurysm occurred in five patients (5.9%) and one patient (1.2%), respectively.Catheterization through DRA is feasible in patients undergoing HD, with a clinically acceptable incidence of CRA and complications.

BACKGROUND The MitraClip NT System was approved for marketing in Japan on October 31, 2017, and a prospective, multi-center, single-arm Post-Marketing use Surveillance (PMS) study was launched in 2018. This is the first report of the Japan PMS study with 1-year subject outcomes.Methods and Results:A total of 500 patients were registered between April 2018 and January 2019. Patients with symptomatic chronic moderate-to-severe (3+) or severe mitral regurgitation (MR; 4+), MR with a Society of Thoracic Surgery (STS) replacement score of ≥8%, or presence of 1 pre-defined risk factor were enrolled. Primary outcome measures included acute procedural success (APS), and rate of Single Leaflet Device Attachment (SLDA) at 30 days. The overall cohort was elderly (77.9±9.48 years) with functional MR etiology in 71.6% of the subjects. The majority of subjects were New York Heart Association (NYHA) class III/IV (68.9%), with mean STS replacement score of 11.95±9.66%. The APS rate was 91.13% and the 30-day SLDA rate was 1.21%. Durable MR reduction was achieved with 88.1% of subjects at MR ≤2+ at 1 year. Significant improvement in the functional capacity was observed, with 93% of subjects at NYHA class I/II at 1 year. CONCLUSIONS In the Japan PMS experience, the MitraClip procedure resulted in improvements in MR severity, with significantly improved functional outcomes. These results demonstrate safety and efficacy of MitraClip therapy in the eligible Japanese population.

The patient was an 84-year-old man who had moderate-to-severe eccentric mitral regurgitation due to a prolapsed P1 segment ([Figures 1A and 1B][1], [Videos 1][2] and [2][3]). MitraClip implantation (Abbott Vascular, Santa Clara, California) was performed via the right femoral vein. When the guiding

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: 0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P P P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/ . Unique identifier: UMIN000020423.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/., Background: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers., Open Access funding provided by Universität Zürich. CT has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation. L.S.M. has been supported by EU HORIZON 2020 (SILICOFCM ID777204). J.R.G has received a grant “Filling the gap” from the University of Zurich. The InterTAK Registry is supported by The Biss Davies Charitable Trust.

Aims: Difficulties are often encountered while controlling atrial fibrillation (AF), especially in hemodialysis (HD) patients. Previous data revealed that cryoballoon ablation (CBA) for treating paroxysmal atrial fibrillation (PAF) was not inferior to radiofrequency ablation (RFA); however, HD patients were excluded in this prior trial. Thus, the efficacy of CBA for HD patients is still unknown. Methods: This retrospective study analyzed HD patients who underwent catheter ablation (CA) for AF from August 2011 to June 2019. Patients who received CBA (CBA group) and those who received RFA (RFA group) were compared. The primary endpoint was defined as freedom from a composite outcome (a documented recurrence of any atrial tachyarrhythmia or a prescription of antiarrhythmic drugs) at one year after CA. The secondary endpoint was freedom from a documented recurrence of any atrial tachyarrhythmia at one year after CA. Results: The RFA and CBA groups were composed of 21 and 23 patients, respectively. Freedom from a composite outcome was 58.4% in the RFA group and 68.2 % in the CBA group (Log-rank: p=0.571). Freedom from any atrial tachyarrhythmia was 63.5% in the RFA group and 90.9% in the CBA group (Log-rank: p=0.042). Conclusion: Our results suggest that patients on HD with AF who were treated with CBA tended to have better outcomes than patients treated with RFA. Therefore, CBA could be a suitable ablation method for HD patients.

Objectives: This study investigated the diagnostic performance of instantaneous wave-free ratio (iFR) in patients with aortic valve stenosis (AS).Background: The iFR was introduced as a new...

Objectives The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure. Background Consistent data on the outcomes of transradial PCI for treating CTO are scarce. Methods Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined. Results In total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score–matched analysis (74.6% vs. 72.5%; p = 0.51 and 70.6% vs. 73.3%; p = 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores of ≥3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; p = 0.04). The use of guiding catheter size 20 mm (OR: 2.97; p Conclusions Transradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter size ≥7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification.

