椎动脉开口狭窄的血管内支架成形术治疗

目的研究血管内支架成形术治疗椎动脉开口狭窄的安全性及有效性。方法采用球囊扩张式支架对16例椎动脉开口段狭窄患者进行血管内支架成形术,分析其疗效,总结其经验。结果 16例病人共植入16枚支架,椎动脉平均狭窄率术前为85.6%,术后为19.1%,无并发症发生。随访1～6个月,所有患者症状均获不同程度改善。1例发生再狭窄,余患者未见再狭窄。结论血管内支架成形术治疗椎动脉开口段狭窄是一种安全有效的方法。     

超声检查在输尿管内支架术前后的应用

目的评价超声检查在输尿管内支架术前后临床应用的价值。方法对73例上尿路梗阻肾积水患者行双＂J＂管置入术前进行超声检查了解肾脏输尿管的常规情况、了解梗阻及肾积水状况,协助选择解除梗阻的手术方法和置管方式,置管后用超声检查观察置管所处状况、梗阻解除、肾积水消失、双＂J＂管引流效果。结果经开放手术后双＂J＂管放置成功率100%,切口尿漏2例,拔管后经膀胱再置管治愈;经输尿管镜下碎石后内镜下双＂J＂管放置成功率100%,内支架管自行脱出1例再置管成功;术后超声检查显示全组病例梗阻解除,双＂J＂管位置正常,引流效果良好,肾积水消失。结论输尿管内支架术前后超声检查是一种快速安全有效的检查方法,超声检查具有无损伤,适应症宽,操作简单等特点,值得在临床进一步深入研究和推广     

扩张置管术治疗难治性食管狭窄和瘘的研究

目的总结难治性食管狭窄和瘘的种类,探讨难治性食管狭窄和瘘的扩张置管方法、临床应用价值和治疗中应注意的问题。方法选择常规扩张置管比较困难,技术要求较高,常规支架治疗效果不好,反复需要扩张置管或过去认为不宜扩张置管治疗者作为研究对象,共73例。对狭窄病例在内镜或X线下应用气囊扩张器或Sa-vary-Gilliard扩张器扩张治疗,然后置入记忆合金支架。结果 73例患者中有70例一次顺利置入支架,3例因情况复杂第二次置管成功,共放置支架94个。53例食管狭窄患者支架置入术后狭窄处直径由4.0±1.3mm增至18.3±1.2mm（P〈0.01）。吞咽困难由2.63±0.42改善为0.91±0.83级（P〈0.01）;20例食管瘘患者均成功置入支架,食管瘘全部闭合,患者吞咽困难及呛咳症状消失,恢复经口进食,控制了严重感染,病人一般情况明显改善。术后并发症：穿孔0例,出血2例,因扩张引起,内镜止血后出血停止。胸痛67例,用药一周后逐渐缓解。结论据难治性食管狭窄和瘘特点,采取不同的扩张置管方法,可取得较好的临床疗效。     

支架内血栓形成的相关因素和预防策略

目前,冠状动脉内支架植入术是冠心病血运重建的主要方法,支架植入可显著减少靶血管的急性闭塞和再狭窄。虽然支架术后支架内血栓形成少见,但危害极大,临床上可表现为急性心肌梗死或猝死。在药物洗脱支架广泛使用的今天,支架内血栓形成引起了业内人士的高度警惕和重视。现就冠状动脉支架内血栓形成的相关因素及预防策略进行综述。     

糖尿病足动脉病变的介入治疗

目的探讨经皮腔内血管成形术（PTA）联合部分支架植入术治疗糖尿病足动脉病变的临床价值。方法选择我院2009年2月至2011年3月收治的60例糖尿病足动脉病变患者,共78条肢体,Fonfaine分期Ⅰ～Ⅱ期3例,Ⅱ—Ⅲ期35例,Ⅲ～Ⅳ期22例,采用新sedinger法穿刺股动脉,行糖尿病足动脉病变经皮腔内血管成形术（PTA）,部分联合支架植入术。结果78条肢体中技术成功69条（成功率885％）,临床成功73条（成功率925％）。观察术后1个月,3个月,6个月的皮肤温度,踝肱指数,跛行距离分别较术前增加,与术前相比较,下肢缺血症状明显改善,所有患者的肢体症状均没见加重或复发。结论经皮腔内血管成形术（PTA）联合部分支架植入术,可作为治疗糖尿病足动脉病变的首选治疗方法,有效改善远段肢体血供,有效防止糖屎病足动脉病变发展,促进肢端创面愈合,提高患者生存质量,近期疗效显著．值得临床应用和讲一步堆广．     

Stent thrombosis following drug-eluting stent implantation. A single-center experience

