Very late coronary aneurysm formation with subsequent stent thrombosis secondary to drug-eluting stent

Drug-eluting stents have changed the practice in interventional cardiology. With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed. While the majority of attention was focused on stent thrombosis, the formation of coronary aneurysm was only described in anecdotal reports. We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.

     

Subacute thrombosis after stents implantation in a patient with two adjacent coronary artery aneurysms

Coronary artery aneurysm is an uncommon disease. When it is associated with significantly obstructive coronary artery disease, percutaneous transluminal coronary angioplasty with graft-coated stent implantation usually provides favorable results. Non-coated stents may have the potential risk of thromboembolism. We present a patient with unstable angina who received elective balloon angioplasty and non-coated stent implantations in two adjacent aneurysms. Two episodes of subacute stent thrombosis occurred subsequently at the two different aneurysmal lesions respectively, which were resolved by repeat balloon angioplasty. Post-procedural intravenous heparin infusion is strongly suggested to prevent the development of stent thrombosis. Long-term oral warfarin is also suggested for prophylaxis of recurrent thromboembolic events.     

LEO自膨式支架结合弹簧圈栓塞椎基底系动脉瘤6例

目的探讨应用LEO自膨式支架结合弹簧圈栓塞颅内椎基底系动脉瘤的技术。方法回顾性分析采用LEO自膨式支架结合弹簧圈技术治疗的6例颅内椎基底系动脉瘤的临床资料。结果基底动脉2例,椎动脉远端4例。1例术后出现眩晕表现,5例随访3个月无复发、无狭窄及再出血。结论在栓塞颅内动脉瘤时应用LEO自膨式支架结合弹簧圈技术,可防止弹簧圈突入载瘤动脉,保持载瘤动脉通畅,提高了颅内动脉瘤的疗效。     

兔腹主动脉分叉双支架术模型的建立

目的 建立兔腹主动脉分叉双支架术模型.方法 雄性新西兰兔5只(体质量3.0～3.5 kg),麻醉消毒后,经颈动脉途径于腹主动脉-髂动脉血管分叉处采用边支支架微突T支架技术(T-stenting and small protrusion,TAP)实施双支架植入术,利用数字减影血管造影(digital subtraction angi-ography,DSA)、血管内超声(intravascular ultrasound,IVUS)和显微CT扫描(micro computed tomography,micro-CT)进行术后即刻评价及术后6个月复查.结果 可通过兔颈动脉放置6F鞘管,于腹主动脉分叉处成功实施TAP双支架术,术后即刻DSA提示支架位置满意,血流TIMI3级,IVUS提示支架贴壁良好,术后6个月复查DSA提示无支架内再狭窄及血栓形成,血流TIMI3级,IVUS提示支架贴壁良好,无支架内再狭窄,micro-CT可见边支开口处支架覆盖完全,无支架内血栓,右侧髂动脉支架下缘微突入腹主动脉管腔[(0.49 ±0.08) mm].结论 成功建立了兔腹主动脉分叉双支架术模型,为冠脉分叉病变的临床前期研究提供了依据.     

