Coronary CT angiography (CCTA) is the most promising, noninvasive tool that allows the visualization of plaque morphology. Plaque morphology characterized by positive remodeling, low attenuation plaque and napkin-ring sign in CCTA has been regarded as rupture-prone vulnerable plaques which account for about 60% of all vulnerable plaques and cause plaque rupture. Currently, importance of stenosis level and plaque volume for vulnerable plaque assessment has been recognized. CCTA is also useful from viewpoint of these evaluations. However, it is considered that evaluation by using CT number that is one of important factors of plaque evaluation is affected various factors. There remain several problems in objectivity and quantitative evaluation. Recently we developed a novel method for evaluating characteristics of plaque in more objective and quantitative way and reported the usability. Moreover, it may be possible to diagnose vulnerable plaque more correctly by comprehensive evaluation on addition to evaluation of fractional flow reserve and endothelial share stress using CCTA. In the future, it is expected construction of evidence in multi-center large-scale clinical trial and development of new evaluation method such as molecular CT imaging.

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Persistent risk of cardiovascular diseases despite using established medical therapies require additional therapeutic approach. Considerable attentions have focused on novel agents targeting high-density lipoprotein (HDL) because of its atheroprotecive functions. HDL has the abilities to promote reverse cholesterol transport and modify inflammatory, oxidative, apoptotic, and endothelial pathways. Numerous basic and preclinical studies have demonstrated the beneficial effects of HDL targeting therapy on atherosclerosis. While recent clinical trials failed to prove favourable effect of HDL targeting therapies on cardiovascular outcomes, further search still continues to identify effective therapeutic approach targeting HDL due to its attractive anti-atherosclerotic properties. Recently, different types of agents modulating HDL have been developed and investigated or currently under clinical trial. Plaque imaging has been increasingly employed to evaluate the efficacy of these therapies because of its association with cardiovascular outcomes. This modality will further play an important role in the assessment of novel drugs modulating HDL in the future. The current article will review characteristics of HDL, its atheroprotective effects, HDL targeting therapies and its efficacy on atherosclerosis evaluated by plaque imaging modalities.

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We encountered a case in whom a coronary stent was unable to be passed through the curved region in the mid-coronary artery during PCI for a peripheral lesion of the right coronary artery. We employed a new and simple technique using a Scoreflex balloon catheter, the so-called Scoreflex method, by which the stent was successfully advanced without a new device. Here, we report the effectiveness of this method.

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Background: We have developed a mobile telemedicine system (MTS) utilizing mobile communications via cellular phones, making it possible to continuously transmit biological information, including 12-lead electrocardiography data, from an ambulance while the patient is being transported to the destination hospital in real time. Purpose: We evaluated whether using an MTS during the transport of acute myocardial infarction patients shortens the interval between arrival at the hospital and balloon inflation to achieve reperfusion (door-to-balloon time). Two hundred eighteen consecutive AMI patients were divided into two groups: 23 patients who had been brought to the hospital in an ambulance equipped with an MTS, and 195 patients who had been brought to the hospital without the use of an MTS. Results: When the MTS group and the non-MTS group were compared, no differences in clinical characteristics , Killip class, incidence of emergency coronary angiography, culprit lesion, or prevalence of multi-vessel disease were seen. No significant differences were seen between the two groups in terms of the incidence of primary percutaneous coronary intervention (PCI), initial angiography findings, or the degree of coronary blood flow after PCI. Regarding outcomes, no differences in the peak creatinine kinase and isozyme MB levels or in-hospital mortality were seen between the two groups. However, the door-to-balloon time was 86 minutes (median times) in the MTS group, which was significantly shorter than the 96 minutes observed in the non-MTS group (P<0.05). Conclusions: We have developed a mobile telemedicine system (MTS) and have shown its efficacy in pre-hospital medical settings.

