急性心肌梗塞患者冠状动脉内支架的临床应用

急性心肌梗塞（心梗）早期再灌注治疗对限制梗塞范围、保护心功能及改善临床症状具有重要意义。我科从１９９５年１１月至１９９６年１１月应用冠脉内支架植入术治疗急性心肌梗塞患者１０例，其效果显著。现报道如下。临床资料一、对象：１０例患者中男性９例，女性１例，...     

冠状动脉内支架植入187例临床分析

从1994年1月至1997年11月，我们为187例冠心病患者进行经皮腔内冠状动脉支架植入术，共植入249个支架。临床结果表明，冠状动脉内支架植入术有效地降低了单纯球囊扩张冠状动脉成形术的半年内再狭窄率及减少了紧急冠状动脉搭桥术，同时改善术后即时的残余狭窄率。因此，我们认为，冠状动脉内支架植入术能有效地提高冠心病介入治疗近、远期疗效。     

冠状动脉内支架植入术的临床应用

冠状动脉内支架植入术的临床应用陈传荣靳立军陈纪言周颖玲黄奕高黄涛冠状动脉内支架植入术（ＣＡＳＩ）作为冠心病的一种新的介入性治疗方法已被广泛应用于临床。本文对３８例行ＣＡＳＩ的病例进行总结，旨在探讨其应用价值。一、对象及方法本组病例为１９９４年１月至１...     

冠状动脉内支架的临床应用

1992年9月至1996年9月，我院共开展冠状动脉内支架置入术138例，将186枚支架置入152支冠状动脉的167处病变。其中左主干病变占0．8％，左前降支50．8％，左回旋支18．3％，右冠状动脉为30．1％。93．7％为B或C型病变。置入的支架类型包括：Palmaz－Schatz支架，Gianturco－Roubin支架，NIR支架，Cordis支架，Wallstent，Multi－link支架，Wiktor支架及Gianturco－RoubinⅡ支架等8种。手术成功率97．8％，狭窄程度由术前的89．3％降至－5．0±8．5％，平均最小血管直径由0．33mm增至3．22mm。主要并发症率为0．72％（1例急性心肌梗塞），严重周围血管并发症1例。我们认为，在有经验的心脏中心可以安全而有效地开展冠状动脉支架术，并可酌情选用不同类型的支架，手术成功率高，并发症率低。     

老年冠心病患者冠状动脉内支架置入术的临床应用

自１９９５年６月至１９９７年１２月,我院为４６例老年冠心病患者置入４８个冠状动脉（冠脉）内支架,取得了满意的效果。一、资料与方法４６例中,男４２例,女性４例;年龄６０～７４岁,平均６６岁。全部患者术前均有不同程度的心绞痛发作,心绞痛病史１～１６年,平...     

70岁及以上冠心病患者冠状动脉内支架置入术的临床评价

~~70岁及以上冠心病患者冠状动脉内支架置入术的临床评价@沈亚平!310013杭州市$浙江医院心内科 @沈法荣!310013杭州市$浙江医院心内科 @黄抒伟!310013杭州市$浙江医院心内科 @凌锋!310013杭州市$浙江医院心内科 @陈建明!310013杭州市$浙江医院心内科 @孟丽萍!310013杭州市$浙江医院心内科 @金宏义!310013杭州市$浙江医院心内科~~     

Driver冠状动脉内支架的临床应用

目的评估Driver冠状动脉内支架的临床应用效果。方法回顾性分析49例接受Driver冠状动脉内支架置入术患者的即刻疗效和临床随访结果。结果49例患者根据ACC/AHA分型,A-B1型病变25处,B2-C型病变29处。全部支架成功置入。1例术后TIMI血流2级。平均随访6～9月,无心源性死亡和心肌梗死,2例行冠状动脉造影复查,未显示支架内再狭窄。结论Driver冠状动脉内支架可安全有效地应用于冠心病的介入治疗。     