覆膜支架联合手术治疗头颈部癌侵犯颈动脉在绵羊模型中的试验性研究

目的 通过在绵羊颈动脉模型中预置覆膜支架于局部假定受侵颈动脉处,手术切除受侵犯血管,探讨覆膜支架联合手术治疗头颈部癌侵犯颈动脉的可行性。 方法 选取10只健康绵羊的颈动脉,通过髂总动脉将覆膜支架置入假定受侵颈动脉处,手术切开支架所覆盖的颈动脉区域,切除覆膜支架覆盖的部分动脉壁,观察术区有无出血及支架松动。通过影像观察术区有无出血、外漏及支架的扭曲、松脱及移位,记录实验动物的意识、活动等。 结果 局部无渗血,除1例支架植入后扭曲,其余9例覆膜支架均释放成功,技术成功率为90%。术中无并发症发生。手术成功切除覆膜支架覆盖的全周动脉壁,术中观察支架固定良好。术后绵羊生命体征平稳,无偏瘫、四肢活动障碍等并发症,覆膜支架区域无出血及肿胀。术后12 h影像检查显示术区无出血外漏,支架保持原位稳定,无扭曲、松脱及移位。术后12 h手术探查绵羊颈动脉覆膜支架区域,无出血及支架移位。术后未见绵羊四肢运动障碍、进食和行为异常。随访6个月后,造影结果显示,1例支架内血栓形成,其余8例未见血栓形成。所有绵羊在随访过程中均成活,无偏瘫及血管破溃等严重并发症。 结论 覆膜支架联合手术治疗是头颈部癌侵犯颈动脉的有效治疗方法之一。     

21例锁骨下动脉瘤(SAA)腔内诊治经验

 目的  总结锁骨下动脉瘤(subclavicular artery aneurysm, SAA)患者腔内治疗的效果。方法  复旦大学附属中山医院血管外科2013年1月至2016年 6月共诊治SAA患者21例,男11例,女10例,平均年龄(39±9)岁。所有SAA患者均行腔内治疗,回顾分析围手术期和术后效果及不良事件。结果  技术成功率为100%。术中1例SAA患者支架植入后,近端Ⅰ型内漏明显,改行平行支架植入术;2例Ⅱ型内漏和2例SAA瘤腔巨大分别行侧支和瘤腔钢圈栓塞;中位随访时间19(6～42)个月。随访期间3例SAA患者发生支架内狭窄,1例右SAA患者在释放支架时未覆盖锁骨下动脉开口,在第2年出现支架近端严重狭窄;2例患者SAA位于锁骨下动脉第3段,左右各1例,分别在第2年和第3年出现支架远端严重狭窄。患者2年和3年支架通畅率分别为90.5%和85.7%。结论  腔内治疗SAA操作简单,效果明确;右SAA治疗中应在右锁骨下动脉和右颈总动脉分叉处的切线位角度,使分叉部位完全展开,尽量覆盖开口;对于短瘤颈平行支架植入效果较好;锁骨下动脉瘤位于第3段时,术后易出现支架内狭窄,要注意远期随访。     

血管内治疗基底动脉瘤

目的探讨经血管内治疗基底动脉瘤的有效性、安全性。方法 30例患者中基底动脉顶端动脉瘤6例,基底动脉干动脉瘤24例;其中夹层动脉瘤10例,梭形动脉瘤9例,囊状动脉瘤11例;未破裂动脉瘤14例,发生过破裂出血16例。在全身麻醉下进行血管内治疗,观察其安全性和治疗效果。结果 30例技术成功率100%,术后均未发生再出血,无新增神经功能缺失,无死亡病例,随访3个月至2 a,原有症状均明显改善。夹层动脉瘤10例中,单纯支架置入4例,支架辅助弹簧圈栓塞6例,动脉瘤未见显影,支架位置理想,无狭窄;囊状动脉瘤11例中完全栓塞8例,次全栓塞2例,部分栓塞1例,支架均到达理想的预定位置,未狭窄,瘤体未见显影;梭形动脉瘤9例中单纯支架置入6例,双支架置入3例,瘤体未见显影,支架位置理想,无狭窄。数字减影血管造影(DSA)复查9例,其中6例基底动脉梭形动脉瘤行支架置入者瘤体明显减小;2例基底动脉顶端宽颈动脉瘤行支架辅助弹簧圈部分栓塞,其中1例瘤腔基本消失,1例瘤体大小无变化;1例基底动脉中下段囊状宽颈动脉瘤单纯支架置入者未发现支架内狭窄,4个月后复查DSA示动脉瘤明显缩小,支架内血流通畅。结论血管内介入治疗为基底动脉瘤的治疗提供了微创和较为安全、有效的治疗方法。     

Transcatheter Aortic Valve Implantation Assisted with Microcatheter: A New Method to Avoid Coronary Artery Obstruction

Background:

Lack of fluoroscopic landmarks can make valve deployment more difficult in patients with absent aortic valve (AV) calcification. The goal of this article was to evaluate the feasibility and effectiveness of transcatheter implantation of a valved stent into the AV position of a goat, assisted with a microcatheter which provides accurate positioning of coronary artery ostia to help valved stent deployment.

