SUMMARYThe aim of this study was to compare the initial and long-term outcomes of sirolimuseluting stents (SES) and bare-metal stents (BMS) in patients with calcified lesions without performing rotational atherectomy.The subjects were 79 consecutive lesions (38 in the SES group and 41 in the BMS group) which were confirmed to have superficially calcified lesions by intravascular ultrasound. In all lesions, the stent was implanted after predilatation with a balloon.The patient characteristics were not different between the 2 groups. All procedures were successfully performed in both groups. Vessel area was significantly smaller in the SES group than in the BMS group (11.01 ± 3.88 mm 2 versus 13.08 ± 3.49 mm 2 , P < 0.005), as was the lumen area (5.41 ± 2.31mm 2 versus 6.48 ± 2.04 mm 2 , P < 0.005). Minimum stent area was significantly smaller in the SES group than in the BMS group (5.61 ± 1.54 mm 2 versus 6.69 ± 1.74 mm 2 , P < 0.01). In cases in whom angiographic follow-ups were performed, the late loss was significantly smaller in the SES group than in the BMS group (0.19 ± 0.49 mm versus 0.76 ± 0.48 mm, P < 0.001). The restenosis rate was significantly lower in the SES group than in the BMS group (8.8% versus 33.3%, P < 0.05) and the TLR rate tended to be lower in the SES group (7.9% versus 19.5%). Stent thrombosis was not observed in either group.The results suggest that SES are more effective than BMS and can be used safely when treating calcified lesions if predilatation with a balloon is possible. (Int Heart J 2007; 48: 137-147)

SUMMARYA 63-year-old Japanese man was readmitted to our hospital due to acute broad-anterior myocardial infarction (AMI). The proximal left anterior descending artery (LAD) at the prior stent, which was implanted 19 months earlier and in which no angiographic restenosis was recognized 13 months before the second study, was totally occluded. After crossing a guide wire and balloon angioplasty, angiographic radiolucency was observed at the prior stent, suggesting that AMI was induced by late coronary stent thrombosis. Intravascular ultrasound performed 19 days after the onset of AMI revealed superficial calcification without significant stenosis and an atherosclerotic plaque distal to the stent that was not significantly changed compared to 19 months previously, consistent with the culprit lesion being an intrastent site. AMI may thus be induced by late coronary stent thrombosis during long-term clinical follow-up without clinical symptoms or angiographic restenosis at the second study. (Jpn Heart J 2004; 45: 147-152)

It has been reported that coronary diseases in patients with Fabry's disease are induced by deposits in endothelial cells and coronary smooth muscle cells. Most of those are ischemia due to stenosis. This report describes a case of patient with Fabry's disease who showed severe vasospasms without coronary artery stenosis during acetylcholine loaded coronary angiography. In this case, a myocardial biopsy revealed that the deposits in the endothelial cells of the myocardial capillaries were lamellated appearance. Recently, it is reported that endothelial cell damage could be an important cause of coronary vasospasm. This case suggests that the some sort of functional disorder was induced by glyco-sphingolipid deposits in the coronary endothelial cells, and that this might have led to coronary artery spasms without the organic stenosis of coronary arteries.

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