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Purpose To investigate the impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia (CLI) patients excluding those with both diabetes and wound infection. Methods Using a retrospective multicenter database, a propensity score matching analysis was performed of 539 consecutive CLI patients (375 men; mean age 71±11 years) without concurrent wound infection and diabetes who underwent balloon angioplasty of isolated infrapopliteal lesions. Propensity score matching produced 2 groups of 182 patients each who underwent angiosome-oriented direct revascularization (123 men; mean age 72±11 years) or indirect revascularization (125 men; mean age 72±11 years). The groups were compared for wound healing rate, freedom from major adverse limb events (MALE), and amputation-free survival (AFS). Results In the overall population, indirect revascularization was performed in 36.6% (n=197). In the propensity matching analysis, the complete wound healing rate at 12 months was higher in the direct group than the indirect revascularization patients (75% vs. 64%, p=0.01), while freedom from MALE (p=0.99) and AFS (p=0.17) were not significantly different at up to 24 months. In multivariate analysis, indirect revascularization had an independent negative impact on wound healing (adjusted hazard ratio 0.7, p=0.008). Conclusion After propensity matching analysis for CLI patients other than those with both diabetes and wound infection, the wound healing rate was higher after direct revascularization than after indirect revascularization, whereas MALE and AFS were not significantly different.

To compare endovascular therapy (EVT) outcomes to those of bypass surgery (BSG) for infrainguinal artery disease in patients with critical limb ischemia (CLI).A retrospective review was conducted of 1053 CLI patients (1053 first treated limbs) who underwent BSG (n=230) or EVT (n=823) for de novo infrainguinal lesions between January 2004 and December 2009 at 14 Japanese centers. Propensity score analysis was used for risk adjustment in multivariate analysis and for one-to-one matching (n=200 in each group). Amputation-free survival, overall survival, limb salvage, and freedom from major adverse limb events (any repeat revascularization or major amputation) were calculated.Mean follow-up was 30±16 months. In the overall series, there was no significant difference at 3 years between the EVT and BSG groups in amputation-free survival (60.5% vs. 62.1%, p=0.84), limb salvage (88.7% vs. 85.4%, p=0.24), or overall survival (65.8% vs. 69.2%, p=0.40). However, freedom from adverse limb events was significantly lower in the EVT group (56.6% vs. 69.2%, p=0.02) at 3 years. In the matched pairs analysis, there was no significant difference in any outcome between BSG and EVT at 3 years: amputation-free survival 66.3% vs. 62.0 (p=0.44), limb salvage 88.8% vs. 84.8% (p=0.44), survival 73.8% vs. 68.8% (p=0.61), and freedom from adverse limb events 61.3% vs. 69.1% (p=0.27).Our cohort suggested that the frequency of serious adverse events after EVT was comparable to that after BSG in CLI patients who underwent their first infrainguinal revascularization.

To assess the safety and efficacy of carbon dioxide (CO2) angiography-guided endovascular therapy (EVT) for renal, iliofemoral artery disease.Patients with peripheral vascular disease (PVD) often have chronic kidney disease (CKD) and the use of iodinated contrast media may enhance the risk of contrast-induced nephropathy (CIN). Contrast volume reduction is an effective CIN preventive strategy.A prospective multicenter registry was developed and six clinical centers participated in the study. Patients with an estimated glomerular filtration rate (eGFR) of60 ml/min/1.73 m2 and stage-3 CKD were recruited between February 2012 and March 2013. CO2 angiography-guided EVT was performed; incomplete CO2 angiograms were supplemented by intravascular ultrasound, pressure wire, and/or minimal iodinated contrast media. The primary endpoint was a composite of freedom from renal events and freedom from major CO2 angiography related complications.This study included 98 patients with 109 lesions. The mean eGFR baseline was 35.2±12.7 ml min(-1). CO2 angiography-guided angioplasty were performed in 16 renal arteries, 31 aortoiliac arteries, and 62 superficial femoral arteries. The technical success rate was 97.9%. Average CO2 consumption was 281.4±155.8 ml, average dose of iodinated contrast media was 15.0±18.1 ml. Primary endpoint was 92.8% (91/98). Incidence of CIN was 5.1% (5/98) and CO2 angiography-related complications occurred in 17.3% (17/98). Two cases (2%) developed severe, fatal, nonocclusive mesenteric ischemia (NOMI).This trial showed that CO2 angiography-guided angioplasty was effective for preventing CIN, however, CO2 angiography related complication was somewhat high.

