Abstract Background Patients with impaired renal function are known to have an elevated risk of both ischemic and bleeding events following percutaneous coronary intervention (PCI). However, there is insufficient data available on the optimal duration of dual antiplatelet therapy (DAPT), especially with the latest generation of drug-eluting stent (DES)s. Objective We investigated to assess the efficacy and safety of abbreviated duration of DAPT in patients undergoing PCI with 3rd generation DESs based on their renal function. Methods In this prespecified subgroup analysis of the HOST-IDEA trial, a total of randomized 1997 patients with available baseline estimated glomerular filtration rate (eGFR) were categorized into three groups: high eGFR (>90 mL/min), intermediate eGFR (60 to 90 mL/min), and low eGFR (<60 mL/min). The primary outcome assessed during the 1-year follow-up period was net adverse clinical events (NACE). Ischemic and bleeding endpoints were also evaluated. Results Compared to intermediate or high eGFR groups, the low eGFR group resulted in significantly worse outcomes (P < 0.001). 3-6 month DAPT was associated with similar risk of NACE across all eGFR groups (High eGFR: HR: 0.91; 95% CI: 0.38-2.20; Intermediate eGFR: HR: 0.76; CI: 0.33-1.73; Low eGFR: HR: 0.99; CI: 0.51-1.92). There was also no significant difference in target lesion failure (HR: 0.95; CI: 0.32-2.83, HR: 0.77; CI: 0.29-2.06, and HR: 1.14; CI: 0.47-2.75) and major bleeding (HR: 0.84; CI: 0.19-3.74, HR: 0.59 CI: 0.14-2.48; and HR 0.83 CI: 0.34-2.05) among all stratified eGFR groups. This effect was also consistent in patients of end stage of renal disease (eGFR <15 mL/min). Conclusions In patients undergoing PCI with third generation DESs, short DAPT was comparable to conventional DAPT regardless of their baseline renal function.

Nutcracker syndrome is caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The use of Doppler ultrasonography to diagnose this condition is challenging due to the dynamic nature of the nutcracker phenomenon and the variability of its symptoms, which can fluctuate with changes in patient posture and respiration. This review emphasizes the critical role of Doppler ultrasonography in identifying and managing nutcracker syndrome. It also explores the various subtypes of the nutcracker phenomenon and discusses how Doppler ultrasonography can improve patient outcomes by enabling management strategies that are informed by dynamic assessments of left renal vein compression.

Purpose: Patients with bladder cancer may show hematuria after radical cystectomy with ileal neobladder formation, causing anxiety regarding tumor recurrence. Here, we aim to show that the nutcracker syndrome (NCS) can be a cause of hematuria post -operation, and is a common, rather than a rare syndrome. Materials and Methods: A retrospective review of contrast -enhanced abdominopelvic CT (CE-APCT) and urine analysis (UA) findings of 255 patients with bladder cancer who underwent radical cystectomy and ileal neobladder formation between 2011 and 2016 was performed. In the CE-APCT review, the left renal vein flow patterns were evaluated to determine the presence of NCS findings. In the UA review, patients were classified according to the percentage of UA tests with positive hematuria among the total number of UA tests. Results: CT findings of NCS were present in 31.9% of the 135 patients. In the positive hematuria group, there were 26% more patients with NCS findings than those without. Conclusion: NCS findings are prevalent even for bladder cancer patients after surgery, and there is a strong correlation between NCS findings and hematuria. Furthermore, the prevalence of NCS findings is much higher than urinary tract recurrence after the surgery.

