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自治医科大学附属さいたま医療センター

診療科のご案内

冠動脈疾患へのカテーテル治療実績


１．急性心筋梗塞の受け入れ実績


急性心筋梗塞は命に関わる疾患であり、また治療は一刻を争います。
当院はさいたま市および周辺地域における急性心筋梗塞を積極的に受け入れており、
ここ数年は年間300例前後の急性心筋梗塞患者様を受け入れており、全国でも有数の症例数です。

cad_catheter_achievement_01


上記のようにたくさんの急性心筋梗塞患者様を診療しておりますが、残念ながら救命できないこともあります。
直近の2023年は1年間で入院中にお亡くなりになった患者様は19名でしたので、2023年急性心筋梗塞院内死亡率は6.6%でした。
お亡くなりになった患者様19名中、9名の患者様は来院時もしくは緊急カテーテル前に心肺停止もしくは
経皮的心肺補助装置挿入がなされていました。
当院は3次救命センター併設ですので、心肺停止となった最重症の急性心筋梗塞患者様も多く搬入されます。
今後もあらゆる重症度の急性心筋梗塞患者様にベストの治療ができるよう、全力を尽くしていきます。
急性心筋梗塞では閉塞した血管へのカテーテルインターベンションはもちろん重要ですが、
その後のリハビリテーションも極めて重要になります。
当院では独自のリハビリテーションプログラム(Novel Acute Myocardial Infarction Risk Stratification (nARS) System)を作成し、
急性心筋梗塞患者様をそのリスクに応じてリハビリし、退院していただいています。




急性心筋梗塞に関する研究実績（2019年～の直近5年間）

  1. Noguchi M, Sakakura K, Akashi N, Adachi Y, Watanabe Y, Taniguchi Y, Ibe T, Yamamoto K, Wada H, Momomura SI, Fujita H. The Comparison of Clinical Outcomes Between Inferior ST-Elevation Myocardial Infarction with Right Ventricular Infarction Versus Without Right Ventricular Infarction. Int Heart J. 2019;60(3):560-8.

  2. Ohashi J, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Nanba-Sato H, Shibata K, Sasaki W, Ikeda T, Wada H, Momomura SI, Fujita H. Determinants of Improvement of Mid-term Ejection Fraction in Patients with Acute Myocardial Infarction. Int Heart J. 2019;60(6):1245-52.

  3. Otani A, Sakakura K, Yamamoto K, Taniguchi Y, Ito M, Ibe T, Wada H, Momomura SI, Fujita H. Comparison of mid-term clinical outcomes after acute myocardial infarction in diabetic men between living alone and living together. Heart Vessels. 2019;34(8):1288-96.

  4. Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Seguchi M, Taniguchi Y, Ugata Y, Wada H, Momomura SI, Fujita H. Novel Acute Myocardial Infarction Risk Stratification (nARS) System Reduces the Length of Hospitalization for Acute Myocardial Infarction. Circ J. 2019;83(5):1039-46.

  5. Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Comparison of Clinical Outcomes between the Ostial Versus Non-Ostial Culprit in Proximal Left Anterior Descending Artery Acute Myocardial Infarction. Int Heart J. 2019;60(1):37-44.

  6. Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes between sufficient versus insufficient diagonal branch flow in anterior acute myocardial infarction. Heart Vessels. 2019;34(7):1096-103.

  7. Haraguchi Y, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Determinants of Insufficient Optimal Medical Therapy after Acute Myocardial Infarction. Intern Med. 2020;59(12):1489-95.

  8. Kasahara T, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Clinical Factors Associated with In-Hospital Mortality in Patients with Acute Myocardial Infarction Who Required Intra-Aortic Balloon Pumping. Int Heart J. 2020;61(2):209-14.

  9. Sawano S, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Outcomes of Patients With Acute Myocardial Infarction Who Recovered From Severe In-hospital Complications. Am J Cardiol. 2020;135:24-31.

  10. Sawano S, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Further Validation of a Novel Acute Myocardial Infarction Risk Stratification (nARS) System for Patients with Acute Myocardial Infarction. Int Heart J. 2020;61(3):463-9.

  11. Seguchi M, Sakakura K, Tsukui T, Yamamoto K, Taniguchi Y, Wada H, Momomura SI, Fujita H. Determinants of In-Hospital Death Among the Very Elderly with Acute Myocardial Infarction. Int Heart J. 2020;61(5):879-87.