Endovascular therapy (EVT) is widely applied for femoro-popliteal (FP) lesions of Trans-Atlantic Inter-Society Consensus (TASC) II class A to C in patients with peripheral arterial disease (PAD). However, restenosis after stenting remains a major concern. We investigated whether the use of

Aim Beta-blockers are not considered to be contraindicated in patients with peripheral artery disease, and carvedilol and bisoprolol are commonly used in patients with PAD in Japan. Because there have been only a few reported comparative studies of the effects of different beta-blockers, we compared the clinical outcomes in patients treated with these beta-blockers after undergoing femoropopliteal stenting. Methods Between January 2004 and December 2011, 2911 consecutive patients who had undergone their first femoropopliteal stenting were enrolled in this study. Of these patients, 438 patients(532 limbs) on carvedilol(187 patients, 229 limbs) or bisoprolol(251 patients, 303 limbs) were identified and analyzed retrospectively. The primary outcome was the primary patency and the secondary outcomes were the secondary patency and overall survival and freedom from major adverse limb events(MALE; including any repeated revascularization and major amputation), and these were compared between the groups. The mean follow-up interval of the survivors was 27±17 months. Results The primary patency was significantly higher in the bisoprolol-treated group than in the carvedilol-treated group(82.4% vs. 73.6% at 2 years, p=0.0006) as were the secondary patency (93.5% vs. 88.1% at two years, p=0.0004) and freedom from MALE (unadjusted: 79.6% vs. 67.9% at two years, p＜0.0001). However, the two-year overall survival was similar between the groups(91.2% vs. 89.9% at two years, p=0.44). Even after adjusting for baseline differences, bisoprolol was still found to be significantly more effective for the primary patency (HR 0.56, 95% CI 0.37 to 0.83, adjusted p=0.005). Conclusion Our retrospective study suggests that bisoprolol is associated with more favorable outcomes for vessel patency and avoidance of MALE than is carvedilol.

ObjectivesThis study sought to investigate factors associated with restenosis after endovascular therapy comparing TASC (Trans-Atlantic Inter-Society Consensus) II classes A to C with class D femoropopliteal (FP) lesions.BackgroundIt is unclear whether the determinants of restenosis for TASC II class D lesions are the same as those for TASC II classes A to C FP lesions.MethodsWe studied 2,400 limbs from 1,889 consecutive patients (73 ± 17 years of age; 31% women; 30% critical limb ischemia) who underwent successful endovascular therapy for de novo FP lesions. Predictors for restenosis in TASC II classes A to C and class D lesions were assessed using a Cox proportional hazards model.ResultsThe 5-year primary patency rate was 50% in TASC II classes A to C and 34% in TASC II class D lesions, respectively (p < 0.001). Overall, restenosis had a significant interaction with sex and renal failure (both p < 0.01). Female sex was a significant risk factor for restenosis in TASC II class D lesions (adjusted hazard ratio [HR]: 1.80, p < 0.001) but not TASC II classes A to C lesions (adjusted HR: 1.10, p = 0.352). Conversely, renal insufficiency was a significant risk factor for restenosis in TASC II classes A to C lesions (adjusted HR: 1.43, p < 0.001) but not TASC II class D lesions (adjusted HR: 0.79, p = 0.129). Diabetes mellitus, no stent use, chronic total occlusion, and poor below-the-knee runoff were shared risk factors for restenosis between TASC II classes A to C and class D lesions (all p < 0.05).ConclusionsFor de novo FP lesions, diabetes, no stent use, chronic total occlusion, and poor below-the-knee runoff were shared restenosis predictors for TASC II classes A to C and class D lesions, whereas renal failure was a predictor for TASC II classes A to C lesions and female sex for TASC II class D lesions.

