Early experience of transluminal coronary angioplasty (TCA) by the brachial artery (the sones technique in transluminal angioplasty)

Sixteen translumlnal coronary angioplasty procedures (TCA), eight right coronary artery (RCA) and eight left anterior descending coronary artery (LAD), by the brachial artery cut-down approach, were attempted with 9/16 (56%) immediate successes and 2/16 (12%) early recurrences. The procedure success rate for RCA obstructive lesions, 6/8 (75%) was greater than for LCA obstructions, 3/8 (38%). In six unsuccessful procedures the balloon catheter could not be advanced into the lesion, and in one unsuccessful procedure dissection of the coronary artery proximal to the lesion occurred. The brachial (Sones) technique for transluminal coronary angioplasty permits the use of softer guiding catheters for selective probing and approach to the coronary lesion but may be more likely to induce coronary spasm. Complete and high-resolution pre TCA anglograms with multiple views to disclose the exact anatomy of the coronary artery and Its lesion Is essential to ensure successful dilatation.     

Stenting with the half (disarticulated) palmaz-schatz stent

A total of 110 half (disarticulated) Palmaz-Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail-out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non-Q wave myocardial infarctions), and one non-Q wave infarction related to side branch closure. Stenting with the half Palmaz-Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.     

Dual left anterior descending coronary artery (dual lad)

Presence, extent, and evolution of atherosclerotic coronary narrowings, as well as the anatomic possibilities for revascularization, can be reliably defined at (and only at) selective coronary angiography. The latter remains, therefore, the pivotal diagnostic tool for patients with suspected coronary artery disease. However, in spite of the increasing availability of on-line quantitative coronary angiography, it still holds that the functional (physiologic) consequences of an epicardial coronary narrowing cannot be completely derived from geometric (anatomic) information. Clinical decision making can be particularly difficult in lesions of intermediate severity (40–70% diameter reduction), in postinterventional segments, and in some particular anatomic settings, namely, ostial stenoses, bifurcation lesions, and diffuse atherosclerotic disease. This has led to an explosive growth of new methods for assessing the physiological significance of coronary narrowings documented at angiography. Among them, Doppler blood flow velocitometry and transstenotic pressure gradient measurements have emerged as the only techniques easily applicable in most catheterization laboratories. Here, we briefly review the clinical interest of measuring transstenotic pressure gradients. © Wiley-Liss, Inc.     

冠心病患者血浆内皮素水平

采用放免技术,测定了28例次冠心病患者冠状窦血及外周静脉血内皮素水平,结果显示,冠状静脉窦血ET为132.82±23.14pg/ml,外周静脉血ET为104.25±21.08pg/ml,冠状窦血ET高于外周静脉血,P<0.001,但两者相关性良好,r=0.808,P<0.001.研究发现,不同类型冠心病外周血ET高低次序为急性心梗、不稳定型心绞痛、稳定型心绞痛、正常人.冠心病患者冠脉循环ET水平高于外周静脉血,但两者相关性良好,ET随冠心病患者病情程度加重及冠脉病变范围增大而升高.     

Single coronary artery Left (SCA L)-Right coronary artery arising from mid-left anterior descending coronary artery: New variant of Lipton classification (SCA L-II) diagnosed by computed tomographic angiography

Isolated single coronary artery (SCA) is a rare anomaly. Current classification of left and right is further classified based on the course of the anomalous vessel. We report two SCA L cases where right coronary artery (RCA) arose from mid-left anterior descending coronary artery (LAD). Our observation is a variation from the current Lipton classification SCA L Type II where RCA arose from left coronary artery before the LAD, in our cases the RCA arose from mid LAD after the first septal perforator. We believe that this variant should be described as SCA L Type II variant 2 (V2) while the original Lipton classification should be described as SCA L Type II variant 1 (V1).     

药物洗脱支架与冠状动脉旁路移植术治疗无保护左主干病变的临床疗效对比

目的:评估药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗无保护左主干病变的临床疗效。方法:分析2003-10-2010-09期间行血运重建的282例无保护左主干患者的临床资料,其中接受DES者143例(DES组),接受CABG者139例(CABG组),比较2组住院期和随访期心脑血管不良事件(死亡、非致死性心肌梗死、脑卒中和再次血运重建,即MACCE)的发生情况。结果:DES组手术成功率为100%,住院期间1例发生非致死性心肌梗死,无一例死亡、脑血管意外或需再次血运重建;CABG组手术成功率为95.7%,住院期间有1例发生非致死性急性心肌梗死,无一例需再次血运重建,共有6例死亡;CABG组住院期死亡率明显高于DES组(4.3%∶0,P<0.05),住院期CABG组总MACCE发生率也明显高于DES组(5.0%∶0.7%,P<0.05);随访期平均(17±8)个月,DES组临床心绞痛复发率和再次血运重建率较CABG组有增高趋势(7.8%∶2.7%,7.0%∶1.8%),但差异无统计学意义,其总MACCE发生率显著高于CABG组(14.8%∶7.1%,P<0.05);剔除新发病变及病变进展病例后,2组总MACCE发生率(7.8%∶7.1%)差异无统计学意义。结论:DES治疗无保护左主干病变安全和有效,可以作为CABG的一种替代治疗手段。     

