慢性冠状动脉闭塞病变介入术中应用微球囊导管远段血管造影术

目的探讨冠状动脉慢性闭塞性病变再通术中钢丝是否在血管真腔内的鉴别方法,并观察其对急性心包填塞的预防作用。方法将冠状动脉闭塞性病变分为I型、II型和III型,前2型闭塞远段血管显影,后者闭塞远段血管不显影。2003年～2005年32例III型慢性闭塞病变钢丝通过病变后,采用直径为1.5mm的非快速交换小球囊通过病变（相当于微导管作用）,近段造影远段血管不显影,则将钢丝退出指引导管保留球囊在原位,从钢丝孔注射2ml造影剂使远段血管显影,确认在血管真腔后预扩张、植入支架。结果32例冠状动脉III型闭塞性病变再通术患者均成功完成手术,无1例发生急性心包填塞。结论冠状动脉慢性闭塞病变微导管远段血管造影技术能鉴别钢丝是否在血管真腔内,有助于提高手术成功率,降低心包填塞发生率。     

冠状动脉支架置入对分支血管的影响

目的 比较观察不同药物洗脱支架及普通支架置入术后分支血管的自然发展情况,探讨分支血管闭塞及再通的影响因素。方法回顾性分析在解放军总医院心内科接受支架置入术并进行造影随访的183例患的病例资料及术前、术中、术后的造影光盘资料,分析支架覆盖的所有分支血管。结果支架术后分支血管的闭塞率是8．9％,其中Cypher药物支架组为10．5％,Taxus药物支架组为11．1％,普通支架为7．8％,72．0％的闭塞分支在随访时再通,其中Cypher组是90．9％,Taxus组为66．7％,普通支架组为66．7％;三组间差异无统计学意义;分支开口狭窄和起始部位有病变是分支血管闭塞的独立危险因素;支架内再狭窄、病变类型及分支情况等都不会影响闭塞分支的再通。结论不同类型的药物支架和普通支架在对分支血管的影响方面基本一致;分支开口狭窄和分支起始部位病变是分支血管闭塞的独立危险因素;闭塞的分支血管自然预后良好,大部分会自行再通。     

冠状动脉支架对完全闭塞与非闭塞病变的疗效比较

为比较冠状动脉支架对完全闭塞与非闭塞病变的即时结果和长期疗效,对516例(687处病变)行冠状动脉支架术的患者进行分析.将患者按手术部位的阻塞程度分为完全闭塞组(142例,160处病变)和非闭塞组(374例,527处病变),观察两组患者行冠状动脉支架术后的即时疗效及临床和造影复查的结果.结果显示完全闭塞组术前血管最小腔径显著小于非闭塞组(P<0.001),而术后两组没有统计学差异;临床并发症两组差异无显著性,影像学并发症完全闭塞组显著高于非闭塞组(6.1%比2.5%,P<0.05);完全闭塞组27.8%的病变可见再狭窄,非闭塞组23.7%的病变可见再狭窄,两组比较无显著性差异;随访临床事件完全闭塞组25.2%,非闭塞组22.7%,两组比较无显著性差异.以上结果表明冠状动脉支架对冠状动脉完全闭塞病变的即时结果和长期疗效均与非闭塞病变相近.     

闭塞冠状动脉的造影特点和球囊扩张治疗

分析19例患者闭塞冠状动脉(冠脉)的影象特点和球囊扩张治疗结果.发现16例并存非闭塞冠脉狭窄,其中12例表现为70%以上的重度狭窄.所有闭塞冠脉均有良好的侧支循环,左前降支和右冠脉闭塞均表现为对侧侧支循环,左旋支闭塞者3例为同侧侧支循环,1例为对侧侧支循环.13例闭塞血管经球羹扩张后再通,6例失败,其主要原因为导丝不能通过闭塞部位(5例)和球囊不能跨过闭塞部位(1例).     

冠状动脉支架内慢性完全闭塞的介入治疗

冠状动脉支架内慢性完全闭塞(IS-CTO)是慢性完全闭塞(CTO)病变介入治疗中难度最高、最有挑战性的病变,IS-CTO在CTO中占5％～25％.由于导丝及球囊通过困难,IS-CTO介入治疗成功率较低.IS-CTO与非IS-CTO的病理机制不同,特殊的病理机制导致IS-CTO的血管开通率较低.随着杂交策略的应用,IS-...     

