Myocardial Hematoma Documented by Transthoracic Echocardiography After Sequential Coronary Artery Stenting

We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition.     

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate- to long-term efficacy and safety of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA).Materials and Methods: The published literature was electronically searched for randomized controlled trials (RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate- to long-term outcomes were evaluated.Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period (p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group (p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate- to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group (p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short- and intermediate- to long-term outcomes.Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.     

人性化护理在颅内动脉瘤血管内栓塞治疗围手术期的护理效果评价

目的:探讨人性化护理在颅内动脉瘤血管内栓塞治疗围手术期的护理效果。方法:将178例颅内动脉瘤患者随机分为观察组和对照组各89例,2组患者均给予血管内栓塞治疗,对照组给予常规围术期护理,观察组给予围术期人性化护理,比较2组患者护理前后焦虑情绪、生理指标及术后并发症发生率。结果:观察组术前30min收缩压、舒张压、呼吸频率、心率均低于对照组,差异有统计学意义(P<0.05);观察组出院前HAMA、SAS评分均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:人性化护理减少了颅内动脉瘤患者术后并发症的发生,减轻了术前应激反应,缓解了患者焦虑情绪。     

颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响

目的：探讨颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响。方法选择2009年9月至2012年12月期间在该科住院患者156例（狭窄程度大于或等于70％）,行颈动脉支架置入术。在支架置入术前1周内及置入术后3个月采用阿尔茨海默病评估量表认知部分（ADAS‐Cog）、简易智能量表（MMSE）、连线测验（TMTa、TMTb）对患者的认知功能进行评估。结果所有患者均安全、成功的置入颈动脉支架,其中1例患者术后失访。与术前相比,术后3个月患者的认知功能均有所改善,术前术后比较：ADAS‐Cog[（6．60±2．04）分vs．（5．16±1．63）分,P＜0．01],MMSE[（26．32±1．06）分vs．（27．05±1．46）分,P＜0．01],TMTa[（108．94±17．42）分vs．（94．70±20．27）分,P＜0．01],TMTb[（178．65±21．77）分vs．（148．92±23．65）分,P＜0．01],术后3个月内无新发脑梗死。结论颈动脉狭窄可能为认知功能减退的原因之一,颈动脉支架置入术可以改善无症状颈动脉狭窄患者认知功能。     

脑静脉窦血栓形成患者血管内介入治疗的临床分析

目的:评价脑静脉窦血栓形成患者的血管内介入治疗效果。方法:对116例脑静脉窦血栓患者随机数字表的方法分为两组。其中治疗组患者实施血管内介入治疗,对照组患者使用常规抗凝治疗方法。7 d为1个疗程,2个疗程后比较两组临床效果。结果:治疗组患者的临床总有效率为93.1%,与对照组的70.7%相比,P<0.05。两组在治疗过程中均未出现不良反应。结论:血管内介入方法治疗脑静脉窦血栓的临床疗效优于常规抗凝治疗。     

Current status of hybrid intravascular ultrasound and optical coherence tomography catheter for coronary imaging and percutaneous coronary intervention

Both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) play a crucial role in elucidating the pathophysiology of coronary artery disease (CAD) with the goal to improve patient outcomes of medical and/or interventional CAD management. However, no single intravascular imaging technique has been proven to provide complete and detailed evaluation of all CAD lesions due to some limitations. Although sequential use of multiple modalities may sometimes be performed, there may be issues related to risk, time, and cost. To overcome these problems, several hybrids involving dual-probe combined IVUS-OCT catheters have been developed.The aim of this review article is to demonstrate some limitations of stand-alone imaging devices for evaluation of CAD, summarize the advances in hybrid IVUS-OCT imaging devices, discuss the technical challenges, and present the potential value in the clinical setting, especially in patients receiving medical or interventional CAD management.     