BACKGROUND The MitraClip®system is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled. Patients with left ventricular (LV) ejection fraction (EF)

Fractional flow reserve (FFR) measurement is a well-established pressure wire-based procedure that is used to assess the functional severity of coronary lesions [(1)][1]. Various randomized trials have demonstrated that FFR-guided revascularization improves clinical outcomes in patients with

Data regarding neoatherosclerosis after everolimus-eluting bioresorbable vascular scaffold (BVS) (ABSORB BVS Rev. 1.1, Abbott Vascular, Santa Clara, California) implantation are limited.This study investigated the findings of neoatherosclerosis at 5 years after BVS 1.1 implantation by using multi-imaging modalities, including optical coherence tomography (OCT).Patients included in the ABSORB EXTEND (ABSORB EXTEND Clinical Investigation) trial at Shonan Kamakura General Hospital underwent OCT at baseline after the index procedure and at 1 and 5 years. Intimal plaque distributions in the in-scaffold and out-scaffold segments were analyzed.Twenty patients (22 lesions) with stable angina pectoris were enrolled. The median follow-up duration was 67 months (interquartile range: 65 to 69 months), and the mean age was 69 ± 8 years. Patients with diabetes mellitus (25%) were included. Based on the baseline angiogram, 10 (46%) lesions were type B2/C lesions. At 1 and 5 years of follow-up, significant differences in the prevalence of in-scaffold lipid-laden neointima (17% vs. 61%; p = 0.04), calcification (28% vs. 94%; p 0.01), neovascularization (6% vs. 78%; p 0.01), and thin-cap fibroatheroma (0% vs. 22%; p = 0.02) were found. In the out-scaffold segments, no significant difference in the plaque prevalence between 1 and 5 years was noted.The occurrence and progression of in-scaffold neoatherosclerosis with luminal narrowing was observed at 5 years after BVS 1.1 implantation. The small size of the current study warrants confirmation in larger study. (ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789).

The MitraClipThe MitraClip

This study evaluated long-term results following successful endovascular therapy (EVT) for chronic total occlusion (CTO) below the knee (BTK) using the retrograde approach after a failed antegrade approach.Nineteen patients (19 limbs) with critical limb ischemia (CLI) who underwent successful EVT for BTK-CTO using the retrograde approach after a failed antegrade approach during 2010-2014 were studied.Mean duration of the follow-up period was 25.5 ± 17.9 months, and mean age was 76.0 ± 8.6 years. Patients on hemodialysis accounted for 10 cases (52.6%). Patients with Rutherford class 4 constituted 3 cases (15.8%) , while 8 patients each (42.1%) were categorized as Rutherford class 5 and class 6, respectively. All lesions were de novo CTOs. The mean occlusion length was 203.7 ± 114.7 mm. Vascular access for the retrograde approach was obtained via distal puncture in 9 cases (47.4%), whereas the transcollateral approach was employed in 10 cases (52.6%). The amputation-free survival rates at 1, 2, 3, 4, and 5 years after the index procedure were 78.6%, 66.9%, 66.9%, 50.2%, and 50.2%, respectively.Successful EVT for BTK-CTO using various techniques via the retrograde approach provides promising long-term results in patients with CLI.

Objectives To evaluate the risk of long-term dual antiplatelet therapy (DAT) following drug-eluting stent (DES) implantation in octogenarians. Background DES implantation requires DAT; however, DAT-associated risk in octogenarians remains unclear. Methods Two-hundred and six consecutive octogenarians (130 men, 83.3 ± 3.4 years) underwent stent implantation (104 bare metal stents [BMSs] and 102 DESs) and 38.0 ± 13.2 months of follow-up. Results Significantly more DES patients received DAT. The incidence of bleeding events was similar in the DES and BMS groups for 1 year (total: 10.8% vs 5.8%, P = 0.19; major: 4.9% vs 2.9%, P = 0.70). However, after 2 years, significantly more bleeding events occurred in the DES group than the BMS group (total: 2 years, 21.6% vs 9.6%, P = 0.02; 3 years, 29.4% vs 11.5%, P = 0.001; 4 years, 31.4% vs 15.4%, P = 0.007; major: 2 years, 12.7% vs 3.8%, P = 0.04; 3 years, 18.6% vs 5.8%, P = 0.005; 4 years, 19.6% vs 6.7%, P = 0.006). Overall, significantly more total bleeding events (31.4% vs 15.4%, P = 0.007) and major bleeding events (19.2% vs 6.7%, P = 0.006) were observed in the DES group than in the BMS group. The adjusted hazard ratios and 95% confidence intervals (CI) were as follows: total bleeding events, 2.203 (95% CI: 1.065–4.556; P = 0.033); major bleeding events, 4.324 (1.506–12.414; P = 0.007). Conclusions DAT was associated with an increased risk of bleeding events in octogenarians after 2 years. DAT discontinuation should be considered for octogenarians 1-year post-DES implantation. (J Interven Cardiol 2013;26:114–122)

