Takashi Muramatsu

The Drug Coated Balloon Academic Research Consortium project originated from the lack of standardization and comparability between studies using drug-coated balloons in the treatment of obstructive coronary artery disease. This document is a collaborative effort between academic research organizations and percutaneous coronary intervention societies in Europe, the USA, and Asia. This consensus sought to standardize study designs and endpoints for clinical trials involving drug-coated balloons, including defining angiographic, intravascular, and non-invasive imaging methods for lesion assessment, alongside considerations for post-revascularization pharmaco-therapy. The concept of 'blended therapy', which advocates for combining device strategies, is also discussed. This paper delineates study types, endpoint definitions, follow-up protocols, and analytical approaches, aiming to provide consistency and guidance for interventional cardiologists and trialists.

We present a novel, simple, and low-cost "side-hole" technique for a patient with ST-segment elevation myocardial infarction (STEMI) caused by an occlusion of an anomalous origin of the culprit coronary artery (AOCCA). In a case where standard guiding catheters failed to engage the anomalous left coronary artery (LCA), we created an approximately 3 mm side-hole near the tip of a 5 Fr diagnostic catheter and then introduced a guidewire and microcatheter directly into the anomalous left main trunk (LMT). Subsequently, we withdrew this diagnostic catheter and exchanged it for a guiding catheter over the guide wire, enabling rapid primary PCI. This approach facilitated rapid wire passage, minimized additional device use, and helped reduce overall reperfusion time. It may be especially useful in urgent STEMI cases where a suitable guiding catheter for AOCCA lesions cannot be readily identified.

Evaluation of calcified lesions by intravascular imaging has revealed that atherectomy devices have only limited impact. However, subsequent use of coronary intravascular lithotripsy (IVL) may increase treatment effectiveness without increasing risk of complications. This study was designed to evaluate the safety and effectiveness of IVL use after atherectomy in severely calcified coronary lesions as pre-treatment for drug-eluting stents (DES). The Dual-Prep registry is a multicenter, prospective registry of consecutive image-guided percutaneous coronary interventions (PCI). The primary effectiveness and safety endpoints were procedural success (residual stenosis < 50% by quantitative coronary angiography) without an in-hospital major adverse cardiac event (MACE) and 30-day freedom from MACE, respectively. Baseline vessel calcification score and final DES expansion were evaluated by optical coherence tomography (OCT). A total of 118 patients with 120 lesions were enrolled at 20 sites. The calcification score of lesions after atherectomy by core-lab assessment was 4.0 in all cases. Rotational atherectomy was applied prior to IVL in 83.9% cases with mean burr size of 1.57 ± 0.20 mm; IVL was subsequently successfully delivered in all cases (mean balloon diameter 3.02 ± 0.45 mm), followed by DES deployment (mean diameter 3.19 ± 0.51 mm, length of 36.3 ± 16.0 mm). The primary efficacy and safety endpoints were met in 98.3% and 98.3% of cases, respectively. A DES expansion index < 0.8 was seen in 42.2%, and an eccentricity index < 0.7 was not observed in any patient. In severely calcified lesions, image-guided atherectomy followed by IVL lesion preparation demonstrated high procedural success rates and satisfactory non-eccentric stent expansion. This approach may be considered for lesions where an 'IVL-first' strategy may not be feasible. jRCT1032230384 (Oct 7, 2023).

OBJECTIVE: This study highlights a case in which we performed a complex percutaneous coronary intervention on a 60-mm chronic total occlusion lesion with a remarkably low radiation dose by using the SPOT region of interest (SPOT ROI) function available on the Alphenix Evolve Edition X-ray system (Canon Medical Systems). KEY STEPS: Fluoroscopy was conducted exclusively using SPOT ROI from the start of guiding catheter engagement. The wire successfully traversed the chronic total occlusion lesion with SPOT ROI. Despite a fluoroscopy time of 71 min, the total radiation dose was kept at 990 mGy, remaining <1 Gy. POTENTIAL PITFALLS: The SPOT ROI function is only available on the Alphenix Evolve Edition X-ray system and cannot be used with other X-ray equipment. TAKE-HOME MESSAGE: This case suggests that SPOT ROI can be leveraged to safely reduce radiation during complex percutaneous coronary intervention.