老年冠心病患者经皮腔内冠状动脉成形术和支架植入术的疗效评价

目的 评价老年冠心病患经皮冠状动脉腔内血管成形术（PTCA）的临床疗效。方法 48例老年和50例非老年冠心病患接受经皮腔内冠状动脉成形术（PTCA）和支架植入术治疗的结果进行对比研究。结果 老年冠心病患的冠脉病变特点和病变血管支数与非老年冠心病患无显差别,支架植入比例和成功率无区别;老年组和非老年组PTCA治疗的病例成功率分别为95．8％和94．0％,围手术期的并发症老年组未见增加。结论 老年冠心病患接受PTCA和支架植入治疗安全有效。     

老年冠心病患者经皮冠状动脉介入治疗分析

目的 探讨老年与非老年冠心病患者择期经皮冠状动脉介入治疗(PCI)的特点.方法 217例冠心病患者,依年龄分为老年组(＞65岁)72例和非老年组(≤65岁)145例,冠状动脉造影(CAG)显示404处病变,相应接受了245次PCI治疗,其中有153例患者成功植入冠状动脉支架172枚,记录术中并发症以及术后住院期间主要不良心脏事件(MACE)发生情况,结合病史分析两组特点及区别.结果 老年组女性患者比例、高血压、糖尿病、不稳定型心绞痛发生率、多支病变率、手术并发症发生率、支架植入率均高于非老年组;但老年组吸烟率、合并高脂血症及单支病变率均低于非老年组;两组患者重度血管狭窄(狭窄≥90％)率及手术成功率相似(P＞0.05).结论 老年组与非老年组相比,PCI的手术成功率差异无统计学意义,但老年组手术并发症以及手术后MACE发生率高于非老年组,因此,对老年患者行PCI治疗前应权衡利弊.     

无保护左冠状动脉主干病变的支架术治疗

目的 :探讨无保护左主干病变PTCA和支架术治疗的经验及疗效。方法 :选择 5例经冠状动脉造影证实的左主干病变及或合并其它三支冠脉病变的患者 ,其中 3例有不同程度的心功能不全 ,3例有恶化劳累性心绞痛 ,2例有心肌梗死史 ,2例合并有高血压病。入院常规心脏彩超检查评价左室射血分数 (LVEF)。术中常规造影 ,正确快速完成PTCA和支架植入术 ,其中 2例行直接支架植入术 ,3例行球囊扩张后 ,再植入支架。术后观察分析临床疗效 ,手术成功率 ,并发症及随访结果。结果 :5例左主干病变的PTCA和支架植入均获得成功 ,手术成功率 10 0 %。术后临床症状明显改善 ,无严重并发症发生 ,随访 3.5± 0 .5个月 ,无 1例复发或死亡 ,心功能明显改善 ,劳动耐受力及生活质量明显提高。结论 :择期无保护左主干病变支架术治疗在经验丰富、技术熟练介入医生操作下是安全有效的一种治疗手段     

冠脉成形术／支架术前后高敏C-反应蛋白、白介素-6血清水平改变的临床意义

目的 探讨经冠脉成形术(PTCA) 支架植入术前后炎症反应物高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)血清水平对评估和预防再狭窄(RS)的临床意义。方法 选择45例不稳定型心绞痛(UA)，采用ELIA法分别检测Plyl A 支架植入术前、术后6h、术后2d及术后6d hs-CRP、IL-6血清水平，并随访6个月内急性和远期RS率，分别比较急性和远期RS组与非RS组之间血清hs-CRP、IL-6的值。结果 PTCA／支架植入术后6h血清IL-6水平显著升高，而术后48h血清IL-6水平逐渐降低；PTCA／支架植入术后48h血清hs-CRP水平显著升高，术后6d与术前差异无显著性(P≥0．05)。随访早期发现1例PTCA／支架术后急性再狭窄患者术后6h IL-6血清水平明显升高；随访中远期8例RS与37例非RS患者发现RS组PTCA／支架术后48h血清CRP水平明显升高，而非RS组患者血清CRP水平相对较低。结论 冠心病是一种炎症性疾病，不稳定型心绞痛(UA)有炎症反应；hs-CRP和IL-6是反映PTCA／支架术后炎症反应加重的敏感性指标，hs-CRP和IL-6水平表现出正相关性；PTCA／支架术后6h高浓度IL-6可能与急性血管RS有关；PTCA／支架术后48h血清高浓度hs-CRP对远期RS有预测意义。     