Background: In-stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results: We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three-dimensional coronary reconstruction was performed in 374 post-PCI patients at baseline and 6 to 10 months follow-up as part of the PREDICTION Study. Each vessel was divided into 1.5-mm-long segments, and we calculated the local ESS within each stented segment at baseline. At follow-up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in-stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare-metal stents (BMS), 104 (42.3%) sirolimus-eluting stents, and 42 (17.1%) paclitaxel-eluting stents. In BMS, low ESS post-PCI at baseline was independently associated with ISH (β=1.47 mm 2 per 1-Pa decrease; 95% CI, 0.38-2.56; P < 0.01). ISH was minimal in drug-eluting stents. During follow-up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post-PCI ESS and in-stent restenosis requiring PCI. Conclusions: Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug-eluting stents. Post-PCI ESS is not associated with in-stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in-stent restenosis is likely attributed to factors other than ESS within the stent., Hellenic Cardiological Society, Schaubert Family, George D. Behrakis Cardiovascular Research Fellowship

A 74-year-old man included in the ABSORB EXTEND Clinical Investigation ([NCT01023789][1]) underwent percutaneous coronary intervention with an everolimus-eluting bioresorbable vascular scaffold (BVS) (Absorb BVS1.1, Abbot Vascular, Santa Clara, California) 3.0 × 18 mm in proximal right coronary

Background and aims The natural history and the role of atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared to first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH). Methods Three-dimensional coronary reconstruction by angiography and intravascular ultrasound was performed after intervention and at 6–10-month follow-up in 157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99). Results There was a significant decrease in PBS area (−7.2%; p < 0.001) and vessel area (−1.7%; p < 0.001) after BMS and a respective increase in both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001, respectively). The decrease in PBS area significantly predicted neointimal area at follow-up after BMS (β: 0.15; 95% confidence interval [CI]: 0.10–0.20, p < 0.001) and DES (β: 0.09; 95% CI: 0.07–0.11; p < 0.001) implantation. The decrease in PBS area was the most powerful predictor of significant NIH after BMS implantation (odds ratio: 1.13; 95% CI: 1.02–1.26; p = 0.02). Conclusions The decrease in PBS area after stent implantation is significantly associated with the magnitude of NIH development at follow-up. This finding raises the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis and late/very late stent thrombosis.

Background Although patients receiving hemodialysis (HD+) have significantly different backgrounds, including a history of progressive atherosclerotic disease, compared with those not receiving hemodialysis (HD−), there are no studies evaluating the risks for loss of primary patency (PP) and need for target lesion revascularization (TLR) in HD+ patients following bare self-expandable nitinol stent (BSNS) implantation to femoropopliteal (FP) artery occlusive lesions, after adjusting for differences using propensity score (PS) analysis in observed characteristics between groups. Methods We studied 531 limbs of 432 Japanese patients (HD+, n =107; HD−, n =325) who received BSNS implantation to FP lesions between 2004 and 2014. Patients were followed-up for an average of 44.3±33.6months. We compared the long-term results between HD+ and HD− patients using the Cox-proportional hazard model with adjustment for inverse probability treatment weight (IPTW) of PS, which was calculated for covariates with HD as a dependent variable. Results PP rate in HD+ vs. HD− patients at 9years after the procedure was 19.1% vs. 47.9%, with a freedom from TLR rate of 47.6% vs. 62.9%, respectively. Adjusted HRs in HD+ patients with 95% confidence intervals (CIs) were as follows: loss of PP: HR 1.64, 95% CI 1.052–2.557, P =0.03; TLR: HR 1.862, 95% CI 1.104–3.139, P =0.02. Conclusions The present study suggests that HD+ patients have an increased risk for loss of PP and need for TLR after BSNS implantation to FP lesions.

