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Kazuhisa Kodama - One of the best experts on this subject based on the ideXlab platform.

  • aortic angioscopy assisted thoracic endovascular repair for chronic type b aortic dissection
    Journal of Cardiology, 2020
    Co-Authors: Hiroyuki Nishi, Atsushi Hirayama, Sei Komatsu, Yoshiharu Higuchi, Toshiki Takahashi, Keitaro Domae, Keita Inoguchi, Ryo Kawasumi, Yuma Hamanaka, Kazuhisa Kodama
    Abstract:

    Abstract Background Non-obstructive general angioscopy is a powerful modality for detecting areas in the aorta with vulnerable plaque, which are difficult to visualize using conventional diagnostic tools such as computed tomography (CT). The aim of the present study was to clarify the efficacy and usefulness of aortic angioscopy in patients with chronic type B aortic dissection scheduled for thoracic endovascular repair (TEVAR). Methods Ten patients with chronic type B aortic dissection who underwent elective TEVAR were enrolled. Before starting the stent graft procedure, the aortic intima was observed by use of non-obstructive general angioscopy. Based on those findings, the range of the stent graft position was confirmed. Results In all patients, observations of the aortic intima with non-obstructive general angioscopy from a point just proximal of the descending aorta to the iliac artery were successful. At the proximal site, an entry site or ulcer-like projection was detected in all patients, while a small intimal tear or entry, or an irregular intima surface with a salmon-pink color were seen in some cases. In contrast, preoperative CT did not detect any such findings in the same locations. After confirming the position of the abnormal intima, we determined the position of the distal end of the stent graft. No complications considered to be related to aortic angioscopy were noted. Conclusions Non-obstructive general angioscopy is useful for observing the condition of the aortic intima, revealing abnormal conditions, and confirming a normal aortic intima in patients with chronic type B aortic dissection. This modality may play an important role in determining the precise position of a stent graft for a TEVAR procedure.

  • detection of vulnerable atherosclerotic plaque during thoracic endovascular aortic repair using nonobstructive angioscopy
    Journal of International Medical Research, 2018
    Co-Authors: Takashi Murakami, Kazuhisa Kodama, Sei Komatsu, Toshihiko Shibata
    Abstract:

    : An Angioscope was used to observe the intima of the aorta in an 82-year-old patient who had undergone thoracic endovascular aortic repair. The aortic angioscopic findings showed vulnerable plaques from the ascending aorta to the aortic arch that had not been visualized using preoperative computed tomography. After deploying a stent graft from zone 1 to zone 4, the proximal edge of the stent graft was adjacent to the ruptured plaque with mixed thrombi. In spite of these findings, the patient had an uneventful recovery. Angioscopy may have the potential to stratify the risk of thoracic endovascular aortic repair-related complications.

  • in stent yellow plaque at 1 year after implantation is associated with future event of very late stent failure the desnote study detect the event of very late stent failure from the drug eluting stent not well covered by neointima determined by angio
    Jacc-cardiovascular Interventions, 2015
    Co-Authors: Yasunori Ueda, Akio Hirata, Kazunori Kashiwase, Koshi Matsuo, Yuji Nishimoto, Ryuta Sugihara, Takayoshi Nemoto, Masato Okada, Ayaka Murakami, Kazuhisa Kodama
    Abstract:

    Abstract Objectives This study examined whether coronary angioscopy-verified in-stent yellow plaque at 1 year after drug-eluting stent (DES) implantation is associated with future event of very late stent failure (VLSF). Background Atherosclerosis detected as yellow plaque by angioscopy has been associated with future events of acute coronary syndrome. Development of in-stent neoatherosclerosis is a probable mechanism of VLSF. Methods This study included 360 consecutive patients who received successful angioscopic examination at 1 year after implantation of a DES. They were clinically followed up for VLSF defined as cardiac death, acute myocardial infarction or unstable angina, or need for revascularization associated with the stent site. Results The follow-up interval was 1,558 ± 890 days (4.3 ± 2.4 years). The incidence of VLSF was significantly higher in the patients with yellow plaque than in those without (8.1% vs. 1.6%; log rank p = 0.02). Multivariable analysis revealed the presence of yellow plaque (hazard ratio [HR]: 5.38; p = 0.02) and absence of statin therapy (HR: 3.25; p = 0.02) as risks of VLSF. Conclusions In-stent atherosclerosis evaluated by yellow plaque at 1 year after the implantation of DES and the absence of statin therapy were risks of VLSF. The underlying mechanism of VLSF appeared to be the progression of atherosclerosis as demonstrated by the yellow plaque.

