次高温热球囊及冷冻球囊血管成形术的初步研究

目的探讨用次高温热球囊及冷冻球囊处理动脉狭窄模型的可行性及最佳效果参数。方法取动脉粥样硬化性狭窄动物模型,采用热球囊及冷冻球囊扩张髂内动脉粥样硬化狭窄段。将符合研究条件的实验对象(6头长白猪)分为A组(热球囊,42～50℃,扩张10 min)、B组(热球囊,42～50℃,扩张20 min)和C组(冷冻球囊,-10℃,扩张2 min),每组2头。DSA下导入球囊至血管狭窄段,在X线透视下,向球囊注入载热液体或氧化亚氮介质扩张球囊,同时用高灵敏温度测量仪实时测量球囊局部靶血管壁所承受的热、冷负荷。血管成形术后4周行病理学检查,动物处死前均行血管造影。观察局部血管对次高温、浅低温的反应及演变过程。结果 A、B、C组的血管横断面积分别为(263 653.76±251 422.46)μm2、(348 123.68±199 871.47)μm2和(260 960.68±141 244.12)μm2,B组大于A组和C组(P=0.003 7);每高倍镜视野内膜平滑肌细胞数目及管腔狭窄指数分别为(289±34)个和0.49±0.18、(330±105)个和0.78±0.17、(232±66)个和0.57±0.19,B组亦高于A组和C组(P=0.000 1);中膜面积及内膜面积分别为(545 198.09±64 574.07)μm2和(178 497.16±83 903.75)μm2、(543 880.64±66 129.98)μm2和(84 640.09±55 330.06)μm2、(640 743.85±262 858.74)μm2和(263 897.40±268 037.66)μm2,C组大于A组和B组(P=0.000 1);内膜/中膜面积比(代表内膜增生程度)及内膜增生指数分别为0.34±0.19和0.25±0.11、0.16±0.10和0.13±0.07、0.42±0.50和0.24±0.19,B组低于A组和C组(P=0.000 1)。结论局部导入次高温或浅低温均可抑制平滑肌细胞增殖、移行和分泌基质,从而可能会降低血管成形术后远期再狭窄率,最佳效果参数为次高温42～50℃,扩张时间20 min。     

32P液体球囊血管内照射预防血管成形术后再狭窄

目的 探讨^32P液体球囊血管内近距离照射治疗对防止血管成形术后再狭窄的量效关系及其抑制再狭窄发生的可能机制。方法 27只雌性大白兔据动脉球囊扩张损伤后，实验组(18只)分别给予3、9、18和36Gy^32P液体球囊行内照射治疗，对照组(9只)灌注生理盐水。术后于不同时间点取材，行HE染色、增殖细胞核抗原(PCNA)免疫组织化学染色以及电镜观察血管组织形态学的改变，用计算机图像分析法测量管腔面积和内膜面积。结果 对照组血管内膜明显增生，管腔变狭窄。18Gy组血管壁平滑肌细胞增殖明显受抑，细胞凋亡增加，管腔面积无明显丢失；36GY组血栓形成明显；3和9Gy组均未观察到明显的生物效应。结论 ^32P液体球囊血管内照射可防止血管成形术后再狭窄发生，其机制可能为抑制血管壁平滑肌细胞增殖，促进其凋亡及改善血管重塑形。     

切割球囊治疗儿童先天性心脏病术后肺动脉分支狭窄的临床评价

目的评价切割球囊(cutting balloon,CB)治疗儿童先天性心脏病(先心病)术后肺动脉分支狭窄的疗效和可行性。方法收治3例先心病术后肺动脉分支狭窄患儿,其中2例为男性,分别为法洛四联症(TOF)术后残存左肺动脉狭窄和肺动脉闭锁(PA)、室间隔缺损(VSD)术后残存右肺动脉狭窄。1例女性,为"PA、VSD、动脉导管未闭(PDA)"术后残存左肺动脉狭窄。完善术前检查后行心导管介入治疗,分别测狭窄段压差和血管内径,选择合适CB扩张,根据扩张效果决定是否应用高压球囊再扩张。结果 TOF男性患儿和PA/VSD女性患儿先选择CB扩张后,予高压球囊再次扩张,血管内径由术前4.6 cm和4.2 cm分别增至5.8 cm和5 cm,压差由术前35 mmHg和12 mmHg分别降为19 mmHg和7 mmHg;PA/VSD男性患儿,应用CB扩张后,血管内径由术前4.8 cm变为5.6 cm,压差由术前12 mmHg降为6 mmHg。术中和术后均无肺水肿、肺出血等并发症发生。结论 CB治疗先心病术后肺动脉分支狭窄安全、有效,并发症少。     