Background— 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. Methods and Results— 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 Conclusions— With the superior trackability of the 4F child catheter and with increased backup support of the mother-child system, the 4F mother-child system provided >90% success rate for lesions in which conventional techniques had failed. The 4F mother-child system may become a viable alternative to conventional techniques in treating complex coronary lesions.

To evaluate the long-term outcomes of self-expandable nitinol stent implantation with intraluminal angioplasty for chronic total occlusion (CTO) in the superficial femoral artery (SFA) of patients with TransAtlantic Inter-Society Consensus (TASC) D lesions.From 2004 to 2011, self-expandable nitinol stent implantation in SFA was performed successfully in 72 consecutive limbs of 68 patients with TASC D lesions. These patients were assessed for an average of 38.8 ± 25.6 months. The procedure was performed using a 0.014" or 0.018" guidewire and intraluminal angioplasty.Patients with hemodialysis constituted 20.6% of cases. The mean occlusion length was 244.6 ± 34.1 mm. A bidirectional approach was performed in 69.4% of cases. Primary patency rates were 77.9%, 71.9%, 67.2%, and 51.5% at 1 year, 2 years, 3 years, and 5 years, respectively. Secondary patency rates were 88.6%, 78.7%, 71.1%, and 56.0% at 1 year, 2 years, 3 years, and 5 years, respectively. Cox regression multivariate analysis for hemodialysis pertaining to loss of primary and secondary patency resulted in hazard ratio = 2.555 (95% confidence interval, 1.108-5.891; P=.03) for loss of primary patency and hazard ratio = 3.615 (95% confidence interval, 1.380-9.471; P=.01) for loss of secondary patency.Long-term patency of self-expandable nitinol intraluminal stent implantation with intraluminal angioplasty to treat CTO (TASC D) in SFA is promising. Hemodialysis was the only independent predictor for loss of primary and secondary patency.

Atherosclerosis is determined by both systemic risk factors and local vascular mechanisms. The arterial remodeling in response to plaque development plays a key role in atherosclerosis. Compensatory expansive remodeling is an adaptive mechanism that maintains lumen patency as a plaque develops. In contrast, excessive expansive remodeling, signifying an enlargement in vascular and lumen volume as a result of local plaque buildup, is a consistent attribute of high-risk plaques. Local hemodynamic factors, in particular low endothelial shear stress (ESS), is an intensely proinflammatory and proatherogenic stimulus and largely accounts for the spatially diverse distribution of atherosclerotic plaques. However, plaque, remodeling and ESS have hitherto been investigated only in the cross-sectional arterial axis and their distribution in the longitudinal axis of individual plaques has not been characterized.

