ease. We also have recently demonstrated that 18F-FDG PET is useful to visual- ize perivascular inflammation of the porcine coronary artery. However, it remains to be elucidated whether coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina (VSA). Purpose: We tested our hypothesis that coronary artery spasm is associated with perivascular inflammation in VSA patients using multi-modality imaging ap-proach, and if so, whether there are correlations between adventitial VV formation and Rho-kinase activity in circulating neutrophils (a marker of activity of spasm) (UMIN000016675). Methods: We prospectively examined 27 consecutive VSA patients with acetyl- choline (ACh)-induced diffuse spasm in the left anterior descending arteries (LAD) and 13 control subjects without the spasm. Using ECG-gated 18F-FDG PET/CT, we examined PVAT volume corrected by body surface area (volume in-dex) and standardized FDG uptake value corrected by blood pool (target to back- ground ratio, TBR) of coronary PVAT in the LAD. We also examined the extent of VV formation in the LAD with optical frequency domain imaging (OFDI) and measured Rho-kinase activity in circulating neutrophils. Results: Patient characteristics were comparable between the VSA and control groups. PVAT volume and FDG uptake of PVAT significantly increased in the VSA group compared with the control group (VSA, 18.8±0.8 vs. control, 14.7±1.4 cm 3 /m 2 for volume index, VSA, 1.04±0.03 vs. control, 0.85±0.04 for TBR, both P < 0.05) (Figures A-F, K, L). In addition, there were significant positive correla- tions between the extent of PVAT volume or FDG uptake and that of coronary vasoconstricting responses to ACh in the VSA group (R=0.45 R=0.43 for TBR, P 0.05). OFDI VV formation significantly in VSA group the control group (0.086±0.006 0.045±0.006 , Rho-kinase activity (1.21±0.05 P 0.05) (Figures G-J). correlations PVAT or FDG uptake of VV formation VSA group (R=0.47 for index, R=0.40 for TBR, P 0.05) (Figures there were significant positive correlations between the extent of PVAT volume or FDG uptake and that of Rho-kinase activity in the VSA group (R=0.49 for volume index, R=0.45 for TBR, both P < 0.05). Background: High residual platelet reactivity (HRPR) is related to increased risk of peri-procedural myocardial injury (PMI) even in non-acute settings. However, the under mechanisms including local in-stent findings have been largely specu- lative. Purpose: The aim of this study was to clarify the impact of P2Y12 reaction unit (PRU) on intra-stent tissues (ISTs) detected by optical coherence tomography (OCT) as well as creatine kinase-myocardial band (CK-MB) leakage following elective PCI patients receiving clopidogrel and aspirin. Methods: A total of 102 patients were registered in MECHANISM-elective. OCT images were acquired immediately after PCI. ISTs were classified to thrombus, irregularprotrusion(IRP)andsmoothprolapse.WecountednumberofeachISTs,andmeasuredthemaximumareaand%lengthofISTs,atotallengthdividedbystentlength × 100, of each ISTs in the stented segment. HRPR on clopidogrel was defined as a PRU ≥ 208 at the time of stenting. CK-MB was measured 16±4 hours after percutaneous coronary intervention (PCI). Results: Among 102 patients, 49 patients presented with HRPR. Averaged area of thrombus, averaged area of IRP, and %length of IRP were significantly greater in patients with HRPR than those without HRPR (table), but quantitative measures of smooth protrusion were not different. Serum CK-MB level after PCI was numerically higher in patients with HRPR, and there was significant positive cor-relation between PRU and serum CK-MB level (r=0.259, p=0.021). MECHANISM-elective during that during reduce injury through suppression Background: Vascular complications are the most common complication of di- agnostic and interventional cardiac catheterisation procedures performed from the femoral approach, occurring in 1.5% to 4% of patients. Bleeding complica- tions are associated with increased morbidity, mortality, and health care costs. As part of an effort to reduce femoral complications we initiated a quality improve- ment project recommending that the location of the femoral head as seen on fluoroscopy be used to help determine the site of femoral artery puncture and that upfront femoral angiography should be performed post sheath insertion to assess for location and immediate complications. Therefore, we assessed the introduc- tion of these measures to determine whether they reduced the rate of vascular complications. Methods and results: Data were collected prospectively on 3653 consecutive patients undergoing femoral coronary angiographic procedures from May 2015 to December 2016. The primary end-point was any access complication, defined as: haematoma ≥ 5 cm, pseudoaneurysm formation, retroperitoneal hemorrhage, arterial dissection, vessel thrombosis, non-coronary artery bypass graft-related access bleeding requiring transfusion, access site infection, or haemoglobin drop of ≥ 3 g/dl with an access source or ≥ 4 g/dl with an unknown source. 1763 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 1890 post. Baseline characeteris- tics, large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. zone” in over 91% cases and angiography resulted in management changes i.e procedural were incidence access site Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates and a shorter length of stay.