三种方式同期放置双侧金属支架治疗肝门胆管恶性梗阻的比较研究

目的 探讨内镜下3种方式同期平行放置双侧金属支架治疗无法手术切除肝门胆管恶性梗阻的疗效。方法 回顾性分析2012年1月—2019年2月期间上海东方肝胆外科医院采用内镜下同期平行放置双侧金属支架治疗无法手术切除肝门胆管恶性梗阻（Bismuth Ⅱ~Ⅳ型）的118例患者资料。按照支架放置方式分为3组：双侧支架均跨越十二指肠主乳头（long long-stent by stent,LL-SBS）组（53例）、单侧支架跨越十二指肠主乳头（long short-SBS,LS-SBS）组（53例）和双侧支架均不跨越十二指肠主乳头（short short-SBS,SS-SBS）组（12例）。主要观察指标包括临床成功率、支架通畅期、内镜下双侧胆管再干预成功率和生存时间。结果 3组的临床成功率分别为96.2%（51/53）、98.1%（52/53）、91.7%（11/12）,支架通畅期分别为9.2个月(8.0~10.3个月)、11.6个月(6.8~16.4个月)、8.1个月(3.7~12.5个月),患者生存时间分别为6.7个月(4.6~8.8个月)、7.6个月(5.7~9.4个月)、7.1个月(0.7~13.6个月),以上指标3组间比较差异均无统计学意义（P>0.05）;在内镜下双侧胆管再干预成功率上,LL-SBS组为12/13,LS-SBS组为0/10,SS-SBS组为1/5,差异有统计学意义（P<0.001）。结论 平行放置胆管双侧金属支架是治疗肝门胆管恶性梗阻的一项有效的内镜引流技术;双侧支架均跨越十二指肠主乳头的方式可以提高双侧胆管再干预的成功率。     

Comparison of paclitaxel-eluting stent and sirolimus-eluting stent expansion at incremental delivery pressures

OBJECTIVES: We sought to compare the adequacy of paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) expansion based on intravascular ultrasound (IVUS) imaging criteria at conventional delivery pressures. METHODS: Forty-six patients underwent SES implantation and 42 patients underwent PES implantation for de novo native coronary lesions<33 mm in length with reference lumen diameters of 2.5-3.5 mm. Stents were serially expanded with gradual balloon inflations at 14 and 20 atm. IVUS imaging was performed prior to intervention and after each balloon inflation. Stent expansion (minimal stent cross-sectional area/reference lumen cross-sectional area) was measured. Inadequate stent expansion was defined using the MUSIC criteria (all struts apposed, no tissue protrusion, and final lumen cross-sectional area>80% of the reference or >90% if minimal lumen cross-sectional area was <9 mm2). RESULTS: The baseline characteristics of the two groups were similar except for shorter lesion length, larger mean lumen cross-sectional area, larger lumen diameter, and lower plaque burden in the PES group. Stent expansion was inadequate in 80% of patients with SES versus 63% of patients with PES at 14 atm, although this was not statistically significant. After 20 atm, 48% of patients with SES remained underexpanded as compared with 35% of patients with PES. CONCLUSION: Drug-eluting stents showed significant underexpansion by MUSIC criteria at conventionally used inflation pressures. Higher balloon inflations are required especially during deployment of a SES. IVUS guidance is recommended to ensure optimal results and outcomes with both stents.     

Silent healing of spontaneous plaque disruption demonstrated by intracoronary ultrasound

Intracoronary ultrasound was performed at diagnostic coronaryangiography and 10 days later in a 45-year-old patient witha 3-day history of acute inferior myocardial infarction. Coronaryangiography showed considerable stenosis (80%) in the distalright coronary artery (RCA) (pre the crux) and what appearedto be a dissection in the middle RCA. Intracoronary ultrasoundidentified this as plaque disruption. Coronary balloon angioplastywas then performed in the distal stenotic segment. Follow-upangiography 10 days after coronary intervention revealed thatthe flap in the lumen had disappeared intracoronary ultrasoundimaging showed that the ruptured plaque had resealed and hadthe appearance of layering in the atheroma similar to thrombusformation. In summary, plaque disruption and subsequent thrombus formationcan be demonstrated in vivo by intracoronary ultrasound Monitoringthis process may have important clinical significance in patientmanagement and in assessing clinical prognosis.     

New insights towards catheter-based identification of vulnerable plaque

Sudden cardiac death or unheralded acute coronary syndromes are common initial manifestations of coronary atherosclerosis and most such events occur at sites of non-flow limiting coronary atherosclerosis. Autopsy data suggests that plaque composition is a key determinant of the propensity of atherosclerotic lesions to provoke clinical events. Most of these events are related to plaque rupture and subsequent thrombotic occlusion at the site of non-flow limiting atherosclerotic lesions in epicardial coronary arteries. Detection of these non-obstructive, lipid rich, high-risk plaques may have an important impact on the prevention of acute myocardial infarction and sudden death. Currently, there are several intravascular tools capable of locally evaluating determinants of plaque vulnerability such as the size of the lipid core, thickness of the fibrous cap, inflammation within the cap and positive remodeling. These new modalities have the potential to provide insights into the pathophysiology of the natural history of coronary plaque by means of prospective studies.