Access site problems often cause serious complications in endovascular treatment. The aim of this study is to investigate whether a sheath-less nitinol stenting technique leads to reduce access site complications. This study was a single-center retrospective analysis of a prospectively maintained database. The study enrolled consecutive 98 patients with 111 lesions undergoing provisional stenting for de novo iliac artery or femoro-popliteal artery stenosis between August 2010 and November 2011. The patients were divided into two groups, a conventional procedure group and a sheath-less procedure group. The outcomes of this study were peri-procedural access site complications, initial success rate, procedure time, hemostatic time and bed-rest time. Forty-four lesions in 39 patients that treated using the sheath-less nitinol stent delivery technique were compared with 67 lesions in 59 patients treated using the conventional procedure. All procedures were successful. The incidence of pseudoaneurysm was significantly lower in the sheath-less procedure group than in the conventional procedure group (p = 0.043). However, there were no significant differences in any other complications. No significant difference was observed in the procedural time (p = 0.309). However, hemostatic time and bed-rest time were significantly shorter in the sheath-less procedure than in the conventional procedure (p < 0.0001). A sheath-less stenting technique reduced the access site incidence of pseudoaneurysm and did not increase other access site complications. Besides, this technique shortened hemostatic time and bed-rest time. The sheath-less stenting technique is considered to be a useful method for endovascular treatment.

Background: A strong association exists between diabetes mellitus and critical limb ischemia. Methods and Results: We performed endovascular therapy on 1060 limbs in 884 patients with below knee lesions only. The patients were divided into diabetes (DG) and nondiabetes groups (NDG). Limb salvage was poorer in the DG (79% vs 89%, P = .0061). No significant difference was observed in mortality, amputation-free survival (AFS), and target vessel revascularization (TVR). Multivariate analysis revealed diabetes status, infection, poor activity of daily living (ADL), younger age, and procedure failure as independent predictors of major amputation in DG. In the NDG, procedure failure was the predictor, and younger age and poor ADL showed tendency of major amputation. Conclusions: Mortality, AFS, and TVR showed no significant difference between the 2 groups, but major amputation was more frequent in DG. Not only revascularization but also infection and diabetes control were very important for limb salvage in DG.

Background— It remains unclear whether cilostazol, which has been shown to improve the clinical outcomes of endovascular therapy for femoropopliteal lesions, also reduces angiographic restenosis. Methods and Results— The Sufficient Treatment of Peripheral Intervention by Cilostazol (STOP-IC) study investigated whether cilostazol reduces the 12-month angiographic restenosis rate after percutaneous transluminal angioplasty with provisional nitinol stenting for femoropopliteal lesions. Two hundred patients with femoropopliteal lesions treated from March 2009 to April 2011 at 13 cardiovascular centers were randomly assigned 1:1 to receive oral aspirin with or without cilostazol. The primary end point was 12-month angiographic restenosis rate. Secondary end points were the restenosis rate on duplex ultrasound, the rate of major adverse cardiac events, and target lesion event-free survival. Researchers evaluated all follow-up data and assessed the end points in a blinded fashion. The mean lesion length and reference vessel diameter at the treated segment were 128±86 mm and 5.4±1.4 mm, respectively. The frequency of stent used was similar between groups (88% versus 90% in the cilostazol and noncilostazol group, respectively, P =0.82). During the 12-month follow-up period, 11 patients died and 152 patients (80%) had evaluable angiographic data at 12 months. The angiographic restenosis rate at 12 months was 20% (15/75) in the cilostazol group versus 49% (38/77) in the noncilostazol group ( P =0.0001) by intention-to-treat analysis. The cilostazol group also had a significantly higher event-free survival at 12 months (83% versus 71%, P =0.02), although cardiovascular event rates were similar in both groups. Conclusions— Cilostazol reduced angiographic restenosis after percutaneous transluminal angioplasty with provisional nitinol stenting for femoropopliteal lesions. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00912756; and URL: https://www.umin.ac.jp . Unique identifier: UMIN000002091.