  12. Seguchi M, Sakakura K, Yamamoto K, Taniguchi Y, Wada H, Momomura SI, Fujita H. Comparison of In-Hospital Clinical Outcomes of Acute Myocardial Infarction Between Nonagenarians and Octogenarians. Int Heart J. 2020;61(1):7-14.

  13. Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Jinnouchi H, Wada H, Fujita H. Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes. PLoS One. 2020;15(10):e0241251.

  14. Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Wada H, Momomura SI, Fujita H. Association between the Door-to-balloon Time and Mid-term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Intern Med. 2020;59(13):1597-603.

  15. Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Seguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Association of slow flow with clinical factors in intravascular ultrasound-guided percutaneous coronary intervention for patients with left main trunk-acute myocardial infarction. J Cardiol. 2020;75(1):53-9.

  16. Akashi N, Tsukui T, Yamamoto K, Seguchi M, Taniguchi Y, Sakakura K, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus. Heart Vessels. 2021;36:1445-56.

  17. Ban S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of Asymptomatic Low Ankle–Brachial Index with Long-Term Clinical Outcomes in Patients after Acute Myocardial Infarction. Journal of Atherosclerosis and Thrombosis. 2021;29:992-1000.

  18. Hatori M, Sakakura K, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors Associated with In-Hospital Death in Patients with Killip Class 3 Acute Myocardial Infarction. Int Heart J. 2021;62:756-63.

  19. Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with difficulty in crossing the culprit lesion of acute myocardial infarction. Sci Rep. 2021;11(1):21403.

  20. Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Clinical Factors Associated with Long Fluoroscopy Time in Percutaneous Coronary Interventions to the Culprit Lesion of Non-ST-Segment Elevation Myocardial Infarction. Int Heart J. 2021;62(2):282-9.

  21. Kani K, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Momomura SI, Fujita H. Association of Baseline Anemia with Mid-Term Clinical Outcomes in Patients Who Underwent Trans-Radial Primary Percutaneous Coronary Intervention. Int Heart J. 2021;62(2):256-63.

  22. Murakami T, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Comparison of the cost in percutaneous coronary intervention between ST-segment elevation myocardial infarction vs. non-ST-segment elevation myocardial infarction. Cardiovascular Intervention and Therapeutics. 2021;37:293-303.

  23. Ohashi J, Sakakura K, Sasaki W, Taniguchi Y, Kani K, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Usefulness of 500-m walk electrocardiogram test on clinical outcomes in patients with ST-segment elevation myocardial infarction. Heart Vessels. 2021;36(1):48-57.

  24. Shibata K, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Comparison of Clinical Outcomes of Acute Myocardial Infarction Between Prasugrel and Clopidogrel. Int Heart J. 2021;62:479-86.

  25. Yamamoto K, Sakakura K, Tsukui T, Seguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Clinical factors associated with slow flow in left main coronary artery-acute coronary syndrome without cardiogenic shock. Cardiovasc Interv Ther. 2021;36:452-61.

  26. Yanase T, Sakakura K, Jinnouchi H, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Fujita H. Factors associated with temporary pacing insertion in patients with inferior ST-segment elevation myocardial infarction. PLoS One. 2021;16(5):e0251124.

  27. Yanase T, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Comparison of Clinical Characteristics of Acute Myocardial Infarction Between Young (< 55 Years) and Older (55 to < 70 Years) Patients. Int Heart J. 2021;62(1):33-41.

  28. Yoshida H, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Moriya T, Fujita H. Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency. Cardiovasc Interv Ther. 2021;36:444-51.

  29. Ban S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of Increased Pulse Wave Velocity With Long-Term Clinical Outcomes in Patients With Preserved Ankle-Brachial Index After Acute Myocardial Infarction. Heart, Lung and Circulation. 2022;31:1360-8.

  30. Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Outcomes of Patients With Acute Myocardial Infarction Between Chronic Total Occlusion Versus 90-99% Stenosis in Non-Culprit Arteries. The American Journal of Cardiology. 2022;170:17-24.

  31. Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of collateral flow with clinical outcomes in patients with acute myocardial infarction. Heart Vessels. 2022;37:1496-505.

  32. Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic. Cardiovascular Intervention and Therapeutics. 2022;37:641-50.

  33. Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Complications related to veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction: VA-ECMO complications in AMI. J Cardiol. 2022;79:170-8.

  34. Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of medical resource use and total admission cost in patients with acute myocardial infarction between on-hours visit versus off-hours visit. Cardiovascular Intervention and Therapeutics. 2022;37:651-9.