老老年冠心病患者经皮冠状动脉介入治疗的临床观察

目的观察老老年（≥75岁）冠心病患者经皮冠状动脉介入治疗（PCI）的临床疗效及并发症。方法对比分析2010年6月至2012年12月在我科行PCI治疗的68例老老年和220例老年（≥65～74岁）冠心病患者的临床情况、PCI成功率、支架植入数量及围手术期并发症发生率,随访PCI术后1年内主要心血管事件、脑卒中和出血事件发生率。结果两组 PC I成功率、支架植入数量、围手术期并发症发生率无明显差异（ P ＞0．05）;两组PCI术后1年内主要心血管事件、出血事件、脑卒中发生率无显著性差异（ P ＞0．05）。结论老老年冠心病患者行冠脉介入治疗安全、有效。     

不用球囊预扩张的直接冠脉内支架术

目的 :探讨直接冠脉内支架术在冠心病治疗中的疗效和安全性。方法 :选择有支架植入指征的A型和部分B型血管病变的冠心病者 ,不用球囊预扩张 ,直接将第二代支架放在病变血管处高压扩张 ,术后重复造影和临床随访。结果 :15例冠心病患者植入支架 15只 (前降支 10只 ,回旋支 2只 ,右冠脉 3只 ) ,手术成功率 10 0 %。靶血管直径从术前平均 (1 0 3± 0 6 8)mm扩大至 (3 0 6± 0 32 )mm ,狭窄程度由术前平均 (82 6±11 3) %减至 (6 4± 4 1) % ,无严重并发症。随访 3～ 2 0 (12± 6 )个月 ,无心脏事件发生。 13例 (86 6 % )心绞痛消失 ,2例心绞痛复发。结论 :直接冠脉内支架术对某些选择性病例具有疗效满意、安全而费用减少的优点。     

PTCA+支架术治疗冠心病的疗效评估

目的:评估择期经皮冠状动脉腔内成形 支架植入术(PTCA 支架术)治疗冠状动脉粥样硬化性心脏病(CHD)的疗效。方法:分析2002年10月~2004年12月接受PTCA 支架术治疗患者的临床资料,均以标准方法行冠状动脉造影(CAG)和介入治疗。手术成功标准为:残余狭窄<20%,TIMI血流3 级,且无围术期严重并发症(死亡、急性心肌梗死、急性冠状动脉旁路移植术)。结果:215例274处冠状动脉病变内植入260只支架,植入成功率94.9%,术后随访效果良好。结论:择期PTCA 支架术对CHD患者是一种安全有效的治疗方法。     

经皮冠状动脉成形术与支架植入术91例临床分析

目的分析经皮冠状动脉成形术(PTCA)与支架植入术(支架术)治疗冠心病的临床疗效。方法91例冠心病患者,稳定型心绞痛20例,不稳定型心绞痛29例,心肌梗死42例。单支血管病变29例,双支血管病变41例,三支血管病变21例。共处理病变血管176处,置入支架170枚。其中左前降支88处,右冠46处,左回旋支35处,第一对角支6处,左室后支1处。观察PTCA与支架术的成功率及临床成功率。结果PTCA与支架术成功率100%,临床成功率98.3%。结论PTCA与支架术是一种安全、有效的介入性治疗技术,成功率高,疗效良好,并发症少。     

40岁以下冠心病患者的冠脉介入治疗分析

目的评价40岁以下冠心病患者的冠脉造影及介入治疗的特点、疗效。方法选择我院近4年行冠状动脉造影证实病变血管狭窄≥75%且年龄小于40岁的患者,常规进行经皮腔内冠状动脉成形术(PTCA)及支架植入治疗。结果40例患者共47处病变行PTCA及支架置入术,手术成功率达97.5%,无1例发生血管闭塞等严重并发症。临床随访28例,平均随访时间(8.1±4.3)个月,4例(14.3%)患者复发心绞痛症状,其余24例保持无心绞痛症状,无再发心肌梗死及死亡。支架再狭窄率12.2%。结论冠状动脉介入治疗对青年冠心病患者具有疗效好、安全性高、并发症少的特点。     