  • stabilization and regression of coronary plaques treated with pitavastatin proven by angioscopy and intravascular ultrasound
    Circulation, 2010
    Co-Authors: Kazuhisa Kodama, Yasunori Ueda, Sei Komatsu, Tadateru Takayama, Hiroshi Matsuoka, Shinsuke Nanto, Jyunji Yajima, Satoshi Saito, Atsushi Hirayama
    Abstract:

    Background: Few studies have serially monitored the change of coronary plaque after statin therapy using multiple plaque imaging modalities. Methods and Results: A prospective open-label trial was performed to assess coronary plaque regression and stabilization following 52 weeks of pitavastatin treatment (2 mg/day). Coronary segments that included the most diseased plaque of 90 patients determined on angioscopy were analyzed using intravascular ultrasound (IVUS). The yellow grade of each plaque of 46 patients who had matched angioscopy and IVUS data was evaluated on angioscopy. Low-density lipoprotein-cholesterol (LDL-C) was reduced 34.5% (145.0±24.0 mg/dl to 93.6±22.6 mg/dl, P<0.001), and high-density lipoprotein cholesterol increased 17.8% (44.9±11.1 mg/dl to 51.9±11.7 mg/dl, P<0.001). Yellow grade decreased (2.9±0.8 to 2.6±0.7, P=0.040) during 52 weeks. The reduction of yellow grade was not correlated with the LDL-C level at 52 weeks or its change. The change of yellow grade was inversely correlated with maximum yellow grade at baseline. Percent atheroma volume on IVUS did not change during 52 weeks, but its change for 52 weeks was significantly correlated with LDL-C level at 52 weeks (Spearman's rank correlation coefficient 0.312, P=0.035). Conclusions: Fixed dose pitavastatin stabilized vulnerable coronary plaques by the reduction of yellow grade without significant reduction of plaque volume. The stabilization and regression of atherosclerotic plaques by statin may differ, but both nonetheless contribute to the reduction of cardiovascular events (UMIN Clinical Trials Registry UMIN000001107).  (Circ J 2010; 74: 1922 - 1928)

  • Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study.
    JACC. Cardiovascular imaging, 2009
    Co-Authors: Tomoaki Higo, Yasunori Ueda, Jota Oyabu, Katsuki Okada, Mayu Nishio, Akio Hirata, Kazunori Kashiwase, Nobuyuki Ogasawara, Shinichi Hirotani, Kazuhisa Kodama
    Abstract:

    Objectives We sought to examine by angioscopy the neointima formation and thrombogenic potential of the neointima after deployment of a drug-eluting stent (DES). Background Late stent thrombosis after DES implantation, a major safety concern, has been associated with poor strut coverage by neointima. Intracoronary angioscopy provides a method for visual evaluation of stent coverage by neointima and detection of thrombus in the stented coronary segment. Methods Patients undergoing implantation of a sirolimus DES (n = 57) were serially examined by angioscopy immediately after (baseline) and again at 10 months (follow-up) after implantation. The angioscopic color grade of the neointima from white to yellow was assessed in a semiquantitative manner. Stent coverage was classified into not covered (Grade 0), covered by a thin layer (Grade 1), or buried under neointima (Grade 2). The thrombogenic potential of the neointima was evaluated by the prevalence of thrombus on the neointima. Results The maximum yellow color grade of the neointima within DES-implanted lesions increased significantly from baseline to follow-up (1.4 ± 1.1 vs. 1.9 ± 0.6, p = 0.0008). Even among lesions without yellow color at baseline, yellow color was detected in 94% (17 of 18) of lesions at follow-up. The prevalence of thrombus was significantly higher on the yellow than on the white neointimal areas. Thrombus was detected on yellow and/or Grade-0/1 neointima, but never on the white Grade-2 neointima. Conclusions Sirolimus DES promoted formation of atherosclerotic yellow neointima in the stent-implanted lesion at 10-month follow-up. Thrombus was detected more often on the yellow area than on the white area and was never detected where a stent was buried under white neointima. These data suggest that the increased potential risk of late stent thrombosis in DES lesions may be due to the newly formed yellow neotima and cholesterol-laden plaque.

Yasumi Uchida - One of the best experts on this subject based on the ideXlab platform.