  35. Ohashi J, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Long-Term Clinical Outcomes in Patients Stratified by a Novel Acute Myocardial Infarction Risk Stratification (nARS) System. Circ J. 2022;86:1519-26.

  36. Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Tsukui T, Jinnouchi H, Wada H, Fujita H. Long-term outcomes of the modest stent expansion strategy for the culprit lesion of acute myocardial infarction. Cardiovascular Intervention and Therapeutics. 2022;37:660-9.

  37. Aono-Setoguchi H, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Factors associated with intensive care unit delirium in patients with acute myocardial infarction. Heart Vessels. 2023;38(4):478-87.

  38. Ban S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of Increased Inter-arm Blood Pressure Difference with Long-term Clinical Outcomes in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention. Intern Med. 2023.

  39. Hori Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Association of peak C-reactive protein with long-term clinical outcomes in patients with ST-segment elevation myocardial infarction. Heart Vessels. 2023;38:764-72.

  40. Ishibashi S, Sakakura K, Asada S, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Angiographic Coronary Calcification: A Simple Predictor of Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. Journal of Atherosclerosis and Thrombosis. 2023;30:990-1001.

  41. Ishibashi S, Sakakura K, Ikeda T, Taniguchi Y, Jinnouchi H, Tsukui T, Watanabe Y, Hatori M, Yamamoto K, Seguchi M, Fujita H. Appetite Predicts Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. Journal of clinical medicine. 2023;12:6134.

  42. Kasahara T, Sakakura K, Hori N, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of in-hospital outcomes of acute myocardial infarction between patients with cardiogenic shock and with cardiac arrest. Heart Vessels. 2023;38:139-46.

  43. Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of controlled blood pressure and pulse rate at discharge on clinical outcomes in patients with ST-segment elevation myocardial infarction. J Cardiol. 2023.

  44. Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Influence of daily temperature on the occurrence of ST-elevation myocardial infarction. J Cardiol. 2023;81(6):544-52.

  45. Konoma S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Fujita H. Impact of the Japanese Version of High Bleeding Risk Criteria on Clinical Outcomes in Patients with ST-segment Elevation Myocardial Infarction J Atheroscler Thromb. 2023.

  46. Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Development of a simple prediction model for mechanical complication in ST-segment elevation myocardial infarction patients after primary percutaneous coronary intervention. Heart Vessels. 2023.

  47. Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention. Journal of clinical medicine. 2023;12(3):840.

  48. Yamashita T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Fujita H. Impact of Excessive Increase in Systolic Blood Pressure after Exercise on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Journal of clinical medicine. 2023;12(21).



２．経皮的冠動脈形成術（Percutaneous coronary intervention：PCI）治療実績


経皮的冠動脈形成術（PCI）は年間800例前後であり、大学病院附属施設としては全国で最も多い症例数となっています。

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尚、PCIを緊急、非緊急で分けると緊急PCIは174件、非緊急PCIは608件でした。
急性心筋梗塞の件数に比べて緊急PCIが少ないのは、欧米のガイドラインに準拠して、
ST上昇型急性心筋梗塞以外の急性心筋梗塞については必ずしも緊急PCIをしていないからです。
ST上昇型急性心筋梗塞以外の急性心筋梗塞については、冠動脈バイパス手術（CABG）も含めて選択肢になるため、
各病変に最適な治療をカンファレンス等で議論して決めています。
また、高度石灰化病変が非ST上昇型急性心筋梗塞の責任病変であった場合には、
薬物療法で安定化させてから、後日ロータブレーターを含めた治療を行っています。




経皮的冠動脈形成術に関する研究実績（2019年～の直近5年間）

  1. Tamanaha Y, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access. Int Heart J. 2019;60(5):1030-6.

  2. Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Comparison of the device performance between the conventional guide extension catheter and the soft guide extension catheter. Cardiovasc Revasc Med. 2019;20(2):113-9.

  3. Yamamoto K, Sakakura K, Momomura SI, Fujita H. Conservative management of severe coronary artery hematoma and dissection following stent implantation. Cardiovasc Revasc Med. 2019;20(4):347-50.

  4. Asada S, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Association of the long fluoroscopy time with factors in contemporary primary percutaneous coronary interventions. PLoS One. 2020;15(8):e0237362.

  5. Asada S, Sakakura K, Yamamoto K, Momomura S, Fujita H. An alternative strategy for coronary artery lesions with an extra-large reference diameter using a perfusion balloon. Postepy w kardiologii interwencyjnej = Advances in interventional cardiology. 2020;16(2):219-20.