冠状动脉介入支架植入术358例临床护理

目的:探讨冠状动脉内球囊成形(PTCA)及支架植入术围手术期护理措施。方法:将358例冠心病患者经冠状动脉造影确诊后,根据冠状动脉血管狭窄程度行PTCA加内支架植入术,并精心护理。结果:358例患者植入1个支架者186例(52%),2个支架者112例(31%),3个支架者50例(14%),4个支架者9例(3%),全部成功。结论:围手术期精心护理对提高PTCA成功率,减少并发症具有重要意义。     

Screening angiography of supraaortic vessels performed by invasive cardiologists at the time of cardiac catheterization: indications and results

An aging population makes multiple vascular distributions more likely in patients arriving at the cath lab for coronary artery angiography or complete cardiac catheterization. Whether or not screening angiography of supraaortic vessels can be performed at the time of cardiac catheterization by the invasive cardiologist is still debatable. We sought to determine safety and utility of performing angiography of supraaortic vessels during cardiac catheterization. Medical records of all patients undergoing combined coronary and noncoronary angiography between May 1998 and December 2002 was retrospectively reviewed. One hundred and forty patients (80 males, mean age 67.8 ± 5.4 years) underwent combined cardiac catheterization and angiography of supraaortic vessels. Carotid artery angiography was performed at the same time of cardiac catheterization in 62 patients and subclavian artery angiography in the other 78 patients. Significant findings were reported in 32 (22.8%) patients. Complications included 1 transient ischemic attack and 2 carotid spasm resolved with nitrates infusion. In most cases the same standard catheters used during coronary angiography were used also for noncoronary angiography (119 patients, 85%). The incidence of significant angiographic findings and the relatively frequent association of CAD with supraaortic vessel atherosclerosis supports combined cardiac catheterization and angiography of supraaortic arteries but only in patients with multivessel coronary artery disease.     

Aortoiliac Angiography During Coronary Artery Angiography Detects Significant Occult Aortoiliac and Renal Artery Atherosclerosis in Patients with Coronary Atherosclerosis

PURPOSE: Peripheral atherosclerosis (renal and aortoiliac localizations) are frequently detected in aged patients with concomitant coronary artery disease (CAD): the risk of finding peripheral disease is increased in patients with CAD. Angiography of the aortoiliac vessels performed at the time of coronary angiography may detect any occult renal artery stenosis and atherosclerotic involvement of the aortoiliac segment. We sought to determine utility of performing angiography of aortoiliac and renal arteries during coronary arteriography in patients with known or suspect coronary atherosclerosis. METHODS: Medical records of all patients undergoing combined coronary and aortoiliac angiography between May 1998 and December 2002 was retrospectively reviewed. Moderate to severe arterial stenosis (>50% stenosis), vessel occlusion, aneurismal vessels were noted as significant angiographic findings. Contrast-induced nephropathy was defined as a rise in serum creatinine of > or =25% form baseline. RESULTS: In the study period 112 patients (81 males, mean age 68.4+/-7.8 years) with known or suspected CAD underwent combined cardiac catheterization and aortoiliac angiography. Pretreatment with 0.45% saline at a rate of 1 ml/kg/h for 12 h was administered to all patients. Significant findings were reported in 37 (33%) patients including 14 renal artery stenoses, 8 aortic aneurismal disease, and 15 aortoiliac lesions. Most patients with significant findings had 2 and 3-vessel CAD. A strong correlation was found between the number of risk factors and the frequency of angiographic findings (r = 0.92). Complications include six contrast-induced nephropathy: no case required renal replacement therapy. CONCLUSIONS: Aortoiliac and renal atherosclerosis is frequently associated to multivessel CAD. In selected patients undergoing cardiac catheterization aortoiliac angiography may be practical in detecting occult renal or aortoiliac artery lesions. Further clinical outcome studies are strongly required to support this strategy.     

