SCAD is not a rare cause for ACS, especially in females without classical coronary risk factors.

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Patients with diabetes frequently present with complications such as impaired skin wound healing. Skin wound sites display a markedly enhanced expression of CCL2, a potent macrophage chemoattractant, together with macrophage infiltration during the early inflammatory phase in skin wound healing of healthy individuals, but the association of CCL2 with delayed skin wound healing in patients with diabetes remains elusive. In this study, we showed that, compared with control mice, mice with streptozotocin-induced diabetes displayed impaired healing after excisional skin injury, with decreased neovascularization, CCL2 expression, and macrophage infiltration. Compromised skin wound healing in mice with diabetes was reversed by the administration of topical CCL2 immediately after the injury, as evidenced by normalization of wound closure rates, neovascularization, collagen accumulation, and infiltration of macrophages expressing vascular endothelial growth factor, a potent angiogenic factor, and transforming growth factor-b. CCL2 treatment further increased the accumulation of endothelial progenitor cells at the wound sites of mice with diabetes and eventually accelerated neovascularization. Thus, the topical application of CCL2 can be an effective therapeutic option for the treatment of patients with diabetes with defective wound repair, promoting neovascularization and collagen accumulation at skin wound sites.

After the ligation of the inferior vena cava (IVC) of wild-type (WT) mice, venous thrombi formed and grew progressively until 5 days and resolved thereafter. Concomitantly, intrathrombotic gene expression of Il6 was enhanced later than 5 days after IVC ligation. IL-6 protein expression was detected mainly in F4/80-positive macrophages in thrombus. When Il6-deficient (Il6 −/−) mice were treated in the same manner, thrombus mass was significantly larger than in WT mice. Moreover, the recovery of thrombosed IVC blood flow was markedly delayed in Il6 −/− compared with WT mice. F4/80-positive macrophages in thrombus expressed proteolytic enzymes such as matrix metalloproteinase (Mmp) 2, Mmp9, and urokinase-type plasminogen activator (Plau); and their mRNA expression was significantly reduced in Il6 −/− mice. Consistently, the administration of anti-IL-6 antibody delayed the thrombus resolution in WT mice, whereas IL-6 administration accelerated thrombus resolution in WT and Il6 −/− mice. Moreover, IL-6 in vitro enhanced Mmp2, Mmp9, and Plau mRNA expression in WT-derived peritoneal macrophages in a dose-dependent manner; and the enhancement was abrogated by a specific Stat3 inhibitor, Stattic. Thus, IL-6/Stat3 signaling pathway can promote thrombus resolution by enhancing Mmp2, Mmp9, and Plau expression in macrophages.

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VV increase with fibrous plaque volume and intraplaque neovessels with particular structures are associated with plaque vulnerability. Imaging for microvasculature could become a new window for plaque vulnerability.

P ercutaneous coronary intervention (PCI) is a common and established therapy for coronary artery disease. Drugeluting stents have been shown to reduce neointimal hyperplasia and restenosis in stent segments. However, restenosis in reference segments adjacent to the proximal and distal border of the stent (so-called stent edge restenosis [SER]) remains a potential limitation of drug-eluting stents. 1Stenting from normal to normal is effective to minimize SER. However, the reference segments are rarely normal. Especially in diffuse disease, it is difficult to determine appropriate plaque-free reference segments for stent landing. Previous intravascular ultrasound studies have disclosed that greater residual plaque burden and stent overexpansion are associated with SER. 2,3 Optical coherence tomography (OCT) is a high-resolution (10-20 μm) intravascular imaging technique that uses near-infrared light to create images. An excellent contrast between lumen and vessel wall in OCT allows accurate lumen measurements. 4 Tissue characterization by OCT enables us to identify 3 types of coronary plaques such as lipid, fibrous, and fibrocalcific. 5 In addition, OCT has a high sensitivity for detection of suboptimal stent findings such as intrastent tissue protrusion, incomplete stent apposition, stent edge dissection, and intrastent thrombus. 4 Recently, OCT is becoming increasingly widespread as a clinical tool to guide PCI. The aim of this study was to determine OCT predictors for angiographic SER after everolimus-eluting stent implantation.Background-Stent edge restenosis (SER) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER after everolimus-eluting stent implantation. Methods and Results-We retrospectively analyzed 319 patients who underwent OCT immediately after everolimus-eluting stent implantation and scheduled 9-to 12-month follow-up angiography. The binary angiographic SER rate was 10% (32/319) in the patients, 8.4% (32/382) in lesions, and 4.4% (33/744) in stent edge segments. In the stent edge segments at post stenting, OCT-derived lipidic plaque (61% versus 20%; P<0.001) was more often observed in the SER group, and OCT-measured minimum lumen area (4.13±2.61 versus 5.58±2.46 mm 2 ; P=0.001) was significantly smaller in the SER group compared with the non-SER group. Multivariate analysis identified lipidic plaque (odds ratio: 5.99; 95% confidence interval: 2.89-12.81; P<0.001) and minimum lumen area (odds ratio: 0.64; 95% confidence interval: 0.42-0.96; P=0.029) as independent predictors of binary SER. Receiver-operating characteristic analysis demonstrated that lipid arc of 185° (sensitivity: 71%; specificity: 72%; area under the curve: 0.761) and minimum lumen area of 4.10 mm 2 (sensitivity: 67%; specificity: 77%; area under the curve: 0.787) were optimal cutoff values for predicting ischemiadriven SER. Conclusions-The present OCT study demonstrated that lipidic plaque and minimum lumen area in t...