慢性冠状动脉闭塞的经皮血管重建术

本文评估血管菜术在慢性冠脉闭塞中可用的资料，新的溶栓药物作用仍有限。新的器械至今令人失望。进一步的技术进展已露端倪。     

切割球囊对吻扩张与支架术治疗分叉病变的比较研究

目的　探讨切割球囊与普通球囊对吻扩张治疗分叉病变的疗效及安全性。方法　 34例真性分叉病变患者被分配到切割球囊对吻组 (13例 )和支架组 (2 1例 )。术前及术后即刻行冠状动脉内超声检查 ,测定血管最小内径 ,血管外弹力膜面积 ,血管腔面积 ,斑块面积 ,直径和面积狭窄百分比。结果　与支架组相比 ,切割球囊组病变以前降支 (LAD)和第一对角支 (D1) (4 3 5 %vs 2 8 9% ,P<0 0 1)处多见 ,右冠状动脉 (RCA)和后降支处 (PDA)少见 (12 1%vs 35 0 % ,P =0 0 1)。切割球囊组患者左心室射血分数比支架组低 (5 7 6 %vs 6 7 6 % ,P =0 0 2 )。支架组患者中 14例共 2 8个支架同时置入主干和分支内 ,仅在主干或分支一侧血管内植入支架 7例 ,最大扩张压力为 14 18 5 5kPa,2 0例患者接受IVUS检查 ,主干血管内最终残余狭窄为 2 3 6 %。切割球囊组 10例患者先在主干和分支内进行切割球囊交替扩张 ,3例患者只在主干内行切割球囊扩张 ,最后对吻扩张时的平均压力为 810 6kPa ,13例患者全部接受IVUS检查 ,IVUS测定主干血管内最终残余狭窄为 10 8%。切割球囊组与支架组扩张前即刻血管腔截面积分别为 (2 31± 1 2 0 )mm2 和 (2 36± 1 2 3)mm2 ,扩张后分别为 (6 4 2±1 0 1)mm2 和 (6 5 1± 1 0 7)mm2 ;两组扩张后     

冠状动脉完全闭塞病变的介入治疗

目的观察急性和慢性冠状动脉闭塞经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗的效果。方法３２例患者共３８支完全闭塞血管进行了ＰＴＣＡ或ＰＴＣＡ＋支架治疗。结果１２例急性心肌梗塞（ＡＭＩ）其中４例直接和８例行补救性ＰＴＣＡ均成功（１２／１２,１００％）;２０例择期ＰＴＣＡ中１４例成功（７０％）。结论血管闭塞时间越长,ＰＴＣＡ成功率越低。本组病例无一例出现严重并发症,表明冠状动脉完全闭塞行ＰＴＣＡ＋支架治疗是安全有效的。     

无球囊预扩张直接置入冠状动脉内支架

目的：探讨直接置入冠状动脉内支架的可行性及效果。 方法：４１例患者未经球囊预扩张而直接置入冠状动脉内支架,支架置入后扩张使用同一种球囊。 结果：４１例患者共置入４２个支架。病变分型为;Ａ型１６例,Ｂ１型１９例,Ｂ２型５例,Ｃ型２例。支架置入前狭窄程度为（７５．６±６．４）％。支架置入后管腔残余狭窄程度为（０．５±１．９）％。支架置入成功率为１００％,无并发症发生。随诊３０天所有患者无不良反应。５例进行随访造影,其中３例患者发生再狭窄。 结论：对于冠状动脉病变无或轻度钙化及靶病变部位前无明显弯曲,最好限于Ａ型和Ｂ型的较局限病变,可以采用直接置入支架,成功率高。     

下肢动脉粥样硬化闭塞支架术后再狭窄研究进展

下肢动脉硬化闭塞症(ASO)是由动脉粥样硬化引起动脉狭窄、闭塞性疾病。血管内支架成形术作为一种微创、安全及有效的方法,近年来已广泛应用于股腘动脉ASO治疗,但术后支架内再狭窄(ISR)发生率高,严重影响患者临床预后。支架内再狭窄问题依然是支架应用所面临的主要问题。文章对支架置入后再狭窄的发生机制、危险因素及最新的治疗进展做一综述,对支架内再狭窄防治具有一定的意义。     

评价冠状动脉内支架对冠状动脉闭塞的临床及血管造影的远期疗效

目的　研究对完全闭塞的血管成功ＰＴＣＡ术后,选择性置入支架的近期及远期临床疗效及血管造影结果。方法４９８例完全血管闭塞的病人中,能成功进行ＰＴＣＡ并置入支架,完成临床及血管造影随访的８４例病人,共放置９８个支架,观察其术后近期及远期临床事件发生率及血管造影的特点。结果　置入支架后,住院期间,５％的病人出现亚急性血管闭塞,无死亡,１例发生心肌梗塞,至半年随访终点时,共有３０％的病人出现再狭窄,血管闭塞率１３％,重施血管再通术２０％,半年后的无心脏事件率为６８％。结论对完全血管闭塞病人,选择性支架术明显降低再狭窄及血管闭塞率,减少临床心脏事件的发生率。     

