Background Outcomes after sirolimus-eluting stent (SES: Cypher ® ) implantation remained to be elucidated in Japan. Methods and Results Among 1,070 consecutive angiographic follow-up lesions, 99 lesions underwent target lesion revascularization (TLR) with in-stent restenosis (ISR). Retrospective estimation by multivariate analysis including 50 variables showed that the ostiums of right coronary and left circumflex arteries, hemodialysis, calcification, non-direct stenting, ISR of SES, and non-eccentric lesion were the predictors of TLR. There was no documented late stent thrombosis (LST) among 2,166 lesions and very LST (VLST) among 1,423 lesions. Conclusion Further revises are needed to implant SES to these predictive lesions. LST and VLST were very rare. (Circ J 2007; 71: 1328 -1331

Inhaled NO substantially increases oxygen consumption at the same workload during exercise. This finding supports the possibility of ambulatory NO inhalation therapy in patients with precapillary PH.

SummaryIn order to compare the long-term clinical and angiographic outcomes after sirolimus-eluting stent (SES) and baremetal stent (BMS) placement in severely calcified lesions using a rotablator under the widespread indication of SES, a nonrandomized examination of 312 consecutive lesions after successful implantation of a BMS (99 lesions in 84 patients; from January 2003) or SES (213 in 167; from September 2004) using a rotablator was conducted. The lesionbased primary endpoints (cardiac death and nonfatal recurrent myocardial infarction) and the secondary endpoint [binary restenosis (BR) (diameter stenosis > 50%) at follow-up angiography] were retrospectively determined in August 2010. The incidence of primary endpoint in the SES group (2.3%; mean follow-up period of 1289 ± 526 days) was significantly lower than that in the BMS group (7.1%; P = 0.043; 1803 ± 887 days), although the several variables related to the endpoints were present in the SES group. Cox proportional hazard model analysis revealed that SES was not significantly related to a primary endpoint [hazard ratio of 0.42 (95% CI, 0.073-2.42; P = 0.33)]. The incidence of BR in the SES group (21.3%) was not significantly different from that in the BMS group (27.1%) (P = 0.33). Multivariate logistic regression analysis revealed that SES was not a significant predictor of BR [Odds ratio of 0.78 (95% CI, 0.41-1.51; P = 0.47)]. Thus, although the results of the present retrospective nonrandomized study demonstrate the long-term safety of SES for calcified lesions using a rotablator in daily practice, SES did not show a benefit for the angiographic outcomes and is one of the complex and challenging targets of percutaneous coronary intervention (PCI). Since calcified coronary lesions are associated with the risk of suboptimal stent expansion, calcification of coronary arteries relates to in-stent restenosis (ISR) and target lesion revascularization (TLR) 2-4) and subsequent stent thrombosis (ST) 5) after sirolimuseluting stent (SES; Cypher Bx Velocity, Cordis, Johnson & Johnson, NJ, USA) implantation. Therefore, it is necessary to evaluate whether SES is consistently beneficial for the treatment of calcified lesions in daily clinical practice with a widespread indication in the field of percutaneous coronary intervention (PCI). However, the impacts of severely calcified lesions on the long-term clinical and angiographic outcomes after successful SES placement in daily clinical practice are still not fully understood.Rotational atherectomy (RA) using a rotablator (Boston Scientific, Natick, MA, USA) is useful for treating calcified lesions. The rotablator facilitates optimal stent implantation by debulking the hard calcified matrix and modifies vessel compliance.6) However, SES implantation with RA for a calcified coronary artery has yielded inconsistent outcomes, 7-9) despite the consistent efficacy revealed in the overall field of PCI using SES. 2,10,11) In the present study, we retrospectively examined whether SES implantation with RA improved clinical...

In this study of a small sample of patients with mild to severe essential hypertension and angina pectoris, efonidipine was as effective as other DHPs. Moreover, the drug attenuated the reflex tachycardia that occurred with traditional DHPs.

This is the first case report of postsurgical constrictive pericarditis confined to the left ventricle in which the majority of diagnosis tests were not indicative of the disease. A 50-year-old woman with a past history of mitral valve replacement was admitted for right heart failure. Cardiac catheterization showed impaired diastolic filling but lacked the characteristic ventricular interdependence recently reported to be specific for the disease, without manifest radiological appearance of pericardial thickening. However, a new technique using magnetic resonance tagging cine revealed pericardial adhesion, limited to the left ventricle, which was confirmed during pericardiectomy. After the surgery, right heart failure and diastolic filling abnormality disappeared with restoration of normal heart pressures.

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