Background The efficacy of stent-assisted endovascular therapy (EVT) in patients with critical limb ischemia (CLI) compared to bypass surgery (BSX) remains unclear. Methods and results This study was performed as a multicenter retrospective registry. Between January 2004 and December 2009, 460 CLI patients (460 first treated limbs) who underwent BSX (237 patients) or EVT (223 patients) for de novo infrainguinal lesions were identified retrospectively and analyzed. The main endpoints of this study were amputation-free survival (AFS), overall survival, limb salvage rate and freedom from major adverse limb events (MALE; includes any repeat revascularization and major amputation). Three-year AFS, limb salvage rate and overall survival were not different between the BSX and EVT groups (60.3% vs. 58.0%, P=0.43; 85.1% vs. 84.2%, P=0.91; 67.2% vs. 69.8%, P=0.96, respectively), but freedom from MALE was significantly lower in the EVT group during follow-up (69.1% vs. 51.1%, P=0.002). After adjusting endpoints with covariates, there was also no significant difference in AFS, limb salvage, and overall survival between EVT and BSX. Freedom from MALE, however, was still significantly lower in the EVT group (hazard ratio, 0.66; 95% confidence interval: 0.47-0.92, adjusted P=0.01). Conclusions Serious adverse events with the exception of MALE after EVT seem to be acceptable compared to that after BSX in patients with CLI due to infrainguinal disease.

Background— Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia. Methods and Results— A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index P =0.008), heart failure (HR, 1.73; P =0.04), and wound infection (HR, 1.89; P =0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98; P =0.005), heart failure (HR, 1.69; P =0.02), and Rutherford classification 6 (HR, 2.25; P =0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index P =0.03) and wound infection (HR, 0.60; P =0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event–free. Conclusions— The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr . Unique identifier: UMIN000002830.

Objective Although clinical trials demonstrated the superiority of the Zilver (Cook Medical, Bloomington, Ind) paclitaxel-eluting stent (PTX), a recently developed drug-eluting stent (DES), to conventional therapy for femoropopliteal (FP) lesions, the incidence and risk factors of the repetition of reintervention after DES implantation in clinical practice remained unrevealed. Methods This was a subanalysis of the ZEPHYR (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) study, enrolling FP lesions undergoing endovascular therapy (EVT) with DES implantation. The current study analyzed the 2-year database including 583 FP lesions in 495 patients undergoing preoperative intravascular ultrasound imaging before DES implantation. The primary outcome measure was re-re-EVT, defined as undergoing additional EVT more than once during the 2-year follow-up after DES implantation. The secondary outcome measure was re-EVT, defined as undergoing at least one additional EVT during the follow-up. Results Critical limb ischemia (CLI) was present in 28% of the study population, 23% had a history of EVT, and 43% had chronic total occlusion. Mean lesion length was 16 ± 10 cm, and intravascular ultrasound imaging-evaluated external elastic membrane area was 28 ± 10 mm 2 . The cumulative incidence rate of re-re-EVT at 2 years was estimated to be 14%, whereas that of re-EVT was 31%. After multivariate analysis, CLI and smaller external elastic membrane area were independently associated with the outcome. Conclusions The incidence and risk factors of the repetition of reintervention after DES implantation for FP lesions were revealed. The current findings suggest that DES implantation might be a careful indication in CLI cases especially with a small vessel.

Aims We investigated the mechanism and predictors of jailed branch vessel (BV) compromise during the stenting of left main trunk (LMT) bifurcation lesions from a multidetector row computed tomography (MDCT) analysis. Methods and results Eighty patients who underwent MDCT and stenting for LMT bifurcation lesions were examined. The patients were retrospectively classified into a BV stenosis (BVS; n=38) group and a non-BV stenosis (NBVS; n=42) group according to a coronary angiography obtained just after crossover stent deployment for the target vessel (TV). The angle between the LMT and TV was significantly wider in the BVS group than in the NBVS group (140.2±10.3 degree vs. 132.6±14.2 degree, p=0.0076), and the frequency of carina side plaque at the TV in the long and short axis was significantly higher in the BVS group than in the NBVS group (50.0% vs. 16.7%; p=0.0012, 63.2% vs. 38.1%; p=0.0251, respectively). In a multivariate analysis, the presence of carina side plaque at the TV in the long and short axis were independent predictors of BVS (odds ratio: 5.15, p=0.0086, odds ratio: 3.83, p=0.0231, respectively). Conclusions The plaque distribution and morphology assessed by MDCT may provide useful information that can predict the potential compromise of the BV during treatment for an LMT bifurcation lesion.

