Percutaneous transluminal angioplasty and stenting for 140 cases with stenosis of carotid artery

Objective To evaluate the operation method, indications and prevention from complication in 140 cases with stenosis of carotid artery by percutaneous transluminal angioplasty and stenting. Methods The procedures of percutaneous transluminal angioplasty and stenting of carotid arteries were performed after the diagnosis of 140 cases with carotid artery stenosis which were confirmed by MRA and DSA.[第一段]     

经皮冠状动脉腔内成形术82例报告

对８２例冠心病患者行经皮冠状动脉腔内成形术（ＰＴＣＡ），共扩张血管９６支及病变１０６处，总成功率为９５％。术后追踪平均８个月，临床有效率８７％，潘生丁核（９９ｍＴＣ）心肌灌注断层显像追踪有效率８５％，３例冠脉造影证实再狭窄，２例再次ＰＴＣＡ成功。     

经皮冠状动脉腔内成形术并支架植入术的护理

随着现代心脏病介入治疗学的发展,经皮腔内冠状动脉成形术(PTCA)广泛地应用于冠状动脉狭窄再通的治疗。血管内支架由于其良好的弹性记忆力,几何稳定性和相对的组织稳定性,不但扩大了PTCA的适应症,同时减少了PTCA后再狭窄及急性血管闭塞的发生。两种合用是目前治疗冠心病较为成熟、安全有效的方法之一。1998-2000年贵州省人民医院心内科成功地为13例冠心病患者施行了PTCA并冠状动脉支架植入术,现将护理体会介绍如下。     

Potential role of Chinese medicinal herbs in the prevention of coronary artery restenosis

Percutaneous coronary intervention （PCI） especially stent implantation has now become a mainstay of therapeutic armamentarium in the treatment of patients with coronary artery disease even at clinically or angiographically high risk. However, restenosis requiring reintervention remains a major limitation and a challenging problem of percutaneous revascularization. 1 Despite the use of coronary stents, the rate of restenosis is still relatively high,     

经皮冠状动脉腔内成形术对急性心肌梗塞行早期血运重建

１２例急性心肌梗塞患者应用经皮冠状动脉腔内成形术进行早期血运重建，１１例梗塞相关血管再灌注血流为ＴＩＭＩ３级，残留狭窄１５．５±８．８％，１例并发血管内膜夹层形成行紧急冠状动脉旁路移植术，术后死亡。结果认为急性心肌梗塞早期直接进行经皮冠状动脉腔内成形术可实现稳定有效的血运重建，有利于减少心肌梗塞面积及心脏泵功能损害、降低再梗塞率和病死率。     

经皮冠状动脉经腔血管成形术术后再狭窄机制研究及其防治进展

冠脉支架植入后支架内在狭窄 (ＲＳ)的问题越来越受到关注 ,新近资料显示ＲＳ率为 2 8% [1 ] 。较高的再狭窄发生率影响了经皮冠状动脉经腔血管成形术 (ＰＴＣＡ)的远期疗效 ,这是目前开展冠心病介入治疗的主要障碍。本文就目前有关支架内ＲＳ形成病因、发病机制、诊疗措施方面作一综述报道1　ＲＳ的发病情况及其影响因素冠状动脉内再狭窄 (ＩＳＲ)的发生距离支架植入时间间隔平均在两个月左右 ,其发病率约占植入支架病人的 1 5 %～35 % [2 ] ,就ＩＳＲ的严重程度而言 ,轻者病人可以无症状而仅在复查冠状动脉造影或血管内超声 (ＩＶＵＳ)时…     

经皮冠状动脉成形术与支架置入术的临床应用

目的 分析经皮冠状动脉成形术(PTCA)及支架植入术(支架术)治疗冠心病的临床疗效。方法 212例冠心病患者中，稳定型心绞痛46例，不稳定型心绞痛78例，心肌梗死104例。单支血管病变84例，双支血管病变62例，三支血管病变66例。共处理病变血管298处，置入支架252枚。其中左前降支(LAD)118处，右冠脉(RCA)84处，左回旋支(LCX)84处，左主干(LM)2处。观察PTCA和／或支架术的成功率、并发症和术后6个月靶病变再血管化率。结果 PTCA和／或支架术的技术成功率为97．6％，临床成功率为97．2％；并发症发生率为11．3％，多为穿刺局部并发症。6个月靶病变再血管化率为2．83％。结论 PTCA和支架术是一种安全、有效的介入性治疗技术，成功率高、严重并发症少。     