糖尿病下肢血管病变球囊成形术后高灌注并发症的观察与护理

目的 比较是否采用对症护理,两组糖尿病患者下肢血管病变球囊成形术后发生高灌注并发症的差异.方法 18例糖尿病下肢血管病变球囊成形术后发生高灌注的患者,随机分为治疗组和对照组,以采用我科制定的抬高患肢、加强屈伸运动、冷敷和暴露创口等对症护理计划为治疗组,与非对照组进行对照研究,评价对症护理计划对于减轻PTA术后高灌注引起...     

使用长球囊行膝下血管成形术治疗糖尿病严重下肢缺血的回顾性分析

目的 回顾性分析使用长球囊经皮腔内血管成形术(PTA)治疗糖尿病严重下肢缺血的安全性和疗效.方法 从2007年4月到2008年3月,34例患者(53条下肢,119处血管病变)接受了长球囊膝下血管PTA.回顾性分析血管造影图像,根据病变长度和程度进行分类和分级.平均随访期(7.4±2.6)个月,随访期内每3个月进行1次下...     

激光球囊血管成形术治疗髂,股动脉闭塞

目的：研究国产Ｎｄ：ＹＡＧ激光经皮腔内协助球囊血管成形术（ＰＴＬＢＡ）治疗髂、股动脉闭塞性硬化疾病的临床应用价值。材料和方法：对１３例髂动脉、股动脉闭塞性硬化患者的１５段闭塞血管用激光行ＰＴＬＡ再通后，再用球囊导管行ＰＴＡ扩大血管管腔，并局部灌注４－１０万尿激酶，术后抗凝、溶栓治疗一月左右。结果：当时血管造影显示闭塞血管再通率达８０％，平均踝一臂压力指数从０４５±０２０升至０８０±０１６（Ｐ＜０００１），１例发生血管穿孔，在６－１５个月（平均１１±５月）随访期内，１２例临床症状持续缓解，１例症状加重，踝一臂压力指数下降。结论：ＰＴＬＢＡ对髂、股动脉闭塞性硬化的治疗是安全有效的，作者对ＰＴＬＢＡ的作用机理和并发症进行了讨论。     

冠脉内球囊成形术后再心绞痛的临床防治

自70年代Grutizig成功地进行了首例冠脉内球囊成形术（PTCA）之后，目前PTCA已成为冠心病治疗的主要手段之一。但是，PTCA后有相当一部分病例再发心绞痛，其中59％为再狭窄所致[1]。现在成功PTCA后再狭窄平均单为33％[2]。为此，本文对35例成功PTCA患者进行了再发心绞痛和再狭窄的预防研究。临床资料1．一般情况：35例为1990～1994年全部PTCA成功（即PTCA后残余狭窄＜30％）患者，男31例；女4例，平均年龄54．5±8．9岁。共扩张病变46处，其中左前降支（LAD）23处，左族支（LCX）10处，右冠脉（RCA）13处。狭窄程度100％者8…     

血管成形球囊导管在钢圈栓塞治疗2例血管性病变的应用

血管成形球囊导管在钢圈栓塞治疗２例血管性病变的应用胡道予①Ｂ．Ｋｒａｍａｎｎ②自１９９５年由Ｄｔｅｒ发明的球囊导管问世以来，不同类型的球囊导管和技术得到发展。本文介绍２例扩张球囊导管和眼镜蛇导管同时用于血管栓塞治疗的方法。例１７５岁。因胆囊炎伴腹主动...     

观察药物洗脱球囊治疗女性冠状动脉小血管病变以及对焦虑情绪的影响

目的 观察药物洗脱球囊治疗女性冠状动脉小血管病变中的有效性和安全性.方法 入选65例需择期行冠脉介入治疗的女性患者,均为冠状动脉小血管病变,随机分为药物洗脱球囊组(DEB,34例)、药物洗脱支架组(DES,31例).观察两组术后治疗效果、HAMA评分变化,并随访1年.结果(1)两组最小管腔直径在术后即刻和术后1年均无明...     