急性冠脉综合征PCI术后伴抑郁患者左洛复干预的研究

目的 观察左洛复对急性冠脉综合征（ACS）PCI术后合并抑郁患者抗抑郁治疗的疗效及对低密度脂蛋白（LDL）、高敏C反应蛋白（hs-C RP）的影响.方法 对150例确诊为急性冠脉综合征的患者行PCI术治疗,术后筛选出伴有抑郁症的患者并通过汉密尔顿（HAMD）抑郁量表进行评分.将其随机分成两组,分别给予心理治疗和左洛复治疗.2个月后对比两组LDL、hs-CRP水平,再次利用HAMD抑郁量表进行评分,根据评分减分率判断疗效.结果 与对照组相比,左洛复治疗组2个月后低密度脂蛋白、hs-CRP水平低于对照组,左洛复对抑郁治疗效果明显高于对照组,差异具统计学意义.结论 左洛复抗抑郁治疗及对冠心病患者预后优于心理治疗.     

Coronary collateral development in the rhesus monkey (Macaca mulatta)

Summary The ability of the rhesus monkey to form coronary collaterals was tested in ten animals. Ameroid constrictors were implanted on the left circumflex coronary artery and allowed to remain for 12 weeks. One animal died of an acute myocardial infarction nine days after surgery; the remaining animals survived without clinical signs referable to myocardial ischemia. The hearts were excised at 12 weeks postsurgery for perfusion fixation and coronary vascular injection with barium-gelatin. All hearts exhibited infarction scars in the circumflex-perfused regions, with infarcts varying from a transmural scar to cases with a thin margin of surviving myocardium at the epicardial surface. Coronary collaterals were infrequent and small in size, and particularly evident in the atria. We conclude that the rhesus monkey is unable to develop sufficient coronary collateral blood flow to prevent myocardial infarction after gradual, total coronary occlusion with ameroid constrictors.Florida Agricultural Experiment Station Journal Series No. 4441.     

A novel finding to assess ischemia in pacing stress echocardiography (PASE)

Background: Normalization of heart rate post–pacing stress echocardiography (PASE) could enable evaluation of effect of ischemia on diastolic function. Methods: We examined the effect of pacing on left ventricular (LV) filling in 55 patients who underwent a transesophageal PASE. Pulse wave Doppler of mitral inflow was obtained at baseline and during transition from peak pacing to up to three beats immediate post pacing. Results: Thirty-four patients (62%; 62 ± 12 years) had normal (NL) PASE, wall motion score index (WMSI) 1 ± 0 at baseline and during PASE. Sixteen patients (29%; 64 ± 12 years) had ischemic (ISCH) PASE, WMSI 1.07 ± 0.08 at baseline and 1.40 ± 0.21 during PASE. Five patients (9%; 81 ± 5 years) had abnormal (ABN) PASE, WMSI 1.55 ± 0.34 at baseline and 1.55 ± 0.34 during PASE. The ABN group had the most pronounced decrease in deceleration time (DT) seen in all three post-PASE beats (221 ± 29 ms at baseline vs. 145 ± 46, 144 ± 26 and 144 ± 18 ms at beats 1, 2, and 3, P < 0.005 from baseline for all). The DT reduced significantly at post-PASE beat 1 from baseline (234 ± 45 ms vs. 158 ± 36 ms, P = 0.02) in the ISCH group, whereas no significant change in DT occurred in the NL group (239 ± 74 ms vs. 222 ± 58 ms, P = 0.14) at beat 1. Conclusion: In ISCH and ABN ventricles the duration of early diastolic filling decreased post-pacing. This new finding of a shortened deceleration time (DT) may be a marker of an ischemic response in PASE reflecting abnormal LV compliance.     