Predictors of short term clinical and angiographic outcome after coronary angioplasty for acute myocardial infarction

Coronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct-related artery (IRA) within 24 h after the onset of symptoms (mean delay 10±7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%). Failure without complications occurred in 12 patients (8.4%); untoward events (death and emergency CABG) occurred in seven patients (5.3%). Pts in the failure group were more likely to have cardiogenic shock (53 vs. 8.8%, P<.0005), longer time to reperfusion (15±6 vs. 9±6 h, P<.0005), lower ejection fraction (EF) (42±16 vs. 54±12%, P<.0005), multivessel disease (74 vs. 43%, P<.03), and a smaller IRA diameter (2.8±0.6 vs. 3.1± 0.6 mm, P<.03). Sex, age, previous bypass surgery, previous thrombolytic treatment, IRA, and infarct location were similar in both groups. Absence of cardiogenic shock (P<.0001), decreasing time to reperfusion (P<.005) and increasing EF (P<.02) were independent predictors of successful PTCA. Presence of cardiogenic shock (P<.0001) and decreasing EF (<.05) were independent predictors of untoward events. Repeat angiography was performed 24 h after the procedure in the success group. Angiographic deterioration (stenosis ? 50% and/or TIMI flow grade ? 1) was present in 18 pts (16%), among whose 5 pts (4.4%) had re-occlusion of the IRA. Pts with early angiographic deterioration were more likely to have a lower IRA diameter (2.8±0.5 vs. 3.1±0.6 mm, P<.02). Conclusion: Emergency PTCA is an effective method for establishing reperfusion in AMI. Pts with high-risk baseline characteristics show the highest rate of untoward events, but are the most likely to benefit from aggressive reperfusion therapy. © 1995 Wiley-Liss, inc.     

Clinical and angiographic follow-up after long versus short stenting in unselected chronic coronary occlusions

BACKGROUND: Few data are available on the efficacy of long stenting for lesions in unselected chronic total occlusion (CTO). HYPOTHESIS: The study was undertaken to evaluate the angiographic restenosis and long-term clinical outcomes after long stent implantation in patients with CTO. METHODS: Our retrospective analysis includes a consecutive series of stent implantation in 220 patients with CTO. We compared angiographic restenosis, target lesion revascularization, and long-term clinical outcomes of short stenting (< 20 mm, Group 1, n = 113) with a concurrent series of long stenting (> or = 20 mm, Group 2, n = 107). RESULTS: Angiographic follow-up was obtained in 174 patients (79.5% of those eligible), and the rates of angiographic restenosis were 19.3% in Group 1 and 33.7% in Group 2 (p < 0.05). In multivariate analysis, the postinterventional minimal lumen diameter was the only independent predictor of restenosis (odds ratio = 0.20, 95% confidence interval 0.08-0.49, p < 0.01). The angiographic restenosis rate was significantly lower in Group 1 than in Group 2 in patients with final minimal lumen diameter < 3.0 mm (28.9 vs. 55.9%, respectively, p < 0.05). However, the angiographic restenosis rate was not significantly different between the two groups in patients with final minimal lumen diameter > or = 3 mm (12.0 vs. 19.2%, respectively, p = NS). During the follow-up (29.1 +/- 10.8 months), there was no difference between the two groups in death, nonfatal myocardial infarction, and target lesion revascularization. CONCLUSIONS: The use of long (> or = 20 mm) versus short (< 20 mm) stents in patients with CTO is associated with a higher angiographic restenosis rate, but there is an equivalent risk of restenosis in selected patients with relatively large-sized vessels.     

Incidence and predictors of late total occlusion following coronary stenting

To determine the incidence and predictors of total occlusion in‐stent restenosis, we reviewed three randomized stent vs. stent trials and one stent registry, which provided 955 coronary artery lesions with 6‐month angiographic follow‐up. Fifteen (1.6%) of the 955 stented lesions were totally occluded at 6‐month follow‐up. Most patients with total occlusion presented with recurrent angina at the time of repeat angiography (60.0%) while no patient presented with an acute ST segment elevation myocardial infarction. The univariate predictors of total occlusion following elective coronary stenting included stenting for restenosis after a previous percutaneous intervention (P = 0.001), longer stent length (P < 0.001), longer lesion length (P < 0.001), smaller reference vessel diameter (P = 0.022), smaller preprocedure minimum lumen diameter (MLD; P = 0.004), and smaller postprocedure MLD (P = 0.036). Stepwise multiple logistic regression analysis demonstrated that stenting for restenotic lesions (P = 0.004), longer stent length (P < 0.001), and smaller preprocedure MLD (P = 0.012) were independent predictors of total occlusion following coronary stenting. Catheter Cardiovasc Interv 2003;60:344‐351. © 2003 Wiley‐Liss, Inc.     