Coroflex冠状动脉内支架的临床应用

目的　评估Coroflex冠状动脉内支架的临床应用效果。方法　回顾性分析 81例接受Coroflex冠状动脉内支架置入术患者的即刻疗效和临床随访结果。结果　 81例患者共置入Coroflex冠状动脉内支架 88枚。根据ACC AHA分型 ,A B1 型病变 38处 ,B2 C型病变 5 0处。原发病变 5 2处 ,单纯球囊扩张术疗效不满意病变 2 2处 ,内膜撕裂病变 14处。支架成功置入 82处 (93 2 % )。 3例严重钙化病变需辅以高压 (16～ 18atm)球囊才充分扩张 ,2例支架远端发生内膜撕裂 ,1例弥漫性病变支架置入术后TIMI血流 2级。 75例患者平均随访 (7 5± 3 0 )月 (3～ 13月 ) ,无心源性死亡和心肌梗死 ;17例 (2 2 7% )有心绞痛 (CCS分类Ⅰ级 )发生 ;7例行冠状动脉造影复查 ,2例显示支架内再狭窄 ,予再次血管重建术后缓解。结论　Coroflex冠状动脉内支架可安全有效地应用于冠心病的介入治疗。     

冠状动脉内支架的临床应用

目的:探讨太动脉内支架治疗冠心病的作用.方法:冠心病患282例放置了398个冠脉内支架,其中Denove支架198例,Bail-out支架84例,放置血管,左冠前降支231个,左冠回旋支39个,右冠动脉128个,结果:住院期间无急性血栓形成或严重出血性并发症,随访20天至1年亦无血栓形成,除1例病人有活动后胸闷外,其余患心绞痛消失,能正常生活和工作.结论:冠脉内支架置入术是一种安全有效的介入性治疗,对于提高PTCA成功率,改善预后有重要意义.     

国产冠状动脉支架的临床应用

目前国内冠心病介入治疗中仍以应用欧美进口支架为主。本研究回顾性总结国产支架临床应用的即刻及2年随访结果。资料与方法2 0 0 1年3月～2 0 0 3年6月我院共对118例住院冠心病患者应用国产预装型佩格斯支架(北京微斯曼医疗器械公司生产)置入术治疗,其中男93例,女2 5例,年龄38～75 (6 3 1±12 3)岁。发病12h内AMI行急诊介入治疗37例(其中合并心原性休克4例) ,不稳定性心绞痛76例,稳定性心绞痛5例。既往曾行冠状动脉旁路移植术(CABG) 1例,陈旧性心肌梗死38例,合并高血压病5 8例、糖尿病30例、高脂血症32例。心功能不全2 9例(2 4 6 % )。…     

冠状动脉支架V-FlexTM的临床应用及随访结果

为评价V－Flen冠状动脉支架置入后的安全性和再狭窄的发生率,在124例冠心病病人中,138处血管病变植入174个V－Flen冠状动脉支架,成功率为100％。住院期间,1例病人因严重心衰死亡,4例病人出现非Q波心肌梗死,股动脉穿刺血肿5例,其余病人均无支架相关并发症。122例病人6月临床随访中,16例（13％）出现胸痛或运动试验阳性;108例6个月后定量血管造影显示再狭窄率为24．0％。此结果提示,V－Flen冠状动脉支架对治疗冠状动脉狭窄病变具有较高的安全有效性,且再狭窄发生率低。     

复杂性冠状动脉病变的支架治疗

对２８例３２处复杂性冠状动脉（冠脉）病变的病人行冠脉内支架置入术，置入ＰａｌｍａｔｚＳｃｈａｔｚ型支架３２个，Ｇｉａｎｔｕｒｃｏ－Ｒｏｕｂｉｎ型支架４个，其中２例置入３个支架，２例由于病变较长，故在同一病变部位置入２个支架，２例因置入支架时造成病变近端血管撕裂而重新置入另一个支架，支架置入成功率１００％，２例出现局部血管撕裂，１例术后股动脉穿刺部位血肿，２例出院后口服华法令过程中出现皮肤淤斑，１例出现肉眼血尿，无其它并发症。有５例术后半年行冠脉造影示支架部位血流通畅，无再狭窄发生。     

Endoscopic biliary stenting: Plastic stent or expandable metallic stent?

Since its introduction 1979, endoscopic biliary stenting has become the method of first choice to treat cholestasis in malignant or benign biliary obstuction or leakage of biliary fistulas. The success rate of endoscopic biliary stenting generally exceeds 90% and procedure-related complications are rare. Although metal stents are becoming more popular, plastic stents are still the first choice. Their major drawback is occlusion with sludge mediated by bacteria. Pharmaco-chemical measures failed to prevent occlusion. With Teflon material and a 10-French stent, stent exchange rates were reduced to 15% in patients with malignant biliary obstruction, the shape without sideholes showing the best results. Stent exchange is easily feasable. Metal stents are expensive and more difficult to handle. Occlusion with sludge is rare, but patency is limited by tumor ingrowth. Metal stents may be indicated in selected patients, such as those with recurrent stent occlusion causing cholangitis. If only a small-caliber prosthesis (7-Fr) can be placed (e.g. in Klatskin tumor) metal stents may have a longer patency than plastic stents. Metal stents should not be used in benign biliary obstruction because these stents are not removable.     