Comparative use of cold blood potassium cardioplegia in coronary bypass patients necessitating long (2.5-6 h) versus short (less than 1.5 h) aortic cross-clamp times

In symptomatic patients with severe diffuse multivessel coronary disease undergoing bypass surgery, complete revascularization with multiple bypass grafts using saphenous vein and internal mammary conduits, and multiple endarterectomies may be necessary. Such complex surgeries may require long aortic cross-clamp times in excess of 2.5 h. To evaluate the myocardial preservation provided by cold potassium blood cardioplegia, two groups of consecutive patients using nearly similar surgical techniques were compared. Group A consisted of 100 patients who received an average of 3.8 grafts per patient and had a mean aortic cross-clamp time of 66 (range 15-90) min. Group B was comprised of 100 patients who received an average of 9.3 grafts per patient and had a mean cross-clamp time of 187 (range 150-351) min. Operative mortality and perioperative myocardial infarction were low (0-2%) and were not significantly different between the groups. In addition, the postoperative creatine kinase-MB isoenzyme levels, use of pharmacologic and/or mechanical (i.e., intra-aortic balloon) support, and follow-up exercise treadmill tests were not significantly different in the two groups. These findings suggest that cold potassium blood cardioplegia is equally protective of the myocardium during surgical revascularization in patients with short aortic cross-clamp times (less than 1.5 h) as in those with severe diffuse multivessel coronary artery disease requiring long cross-clamp times exceeding 2.5 h and up to 6 h.     

Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS)

Eight hundred seventy arteriograms from the Coronary Artery Surgery Study (CASS) were independently read by readers at two different clinics to evaluate the reproducibility of the interpretation of coronary arteriograms. Among proximal segments, the interpretation of lesions of the left main coronary artery were the least reproducible, P < .02. When one angiographer reads a stenosis of 50% or more in the left main coronary artery, it is estimated that a second reader will report no lesion 18.6% of the time. In 94.7% of the films, the number of significantly (≥70% stenosis) diseased vessels was the same for both readers (72.1%) or differed by one vessel (22.6%). The reproducibility of interpretation of films of good or acceptable quality or completeness was better than the reproducibility of readings of arteriograms judged to be of poor quality or incomplete studies. The mean absolute difference between readings of the percent stenosis decreased over the time of the patient enroliment, 1975 to 1978. This may have resulted from major collaborative efforts made during the course of the study to improve the quality of angiography and to standardize the reading of the cine films.     

Contribution of adenosine A(2A) and A(2B) receptors to ischemic coronary dilation: role of K(V) and K(ATP) channels

This study was designed to elucidate the contribution of adenosine A(2A) and A(2B) receptors to coronary reactive hyperemia and downstream K(+) channels involved. Coronary blood flow was measured in open-chest anesthetized dogs. Adenosine dose-dependently increased coronary flow from 0.72 ± 0.1 to 2.6 ± 0.5 mL/minute/g under control conditions. Inhibition of A(2A) receptors with SCH58261 (1 μm) attenuated adenosine-induced dilation by ～50%, while combined administration with the A(2B) receptor antagonist alloxazine (3 μm) produced no additional effect. SCH58261 significantly reduced reactive hyperemia in response to a transient 15 second occlusion; debt/repayment ratio decreased from 343 ± 63 to 232 ± 44%. Alloxazine alone attenuated adenosine-induced increases in coronary blood flow by ～30% but failed to alter reactive hyperemia. A(2A) receptor agonist CGS21680 (10 μg bolus) increased coronary blood flow by 3.08 ± 0.31 mL/minute/g. This dilator response was attenuated to 0.76 ± 0.14 mL/minute/g by inhibition of K(V) channels with 4-aminopyridine (0.3mm) and to 0.11 ± 0.31 mL/minute/g by inhibition of K(ATP) channels with glibenclamide (3 mg/kg). Combined administration abolished vasodilation to CGS21680. These data indicate that A(2A) receptors contribute to coronary vasodilation in response to cardiac ischemia via activation of K(V) and K(ATP) channels.     

Diabetes Atherosclerosis Intervention Study (DAIS): Quantitative coronary angiographic analysis of coronary artery atherosclerosis