Novel insights into an old controversy

Coronary artery ectasia (CAE) is defined as a localized or diffuse non-obstructive lesion of the epicardial coronary arteries with a luminal dilation exceeding 1.5-fold the diameter of the normal adjacent arterial segment. The incidence of CAE has been reported to range between 2% and 4%, which might be an overestimation of the true frequency. The coincidence of CAE with other systemic vascular dilatations has suggested that the mechanism underlying CAE is not only localized to coronary arteries, but also to other vascular compartments such as aorta or peripheral veins. Although the pathophysiology of CAE remains largely unknown, it was supposed to represent a variant of coronary atherosclerosis. This review focuses on this controversy of whether CAE and coronary artery disease (CAD) are two manifestations of the same underlying process. There are clear differences between CAD and CAE with respect to cardiovascular risk factors such as diabetes mellitus, and pathogenic steps in disease progress such as inflammation or extracellular matrix remodeling. As this review will underscore, the current knowledge of the field is insufficient to finally clarify the causative interrelation between CAE and CAD. The clinical course and treatment of CAE mainly depends on its coexistence with CAD. When coexisting with CAD, the prognosis and treatment of CAE are the same as for CAD alone. In isolated CAE, prognosis is better and anti-platelet drugs are the mainstay of treatment. Surgical treatment can be considered in selected patients. For clarifying the mechanism underlying CAE, additional clinical, histopathological and pathophysiological investigations are required. In fact, every patient with CAE should be evaluated systematically for pathological changes in other vascular territories, both in the arterial system as well as in the venous system, which might occur in the disease process.     

Is coronary stent deployment and remodeling affected by predilatation? An intravascular ultrasound randomized study Stenting with or without predilation: an IVUS study

In this intravascular ultrasound (IVUS) randomized trial we compared a strategy of direct stenting (DS) without predilation (n = 30) vs. conventional stenting with predilation (SWP) (n = 30) in patients with suitable type A or B non-calcified lesions in native vessels 3 mm. Optimal deployment was achieved using angiographic criteria without interactive IVUS. The goal of our study was to determine whether stent expansion and coronary remodeling were similar. Maximal pressure inflation was comparable in the two groups (11.4 ± 2.2 vs. 11.8 ± 1.9 atm; NS). Stent deployment was obtained in all patients with complete apposition to the vessel wall. DS and SWP resulted in comparable lumen enlargement (5.4 ± 2.5 vs. 5.5 ± 2.1 mm²) with an identical mechanism: 66% of lumen enlargement was due to increased enlarged elastic membrane (EEM)-cross sectional area (CSA) ( = 3.7 ± 2.1 mm² and = 2.4 ± 6.8 mm², respectively, p < 0.49) and 34% was due to a reduced P + M-CSA ( = 0.02 ± 6.9 mm² and = 1.2 ± 6.3 mm², respectively, p < 0.50). We conclude that at the same maximal pressure inflation the mechanisms of stent expansion are similar in both DS and SWP groups. In this observational study, the IVUS data showed clearly under-expansion of stents in both groups in comparison with previously published CSA values (minimum stent CSA of 7.5 mm²).     

Mid‐term outcome after carotid artery stenting depends on presence of coronary artery disease

BACKGROUND. Longer‐term outcome of patients following carotid artery revascularization depends predominantly on cardiac events rather than neurological events.

AIM. To assess the longer‐term outcomes of patients with known coronary artery morphology undergoing carotid artery stenting.

METHOD. In a prospective observational study including 549 consecutive patients undergoing carotid artery stenting, a coronary angiography was performed in a single session unless a recent angiogram was available. Following the intervention, patients were followed prospectively to determine neurological events as well as major adverse coronary events (MACE) during long‐term follow‐up.

RESULTS. Coronary artery disease was present in 378 patients including 92 patients without current significant stenosis. The MACE rate was 6.4% in patients without coronary artery disease compared to 28.3% in patients with coronary artery disease (P<0.00001). Cardiac and all‐cause mortality were statistically significantly higher in patients with a significant coronary stenosis than in patients without coronary artery disease (P<0.001 and P<0.01). Cardiac mortality and all‐cause mortality were 2.3% and 7.6% in patients without coronary artery disease (patient group I), 7.6% and 13.0% in patients with coronary artery disease but no current significant stenosis (patient group II), and 10.5% and 16.1% in patients with significant coronary stenosis (patient group III). Neurological events, however, were distributed equally among the three patient groups.