经皮腔内冠状动脉斑块旋切术临床应用：除2例报告

对冠状动脉造影证实为右冠脉及左旋支狭窄冠心病心绞痛患者各１例，作冠脉腔内斑块旋切术后内经扩大＞２０％，症状改善，取得满意疗效。     

44例老年冠心病患者经皮冠状动脉介入治疗

冠心病是影响老年人健康的主要疾病,当前我国的老龄化问题日益突出,提高老年人的生存率和生活质量是心脏病医生面临的新挑战。经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)已成为老年冠心病患者血管重建的主要方式。我院对44例老年冠心病患者行PCI治疗,以评价冠状动脉介入治疗在老年冠心病患者中应用的安全性和疗效。     

切割球囊冠状动脉腔内成形术69例临床应用报告

目的　应用切割球囊行冠状动脉腔内成形术并对其疗效进行评价 .方法　对 6 9例冠心病患者的 80处病变行切割球囊扩张治疗 ,对其进行分析 ,并短期随访 .结果　 80处病变血管直接切割球囊扩张治疗 ,成功率 93% ,其中 9例完全闭塞性病变中 7例获得成功 (成功率 78% ) .3例支架内再狭窄均扩张成功 .80处病变切割球囊扩张后安放支架 5 8个 (支架安放率 73% ) ,2 2例单纯行切割球囊扩张术者残余狭窄为 0～2 0 % [平均 (7± 6 ) % ].1例患者术后出现心包填塞 ,无严重内膜撕裂发生、急性闭塞、急诊冠脉架桥术及急性心肌梗死发生 .随访 1～ 10 mo(平均 5 .9mo) ,1例单纯行切割球囊扩张术患者于术后 1mo出现心绞痛 ,经冠脉造影证实为再狭窄 .其他患者随访期间无心脏事件发生 .结论　切割球囊行冠状动脉腔内成形术安全、有效 ,短期疗效良好 .     

The effect of magnetic stent on coronary restenosis after percutaneous transluminal coronary angioplasty in dogs

探讨磁化支架对经皮经腔冠状埃及成形术 (PTCA)后冠状动脉再狭窄的防治作用。方法　 2 0只健康杂种犬 ,超大球囊反复扩张损伤靶血管 (前降支或旋支中段 )制备PTCA术后冠状动脉狭窄模型(>5 0 % ) ,后随机分成对照组和实验组各 10只。对照组靶血管置入普通Palmaz支架 ,实验组靶血管置入磁化Palmaz支架。手术前后不用抗血小板药和抗凝药 ,术后 6个月冠状动脉造影 ,并处死犬切取靶血管 3cm进行组织病理学检查。结果　冠状动脉造影冠状动脉再狭窄率对照组 30 % ,实验组 0 ;组织病理学检查靶血管平均内膜厚度 (对照组 2 .98± 0 .5 6mm) ,(实验组 1.13± 0 .4 1mm)有显著差异 ,P <0 .0 5。结论　磁化支架对犬PTCA术后冠状动脉再狭窄可能具有防治作用。     

冠心病经皮冠状动脉介入治疗术后支架内再狭窄与尿微量白蛋白的关系

目的探讨冠心病PCI术后支架内再狭窄（ISR）与尿微量白蛋白（MAU）的关系。方法选取2008年12月至2009年12月160例行PCI治疗并于1年[平均随访（10．2±2．5）个月]内再次行冠状动脉造影术（CAG）检查的冠心病患者。通过术前MAU的测定及术后1年内的冠状动脉造影检查支架内再狭窄与否的结果,分为无再狭窄组（NISR）（作为对照组）及再狭窄组（ISR）。依据再狭窄组中植入支架的血管支数,分为单支组、双支组、三支组。结果ISR组MAU水平（60±19）mg／L,较NISR组（41±17）mg／L明显增高（t=5．109,P〈0．05）;ISR组三支组MAU水平（83±12）mg／L较双支组（58-4-7）mg／L明显增高（P〈0．05）,双支组MAU水平较单支组（38．9±2．0）mg／L明显增高（P〈0．05）。结论尿微量白蛋白可能是预测PCI术后支架内再狭窄的一个指标。     