  • detection of ceramide a risk factor for coronary artery disease in human coronary plaques by fluorescent angioscopy
    Circulation, 2017
    Co-Authors: Yasumi Uchida, Yasuto Uchida, Seiichiro Shirai, Ei Shimoyama, Nobuyuki Hiruta, Takanobu Kobayashi, Tsuyoshi Tabata
    Abstract:

    BACKGROUND The presence of ceramide in human coronary plaques is a risk factor for ischemic heart disease, but its visualization in the human vessel wall is currently beyond the scope of any available imaging techniques.Methods and Results:Deposition of ceramide was examined by fluorescent angioscopy (FA) and microscopy (FM) using golden fluorescence (Go) as a specific marker of ceramide in yellow plaques, which were obtained from 23 autopsy subjects and classified by conventional angioscopy and histology. Ceramide was observed by FM in 34 of the 41 yellow plaques with a necrotic core (NC) but rarely in the 28 without. Ceramide and macrophages/foam cells co-deposited mainly in the border zone of the NC and fibrous cap (FC). The Go of ceramide was seen when the fibrous cap thickness was ≤100 µm. FA was performed to detect coronary plaques exhibiting Go in patients with coronary artery disease. Ceramide was also detected by FA in 6 of 18 yellow plaques (33.3%) in 8 patients with stable angina and in 18 of 24 yellow plaques (75.0%, P<0.05 vs. stable angina) in 8 patients with old myocardial infarction. CONCLUSIONS The Go of ceramide in human coronary plaques is detectable by FA and Go could be used as a marker of vulnerable plaque (i.e., thin FC with NC).

  • Characterization of Coronary Fibrin Thrombus in Patients With Acute Coronary Syndrome Using
    2016
    Co-Authors: Dye-staining Angioscopy, Yasumi Uchida, Yasuto Uchida, Takeshi Sakurai, Masahito Kanai, Seiichiro Shirai, Toshihiro Morita
    Abstract:

    Objective—Because fibrin is transparent and almost invisible by any conventional imaging methodologies, clinical examinations of coronary fibrin thrombus have been ignored, and little is known about its role in the genesis of acute coronary syndrome (ACS). The present study was performed to visualize coronary fibrin thrombus and to examine its role in ACS. Methods and Results—Dye-staining coronary angioscopy using Evans blue dye, which selectively stains fibrin blue but does not stain blood corpuscles, was performed for observation of globular coronary thrombi in 111 ACS patients. The thrombi were aspirated for histological examination. The thrombi were classified by visual appearance into 8 transparent, 3 light-red, 2 frosty glass–like and membranous, 32 white, 8 brown, 34 red, and 19 red-and-white in a mosaic pattern. Transparent thrombi that were not visible by conventional angioscopy were visualized as a blue structure by dye-staining angioscopy, and they were observed in patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). The thrombi caused total or subtotal coronary occlusion. The aspirated thrombi were composed of fibrin alone by histology. Fibrin-rich thrombi were visualized using dye-staining angioscopy in 60 % of 50 patients with UANSTEMI and in 29 % of 61 patients with ST-elevation myocardial infarction. By histology of th

  • molecular imaging of native low density lipoprotein by near infrared fluorescent angioscopy in human coronary plaques
    American Journal of Cardiology, 2016
    Co-Authors: Yasumi Uchida, Tomoe Yoshida, Ei Shimoyama, Yasuto Uchida
    Abstract:

    Low-density lipoprotein (LDL) is an important risk factor for coronary artery disease, but its localization within the human coronary arterial wall is poorly understood. Imaging of LDL in 30 coronary arteries excised from 15 subjects who underwent autopsy was performed using near-infrared fluorescent angioscopy system and using indocyanine green dye as a biomarker of LDL. The percentage incidence of LDL in 28 normal segments, 24 white plaques (early stage of plaque growth), and 21 yellow plaques (mature stage of plaque) classified by conventional angioscopy, was 14.2, 79.1 (p <0.01 vs normal segments and p <0.05 vs yellow plaques), and 28.5, respectively. Coronary near-infrared fluorescent angioscopy showed similar results in 7 patients in vivo. Our results suggested that LDL begins to deposit in the human coronary arterial wall in the early stage of atherosclerosis, increasingly deposits with plaque growth and decreases in the mature stage; and therefore, molecular therapy targeting LDL should be started before plaque maturation.