Background: The patency and complications in aorto-iliac (AI) stenting remain poorly understood. The aim of this paper was to investigate the safety and efficacy after AI stenting. Methods and Results: This study was performed as a large-scale multicenter, retrospective registry. A total of 2,147 consecutive patients with AI disease were enrolled. The safety endpoints were procedure success, complications and 30-day mortality. The efficacy endpoints were primary, assisted primary and secondary patency, overall survival, freedom from major adverse cardiovascular events (MACE; all-cause death, myocardial infarction and stroke), and major adverse cardiovascular and limb events (MACLE; any repeat revascularization for limb and leg amputation in addition to MACE). Procedure success, complication rate and 30-day mortality were 97.6%, 6.4% and 0.7%. Primary patency was 92.5%, 82.6% and 77.5% at 1, 3 and 5 years, assisted primary patency was 97.0%, 92.7% and 91.9% at 1, 3 and 5 years and secondary patency was 99.0%, 98.7% and 98.5% at 1, 3 and 5 years. The overall survival rate was 95.0%, 87.6%, and 79.3% at 1, 3 and 5 years. The cause of death was cardiovascular in 44.1%. Freedom from MACE (MACLE) was 93.3% (89.9%), 84.4% (76.7%), and 74.9% (66.8%) at 1, 3 and 5 years. Female gender, diabetes, renal failure, absence of aspirin, reference vessel diameter

To examine the long-term outcome of the stent fracture (SF) and the potential predictive factors contributing to in-stent restenosis (ISR) in the fractured stent.The SF is thought to be a higher risk of ISR in drug-eluting stent, although SF does not always develop ISR.The consecutive 1,228 de novo lesions in 1,079 patients who underwent sirolimus-eluting stents implantation and assessed by 8 months follow-up coronary angiography were retrospectively analyzed.One hundred and seventeen SFs (9.5%) were identified in 100 patients and 22 (18.8%) SFs revealed ISR at the first follow-up. In addition, 16 (13.7%) developed new ISRs from 95 residual SFs without ISR prior to the second follow-up. Overall, 38 (32.5%) of all 117 SFs developed ISR, and 16 (42.1%) of 38 SFs occurred in a late phase beyond the first 8 months follow-up. A higher risk of ISR in the SF site was associated with the chronic total occlusion (ISR vs. no ISR: 34.2% vs. 16.5%, P = 0.0304), calcified lesions (55.3% vs. 34.2%, P = 0.0299), and correspondence 89.5% versus 43.0%, P0.0001 (SF site occurring at the original target lesion site) in the univariate analysis. The correspondence was identified as the only strong predictive factor for ISR at the SF site according to a multivariate logistic regression analysis (odds ratio 12.6, 95% confidence interval 3.82-53.5, P0.0001).SF occurring at the site of the original target lesion was a strong independent predictor of ISR. This indicates the need for a careful, long-term follow-up in those situations, even when no significant ISR is initially detected.

Patient initials or identifier number K.F. ### Relevant clinical history and physical exam An 84 year-old-man suffered from intermittent claudication (Rutherford 2) in his right leg. His absolute claudication distance (ACD) was 90 m. His right popliteal artery and dorsal artery were weakly

BACKGROUND Various two-stent techniques have been applied to aggressively treat bifurcation lesions as the introduction of drug-eluting stents (DES) and the importance of the bifurcation angle and three-dimensional (3D) structure has come to be recognized. Recent 64 multislice computed tomography (MSCT) technology provides accurate information about the 3D bifurcation geometry of the coronary arteries and with reproducibility. OBJECTIVES The purpose of this study is to disclose the coronary bifurcation angle and 3D structure in humans and elucidate the importance of bifurcation angle for the crush technique using MSCT. METHODS Two hundred and nine patients who were suspected to have angina pectoris and underwent CT angiography using MSCT were examined. The 3D-volume rendering (VR) image was reconstructed by two technicians and was used for the assessment of each coronary bifurcation angles. RESULTS The average LMT bifurcation angles (angle LMT-LAD, angle LMT-LCx, angle LAD-LCx) were 143 +/- 13 degrees , 121 +/- 21 degrees , and 72 +/- 22 degrees , respectively, the average angle LAD-D was 138 +/- 19 degrees , the average angle LCx-OM was 134 +/- 23 degrees , the average distal RCA bifurcation angles (angle RCA-4AV, angle RCA-4PD, angle 4AV-4PD) were 152 +/- 15 degrees , 137 +/- 20 degrees , and 61 +/- 21 degrees , respectively. In addition, a percentage of steep angled bifurcation (

