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This study aimed to evaluate the feasibility and utility of using motorized pullback of the pressure guidewire to provide a graphic assessment and prediction of the benefits of coronary intervention. Fractional flow reserve (FFR) measurements were performed with motorized pullback imaging in 20 patients who underwent successful percutaneous coronary intervention (PCI) of the left anterior descending artery. Physiological lesion length (PLL) was calculated using frame counts to determine stent length. FFR area was calculated by integrating the FFR values recorded during pullback tracing (FFRarea). The percentage increase in FFR area (%FFRarea) was defined as the ratio of the difference between the pre- and post-intervention FFRarea to the total frame count. The average FFR values were enhanced following PCI, from 0.64 to 0.82, and the median value of the difference between pre- and post-interventional FFR values (D-FFR) and %FFRarea were 0.13 and 10.6%, respectively. The %FFRarea demonstrated a significant positive correlation with D-FFR (R 2 , 0.61; p < 0.01). PLL tended to be longer and the %FFRarea was smaller in lesions with a gradual pressure-drop pattern than those with an abrupt pressure-drop pattern (35.37 vs. 20.40 mm, p = 0.07; 5.78 vs. 16.21%, p < 0.05, respectively). Motorized pullback tracing was able to identify the extent and location of stenosis and help in appropriate stent implantation, in addition to visualizing and quantifying the improvement in FFR following PCI.

The most important factor for preventing contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in patients with severe renal dysfunction is to minimize the contrast volume. Herein, we report a successful case of complete revascularization after 3 separate PCI procedures using a super-low volume of contrast medium in a patient with 3-vessel disease, including two chronic total occlusions (CTOs). A 70-year-old man having exertional angina despite maximal medical therapy was referred to our hospital. He had severe renal dysfunction (estimated glomerular filtration rate 19 mL/minute/1.73 m 2 ). Coronary angiography, in which a total volume of 15 mL (over 3 injections) of contrast medium was used after hydration with normal saline, demonstrated 2 CTOs in the proximal left circumflex artery (LCX) and the proximal right coronary artery (RCA) as well as focal stenosis in the mid left descending artery (LAD). Because the patient refused coronary artery bypass grafting, we opted for revascularization with PCI, divided into 3 procedures. We made full use of microcatheter tip injection and evaluation with intravascular ultrasound and achieved complete revascularization with a total of 31 mL of contrast medium: 9 mL for RCA, 6 mL for LAD, and 16 mL for LCX, without the occurrence of CIN. Additionally, we present tips for performing PCI using super-low contrast medium.

We investigated changes of the complexity of coronary artery disease (CAD) after drug-eluting stent (DES) implantation using SYNTAX score and the predictor of worsened SYNTAX score at follow-up. 116 consecutive patients who underwent de novo PCI with first-generation DES were enrolled. SYNTAX scores were obtained from coronary angiography before PCI, just after final PCI and at follow-up after 6-8 months and investigated. SYNTAX score changed from 19.8 ± 11.9 before PCI to 13.7 ± 10.6 after PCI and to 15.0 ± 11.7 at follow-up. SYNTAX score before PCI was significantly correlated with a difference of SYNTAX score between before and after PCI [acute improved score (AIS)] and between after PCI and at follow-up (r = 0.5, p < 0.0001, r = 0.3, p = 0.002, respectively). At follow-up, SYNTAX score improved from just after PCI in 6.0% of the subjects, did not change in 60.3% and worsened in 33.6%. In-stent restenosis occurred in 43.8% of the patients with worsened score, and progression of lesion occurred in 62.5%. On multivariate analysis for worsened score, only diabetes was a significant independent predictor (OR 3.0, 95%CI 1.3-7.2, p = 0.01); however, SYNTAX scores both before PCI and AIS were not predictors. With regard to re-exacerbation of the complexity of CAD after PCI with DES, we need to exhibit caution in diabetic patients and there is no need to consider the complexity of CAD before PCI or the degree of acute improvement of complexity of CAD with PCI.