  • Localization and deposition patterns of oxidized low-density lipoprotein (oxLDL) in human pericoronary adipose tissues (PCAT) and coronary arterial wall.
    2016
    Co-Authors: Yasumi Uchida, Yasuto Uchida, Ei Shimoyama, Nobuyuki Hiruta, Toshihiko Kishimoto, Soichiro Watanabe
    Abstract:

    (A). Yellow plaque by angioscopy. By immunohistochemical staining, the plaque (arrow in A) contained dotted oxLDL deposits (arrow in A-1) and diffuse or dotted oxLDL deposits in PCAT (arrowhead in A-1). By magnifying the PCAT, it became clear that oxLDL deposited not only in the cytoplasm (arrow in A-2) but also in plasma membrane (arrowhead in A-2). (B). White plaque by angioscopy. By immunohistochemical staining, diffuse deposition of oxLDL was observed in the intima (arrow in B-1) and PCAT (arrowhead in B-1). On magnification, oxLDL deposited in cytoplasm (arrow) and plasma membrane (arrowhead in B-2). AC: adipocyte, L: lumen, I: intima, M: media, and Ad: adventitia, in this and following figures. Scale bars in A-1, B-1 = 100μm. Scale bars in A-2, B-2 = 5μm.

  • CCD Chilled charged device
    2015
    Co-Authors: Yasumi Uchida, Yasuto Uchida, Cs Cardioscopy, Eb Evans Blue
    Abstract:

    # The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Novel imaging techniques using biomarkers have clarified the mechanisms of hitherto unanswered or misunder-stood phenomena of coronary artery disease and enabled eval-uation of myocardial blood and tissue fluid flows in vivo. Dye-staining coronary angioscopy using Evans blue (EB) as the biomarker can visualize fibrin and damaged endothelial cells, revealing that the so-called platelet thrombus is frequent-ly a fibrin-rich thrombus; occlusive transparent fibrin throm-bus, but not platelet thrombus, is not infrequently a cause of acute coronary syndrome; Bfluffy ^ coronary luminal surface is caused by fibrin threads arising from damaged endothelial cells and is a residue of an occlusive thrombus after autolysis in patients with acute coronary syndrome without angiograph-ically demonstrable coronary stenosis; and web or membrane-like fibrin thrombus is a cause of stent edge restenosis. Fluo-rescent angioscopy using visual or near-infrared light wave-lengths is now used clinically for molecular imaging of the substances such as lipoproteins and cholesterol that constitute coronary plaques. Dye-staining cardioscopy using EB or fluo-rescein enables direct and real-time visualization of subendo-cardial microcirculation

Kyoichi Mizuno - One of the best experts on this subject based on the ideXlab platform.

  • optical coherence tomography and coronary plaque characterization
    Journal of the Japanese Coronary Association, 2013
    Co-Authors: Tsunenari Soeda, Shiro Uemura, Yoshihiko Saito, Kyoichi Mizuno
    Abstract:

    Imaging modalities such as intravascular ultrasound (IVUS) and intravascular angioscopy have also been developed, which provide us crucial information for understanding of CAD and planning PCI. In recent decades, intravascular optical coherence tomography (OCT) has been ex-tensively utilized both in research and in the setting of PCI. We will briefly introduce OCT and focus on plaque characterization utilizing OCT.II. Introduction of OCTOCT was developed by two different groups in the late 1980s.

  • relationship between thin cap fibroatheroma identified by virtual histology and angioscopic yellow plaque in quantitative analysis with colorimetry
    Circulation, 2009
    Co-Authors: Masanori Yamamoto, Kentaro Okamatsu, Shigenobu Inami, Yoshihiko Seino, Takayoshi Ohba, Masamichi Takano, Daisuke Murakami, Yong Xie, Koji Seimiya, Kyoichi Mizuno
    Abstract:

    Background: Thin cap fibroatheroma (TCFA) is considered to be a vulnerable plaque. Virtual Histology-intravascular ultrasound (VH-IVUS) can precisely identify TCFA in vivo. Intense yellow plaque on angioscopy determined by quantitative colorimetry with L*a*b* color space corresponds with histological TCFA; in particular, a plaque of color b* value >23 indicates an atheroma with a fibrous cap thickness 10% of plaque area without overlying fibrous tissue, and angioscopic TCFA was a plaque with b* value >23. The frequency of angioscopic TCFA was higher in the VH-TCFA group than in the VH-non-TCFA group (74% vs 23%, P=0.0002). Moreover, yellow color intensity (b* value) significantly correlated with plaque classification on VH-IVUS. When TCFA detected with angioscopy was used as the gold standard, the sensitivity, specificity, and accuracy for TCFA with VH-IVUS was 68%, 81%, and 75%, respectively. Conclusions: VH-TCFA strongly correlated with angioscopic TCFA determined by a quantitative analysis with colorimetry. (Circ J 2009; 73: 497 - 502)