Bare-metal stent thrombosis two decades after stenting

Very late bare-metal stent (BMS) thrombosis is unusual in clinical practice. To the best of our knowledge, the latest that the thrombosis of a BMS has been reported is 14 years after implantation. Here, we describe a case of BMS thrombosis that occurred two decades after stenting. A 68-year-old male patient was admitted with acute anterior myocardial infarction. This patient had a history of BMS implantation in the left anterior descending coronary artery (LAD) 20 years previously. Immediate coronary angiography demonstrated acute thrombotic occlusion of the stent in the LAD. With this case, we are recording the latest reported incidence of BMS thrombosis after implantation.     

在小型猪模型由蛋白涂层金属支架局部转染尿激酶前体基因对冠状动脉再狭窄的影响

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Intracoronary stent implantation using a single high-pressure perfusion balloon catheter

Currently, the recommended strategy for Palmaz-Schatz intracoronary stent implantation is to use two balloons: an undersized balloon for predilation to facilitate a channel for the stent and a high pressure balloon for postdilation to obtain good apposition of the struts into the vessel wall. We reported our experience using the perfusion balloon as the initial balloon to dilate intracoronary lesions and demonstrated a reduction in the total number of balloons used per angioplasty procedure. The objective of this study was to examine whether a single balloon could effectively be used for stent implantation. The study population included 95 patients who underwent elective intracoronary stent placement to 100 lesions using 110 Palmaz-Schatz stents by nine individual operators. Lesions were predilated with an ACS RX LIFESTREAM balloon at a low pressure of 4–6 atm (mean 5.7 ± 2.6). After stent deployment, the same balloon was used at a high pressure (mean 16.2 ± 1.2). Mean balloon size, which was chosen as the stent size, was 3.4 ± 0.4 mm. Comparison of this strategy with the recommended strategy of 68 consecutive elective stent deployments at a single center during the same time was performed. Stent implantation using a single balloon strategy was angiographically successful in 99 of 100 (99.0%) lesions. The single balloon strategy was associated with a balloon burst rate of 9.1%. The number of balloons used per stent deployment was 1.2 vs. 2.4 using the recommended strategy (P < 0.0001). There was no evidence of stent thrombosis, any MI, or target lesion revascularization during the procedure and hospitalization. One in-hospital death as a result of nonhemorragic stroke was documented in the treated group. We concluded that using a single high pressure perfusion balloon for pre and postdilation in patients undergoing elective stent placement is safe and reduces the number of balloons used per procedure. Cathet. Cardiovasc. Diagn. 40:140–143, 1997. © 1997 Wiley-Liss, Inc.     

经皮冠状动脉内血管成形术中冠状动脉内支架的应用

在经皮冠状动脉内血管成形术(PTCA)中,16例患者因发生冠状动脉内膜剥离,血管急性闭塞及再狭窄而放置冠状动脉内支架,成功15例,认为冠状动脉内支架可有效地防止PTCA术急性并发症(内膜剥离、夹层形成,血管急性闭塞等)的发生.     

Intracoronary stent placement proximal to a myocardial bridge: Immediate and long-term results

The intracoronary stent placement in a lesion proximal to a myocardial bridge is of special importance and is considered to be a challenge for the interventional cardiologist. In this study 4 cases of stent implantation proximal to a coronary bridged segment are described. In all cases complications were observed after the procedure. The patients remained free of symptoms and the exercise Tl²⁰¹ test was negative for ischemia 8.5 ± 2.6 months later. Although there is skepticism because of the abnormal coronary flow pattern, the endothelial dysfunction and the subsequent thrombogenicity, the stent placement proximal to a myocardial bridge was safe and with favorable long term results in all 4 cases. However, further studies in large populations are necessary. Cathet. Cardiovasc. Intervent. 46:363–367, 1999. © 1999 Wiley-Liss, Inc.     

Intracoronary stenting of a coronary occlusion resulting from an aortic dissection

Acute myocardial infarction secondary to aortic dissection may occur due to compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. We report a patient with this condition who was successfully treated by Palmaz-Schatz stenting, providing an alternative to thrombolysis or angioplasty. © 1995 Wiley-Liss, Inc.