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AimsWe performed this study to clarify natural consequences of abnormal structures (stent malapposition, thrombus, tissue prolapse, and stent edge dissection) after percutaneous coronary intervention (PCI).Methods and resultsThirty-five patients treated with 40 drug-eluting stents underwent serial optical coherence tomography (OCT) imaging immediately after PCI and at the 8-month follow-up. Among a total of 73 929 struts in every frame, 431 struts (26 stents) showed malapposition immediately after PCI. Among these, 49 remained malapposed at the follow-up examination. The mean distance between the strut and vessel wall (S–V distance) of persistent malapposed struts on post-stenting OCT images was significantly longer than that of resolved malapposed struts (342 ± 99 vs. 210 ± 49 μm; P <0.01). Based on receiver-operating characteristic curve analysis, an S–V distance ≤260 µm on post-stenting OCT images was the corresponding cut-off point for resolved malapposed struts (sensitivity: 89.3%, specificity: 83.7%, area under the curve = 0.884). Additionally, 108 newly appearing malapposed struts were observed on follow-up OCT, probably due to thrombus dissolution or plaque regression. Thrombus was observed in 15 stents post-PCI. Serial OCT analysis revealed persistent thrombus in 1 stent, resolved thrombus in 14 stents, and late-acquired thrombus in 8 stents. Tissue prolapse observed in 38 stents had disappeared at the follow-up. All eight stent edge dissections were repaired at the follow-up.ConclusionMost cases of stent malapposition with a short S–V distance, thrombus, tissue prolapse, or minor stent edge dissection improved during the follow-up. These OCT-detected minor abnormalities may not require additional treatment.

Daily glucose fluctuation may have an effect on coronary plaque vulnerability in patients with CAD pre-treated with lipid-lowering therapy. Further investigations should address the rationale for the early detection and control of glucose fluctuation in the era of universal statin use for CAD patients.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp benefit of routine FKI after single stenting of bifurcation lesions. 6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation. Despite these controversies, the relationship between stenting strategies and local findings, such as stent apposition, thrombus formation, and neointimal coverage, which may be associated with long-term clinical outcome, has not been well evaluated to date.Several studies have shown that the high resolution of optical coherence tomography (OCT) enables visualization of coronary arteries at the micron level for evaluation of strut coverercutaneous coronary intervention (PCI) using drugeluting stents (DES) reduces restenosis and major adverse cardiac events (MACE) compared to PCI with bare metal stents. 1 Even in the DES era, however, the procedures for bifurcation remain complex and challenging. 2,3 The single-stent strategy is currently considered preferable because the 2-stent strategy has higher rates of periprocedural myocardial infarction and long-term MACE, 4,5 which is probably associated with the increased use of contrast and prolonged procedure time. Therefore, a 1-stent strategy with a provisional approach to the side branch with final kissing inflation (FKI) might be the most acceptable strategy in clinical practice.Recently, the Nordic-Baltic Bifurcation Study III, a randomized comparison of clinical outcomes in patients with coronary bifurcation lesions treated with FKI vs. without FKI after main vessel (MV) stenting, found a similar 6-month clinical outcome between the 2 groups, raising questions regarding the Background: Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ual antiplatelet therapy with aspirin plus a thienopyridine derivative is recommended for the prevention of thrombotic events in patients with coronary artery disease who have undergone drug-eluting stent (DES) implantation. 1 Clopidogrel, a thienopyridine derivative, is a prodrug that is converted into an active metabolite in the liver and the metabolite irreversibly inhibits the adenosine diphosphate P2Y12 receptor. 2 Because the conversion is achieved by the hepatic cytochrome P450 (CYP) system in a 2-step oxidative process and CYP2C19 is involved in both of these steps, polymorphisms of the genes encoding CYP2C19 are considered to influence clopidogrel's efficacy by affecting the activity of its metabolite. 3-5 Among the single nucleotide polymorphisms of CYP2C19, the CYP2C19*2 polymorphism (mutation of guanine to adenine at position 681 in exon 5) and the CYP2C19*3 polymorphism (mutation of guanine to adenosine at position 636 in exon 5) are considered to be important loss-of-function polymorphisms. Previous studies demonstrated that the CYP2C19*2 and CYP2C19*3 polymorphisms increase the risk of stent thrombosis, 6-8 but only limited data are available regarding the association between the presence of CYP2C19 polymorphisms and future lesion outcomes after DES therapy. Background: Cytochrome P450 (CYP) 2C19 polymorphism is associated with reduced responsiveness to clopidogrel and poor clinical outcome after drug-eluting stent (DES) implantation, but its contribution to lesion outcome after DES implantation is unclear.