  • delayed endothelialization after polytetrafluoroethylene covered stent implantation for coronary aneurysm
    Circulation, 2009
    Co-Authors: Masamichi Takano, Kentaro Okamatsu, Shigenobu Inami, Yoshihiko Seino, Takayoshi Ohba, Masanori Yamamoto, Daisuke Murakami, Kyoichi Mizuno
    Abstract:

    A polytetrafluoroethylene (PTFE)-covered stent is specially used to treat coronary perforation complicating percutaneous intervention in order to prevent the aneurysm from rupturing, but until now it has not been known if endothelialization occurs inside this type of stent. A patient with a giant aneurysm of the right coronary artery underwent successful implantation of a PTFE-covered stent. Angiography at 9-month follow-up showed focal restenosis at the proximal edge of the stent and coronary angioscopy revealed restenosis as a result of thrombus formation. Absence of endothelialization in the covered stent was also detected by angioscopy and optical coherence tomography. These findings suggest that in-stent thrombosis must be prevented after PTFE-covered stent implantation. (Circ J 2009; 73: 190 - 193)

  • in vivo comparison of optical coherence tomography and angioscopy for the evaluation of coronary plaque characteristics
    American Journal of Cardiology, 2008
    Co-Authors: Masamichi Takano, Kentaro Okamatsu, Shigenobu Inami, Takayoshi Ohba, Masanori Yamamoto, Daisuke Murakami, Koji Seimiya, Ikkyung Jang, Kyoichi Mizuno
    Abstract:

    Atherosclerotic yellow plaques identified by coronary angioscopy are considered as vulnerable plaques. However, characteristics of yellow plaques are not well understood. Optical coherence tomography (OCT) provides accurate tissue characterization in vivo and has the capability to measure fibrous cap thickness covering a lipid plaque. Characteristics of yellow plaques identified by angioscopy were evaluated by OCT. We examined 205 plaques of 41 coronary arteries in 26 patients. In OCT analysis, plaques were classified as fibrous or lipid. Minimal lumen area of the plaque, arch of the lipid, and fibrous cap thickness on the lipid plaque were measured. Yellow grade of the plaque was defined as 0 (white), 1 (light yellow), 2 (medium yellow), or 3 (dark yellow) based on the angioscopy. A total of 149 plaques were diagnosed as lipid plaques. Neither the minimal lumen area nor the arch of the lipid was related to the yellow grade. There was an inverse relationship between color grade and the fibrous cap thickness (grade 0 [n = 45] 218 ± 89 μm, grade 1 [n = 40] 101 ± 8 μm, grade 2 [n = 46] 72 ± 10 μm, and grade 3 [n = 18] 40 ± 14 μm; p

  • high yellow color intensity by angioscopy with quantitative colorimetry to identify high risk features in culprit lesions of patients with acute coronary syndromes
    American Journal of Cardiology, 2007
    Co-Authors: Fumiyuki Ishibashi, Kyoichi Mizuno, Akio Kawamura, Premranjan P Singh, Richard W Nesto, Sergio Waxman
    Abstract:

    High yellow color intensity (HYCI) regions of atherosclerotic plaque, determined by angioscopy with quantitative colorimetry, are associated with lipid cores underneath thin fibrous caps in ex vivo tissue samples. To determine whether HYCI regions of coronary plaque are associated with disruption or thrombus in living patients, quantitative colorimetry was applied to angioscopy, and the color of culprit lesions was measured in patients with acute coronary syndromes. In 46 patients with acute coronary syndromes (acute myocardial infarction, n = 14; unstable angina pectoris [UAP] with culprit thrombus, n = 16; and UAP without culprit thrombus, n = 16), the recorded angioscopic images of culprit lesions were analyzed using a quantitative colorimetric method based on the L*a*b* color space applied to angioscopy (positive b* = yellow color intensity). HYCI was defined as b* value >23. Plaque disruption was significantly more prevalent in 19 of 24 HYCI regions (79%) than in 9 of 22 non-HYCI regions (41%) (p = 0.007). Culprit HYCI regions were prevalent in patients with myocardial infarction (11 of 14 [79%]), followed by those with UAP with thrombus (9 of 16 [56%]) and UAP without thrombus (4 of 16 [25%]) (p = 0.01 for trend), and were significantly more prevalent in 66% of patients with myocardial infarction and UAP with thrombus compared with 25% of those with UAP without thrombus (p = 0.007). In conclusion, HYCI regions of coronary plaque may be indicative of high-risk lesions vulnerable to thrombosis. Coronary angioscopy with quantitative colorimetry could be used to study the association between high-risk coronary lesions and future cardiovascular events.