BACKGROUND: The risk of stent thrombosis (ST) following drug-eluting stent (DES) implantation may extend beyond the initial period after successful implantation. METHODS: We evaluated the incidence, timing, and clinical outcomes of patients who presented with DES-related early (30 days) angiographic ST. Between 1/2004 and 9/2006, a total of 1339 patients underwent DES implantation (90% using Cypher stents) at our institution. Dual antiplatelet therapy was recommended for 3 to 12 months. Clinical follow-up was obtained and adjudicated at 1 and 6 months following any ST event. RESULTS: We identified eight patients (0.6% of the total patients treated with DES) with definite ST. Their mean age was 67+/-13 years. Six patients (75%) were male and 37.5% (3/8) had diabetes. Acute myocardial infarction (AMI) was the clinical presentation in 87.5% of patients. Time to ST was 4 days in two (25%) of eight patients. The other six patients (75%) had late ST (>30 days). The median time to late ST was 480 days (range: 90-1080 days). Two patients had recurrent events of late ST. All cases of late ST, except one, occurred after clopidogrel treatment was discontinued. Median time from clopidogrel withdrawal to late ST was 18 months (range: 0.5-35 months). At 6 months' follow-up from the time of ST, the subsequent major adverse cardiac event (MACE) rate (including death, re-infarction, recurrent ST or need for emergent CABG) was 62.5% and overall and/or cardiac mortality rate was 12.5%. CONCLUSION: We found that ST occurred infrequently (0.6%) and the majority (75%) of patients developed ST late (>30 days) and beyond the period recommended for dual anti-platelet pharmacotherapy. Major adverse cardiac events following ST are substantial at 6 months and thus deserve careful clinical attention.     

Reduction of monocyte-platelet interaction and monocyte activation in patients receiving antiplatelet therapy after coronary stent implantation

BACKGROUND: Monocyte activation induces different procoagulant and proadhesiveinflammatory responses and thus may play a role in thromboticcomplications after coronary interventions. Monocyte-plateletinteraction may trigger these effects inducing monocyte activation. AIMS: To characterize the effect of antiplatelet vs anticoagulationtherapy on monocyte-platelet interaction and monocyte functionafter intracoronary stenting. METHODS AND RESULTS: Immediately before, and during the first 12 days after successfulcoronary stenting, monocyteplatelet conjugates and monocytefunction were assessed by flow cytometric detection of GPIIb/IIIa(CD41) on monocytes and by monocyte surface exposure of Mac-1(CD11b/ CD18) and L-selectin (CD62L). Twenty patients receivingcombined antiplatelet therapy (ticlopidine, aspirin) were comparedto 20 patients with standard anticoagulation (phenprocoumon,overlapping heparin, aspirin). Before stenting, monocyte-plateletconjugates and Mac-1 surface expression in both groups weresignificantly increased, while L-selectin was significantlydiminished. Anticoagulation did not change these variables significantlyduring the subsequent 12 days. In contrast, antiplatelet therapyreduced platelet-monocyte conjugates by 46±9·3%(mean±SEM, P=0·0019) within 4 days, which wasassociated with a decrease in Mac-1 expression (28±6·7%,P=0·0013) and an increase in L-selectin (56±15·0%,P=0·0061). CONCLUSION: After intracoronary stenting, combined antiplatelet therapy,but not anticoagulation, causes reduction of monocyte-plateletinteraction, which is associated with monocyte deactivation.This may contribute to a decreased risk for thrombotic events.     

Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes

BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated.MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores.ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P = 0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P = 0.010 and OR 0.61; 95% CI 0.41–0.89; P = 0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P = 0.011) were independent risk factors for major bleeding.ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population.     

Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal

Introduction and Aims

Shorter patient delays are associated with a better prognosis for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). This study aimed to identify predictors of patient delay in the Portuguese population.

Stent thrombosis and drug-eluting stents

Coronary stents have been used for the treatment of patients with coronary artery disease (CAD), and significantly improved procedural safety and are associated with a lower rate of restenosis compared with balloon angioplasty alone. Drug-eluting stents (DES) have been dominant for the treatment of CAD with efficacy in significantly reducing both restenosis and target lesion revascularization. However, late and very late stent thrombosis have become a major concern in DES-implanted arteries compared with those treated with bare-metal stents (BMS). This review focuses on the feature of DES thrombosis and pathological examination and dual antiplatelet therapy for prevention of stent thrombosis.Currently, the incidence of stent thrombosis associated with first-generation and second-generation DES remains unclear in data from real-world cohort registry studies. Further studies of larger multicenter trials would give us insight into the specific mechanisms of stent thrombosis among different generations of DES.