Impact of pathogen burden on in-stent restenosis in patients after coronary stent implantation

Background Although some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely unknown. Since the number of infectious pathogens has been argued to be relative to the coronary artery diseases, we therefore examined whether there is a link between the number of infections and the incidence of in- stent restenosis after stent implantation. Methods One hundred and eighty-one patients were enrolled in this study. Infectious pathogens including serum anti-Chlymydia p neumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 antibodies and hepatitis B virus antigen were measured in all patients before coronary stent implantation. Coronary angiography was performed before, immediately after and 6 months after stent implantation. Results Restenosis rate 6 months post stent implantation was similar in patients with low pathogen burden （ 〈3 pathagens, 33.3% ） to those with high pathogen burden （ ≥3 pathogens, 29. 1% ）. Conclusions Previous infections with Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-l, human herpes simplex virus-2 and hepatitis B virus do not contribute to the incidence of restenosis after stent implantation.     

冠状动脉支架植入术后再狭窄危险因素的分析

目的 回顾性分析经皮冠状动脉支架植入术后复查冠状动脉造影患者冠状动脉支架内再狭窄(in-stent restenosis,ISR)的相关危险因素.方法 纳入2007年1月至2015年5月在遵义医学院附属医院心内科住院行冠状动脉支架植入术并于术后8～12个月随访行冠状动脉造影的患者1 136例,其中男性835例,女性301例,年龄(61.61 ±12.32)岁.根据随访造影结果支架相关病变血管是否狭窄及程度将其分成ISR组(n=72)和非ISR组(n=1 064),记录两组患者的心血管危险因素、临床合并症、用药情况以及介入治疗相关参数等,分析可能导致ISR的相关因素.结果 本组病例资料造影随访显示ISR发生率为6.3％.与非ISR组比较,ISR组患者在吸烟、糖尿病、血脂异常、高血压、术后服药依从性差、长病变和多支病变、支架直径和长度及最小管腔直径(MLD)等方面差异具有统计学意义(P＜0.05).长期规律服用阿司匹林、氯吡格雷和大剂量他汀类患者的比例,在非ISR组与ISR组比较差异亦具有统计学意义(P＜0.05).结论 冠状动脉支架植入术后再狭窄是临床多因素共同作用结果,与未控制的心血管危险因素、抗血小板治疗和他汀治疗依从性以及支架治疗病变特征相关.     

冠心病介入术后再狭窄危险因素及中医证候要素分析

目的 探讨冠心病介入术后再狭窄的危险因素及中医证候要素特点.方法 对100例冠心病介入术后再狭窄患者进行中医证候判定,以43例冠心病介入术后未狭窄患者作对照,用非条件togistic回归分析等统计学方法进行相关危险因素的分析.结果 冠心病介入术后再狭窄患者常见证候要素有血瘀、气虚、阴虚、痰浊、阳虚等.吸烟、糖尿病、高脂血症、血瘀证、痰浊证、气虚证是冠心病介入术后再狭窄的独立危险因素.结论 中西医结合综合干预包括避免主动或被动吸烟,控制糖尿病和高脂血症;运用中医活血化瘀、化痰通络、益气方药可能是防治冠心病介入术后再狭窄的正确有效途径.     

康复运动对冠状动脉支架植入术后患者血脂的影响

目的研究冠心病患者支架植入术后康复运动对血脂的影响,为冠状动脉支架术后科学的康复运动提供理论依据。方法对植入冠状动脉支架的高血脂患者随机分为康复组和对照组,对照组进行常规术后治疗并按日常习惯运动,康复组除常规治疗外同时进行科学的康复运动训练,比较2组患者血脂水平。结果 2组患者术后对冠心病认知程度有均明显提高,2组间比较,康复组对冠心病认识程度显著提高,血脂明显下降。结论康复运动改善了冠状动脉支架术后患者的血脂水平,降低了危险因素。     

Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

Background  Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.