Masaharu Ishihara - One of the best experts on this subject based on the ideXlab platform.

  • assessment of second and third generation drug eluting stents on chronic coronary angioscopy multicenter study on intra coronary angioscopy after stent micasa prospective data analysis
    Circulation, 2018
    Co-Authors: Toru Miyoshi, Kazuoki Dai, Hiroshi Matsuoka, Hideo Kawakami, Tetsuya Sato, Kouki Watanabe, Masaharu Ishihara
    Abstract:

    Background The vascular response, in terms of quality and quantity, of the second- and third-generation drug-eluting stents (2G- and 3G-DES, respectively) was assessed prospectively on coronary angioscopy (CAS).Methods and Results:The Multicenter study on Intra-Coronary AngioScopy After Stent (MICASA) is a multicenter CAS registry. A total of 107 DES (71 2G- and 36 3G-DES) were prospectively observed on CAS 8.7±2.7 months after percutaneous coronary intervention. Neointimal coverage (NC) grade was evaluated using a 4-point grading scale, from 0 (no coverage) to 3 (complete coverage). Plaque yellow color (YC) was also assessed using a 4-point grading system, from 0 (white) to 3 (bright yellow). Max-NC (2G-DES vs. 3G-DES: 2.14±0.68 vs. 2.44±0.73, P=0.023); min-NC (1.07±0.48 vs. 1.39±0.60, P=0.002), and dominant-NC (1.57±0.69 vs. 2.08±0.84, P=0.002) were significantly higher and the YC grade (1.23±0.82 vs. 0.86±0.76, P=0.031) significantly lower in the 3G-DES group than in the 2G-DES group. There was no significant difference in the presence of thrombus (28.2% vs. 22.2%, P=0.51) between the 2G- and 3G-DES groups. Conclusions The higher NC grade and lower YC grade in 3G-DES than in 2G-DES might be associated with better long-term clinical outcome, which remains to be determined in future studies.

  • abstract 16388 validation of neointimal coverage classification after stent implantation by coronary angioscopy ex vivo histological study
    Circulation, 2017
    Co-Authors: Kenji Kawai, Takahiro Imanaka, Rika Kawakami, Hirokuni Akahori, Kojiro Miki, Nagataka Yoshihara, Koji Yanaka, Seiichi Hirota, Tohru Masuyama, Masaharu Ishihara
    Abstract:

    Introduction: Coronary angioscopy allows to visualize directly neointimal coverage (NIC) after stent implantation. However, histological comparison with qualitative NIC classification by angioscopy...

  • comparison of chronic angioscopic findings of bare metal stents 1st generation drug eluting stents and 2nd generation drug eluting stents multicenter study of intra coronary angioscopy after stent micasa
    Circulation, 2016
    Co-Authors: Kazuoki Dai, Hiroshi Matsuoka, Hideo Kawakami, Tetsuya Sato, Kouki Watanabe, Yasuharu Nakama, Masaharu Ishihara
    Abstract:

    Background No previous study has reported a comprehensive comparison of the chronic angioscopic findings after bare metal stent (BMS), and 1st- and 2nd-generation drug-eluting stents (DES). Methods and results The Multicenter Study on Intra-Coronary Angioscopy after Stent (MICASA) is a multicenter registry of coronary angioscopy. A total of 264 stents were observed by coronary angioscopy 1 year after PCI. There were 15 BMS, 90 1st-generation DES, and 159 2nd-generation DES. Neointimal coverage (NC) of the stent was classified into 4 grades from 0 (no coverage) to 3 (complete coverage). Yellow color (YC) of plaque at the stented segment was graded from 0 (white) to 3 (bright yellow). Minimum (Min-) and Maximum (Max-) NC grade were significantly lower with 1st- and 2nd-generation DES than with BMS. Although the Max-NC grade was similar, the Min-NC grade was significantly higher for 2nd-generation DES than for 1st-generation DES. Both the YC grade and the incidence of thrombus with 2nd-generation DES were lower than with the 1st-generation DES and were comparable to BMS. Multivariate analysis showed that low-density lipoprotein, 1st-generation DES, and acute coronary syndrome were independent factors for yellow plaque (YG2 or 3), and that hypertension and 1st-generation DES were independent factors for the incidence of thrombus. Conclusions Coronary angioscopy revealed more homogeneous coverage with white neointima and less thrombus after 2nd-generation DES as compared with 1st-generation DES. These findings may explain the favorable clinical outcomes observed for patients treated with 2nd-generation DES. (Circ J 2016; 80: 1916-1921).