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Background: Recently, coronary computed tomography angiography (CTA) findings of positive vessel remodeling (PR) and low-attenuation plaque (LAP) have been reported to be associated with the development of acute coronary syndromes (ACS). The aim of this study was to examine the CTA detected vulnerable plaque characteristics by using intracoronary optical coherence tomography (OCT). Method and Result: A total of 16 patients with 16 lesions underwent PCI by using intracoronary OCT, after coronary CTA examination, were enrolled in this study. The CTA detected vulnerable plaque (CT-VP) was defined as LAP (<30 hounsfield unit (HU)) with PR of at least 110%. The lesions were divided into a CT-VP and a non CT-VP group. The CT-VP was observed in 7 lesions (43.7%) of all 16 lesions. Acute coronary syndrome (ACS) was more frequent in the CT-VP group than in the non CT-VP group (71.4% vs 11.1%, p<0.001). OCT examination revealed that the frequency of lipid-rich plaque (100% vs 33.3%, p<0.001), thin-cap fibroatheroma (TCFA) (71.4% vs 22.2%, p<0.01), plaque rupture (42.8% vs 11.1%, p<0.05), thrombus (57.1% vs 11.1%, p<0.01) and macrophage accumulation (100% vs 44.4%, p<0.01) were significantly higher in the CT-VP compared with the non CT-VP group. Conclusion: Our OCT study revealed that the CT-VP was correlated with OCT detected lipid-rich plaque, TCFA and macrophage accumulation leading plaque rupture and thrombus formation, which might contribute to the development of ACS.

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Objectives: Repair of a postinfarction ventricular septal perforation (VSP) had been a difficult procedure with a high risk of postoperative residual shunt and subsequent mortality. This retrospective study aimed to assess a modified infarct exclusion technique with a biventricular approach. Methods: Thirty three consecutive patients who underwent the infarct exclusion procedure for VSP between 2002 and 2013 were reviewed. A biventricular approach (B group: 9 patients) and a left ventricular approach (L group: 24 patients) were analyzed. Results: The overall 30-day mortality of B and L group was 11%, and 21%, respectively, and there was not different between the two groups (p=0.53). No postoperative residual shunt was observed in the B group, however 8 cases in the L group (p=0.034). The overall five-year survival rate in the B and L group was 89% and 61%, respectively (p=0.19), however, the survival rate at five years revealed that significant difference between with and without residual VSP. Conclusion: The repair of post-infarction VSP can be safely performed by the infarct exclusion technique with a biventricular approach. This technique contributed to reduce surgical mortality and prevented recurrence of the VSP.

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Intercoronary communication is a condition in which there is an open-ended circulation with bidirectional blood flow. It is distinguished from the collateral flow by its distinct angiographic features. However, a communicating vessel can be misinterpreted as a functioning collateral vessel indicative of unrecognized severe proximal coronary artery obstruction. A 69-year-old male presented with intermittent complete atrioventricular block. Coronary angiography was performed to rule out ischemia. Standard angiography revealed what was suspected to be coronary artery obstruction; however, intravascular ultrasound did not show any stenotic lesions. Microcatheter angiography successfully diagnosed this to be a case of intercoronary communication. Here we report our case along with some background regarding of intercoronary communication.

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A left main coronary artery pseudoaneurysm is rare and the treatment strategies are poorly defined. Herein we report a surgical treatment for a left main coronary artery pseudoaneurysm in a 56-year-old female patient with end-stage renal disease on hemodialysis. Patch angioplasty with a saphenous vein graft was performed for the left main coronary artery pseudoaneurysm following percutaneous coronary intervention with a rotablator. She underwent a living renal transplantation one year after surgery and then has been doing well these 2 years.

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A 61-year-old Japanese man during posted overseas in Southeast Asia complained chest oppression with cold sweating for >30 minutes during the disaster of great flood in Thailand because of hard work, mental stress, and short sleep time (2–3 hours). He admitted to the cardiology clinic urgently. He was diagnosed as acute coronary syndrome without elevation of cardiac enzyme or abnormal findings on ECG. Emergency coronary angiography was performed but no flow limiting vessel was found. Percutaneous coronary intervention (PCI) was performed on moderate stenotic lesion (50%) at diagonal branch. Dual anti-platelet agents, strong statin, and β-blocker was administered after the PCI procedures. He had complained chest discomfort at early morning for a few minutes one or two times per month since one year ago. When he came back to Japan, he admitted to our hospital for the evaluation of second opinion. From the detailed anamnesis and other examinations (cardiac scintigrams and echo-cardiograms), we judged that his chest oppression attack might be due to coronary artery spasm because of hard work and mental stress. We recommend the administration of calcium channel blocker instead of β-blocker and quit the β-blocker intake. We should transmit the importance of coronary artery spasm for the cardiologists in not only Europe and USA but also Southeast Asia.

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