Abstract Background Angiography-derived radial wall strain (RWS) is a novel method to assess the biomechanical characteristics of the underlying plaque. There is limited data regarding how the biomechanical attributes of atherosclerotic lesions relate to their physiologic and morphological attributes. Purpose This study aimed to investigate the association of RWS with myocardial ischemia and high-risk plaque, and their prognostic implication. Methods From the international CCTA-FFR registry, 484 deferred vessels underwent RWS analysis. Angiography-derived RWS was defined as relative changes of lumen diameter within the cardiac cycle, expressed as a percentage of the largest lumen diameter. Plaque characteristics were assessed in a coronary CT angiography core laboratory and high-risk plaque was defined as 3 or more high-risk plaque characteristics (HRPC) including minimum lumen area <4.0 mm2, plaque burden ≥70%, low-attenuation plaque, and positive remodeling. Functional significance of coronary lesion was assessed by invasively measured fractional flow reserve (FFR). The primary outcome was vessel-oriented composite outcome (VOCO), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization at 5 years. All clinical outcomes were adjudicated by an independent clinical event committee. Results The mean FFR was 0.89±0.07, and that for maximum RWS (RWSmax) was 11.2±2.5%. RWS proportionally increased along with the decrease in FFR values, and the increase in the number of HRPC (Both p-for-trend <0.001). The proportion of vessels with FFR ≤0.80 and that of vessels with high-risk plaque increased in the order of RWSmax quartile group (Both p-for-trend <0.001) and these associations maintained after the adjustment of clinical characteristics (adjusted odds ratio [OR] 1.31, p value <0.001 for FFR ≤0.80; adjusted OR 1.24, p value <0.001 for high-risk plaque) and angiographic parameters (adjusted OR 1.24, p value <0.001 for FFR ≤0.80; adjusted OR 1.14, p value 0.012 for high-risk plaque). High RWSmax (>14.2%, optimal cut-off value for VOCO) was an independent predictor for VOCO after adjusting for diabetes and % diameter stenosis, FFR ≤0.8, or high-risk plaque (Figure 1). In a mediation analysis, RWS showed an independent effect from lesion-specific ischemia or high-risk morphological attributes in defining prognosis (Figure 2). Conclusion(s) Angiography-derived RWS was closely related to coronary physiologic and plaque morphological attributes, but was an independent predictor of clinical events. This novel index can provide additional prognostic implications over physiological severity or plaque characteristics in patients with coronary artery disease.Prognostic implications of high RWSMediation analysis

Purpose:Patients with bladder cancer may show hematuria after radical cystectomy with ileal neobladder formation, causing anxiety regarding tumor recurrence. Here, we aim to show that the nutcracker syndrome (NCS) can be a cause of hematuria post-operation, and is a common, rather than a rare syndrome.Materials and Methods:A retrospective review of contrast-enhanced abdominopelvic CT (CE-APCT) and urine analysis (UA) findings of 255 patients with bladder cancer who underwent radical cystectomy and ileal neobladder formation between 2011 and 2016 was performed. In the CE-APCT review, the left renal vein flow patterns were evaluated to determine the presence of NCS findings. In the UA review, patients were classified according to the percentage of UA tests with positive hematuria among the total number of UA tests.Results:CT findings of NCS were present in 31.9% of the 135 patients. In the positive hematuria group, there were 26% more patients with NCS findings than those without.Conclusion:NCS findings are prevalent even for bladder cancer patients after surgery, and there is a strong correlation between NCS findings and hematuria. Furthermore, the prevalence of NCS findings is much higher than urinary tract recurrence after the surgery.

Abstract Background The HOST-EXAM Extended study evaluated the long-term follow-up results of the original HOST-EXAM trial, which demonstrated that clopidogrel monotherapy was associated with a lower risk of thrombotic and bleeding events compared to aspirin monotherapy. However, the optimal single antiplatelet agent during the chronic maintenance period in patients with high thrombotic risk and/or high bleeding risk has not been assessed. Purpose This study aimed to compare the efficacy of clopidogrel versus aspirin monotherapy in patients with high thrombotic risk and/or high bleeding risk who were stabilized after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods A post-hoc subgroup analysis of the HOST-EXAM Extended study was conducted. High thrombotic risk was defined as patients who had at least one of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. High bleeding risk was defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium bleeding type 3 or 5. Clinical outcome was analyzed according to the patients’ initial thrombotic and bleeding risk. Results Among the total population, 28.2% had high thrombotic risk and 27.0% had high bleeding risk. Patients with high thrombotic risk was not associated with a higher risk of primary endpoint, whereas those of high bleeding risk was associated with a increased risk of the clincical event (Hazard ratio [HR] 2.70, 95% Confidence interval [CI] 2.29-3.18, Log-rank p < 0.001). Clopidogrel consistently reduced the risk of primary endpoint, regardless of the presence of high thrombotic risk or high bleeding risk (Absolute risk difference [ARD] 7.5%, 95% CI 2.7-12.3, HR 0.59, 95% CI 0.43-0.82, Log-rank p=0.001 vs ARD 4.1%, 95% CI 1.5-6.7, HR 0.78, 95% CI 0.66-0.92, Log-rank p=0.004 with or without high thrombotic risk, respectively. P-interaction=0.133; ARD 9.2%, 95% CI 2.4-16.0, HR 0.71, 95% CI 0.55-0.92, Log-rank p=0.008 vs ARD 4.0%, 95% CI 1.6-6.4, HR 0.74, 95% CI 0.60-0.90, Log-rank p=0.003 with or without high bleeding risk, respectively. P-interaction=0.860; Figure 1). The beneficial effect of clopidogrel was consistent across patients divided into four groups based on the presence or absence of high thrombotic risk and high bleeding risk (Figure 2). Conclusion In chronic maintenance period of patients who received PCI with DES, the beneficial effect of clopidogrel was maintained in patients regardless of the presence or absence of high thrombotic risk and high bleeding risk.