Yasunori Ueda - One of the best experts on this subject based on the ideXlab platform.

  • tct 828 quantitative validation of the coronary angioscopic yellow plaque by lipid core burden index assessed by intra coronary near infrared spectroscopy
    Journal of the American College of Cardiology, 2019
    Co-Authors: Takashi Omatsu, Yasunori Ueda, Yuma Hamanaka, Tomoaki Kobayashi, Yohei Sotomi, Yoshiharu Higuchi
    Abstract:

    Coronary angioscopy (CAS) has provided substantial information pertaining to macroscopic pathology, as CAS has reliably detected atherosclerosis as yellow plaques. Coronary lesions with high-grade yellow color have been regarded as high-risk plaques and demonstrated to be associated with future

  • in stent yellow plaque at 1 year after implantation is associated with future event of very late stent failure the desnote study detect the event of very late stent failure from the drug eluting stent not well covered by neointima determined by angio
    Jacc-cardiovascular Interventions, 2015
    Co-Authors: Yasunori Ueda, Akio Hirata, Kazunori Kashiwase, Koshi Matsuo, Yuji Nishimoto, Ryuta Sugihara, Takayoshi Nemoto, Masato Okada, Ayaka Murakami, Kazuhisa Kodama
    Abstract:

    Abstract Objectives This study examined whether coronary angioscopy-verified in-stent yellow plaque at 1 year after drug-eluting stent (DES) implantation is associated with future event of very late stent failure (VLSF). Background Atherosclerosis detected as yellow plaque by angioscopy has been associated with future events of acute coronary syndrome. Development of in-stent neoatherosclerosis is a probable mechanism of VLSF. Methods This study included 360 consecutive patients who received successful angioscopic examination at 1 year after implantation of a DES. They were clinically followed up for VLSF defined as cardiac death, acute myocardial infarction or unstable angina, or need for revascularization associated with the stent site. Results The follow-up interval was 1,558 ± 890 days (4.3 ± 2.4 years). The incidence of VLSF was significantly higher in the patients with yellow plaque than in those without (8.1% vs. 1.6%; log rank p = 0.02). Multivariable analysis revealed the presence of yellow plaque (hazard ratio [HR]: 5.38; p = 0.02) and absence of statin therapy (HR: 3.25; p = 0.02) as risks of VLSF. Conclusions In-stent atherosclerosis evaluated by yellow plaque at 1 year after the implantation of DES and the absence of statin therapy were risks of VLSF. The underlying mechanism of VLSF appeared to be the progression of atherosclerosis as demonstrated by the yellow plaque.

  • stabilization and regression of coronary plaques treated with pitavastatin proven by angioscopy and intravascular ultrasound
    Circulation, 2010
    Co-Authors: Kazuhisa Kodama, Yasunori Ueda, Sei Komatsu, Tadateru Takayama, Hiroshi Matsuoka, Shinsuke Nanto, Jyunji Yajima, Satoshi Saito, Atsushi Hirayama
    Abstract:

    Background: Few studies have serially monitored the change of coronary plaque after statin therapy using multiple plaque imaging modalities. Methods and Results: A prospective open-label trial was performed to assess coronary plaque regression and stabilization following 52 weeks of pitavastatin treatment (2 mg/day). Coronary segments that included the most diseased plaque of 90 patients determined on angioscopy were analyzed using intravascular ultrasound (IVUS). The yellow grade of each plaque of 46 patients who had matched angioscopy and IVUS data was evaluated on angioscopy. Low-density lipoprotein-cholesterol (LDL-C) was reduced 34.5% (145.0±24.0 mg/dl to 93.6±22.6 mg/dl, P<0.001), and high-density lipoprotein cholesterol increased 17.8% (44.9±11.1 mg/dl to 51.9±11.7 mg/dl, P<0.001). Yellow grade decreased (2.9±0.8 to 2.6±0.7, P=0.040) during 52 weeks. The reduction of yellow grade was not correlated with the LDL-C level at 52 weeks or its change. The change of yellow grade was inversely correlated with maximum yellow grade at baseline. Percent atheroma volume on IVUS did not change during 52 weeks, but its change for 52 weeks was significantly correlated with LDL-C level at 52 weeks (Spearman's rank correlation coefficient 0.312, P=0.035). Conclusions: Fixed dose pitavastatin stabilized vulnerable coronary plaques by the reduction of yellow grade without significant reduction of plaque volume. The stabilization and regression of atherosclerotic plaques by statin may differ, but both nonetheless contribute to the reduction of cardiovascular events (UMIN Clinical Trials Registry UMIN000001107).  (Circ J 2010; 74: 1922 - 1928)

  • Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study.
    JACC. Cardiovascular imaging, 2009
    Co-Authors: Tomoaki Higo, Yasunori Ueda, Jota Oyabu, Katsuki Okada, Mayu Nishio, Akio Hirata, Kazunori Kashiwase, Nobuyuki Ogasawara, Shinichi Hirotani, Kazuhisa Kodama
    Abstract:

    Objectives We sought to examine by angioscopy the neointima formation and thrombogenic potential of the neointima after deployment of a drug-eluting stent (DES). Background Late stent thrombosis after DES implantation, a major safety concern, has been associated with poor strut coverage by neointima. Intracoronary angioscopy provides a method for visual evaluation of stent coverage by neointima and detection of thrombus in the stented coronary segment. Methods Patients undergoing implantation of a sirolimus DES (n = 57) were serially examined by angioscopy immediately after (baseline) and again at 10 months (follow-up) after implantation. The angioscopic color grade of the neointima from white to yellow was assessed in a semiquantitative manner. Stent coverage was classified into not covered (Grade 0), covered by a thin layer (Grade 1), or buried under neointima (Grade 2). The thrombogenic potential of the neointima was evaluated by the prevalence of thrombus on the neointima. Results The maximum yellow color grade of the neointima within DES-implanted lesions increased significantly from baseline to follow-up (1.4 ± 1.1 vs. 1.9 ± 0.6, p = 0.0008). Even among lesions without yellow color at baseline, yellow color was detected in 94% (17 of 18) of lesions at follow-up. The prevalence of thrombus was significantly higher on the yellow than on the white neointimal areas. Thrombus was detected on yellow and/or Grade-0/1 neointima, but never on the white Grade-2 neointima. Conclusions Sirolimus DES promoted formation of atherosclerotic yellow neointima in the stent-implanted lesion at 10-month follow-up. Thrombus was detected more often on the yellow area than on the white area and was never detected where a stent was buried under white neointima. These data suggest that the increased potential risk of late stent thrombosis in DES lesions may be due to the newly formed yellow neotima and cholesterol-laden plaque.

  • detection of coronary plaque by computed tomography with a novel plaque analysis system plaque map and comparison with intravascular ultrasound and angioscopy
    Circulation, 2005
    Co-Authors: Sei Komatsu, Yasunori Ueda, Atsushi Hirayama, Yosuke Omori, Isamu Mizote, Yasuo Fujisawa, Masayoshi Kiyomoto, Toshiaki Higashide, Kazuhisa Kodama
    Abstract:

    Background Previous reports suggest that plaque may be characterized by the computed tomography (CT) number, but there is not a comprehensive method for evaluating the gray-scale CT image of the coronary artery obtained by multi-detector row CT (MDCT). Methods and Results Forty-five patients with acute coronary syndrome (ACS) underwent MDCT either 3-4 weeks after the onset of acute myocardial infarction (n=24) or within 1 week after percutaneous coronary intervention in patients with unstable angina (UA; n=21). The cross-sections obtained at intervals of 5 mm were converted to numerical data and a `plaque map' was drawn using the color-based isometric line method and bird's eye view. `Plaque map' was compared with the findings of intravascular ultrasound (IVUS) and angioscopy. Of 662 slices of 78 vessels, soft, intermediate or calcified plaque was detected in 144, 134, and 84 slices, respectively. Compared with IVUS, the sensitivities were 92%, 87%, and 89%, respectively, and compared with angioscopy, sensitivity was 80% and specificity was 87%. Conclusions MDCT with the `Plaque Map' system can noninvasively characterize plaque in patients with ACS. (Circ J 2005; 69: 72 - 77)