The primary objective of the Diabetes Atherosclerosis Intervention Study (DAIS) is to determine by quantitative coronary angiography whether long-term correction of the dyslipoproteinemia of diabetes with micronized fenofibrate results in evidence of decreased progression or regression of angiographically measured obstructive coronary atherosclerosis. The purpose of this communication is to describe the angiographic methodology for the DAIS project, and to present data documenting the reproducibility of measurements that will determine the primary outcome of DAIS. Four hundred eighteen subjects between the ages of 40 and 65 were entered from 11 centers in Canada, France, Finland, and Sweden, with 305 males and 113 females. Thirty-two percent of subjects had undergone a previous coronary artery intervention, either PTCA or bypass grafting. Subjects underwent coronary arteriography at baseline according to a strictly defined protocol. The coronary tree was divided into AHA segments and quantitative analysis of segments was performed using the cardiovascular measurement system described by Reiber. Geometric parameters including mean lumen diameter, minimum lumen diameter, maximum lumen diameter, and segment length were determined. In 15 studies, measurements were carried out on the same frame by two observers, and at least 1 week apart by the same observer. In 13 studies, measurements were performed by the same observer on two separate injections of the same coronary artery. The mean of the standard deviation of the differences of measurements of all segments for the primary study analyst was 0.029 mm, with a mean of correlation coefficients of 1.00. Between two observers, the mean of the standard deviations of segmental mean lumen diameters was 0.347 mm with a mean of coefficients of variation of 0.78. The mean of standard deviations for measurements of segmental mean lumen diameter from two separate coronary injections was 0.122, with a mean of correlation coefficients of 0.94. The mean of correlation coefficients for minimum lumen diameter were 0.98 for intra-observer variability, 0.77 for inter-observer variability, and 0.96 for inter-angiogram variability. For segment length the corresponding values were 0.99, 0.79, and 0.94. These data demonstrate that a high level of reproducibility and precision may be achieved in a multicenter study in assessment of the coronary tree in carefully performed studies using this methodology. We anticipate the results will provide a statistically powerful conclusion with new and unique data to answer the question of the effect of long-term correction of dyslipoproteinemia on coronary atherosclerosis in type II diabetic patients with dyslipoproteinemia. Cathet. Cardiovasc. Diagn. 44:249–256, 1998. © 1998 Wiley-Liss, Inc.     

Stingray CART (K14 technique): A novel antegrade dissection reentry strategy

A novel device based CART technique (K14 technique) has been described with 2 case examples to illustrate the same. This CART has been performed after ADR and Reverse-CART were unsuccessful.     

脂蛋白脂酶基因多态性与冠心病关系的初探

目的探讨脂蛋白脂酶（ＬＰＬ）基因多态性与冠心病的关系。方法选择１０６例住院存活的心肌梗塞病人按１∶１进行病例对照研究，采用条件Ｌｏｇｉｓｔｉｃ回归分析。结果吸烟、ＬＰＬ基因型ＰＶＵⅡ（－－）和单倍体基因型Ｈ＋Ｐ－是冠心病独立的危险因素；高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）和载脂蛋白（Ａｐｏ）Ａ／Ｂ比值是冠心病的保护因素。去除其它因素的影响后，ＬＰＬＰＶＵⅡ（－－）／非（－－）和Ｈ＋Ｐ－／非Ｈ＋Ｐ－的ＯＲ值为１７．１８和３．６７；ＨＤＬ－Ｃ、ＡｐｏＡ／Ｂ比值的ＯＲ值在模型Ａ和Ｂ中分别为０．１４、０．１５和０．０４、０．０９。结论除传统的危险因素外，ＬＰＬ基因型ＰＶＵⅡ（－－）和单倍体Ｈ＋Ｐ－可能是易患冠心病的遗传标志；ＨＤＬ－Ｃ、ＡｐｏＡ／Ｂ比值可能是较其它血脂指标更好的冠心病独立预测因素     

Initial clinical experience with the new EBI (BARD-XT) flexible coronary stent: Acute results and follow-up

The EBI (BARD-XT, C.R. Bard, Murray Hill, NJ) stent is a new radiopaque balloon expandable coronary stent with high resistance to external radial forces. It does not shorten significantly with expansion and allows stent implantation in bifurcation lesions. A total of 28 EBI stents were implanted in 23 lesions in 21 patients. Indications for stent implantation were acute closure in 1, threatened closure in 15, and electively in 7 lesions. In 2 cases, the lesion involved a bifurcation where a stent was implanted in both vessels. All patients received aspirin and ticlopidine. No anticoagulant therapy was given. The stenting procedure was successful in 22 of 23 lesions. No complications occurred with the exception of 1 patient with a thrombotic reocclusion within 1 hr after stent implantation and 1 patient with a temporary occlusion of a side branch. The mean minimal luminal diameter (MLD) increased from 0.74 ± 0.46 mm before balloon dilatation to 1.27 ± 0.62 mm before stent implantation and 2.32 ± 0.57 mm after stent implantation. Percent stenosis decreased from 71 ± 19% before angioplasty to 46 ± 25% after angioplasty to 5 ± 8% after stent implantation. MLD at the time of follow-up angiography after 4 months was 1.98 ± 0.77 mm and percent stenosis was 26 ± 21%. Restenosis of more than 50% occurred in 2 lesions. In these lesions, a second percutaneous transluminal coronary angioplasty was performed. Advantages of this stent are its flexibility together with an acceptable radial strength as well as enabling radiopacity without obscuring the arterial lumen. Stenting of bifurcation lesions is possible. Cathet. Cardiovasc. Diagn. 43:159–162, 1998. © 1998 Wiley-Liss, Inc.