老年冠状动脉慢性完全闭塞病变支架置入术后再闭塞的临床特征分析

目的:研究老年冠状动脉(冠脉)慢性完全闭塞病变支架置入术后再闭塞病变的临床特征。方法:回顾性分析,选择2005年1月至2019年12月老年冠脉慢性完全闭塞支架术后再闭塞患者229例。根据年龄将患者分为40~49岁组60例、50~59岁组58例、60~69岁组55例和70~80岁组56例,分析各组患者支架置入术后再闭塞病...     

药物洗脱支架对完全闭塞性病变介入治疗预后影响的评估

目的比较对于完全性闭塞病变采用药物洗脱支架和金属裸支架的近期和远期预后。方法选择我院近期连续接受置入药物洗脱支架(DES)或金属裸支架(BMS)治疗,并且进行冠状动脉造影随访的155例存在完全闭塞病变的冠心病患者。患者在支架术后6个月左右接受冠状动脉造影随访。结果共155例患者(138名男性,17名女性)159处靶病变置入232枚支架完成造影随访,其中慢性完全性闭塞65例,占41.9%。其中C型病变占总数的85.4%。在患者基本条件方面,DES组2型糖尿病比例要多于BMS组(33.8%比18.5%,P=0.030)。在病变基本条件方面,DES组和BMS组C型病变分别占89.6%和72.0%(P=0.005),DES组病变更为复杂。DES组慢性完全闭塞病变比例明显高于BMS组(60.3%比24.4%,P<0.001)。DES组和BMS组的支架长度和病变长度没有差别。DES组参考血管直径小于BMS组[(2.72±0.36)mm比(2.96±0.52)mm,P=0.001]。6个月随访结果显示支架再狭窄DES组明显低于BMS组(15.6%比41.5%,P<0.001)。DES组支架再狭窄更多为局限性(58.3%比17.6%,P<0.001)。DES组的靶病变血管重建率明显低于BMS组(5.8%比19.9%,P=0.001)。病变内晚期腔径丢失DES明显小于BMS[(0.36±0.63)mm比(1.04±0.70)mm,P<0.001]。晚期支架内血栓DES有2例,BMS为0。DES组有1例死亡。术后主要心脏不良事件发生率两组分别是1.4%和11.1%,DES组显著低于BMS组(P=0.032)。结论我们的研究发现对于完全闭塞性病变的治疗,DES有着良好的治疗效果,比BMS有着明显减低的再狭窄率、靶病变血管重建率,并且在随访期间患者有着更少的心血管事件。     

EXCEL支架在慢性闭塞病变介入治疗中的应用及疗效观察

目的总结冠状动脉性心脏病(冠心病)慢性完全闭塞(chronic total occlusion,CTO)病变经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中EXCEL生物降解药物涂层支架的应用及3年随访结果,评价其在CTO病变的疗效及安全性。方法2006年1月至2009年3月入住成都军区昆明总医院,冠状动脉造影确诊CTO病变并行PCI治疗患者185例,靶病变均植入EXCEL支架,常规二联抗血小板治疗至少6个月。术后6个月、1年、2年、3年临床及冠状动脉造影随访,以主要心血管事件(major adverse cardiac events,MACE)发生率、再狭窄率(in-stent restenosis,ISR)、血运重建率为研究终点,同时了解亚急性及晚期支架内血栓发生率。结果共147例CTO病变血管开通,即刻血管开通率为79.5%(147/185);共201处闭塞病变中,26处导丝无法通过,8处导丝通过闭塞病变后球囊无法跨越病变部位,靶血管开通率83.1%;闭塞时间12个月以内及超过12个月的靶血管开通率分别为87.5%、62.4%,有桥侧支存在者PCI治疗成功率低于无桥侧支者,断端呈刀切状的成功率低于鼠尾状(P0.05)。术中无死亡病例;术后6个月、1年、2年、3年冠状动脉造影复查率分别为30.8%、19.5%、15.1%、10.3%,MASE发生率分别为3.2%、2.3%、1.95、4.0%,再狭窄率分别为8.8%、8.3%、7.1%、5.3%;发生亚急性、晚期支架内血栓各1例,发生率分别为0.6%、0.1%,无急性支架内血栓事件。结论EXCEL支架应用于CTO病变PCI治疗中安全有效,没有增加MACE发生率及支架内血栓事件。