高龄患者弥漫性冠状动脉支架内再狭窄的切割球囊治疗

目的　研究切割球囊成形术 (CBA)治疗高龄患者弥漫性冠状动脉 (冠脉 )支架内再狭窄(ISR)的安全性与疗效。方法　冠脉内支架植入术后复查冠脉造影示ISR >70 %的高龄弥漫性ISR患者117例 ,分为CBA组 (n =74 )和普通球囊成形术 (BA)组 (n =4 3)。于术后 6个月随访冠脉造影 (QCA)和血管腔内超声 (IVUS)。结果　手术成功率CBA组为 99% ,BA组为 10 0 % ;CBA组冠脉管腔的即刻获得大于BA组 ;两组术后即刻管腔直径狭窄百分比 (DS)在CBA组小于BA组 (11.81± 9.17对 2 6 .33±10 .0 4 ,P <0 .0 5 ) ;平均随访时间 (5 .8± 1.6 )个月时CBA组的DS小于BA组 (2 9.4 3%± 12 .16 %对4 6 .12 %± 13.0 1% ,P <0 .0 5 ) ;CBA组复发的ISR病变长度由术前的 (2 3.17± 12 .4 6 )mm缩短至 (11.2 3±5 .6 8)mm ,而BA组手术前后无改变 ,两组差异有显著性 (P <0 .0 5 )。IVUS显示 ,两组术前及术后即刻的MLA、RVA及SA均无显著性差异。结论　CBA治疗高龄患者弥漫性ISR安全、有效 ,其即刻及随访期疗效令人满意 ,复发的ISR病变长度较BA组明显缩短。     

Total occlusion of iliac arteries: Results of balloon angioplasty

Fifty-six occluded iliac arteries (mean length 6.1 cm; range 1–17 cm) in 50 patients were treated by percutaneous transluminal angioplasty (PTA) or laser-assisted PTA (bilateral lesions in 6 patients). Twenty-seven patients (54%) were at high risk for surgery. Patients were followed for a maximum period of 72 months (mean 23.12 months; median 20 months). The initial success rate was 78.5% for arteries and 82% for patients. Laser-assisted PTA was attempted in 11 occluded arteries (19.64%) and was successful in 4 arteries (7.14%). Conventional PTA was successful in 71.4% of arteries including all 7 arteries for which laser-assisted PTA failed (76% of patients). PTA was unsuccessful in 12 arteries (21.43%). Urokinase was used before PTA in I artery. The effect of PTA was evident clinically by relief of rest pain (66.66%), healing of ulcer (57%), increased claudication distance or no claudication (79%) in limbs, and objectively, by improvement in ankle/arm index (AAI) (an increase of 0.16 to 0.91) and increased exercise tolerance. Continuous improvement in AAI was observed after PTA on follow-up in 9 limbs. One patient died during follow-up. On follow-up, 3 arteries were occluded, 6 showed evidence of stenosis, and 1 showed fusiform dilatation at the PTA site. The long-term results using the life-table method determined a 76% primary patency rate and 81% secondary patency rate for 72 months. The overall patency including failures was 63%. Age of the patients (p=0.0169) and hypertension (p=0.0015) significantly affected the long-term patency of the artery but not the initial success. The major complications were arterial rupture in a repeat procedure in 1 artery, axillary artery thrombosis in 1, and distal thromboembolic occlusion during PTA in 4, The long-term patency rates suggest that PTA of totally occluded iliac arteries is a safe and effective procedure and provides a long-term benefit. This paper was presented in part at the 6th Asian Oceanian Congress of Radiology, New Delhi, India, December 14–18, 1991     

高危冠心病患者主动脉内球囊泵反搏支持下冠状动脉内支架术

目的　评估主动脉内球囊泵反搏支持对高危冠心病患者冠状动脉 (冠脉 )内支架术的作用。方法　 16例高危冠心病患者在接受冠脉介入治疗同时应用主动脉内球囊泵反搏作血流动力学支持 ,记录临床、介入治疗及随访情况。结果　 16例患者均存在严重左心功能不全、多支冠脉病变、高冠脉危险评分等高危因素。完全血运重建 12例。术中主动脉内球囊反搏平均时间为 (3 1± 17)min ,主动脉舒张压和平均压显著升高 ,分别由 (69± 11)mmHg升至 (13 1± 15 )mmHg和 (82± 13 )mmHg升至 (111± 7)mmHg ,(P <0 .0 0 1)。平均随访 2年 ,1例死于心力衰竭 ,其余 15例左室射血分数及心功能分级显著改善 ,无严重心脏事件存活率为 75 %。结论　高危冠心病患者介入治疗时联用主动脉内球囊反搏安全可行 ,对改善患者预后具有重要作用     