Purpose We examined the importance of prolonged inflation time for optimal sirolimus-eluting stent (SES) or paclitaxel-eluting stent (PES) expansion. Methods Eighty-one de novo lesions deployed single SES or PES between April 2007 and March 2008 were divided into four groups; group 1: 21 SES deployed at 20 atm x 60 sec, group 2: 20 SES deployed with 2-step inflation at 20 atm x 60 sec following 20 atm x 20 sec, group 3: 20 PES deployed same as group 1, group 4: 20 PES deployed same as group 2. The minimal lumen diameter (MLD) and stent expansion ratio (SER; stent cross- sectional area at lesion/balloon cross-sectional area which was calculated according to the compliance chart at the same atmosphere as stent deployment) were compared between group 1 and group 2 in SES, between group 3 and group 4 in PES. Results The MLD of post 60 sec was significantly higher than that of post 20 sec (2.84 +/- 0.28 mm in group 1, 2.76 +/- 0.33 mm in group 2 vs. 2.54 +/- 0.33 mm in group 2; P = 0.003, 0.045, respectively and 2.94 +/- 0.28 mm in group 3, 3.00 +/- 0.34 mm in group 4 vs. 2.69 +/- 0.35 mm in group 4; P = 0.022, 0.007, respectively). The SER of post 60 sec was significantly higher than that of post 20 sec (79.3% +/- 8.5% in group 1, 80.8% +/- 7.8% in group 2 vs. 71.1% +/- 10.2% in group 2; P = 0.014, 0.011, respectively and 81.1% +/- 7.9% in group 3, 84.3% +/- 9.9% in group 4 vs. 72.6% +/- 10.5% in group 4, P = 0.011, 0.001, respectively). Conclusion The prolonged delivery inflation for 60 sec may result in a more optimal stent expansion. It is therefore considered to be a useful method for deploying drug-eluting stent.

This study sought to characterize coronary hyperintense plaques (HIP) using noncontrast T(1)-weighted imaging (T1WI) in cardiac magnetic resonance, which was then compared with multislice computed tomography and intravascular ultrasound.Carotid plaque components such as intraplaque hemorrhages and/or lipid-rich necrotic cores can be detected as HIP by noncontrast T1WI. Although coronary HIPs have been successfully detected using this technique, the properties of hyperintense signals in coronary plaques have not yet been systematically evaluated.Thirty-eight lesions from 37 patients with angina pectoris who demonstrated70% coronary stenosis on multislice computed tomography were evaluated by noncontrast T1WI using a 1.5-T magnetic resonance imager, and 25 lesions were evaluated by intravascular ultrasound. Signal intensity of coronary plaque to cardiac muscle ratio1.0 was defined as HIP. We divided 25 lesions into the 2 groups, according to the presence or absence of HIP: HIP (n = 18) and non-HIP (n = 7) groups.In comparison with the non-HIP group, the HIP group demonstrated significantly higher coronary plaque to cardiac muscle ratio (1.7 +/- 0.7 vs. 0.9 +/- 0.1, p0.01), higher frequency of positive remodeling as observed by both multislice computed tomography (89% vs. 0%, p0.0001) and intravascular ultrasound (94% vs. 14%, p0.001) and ultrasound attenuation (100% vs. 14.3%, p0.0001). The frequency of spotty calcification tended to be higher in HIP (89% vs. 50%, p = 0.079). The HIP group also exhibited a significantly lower computed tomography density (-23.2 +/- 20.7 Hounsfield units [HU] vs. 9.6 +/- 20.5 HU, p0.01). In addition, the incidence of transient slow-flow phenomena was significantly higher in the HIP group than in the non-HIP group (83% vs. 14%, p0.01).The typical HIP case was associated with ultrasound attenuation, positive remodeling, remarkably low computed tomography density, and a high incidence of slow-flow phenomena. Noncontrast T1WI in cardiac magnetic resonance imaging may be useful for the assessment of coronary plaque characterization in patients with coronary artery disease.

