Background and aims: The optimal duration of dual antiplatelet therapy for acute myocardial infarction is controversial because the bleeding risk outweighs the thromboembolic risk. We hypothesized that an in-stent thrombus (IS-thrombus) detected by coronary angioscopy (CAS) after stent implantation would be associated with high bleeding risk. Methods: This study included 208 patients who underwent CAS at 2 weeks after stent implantation for an acute myocardial infarction. The study was approved by the ethics committee at the Nihon University Itabashi Hospital (reference number RK-200714-10). Results: In 84 patients, in whom no IS-thrombus was identified in the culprit vessel using CAS, the major bleeding event rate was significantly higher than that in patients with IS-thrombi (n = 124). However, no difference was detected in major adverse cardiovascular events (MACE; stroke, hospitalization for a non-fatal myocardial infarction/unstable angina, target lesion revascularization, and cardiovascular death). After adjustments by the propensity score based on patient characteristics, the absence of IS-thrombi remained an independent predictor of major bleeding events (hazard ratio 4.73, 95% confidence interval 2.04-11.00, p < 0.001). Conclusions:The absence of CAS-detected IS-thrombi in the subacute phase was independently associated with future major bleeding events, but not with MACE. These findings may help optimize the duration of dual antiplatelet therapy.

Background. The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear. Methods. Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time. Results. Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, P < 0.001 ) and had a higher prevalence of female sex (42.1% vs. 14.6%, P = 0.007 ), hypertension (94.7% vs. 75.6%, P = 0.02 ), and subclavian artery calcification (73.7% vs. 34.2%, P < 0.001 ) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (ρ = −0.51, P < 0.001 ) and total procedural time (ρ = −0.32, P = 0.004 ). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees (β = 0.45, P < 0.001 ). Conclusion. Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.

Although the association between periodontitis (PD) and acute myocardial infarctions (AMIs) is known, it is unclear whether the severity of the PD is associated with the atherosclerotic cardiovascular status (ASCVS) degree in patients with AMIs. We prospectively investigated 50 patients with AMIs admitted to the Nihon University Itabashi Hospital from July 2019 to May 2022. All patients were classified according to the presence and severity of the PD. The periodontal status was defined by radiographic bone loss in accordance with previous studies (healthy; ≥80% remaining bone [RB], mild-moderate PD; 66 ≤ RB < 80%, and severe PD; RB < 66%), and the degree of the ASCVS was compared. The low-density lipoprotein/high-density lipoprotein ratio significantly increased from healthy to mild-moderate PD to severe PD. The SYNTAX score was numerically higher according to the severity of the PD. The carotid intima-media thickness (cIMT) (p = 0.025) and E/e’ value (p = 0.009) were highest in the severe PD group. The cIMT and E/e’ had a significant negative correlation with the PD (Person’s correlation coefficients; r=-0.296, p = 0.037, and r=-0.411, p = 0.003, respectively). We found that the severity of the PD was associated with carotid atherosclerosis and cardiac diastolic dysfunction in AMI patients, suggesting the importance of scrutinizing PD in AMI practice.

Introduction: Periaortic adipose tissue (PAAT) is related to the development of cardiovascular disease. However, the relationship between periaortic adipose tissue (PAAT) and aortic plaque instability has not been elucidated. Hypothesis: We hypothesized that PAAT would be associated with aortic vulnerable plaques derived non-obstructive general angioscopy (NOGA) in patients with cardiovascular disease. Methods: We investigated 117 patients who underwent NOGA of the aorta and CT. PAAT volume was measured using the volume-rendering method by extracting the area from -30 to -190 HU within the thoracic aorta. PAAT volume index (PAAT-I) was defined as PAAT volume divided by the body surface area. We evaluated the number of vulnerable plaques including ruptured plaques, ulcerations, thrombi, intense yellow plaques by NOGA in the whole aorta. All patients were divided into the median value of PAAT-I (16.9 [13.0 - 21.6] ml/m2) Results: The high PAAT-I patients had significantly greater number of vulnerable plaques in the thoracic aorta than the low PAAT-I patients (2 [1-4] vs 1 [0-3], p<0.05). The PAAT-I had a correlation with the number of vulnerable plaques in the thoracic and whole aorta (r=0.44, p<0.001, r=0.35, p<0.01, respectively) Conclusions: PAAT in the thoracic aorta was related to the number of NOGA derived-aortic vulnerable plaques in patients with cardiovascular disease. PAAT may play an important role in the development of aortic plaque instability.

A cerebral infarction (CI) is a common complication of coronary angiography (CAG); however, repeated CIs in the immediate period after a CAG have not been reported yet. The patient in the present study experienced left upper quadrant blindness immediately after internal thoracic arteriography, and magnetic resonance imaging (MRI) showed a high-intensity area in the right occipital lobe. Despite the administration of antithrombotic therapy, the patient became transiently comatose for 6 hours. MRI showed a new high-intensity area in the left thalamus. A noninvasive assessment should be considered before internal thoracic arteriography to prevent the risk of complications.