Six-month follow-up after thermal balloon angioplasty in canine iliac arteries

We performed thermal balloon angioplasty in 10 iliac arteries in 5 mongrel dogs. By perfusing a modified angioplasty balloon with hot (100°C) saline, a mean balloon temperature of 84°C was obtained. Angiographic and histologic follow-up at 6 months revealed no thrombosis or aneurysm formation but it did reveal fibrotic transformation of the media. Initial overdilatation was maintained in 9 of 10 arteries. We conclude that medial sclerosis induced by thermal balloon angioplasty does not result in aneurysm or thrombosis in dogs.     

Cutting balloons for the treatment of vascular stenoses

The aim of this article is to review the mechanism, technical characteristics, biological response and clinical applications of cutting balloon angioplasty in peripheral vessels. The cutting balloon is a non-compliant, balloon catheter equipped with three-to-four microtome-sharp atherotomes. When used appropriately, it is safe and easy to use, with a high immediate success rate and few complications, provided oversizing is avoided. There is some evidence that pre-dilation with a standard or high-pressure balloon may also predispose to vascular rupture. The cutting balloon has proved to be beneficial in treating difficult complex lesions in the coronary arteries. Early experience in non-coronary vessels shows that cutting balloon angioplasty can be used to treat peripheral bypass anastomotic and haemodialysis fistula stenoses that are resistant to conventional high-inflation pressures. Its application in de novo peripheral arterial lesions and non-coronary in-stent restenosis is still under discussion. Theoretically, this device induces a smaller degree of vessel wall injury localised to the area of incisions and sparing the interincisional segments; however, this postulated reduction in restenosis rates has not been confirmed in clinical practice.     

Autoperfusion balloon catheter for treatment of vertebral artery stenosis

Percutaneous transluminal angioplasty (PTA) of the vertebral artery was performed with an autoperfusion balloon catheter in five patients. There were no complications in the form of embolic episodes or neurological deficits due to brain ischaemia during inflation. In critical cases with insufficient collateral circulation during temporary occlusion, the use of an autoperfusion balloon catheter may expand the indications for PTA in patients with ischaemic cerebrovascular disease.     

紫杉醇涂层球囊治疗冠脉支架术后再狭窄的现状

冠脉支架再狭窄是临床治疗的难点,多种方法都存在着诸多缺陷,基于药物涂层球囊的新技术可有效治疗支架术后再狭窄,目前正逐渐成为冠脉介入治疗领域一个研究热点。本文对紫杉醇涂层球囊在治疗冠脉支架术后再狭窄中的作用作一综述。     

介入治疗肺动脉栓塞疗效探讨

目的：评价介入溶栓球囊扩张术对肺动脉栓塞治疗的效果。方法：8例肺动脉栓塞患者,经股静脉穿刺插管。导管导丝置于肺动脉内进行碎栓,采用尿激酶冲击溶栓、球囊扩张术和24h持续灌注溶栓,同时给予肝素抗凝治疗。结果：完全开通3例,部分开通5例;3例氧分压均达到100％,5例氧分压在93％以上。结论：介入治疗肺动脉栓塞能及时开通肺动脉,恢复肺动脉血供,纠正低氧血症,是治疗肺动脉栓塞一种有效的方法。     

Concurrent dissections of ascending aorta and right coronary artery during primary coronary angioplasty

We present a case of dissection in ascending aorta (AA) accompanying dissection of the right coronary artery (RCA) during transfemoral primary coronary angioplasty (PCA) for acute inferior myocardial infarction (MI). To our best knowledge, this is the first case of dissection both in AA and RCA during angioplasty for acute MI. The dissection in RCA was caused by balloon inflation during PCA. Most probably, an angiographically invisible retro-dissection in RCA resulted in the dissection in AA. A computed tomography (CT) confirmed the diagnosis of aortic dissection that was restrained in AA. The patient was treated conservatively. Five days after the event, a control CT demonstrated that the false lumen in AA disappeared and the dissection was healed entirely.