CONCLUSIONS<1/emph>. In the longer term, outcomes in patients undergoing carotid artery stenting depend on concomitant coronary artery disease rather than neurological events, cardiac mortality and even all‐cause mortality depending on a significant coronary artery stenosis.     

超声CDFI诊断左冠状动脉起源于肺动脉

目的　探索超声CDFI诊断左冠状动脉异常起源于肺动脉的价值。方法　应用多普勒超声心动图分析了 4例左冠状动脉起源于肺动脉患者的超声CDFI的特征。结果　①右冠状动脉明显增宽。②室间隔及其他部位侧支血流丰富。③左冠状窦内无左冠状动脉起源。④肺动脉增宽。结论　超声CDFI可以诊断左冠状动脉起源于肺动脉 ,它为该病的诊断与治疗提供丰富的信息。     

YM—GU—动脉压迫止血器对减少冠状动脉介入术后血管并发症的效果观察

目的评价经股动脉冠状动脉诊疗术后股动脉穿刺部位应用YM-GU-动脉压迫止血器止血的效果和安全性。方法将228例经股动脉冠状动脉介入术后患者随机分成两组，107例采用YM-GU-动脉压迫止血器止血（止血器组），121例采用手工压迫止血（手工组）。比较两组止血成功率、止血时间、下肢制动时间、血管并发症发生情况。结果两组止血成功率无差异（P〉0．05），止血器组止血时间、制动时间较手工组短，血管并发症发生率和卧床不适发生率明显降低，无假性动脉瘤、动静脉瘘发生（均P〈0．01）。结论经股动脉冠状动脉介入术后应用YM—GU—动脉压迫止血器止血的效果好，并发症少，患者舒适度高，值得临床推广使用。     

Angiographic retrograde filling of all left coronary arterial branches in a patient with chronic total occlusion of left main coronary artery

A 81‐year‐old female patient was referred in our hospital with episodes of pulmonary edema and had an isolated chronic total occlusion of the left main coronary artery. Coronary angiogram showed total occlusion the left main and filling the left coronary system by collaterals from the right coronary artery.     

Single coronary artery with anomalous origin from the right sinus Valsalva

Summary A single coronary artery is a rare congenital anomaly with an incidence of 0.02–0.04%. We report on a 65–year–old male presenting with atypical chest pain and a history of hypertension and hypercholesterinemia, having diagnosed a very rare variant of a single coronary artery arising from the right sinus of Valsalva continuing as circumflex coronary artery (LCX) and thereafter as left anterior descending artery (LAD). Because the patient was asymptomatic on antiischemic medication and had a proposed relative benign course, we recommended medical treatment without coronary artery bypass surgery, and the patient has been in fine condition up to now (11 months after angiography). No financial support was received for the present study     

非典型川崎病的临床研究

目的:探讨非典型川崎病(KD)的发病情况及临床特点。方法:对2001年3月至2004年9月住院治疗的141例KD病例资料作回顾分析。结果:141例中113例(80·1%)为典型KD,28例(19·9%)为非典型KD。非典型KD组平均年龄1·33±1·65岁,较典型组小,差异有显著性(P<0·01);非典型KD只具备KD诊断标准中6项之4项或3项,非典型KD冠状动脉扩张(CAD)和冠状动脉瘤(CAA)的发生率为100%,与典型KD比较,差异有显著性(P<0·01);非典型KD组在病程8·9±6·8d接受丙种球蛋白治疗,住院天数为l5·3±6·6d,均较典型组的7·1±2·8d、11·5±5·7d明显延长,差异有显著性(P<0·05)。随访CAD大多数于3~6个月恢复正常。CAA于1年至2年恢复正常。结论:非典型KD更多见于小年龄的婴幼儿,非典型KD冠状动脉病变发生率高,冠状动脉病变是诊断非典型KD的重要依据,临床应重视早期诊断和早期治疗。