Polymer electrolyte membrane fuel cell (PEMFC) are attracted attention as power source in the next generation. However, PEMFC should be achieved the low cost and the long service time in order to realize the wide-spread commercialization. As one of the ultimate solution for these issues, non-platinum electrocatalyst has been reported. In particular, group 4 or 5 transition-metal based-oxide such as Ta, Zr or Ti-based oxide showed high activity of oxygen reduction reaction (ORR) under the acidic conditions. [1] In these oxide catalyst, it is concluded that ORR is occurred at the oxygen vacancy site. [2] Ti based oxide is attracted attention especially as the candidate of non-platinum cathode catalyst, because its chemical stability and natural abundance are higher than other material. Titanium dioxide is known as semiconductor, therefore, it needs to create the electron conductivity when used as electrocatalyst. Fortunately, the electron conductivity of titanium dioxide is improved by the oxygen vacancy site; the most famous example is Ti2O3, Ti3O5, and Ti4O7 as known as titanium suboxides. Thus, the concept of many researchers is efficiently creation of a lot of oxygen vacancy site. On the other hand, titanium dioxide is as well known as photocatalyst material. In water oxidation of photocatalytic reaction, it is reported that a four coordinated titanium showed higher activity that a six coordinated titanium. [3] Moreover, the reaction site in case of the theoretical calculation and using the single crystal is thought low coordination site on surface. [4] Although the low coordination site play important role in water oxidation which is reverse reaction of ORR, it is left out of consideration in ORR. In this study, the effect of coordination number of titanium atom for ORR activity in acidic conditions was investigated. In addition, the relationship between its bandgap and ORR activity was also examined, because bandgap of titanium oxide is narrowed by introduction of oxygen vacancy site to crystal structure. The oxygen vacancy site into titanium oxide was introduced by using the chemical reductant. First, a titanium oxide was mixed with sodium tetrahydroborate as the chemical reductant. Little pure water was added to mixture, and then this mixture was calcined at 300ºC, 400 ºC, 500ºC, 600ºC, and 700ºC. Finally, obtained sample was washed with pure water. Those crystalline structure were decided by XRD and raman spectroscopy. The coordination number and the atomic valence were estimated by XAFS analysis. The bandgap was evaluated from diffuse reflection spectrum by UV-vis spectroscopy. The ORR activity was judged from difference curve of cyclic voltammograms between oxygen flow and argon flow conditions in 0.1 M HClO4. The clearly relationship between the coordination number of titanium and ORR activity was not founded. At this time, it is thought that this difference between ORR and photocatalytic water oxidation may attribute presence or absence of photoexcitation process. In contrast, the bandgap of preparation material and ORR activity was associated. This suggested presumably that the change of band structure by formation of the donner state introduced oxygen vacancy plays important role for ORR. References [1] A. Ishihara, Y. Shibata, S. Mitsushima, K. Ota, J. Electrochem. Soc., 155, B400 (2008); Y. Ohgi, A. Ishihara, K. Matsuzawa, S. Mitsushima, K. Ota, J. Electrochem. Soc., 157, B885 (2010); K. Suito, A. Ishihara，M. Arao，M. Matsumoto，H. Imai, Y. Kohno，K. Matsuzawa，S. Mitsushima，K. Ota, Nenryou Denchi, 12, 130 (2013) [In Japanese]; Y. Ohgi, A. Ishihara, K. Matsuzawa, S. Mitsushima, K. Ota, M. Matsumoto, H. Imai, Electrochim. Acta, 68, 192 (2012); Y. Okada, A. Ishihara, M. Matsumoto, M. Arao, H. Imai, Y. Kohno, K. Matsuzawa, S. Mitsushima, K. Ota, J. Electrochem. Soc., 162, F959 (2015); T. Hayashi, A. Ishihara, T.i Nagai, M. Arao, H. Imai, Y. Kohno, K. Matsuzawa, S. Mitsushima, K. Ota, Electrochim. Acta, 209, 1 (2016); M. Chisaka, Y. Ando, N. Itagaki, J. Mater. Chem. A., 4, 2051 (2016); A. Seifitokaldani, O. Savadogo, M. Perrier, Int. J. Hydrogen Energy, 40, 10427 (2015); C. Gebauer, J. Fischer, M. Wassner, T. Diemant, J. Bansmann, N. Hüsing, R. J. Behm, Electrochim. Acta, 146, 335 (2014). [2] A. Ishihara, M. Tamura,Y. Ohgi, M. Matsumoto, K. Matsuzawa, S. Mitsushima, H. Imai, K. Ota, J. Phys. Chem. C, 117, 18837 (2013). [3] M. Anpo, M. Takeuchi, J. Catalysis, 216, 505 (2003). [4] e.g. W. N. Zhao, Z. P. Liu, Chem. Sci., 5, 2256 (2014); A. Imanishi, T. Okamura, N. Ohashi, R. Nakamura, Y. Nakato, J. Am. Chem. Soc., 129, 11569 (2007).

We would like to thank Dr. Aminian and colleagues for their interest in our study [(1)][1] that assessed whether the transradial approach can be used to treat complex chronic total occlusion (CTO) and that attempted to determine the predictors of transradial percutaneous coronary intervention (PCI)

Coloration phenomenon of L-tryptophan (Trp) derivative treated with dichloroacetic acid (DCA) was observed under varying pH, i.e., between purple (below pH 2.5) and yellow (above pH 4.0). To elucidate the coloration mechanism of Trp treated with DCA, the colored compound was fractionated and investigated spectroscopically. Trp formed yellow compound consist of tricyclic structure by treatment with DCA. The color change with the variation of pH is due to the dissociation of nitrogen atom in the tricycle. Colored copolypeptide hydrogel was also prepared by immersion of copoly (N-hydroxyethyl L-glutamine-co-Trp) membrane, which was obtained by aminolysis of copoly(γ-benzyl L-glutamate-co-Trp) in the presence of crosslinking agent, in DCA. Color change was also observed for the hydrogel. The pH dependence of the degree of swelling (Qw) was investigated. The Qw changed in the pH region of color change and reflected the results of Trp treated with DCA.