Methods: The REAL-AI (REtrospective multicenter AnaLysis of primary stenting for AortoIliac artery disease) registry was performed as a multicenter registry in Japan enrolling consecutive patients undergoing primary stenting for de novo aortoiliac artery stenosis. The primary endpoint was a composite of death/myocardial infarction (MI) /stroke, and the secondary endpoints were primary patency (deined as treated vessel without restenosis).

ObjectiveTo identify anatomical factors associated with major adverse limb events (MALE) after angioplasty as the basis for a novel morphology-driven classification of infrapopliteal lesions.DesignRetrospective-multicenter study.Materials and methodsBetween March 2004 and October 2010, 1057 limbs from 884 patients with CLI due to isolated infrapopliteal lesions were studied. Freedom-from MALE, defined as major amputation or any reintervention, was assessed out to 2 years by the Kaplan–Meier methods. Anatomical predictors and risk stratification for MALE were analyzed by multivariate analysis.ResultsFreedom-from MALE was 47 ± 1% at 2 years. Lesion calcification, target vessel diameter300 mm and no below-the-ankle (BA) run-off were positively associated with MALE by multivariate-analysis. The total number of risk factors was used to calculate the risk score for each limbs for subsequent categorization into 3 groups with 0 or 1 (low-risk), 2 (moderate-risk) and 3 or 4 (high-risk) factors. Freedom-from MALE at 2 year-rates was 59% in low-risk, 46% in moderate-risk, and 29% in high-risk, respectively.ConclusionTarget vessel diameter 300 mm and no-BA run-off were associated with MALE after infrapopliteal angioplasty. Risk stratification based on these predictors allows estimation of future incidence of MALE in CLI with isolated infrapopliteal lesions.

ObjectivesAcceptable limb salvage rates underlie the widespread use of endovascular therapy (EVT) for patients with critical limb ischemia (CLI) secondary to isolated infrapopliteal lesions; however, post-EVT delayed wound healing remains a challenge. Predictors of delayed wound healing and their use in risk stratification of EVT in patients with CLI due to isolated infrapopliteal lesions are explored.MethodsThis was a retrospective multicenter study. 871 consecutive critically ischemic limbs were studied. There was tissue loss in 734 patients (age: 71 ± 10 years old; 71% male) who had undergone EVT between April 2004 and December 2012. The wound healing rate after EVT was estimated by the Kaplan–Meier method. The association between baseline characteristics and delayed wound healing was assessed by the Cox proportional hazard model.ResultsDiabetes mellitus and regular dialysis were present in 75% (553/734) and 64% (476/734) of patients, respectively; 67% of limbs (585/871) had Rutherford class 5 CLI; 8% (67/871) of wounds were located in the heel only; 25% (219/871) of limbs had Rutherford 6 (involving not only the heel); and 42% (354/871) of wounds were complicated by infection. The rate of freedom from major amputation at 1 year reached 88%, whereas the wound healing rate was 67%. Median time to wound healing was 146 days. By multivariate analysis, non-ambulatory status (hazard ratio [HR], 1.58; 95% confidence interval [CI] 1.31–1.91) serum albumin

The Japan EPA Lipid Intervention Study (JELIS) demonstrated the efficacy of eicosapentaenoic acid (EPA) in preventing coronary artery disease (CAD) in hypercholesterolemic patients by mechanisms other than LDL-cholesterol (C) lowering. The aim of this study was to examine the effects of EPA on

Although endovascular therapy (EVT) is widely accepted as revascularization strategy for patients with critical limb ischemia presenting with infrapopliteal (IP) lesions, incidence, predictors and impact on clinical outcomes of 30-day perioperative complications (POC) have not been systematically

Little data are available regarding the association between the site of the leg wound occurring from critical limb ischemia (CLI) and the prognosis of hemodialysis patients with CLI after isolated infrapopliteal balloon angioplasty(BA). This study used data obtained from a multi-center