Methods  The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group). Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time, and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.

Results  Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0–1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001) and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P <0.0001). The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis.

Conclusion  Direct ambulance transport of STEMI patients to the catheterization laboratory could significantly reduce D2B time and improve success rate of primary PCI and 30-day clinical outcomes.

     

Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a pilot studyand 9-month outcomes in a pilot study

Background  The optimal stenting strategy for the treatment of coronary bifurcation lesions (CBLs) remains uncertain. The present study observed technical feasibility and reliability, 9-month clinical and angiographic outcomes of the modified culotte stenting (MCS) in the treatment of CBLs with drug-eluting stents.

Methods  A total of 34 consecutive patients with CBLs that required stenting the parent vessel (PV), the main branch (MB) and the side branch (SB) were included. All patients were first assigned to receive MCS for CBL interventions (per MCS), and might be switched to receive the double-kissing-crush stenting (DKS) in case of temporally acute branch occlusion (per protocol).

Results  The immediate angiographic or procedural success was achieved in 33/34 (97%) lesions (patients) per MCS, 34/34 (100%) lesions (patients) per protocol with 100% successful final balloon kissing. The long-term clinical success at 9 months was 94% per MCS and 94% per protocol, only 2 patients had reoccurrence of angina but none of them needed target lesion revascularization. There were no procedure-related biomarker elevation, no in-stent thrombosis peri-procedurally and at 9-month follow-up. Quantitative coronary angiography data at 9 months showed that in-stent (6%) or in-segment (6%) binary stenosis was infrequent, and minimal lumen diameter was significantly reduced but late lumen loss was acceptable with only (0.10±0.14) mm for PV, (0.21±0.23) mm for MB and (0.27±0.32) mm for SB.

Conclusions  MCS for treatment of CBLs that required dual-stent implantation was technically easier and safer, readily to complete final balloon kissing, and was associated with high immediate success and optimal 9-month outcomes.

     

CRP水平与冠脉药物支架植入术后再狭窄关系的Meta分析

目的探讨术前高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与冠脉药物支架(DES)植入术后再狭窄(ISR)的关系。方法检索维普中文期刊全文数据库、中国生物医学文献数据库、中国知网、PubMed数据库,收集相关原始研究;采用文献质量评价结合Meta分析的方法分析。结果 ISR组患者术前hs-CRP水平显著高于非ISR组的hs-CRP水平,中国人群和随访时间为6个月的亚组分析表明,ISR组患者术前hs-CRP水平显著高于非ISR组的hs-CRP水平。异质性分析显示纳入文献存在显著异质性。偏倚分析表明发表的文章不存在偏倚。结论术前hs-CRP水平与DES植入术后ISR的发生存在显著相关性。     

叶酸对冠脉药物涂层支架植入术患者再狭窄的预防作用

目的研究叶酸对药物涂层支架（DES）内再狭窄（ISR）的预防作用。方法 DES支架术后患者随机分为叶酸（FA）组和对照组,叶酸组加服叶酸5mg/d。检测并对比两组支架术后即刻、术后6个月、术后1年血FA和同型半胱氨酸（Hcy）。两组患者于术后即刻和1年后行冠脉造影检查以测定并对比最小病变血管内径。结果两组患者大部分基线指标差异无统计学意义。叶酸组患者腰围较对照组高（P〈0.01）,低密度脂蛋白（LDL-C）较对照组低（P〈0.05）。两组间术后即刻叶酸浓度、tHcy浓度和最小病变血管直径无统计学意义（P〉0.05）。术后6个月和术后1年叶酸组患者叶酸浓度较对照组升高（P〈0.05）,tHcy浓度较对照组降低（P〈0.05）。术后1年叶酸组最小病变血管直径较对照组大（P〈0.05）。结论叶酸可以预防药物涂层支架内再狭窄。