Secondary coronary revascularizations can be required due to the progression of coronary artery lesions and degeneration of bypass grafts in the long term after initial coronary artery bypass graft (CABG) surgery. It is therefore necessary to clarify the clinical characteristics of these patients and how to improve their prognosis. Optimal medical treatments, including medications, smoking cessation, and cardiac rehabilitation, are essential baseline management to prevent the progression of native coronary atherosclerosis and degradation of bypass grafts among all post-CABG patients who undergo secondary coronary revascularization as well as those who undergo initial CABG surgery in order to avoid situations requiring secondary coronary revascularization. All coronary revascularization procedures should be built upon these firm optimal medical treatments. Percutaneous coronary intervention is the current mainstay of secondary coronary revascularization approaches for patients who have symptoms of heart failure or angina pectoris because of the low invasiveness of the technique and no need for re-sternotomy. Redo-CABG is an option, especially for young patients without patency for internal thoracic artery to left anterior descending artery graft. The individualization of these approaches and improvements in medications and coronary revascularization procedures may improve the clinical outcomes and prognosis of this subgroup.

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Objective: A transfemoral Impella can substantially support patients with cardiogenic shock, and surgical closure has conventionally been used for the removal of large-bore catheters. However, while percutaneous closure is a prompt and minimally invasive technique, single Perclose post-closure outcomes remain to be evaluated. The present study evaluated the safety and efficacy of single Perclose post-closure in the removal of transfemoral Impella catheters.
Methods: Of 37 patients supported by an Impella device, 25 patients (68%) were excluded due to a transsubclavian approach, an inability to wean, or primary surgical closure. We reviewed 12 patients (32%) receiving the single Perclose post-closure method. For percutaneous closure, we inserted a 0.035-inch guidewire through the side port of the Impella device and extracted the device while retaining the guidewire. Single Perclose was deployed with an additional maneuver as backup, such as second Perclose or surgical closure. The outcomes were defined according to the Valve Academic Research Consortium-2 criteria.
Results: All patients had received the Impella CP due to cardiogenic shock. All patients received single/dual antiplatelets without oral anticoagulants. Percutaneous closure was successful in 11 patients (92%); the remaining patient was converted to surgical closure. The mean (range) procedural time was 8.0 (5.8–9.0) minutes. Major bleeding and vascular complications were observed only in the patient with surgical conversion (8.3%). No closure-site infection or closure-related limb ischemia was observed. All patients were discharged alive after the removal of the Impella device.
Conclusion: Single Perclose post-closure is a promising closure method for removing a transfemoral Impella, but further investigations are needed.

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Guidewire insertion into the side branches during percutaneous coronary intervention may be difficult, depending on the angle of the side branch and plaque localization. The reverse wire technique (RWT) is an effective wiring method for markedly angulated bifurcated side branches. Nonetheless, continuing the procedure may be difficult if the RWT system cannot be inserted because of severe main trunk stenosis or if the insertion of the system causes a decrease in the peripheral blood flow. In these cases, balloon pre-dilation is sometimes performed; however, this is unreliable due to the risk of side branch occlusion caused by plaque shift. By performing excimer laser coronary angioplasty (ELCA) as a preparatory procedure before RWT, it is possible to eliminate the main trunk plaque without inducing insufficiency in the side branches. We herein report three acute coronary syndrome (ACS) cases in which ELCA pretreatment was effective after failure of an attempted RWT. This method is considered a novel use of ELCA in ACS.

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Background: In Iwate Prefecture, the registration project for acute coronary syndrome started as a pilot project in 2014 and became a main project in 2016, enabling us to understand and verify the current situation in Iwate Prefecture.
Methods: To obtain a comprehensive understanding of the present status of the region, we compiled data on the registration project for acute coronary syndrome in Iwate Prefecture.
Results: The incidence/death ratio, which indicates the accuracy of registration, and the ambulance use rate increased over time. The percentage of 12-lead electrocardiogram (ECG) transmission implementation in all prefectures was still insufficient, at 7.5% in 2019. In contrast, in medical regions where transmission had already been introduced, 23.6–62.5% of cases had ECG transmission. The atrial fibrillation complication rate showed a slight upward trend over time, exceeding 10% in 2019. The incidence of pre-infarction angina was approximately 30% in this 2019 registry. For urgent recanalization therapy, urgent coronary angiography was performed in 89% of cases in 2019, and recanalization therapy was performed in an additional 83% of cases. These rates have also increased over time.
Conclusion: It is necessary to continue to promote registration projects that provide an overall view of the region, provide data that can be returned to residents, and advise the government.

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