  6. Hasegawa H, Sakakura K, Hamamoto K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Determinants of Greater Peak Radiation Skin Dose in Contemporary Percutaneous Coronary Interventions. Cardiovasc Revasc Med. 2020;21(1):6-11.

  7. Kasahara T, Sakakura K, Momomura SI, Fujita H. A modified reverse guidewire technique for a Crusade-uncrossable bifurcation lesion. J Cardiol Cases. 2020;21(1):32-4.

  8. Kubota M, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Mid-term Clinical Outcomes of Immediate Protamine Use Following Elective Percutaneous Coronary Interventions. Int Heart J. 2020;61(5):865-71.

  9. Mizuno Y, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Determinants of Periprocedural Myocardial Infarction in Current Elective Percutaneous Coronary Interventions. Int Heart J. 2020;61(6):1121-8.

  10. Mukai Y, Sakakura K, Yamamoto K, Taniguchi Y, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Association of less-contrast media with clinical factors in elective percutaneous coronary intervention. Heart Vessels. 2020;35(2):143-52.

  11. Tsukui T, Sakakura K, Momomura SI, Fujita H. A novel method for prevention of intravascular ultrasound catheter entrapment using soft guide extension catheter. Cardiovasc Interv Ther. 2020;35(4):405-6.

  12. Jinnouchi H, Sakakura K, Yanase T, Ugata Y, Tsukui T, Taniguchi Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation. PLoS One. 2021;16(11):e0259693.

  13. Narita M, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Jinnouchi H, Wada H, Fujita H. Factors associated with aorto-ostial stent coverage during intravascular ultrasound-guided percutaneous coronary intervention to severely narrowed non-ostial right coronary artery lesions. Advances in Interventional Cardiology. 2021;17(2):163-9.

  14. Taniguchi Y, Sakakura K, Tsukui T, Yamamoto K, Jinnouchi H, Seguchi M, Wada H, Momomura SI, Fujita H. Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm. Intern Med. 2021;60:2733-40.

  15. Yamamoto K, Sakakura K, Ishibashi S, Shibata K, Tsukui T, Taniguchi Y, Seguchi M, Jinnouchi H, Wada H, Fujita H. Perfusion Balloon for the Treatment of Very Late Stent Thrombosis. Int Heart J. 2021;62(2):422-6.

  16. Mizuno Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of the Incidence of Periprocedural Myocardial Infarction in Bifurcation Lesions Between Medina (1,1,1) and (0, 1,1) in Elective Percutaneous Coronary Intervention. Int Heart J. 2022;63:459-65.

  17. Taniguchi Y, Sakakura K, Ban S, Fujita H. IVUS-assisted parallel wiring for coronary chronic total occlusion. Advances in Interventional Cardiology. 2022;18(1):79-80.

  18. Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Tsukui T, Jinnouchi H, Wada H, Fujita H. Impact of intravascular ultrasound‐incomplete stent apposition on stent failure. Catheter Cardiovasc Interv. 2022;100:1000-9.

  19. Fujimoto Y, Sakakura K, Fujita H. Complex and high-risk intervention in indicated patients (CHIP) in contemporary clinical practice. Cardiovasc Interv Ther. 2023;38:269-74.

  20. Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. Journal of Atherosclerosis and Thrombosis. 2023;30:1229-41.

  21. Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Long-Term Clinical Outcomes of Elective Percutaneous Coronary Intervention Between Complex and High-risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. Am J Cardiol. 2023;194:1-8.



３．冠動脈複雑症例へのPCI(Complex PCI)について


１．冠動脈慢性完全閉塞（CTO）


冠動脈慢性完全閉塞（Chronic total occlusion：CTO）へのPCIは高難度とされており、
一般的なカテーテル治療の成功率は70％前後と報告されています。
当院での2017以降の治療成功率の推移を以下に示します。

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2017年以降、毎年90%前後と高い成功率で推移しています。逆行性アプローチ（Retrograde approach）、
IVUSガイドワイヤリングなど様々な技術を用いて成功を目指して一例一例取り組んでいます。




慢性完全閉塞（CTO）に関する研究実績（2019年～の直近5年間）

  1. Yamamoto K, Sakakura K, Hamamoto K, Hasegawa H, Tsukui T, Seguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Determinants of Greater Peak radiation skin dose in percutaneous coronary intervention for chronic total occlusion. J Cardiol. 2020;76(2):217-23.

  2. Yamamoto K, Sakakura K, Tsukui T, Seguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Factors associated with antegrade true-sub-true phenomenon in percutaneous coronary intervention for chronic total occlusion. PLoS One. 2020;15(4):e0232158.

  3. Taniguchi Y, Sakakura K, Ban S, Fujita H. IVUS-assisted parallel wiring for coronary chronic total occlusion. Advances in Interventional Cardiology. 2022;18(1):79-80.

  4. Taniguchi Y, Sakakura K, Jinnouchi H, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Fujita H. Determinants of successful parallel wire technique in percutaneous coronary intervention to coronary chronic total occlusion. Cardiovasc Revasc Med. 2023.



２．石灰化病変に対するロータブレーター治療について


当院では石灰化病変に対して積極的にロータブレーターを用いています。
年間100例前後の国内有数のロータブレーター使用実績があります。
ロータブレーターを安全に行うために、これまでHalfway Rotational Atherectomy、
Halftime Rotational Atherectomyという概念を提唱し、安全性を報告してきました。

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Halfway Rotational Atherectomy (Sakakura K, et al. PLos One 2019; 14(7):e0219289より引用)



cad_catheter_achievement_05
Halftime Rotational Atherectomy (Sakakura K, et al. Cardiovasc Interv Ther　2024;39:18-27.より引用)。



ロータブレーターに関する研究実績（2019年～の直近5年間）

  1. Sakakura K, Momomura SI, Fujita H. The RotaWire may be spinning in rotational atherectomy under the maximum rotational speed. Cardiovasc Interv Ther. 2019;34(2):182-3.

  2. Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Halfway rotational atherectomy for calcified lesions: Comparison with conventional rotational atherectomy in a propensity-score matched analysis. PLoS One. 2019;14(7):e0219289.

  3. Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Jinnouchi H, Fujita H. Excessive Rotational Speed May Be Associated With the Transection of Guidewires in Rotational Atherectomy. Am J Cardiol. 2020;132:172-3.

  4. Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Comparison of the incidence of slow flow after rotational atherectomy with IVUS-crossable versus IVUS-uncrossable calcified lesions. Sci Rep. 2020;10(1):11362.

  5. Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Association of Excessive Speed Reduction with Clinical Factors During Rotational Atherectomy. Cardiovasc Revasc Med. 2020;21(3):314-9.

  6. Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Tsukui T, Jinnouchi H, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes of intravascular ultrasound-calcified nodule between percutaneous coronary intervention with versus without rotational atherectomy in a propensity-score matched analysis. PLoS One. 2020;15(11):e0241836.

  7. Mizuno Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching. Sci Rep. 2021;11(1):11140.

  8. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics. Cardiovasc Interv Ther. 2021;36(1):1-18.

  9. Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Jinnouchi H, Seguchi M, Wada H, Fujita H. Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy. PLoS One. 2021;16(4):e0250757.

  10. Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Intravascular ultrasound-factors associated with slow flow following rotational atherectomy in heavily calcified coronary artery. Sci Rep. 2022;12(1):5674.

  11. Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of ultrasound reverberation in calcified coronary arteries: Intravascular ultrasound study. Atherosclerosis. 2022;363:1-7.

  12. Mizuno Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of rotational atherectomy on the incidence of side branch compromise in calcified bifurcation lesions undergoing elective percutaneous coronary intervention. J Cardiol. 2022;80(6):518-24.

  13. Sakakura K, Ito Y, Shibata Y, Okamura A, Kashima Y, Nakamura S, Hamazaki Y, Ako J, Yokoi H, Kobayashi Y, Ikari Y. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023. Cardiovasc Interv Ther. 2023;38:141-62.

  14. Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Fujita H. Halftime rotational atherectomy: a unique concept for diffuse long severely calcified lesions. Cardiovasc Interv Ther. 2023.

  15. Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Tsurumaki Y, Mase T, Tamanaha Y, Arao K, Kubo N, Fujita H. Study design and rationale for comparison of the incidence of slow flow following rotational atherectomy to severely calcified coronary artery lesions between short single session and long single session: The randomized ROTASOLO trial. Cardiol J. 2023;30(3):483-8.

  16. Taniguchi Y, Sakakura K, Jinnouchi H, Tsukui T, Fujita H. Rotational atherectomy to left circumflex ostial lesions: tips and tricks. Cardiovascular Intervention and Therapeutics. 2023;38:367-74.

  17. Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Clinical Outcomes and Unique Restenosis of Calcified Nodule in Hea



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