Methods:

The subjects were 10 healthy goats in this study. A microcatheter was introduced into the distal site of right coronary artery (RCA) through femoral artery sheath. A minimal thoracic surgery approach was used to access the apex of the heart. The apex of the left ventricle was punctured; a delivery catheter equipped with the valved stent was introduced over a stiff guidewire into the aorta arch. We could accurately locate the RCA ostia through the microcatheter placed in the RCA under fluoroscopy. After correct valve position was confirmed, the valved stent was implanted after rapid inflation of the balloon. The immediate outcome of the function of the valved stents was evaluated after implantation.

Results:

All ten devices were successfully implanted into the AV position of the goats. Immediate observation after the procedure showed that the valved stents were in the desired position after implantation by angiography, echocardiogram. No obstruction of coronary artery ostia occurred, and no moderate to severe aortic regurgitation was observed.

Conclusions:

When the procedure of transcatheter implantation of a balloon-expandable valved stent into the AV position of goats is assisted with microcatheter positioning coronary artery ostia, the success rate of operation can be increased in those with noncalcified AV.     

冠状动脉支架植入术前血清OX40配体与术后6个月心血管事件的相关性

目的 探讨冠状动脉支架植入术前血清OX40配体（OX40L）对术后6个月患者心血管事件临床预测价值。方法 于2011年3月至2013年7月收集在我院心内科冠心病患者156例,所有患者均在冠状动脉支架植入术前检测血清OX40L水平,术后内科标准化治疗,随访6个月根据心血管事件发生情况分为事件组和无事件组。结果 在147例有效随访患者中,事件组患者31例（21.09%）,无事件组患者116例（78.91%）;事件组患者血清OX40L水平（1.79±0.59）ng/mL明显高于无事件组患者（1.27±0.37）ng/mL,（P〈0.01）;事件组患者心血管危险因素校正后,血清OX40L仍然是心血管事件独立的危险因素（P〈0.05）。结论 冠心病患者支架植入术前血清OX40L水平对术后6个月内心血管事件有很好的临床预测价值。     

移植肾动脉狭窄及移植肾动脉瘤9例介入治疗总结

目的：总结移植肾动脉狭窄、移植肾动脉瘤的介入治疗措施，为进一步提高移植肾长期存活率提高经验。方法：回顾分析9例移植肾动脉狭窄及移植肾动脉瘤患者的临床资料。对7例移植肾动脉狭窄患者球囊扩张狭窄部后放置支架，2例移植肾动脉瘤患者1例向瘤腔注入凝血酶，1例放置覆膜支架。结果：7例动脉患者6例治疗成功，术后3天Cr降至106μmol/L以下；1例动脉瘤注入凝血酶致移植肾栓塞破裂切除移植肾，1例动脉瘤放置覆膜支架治疗成功。结论：介入下球囊扩张支架置入是处理移植肾动脉伯理想方法，移植肾动脉放置覆膜支架是治疗移植肾动脉瘤的重要手段。     

Solitaire AB支架取栓术治疗急性大脑中动脉闭塞的疗效分析

目的探讨Solitaire AB支架取栓术治疗急性大脑中动脉闭塞的临床效果。方法急性大脑中动脉闭塞患者15例,用Solitaire AB支架取栓治疗,观察其疗效、围术期的并发症以及随访情况。结果手术过程中15例患者均能从大脑中动脉取出血栓,数字减影血管造影显示血管再通,血管再通后30 min数字减影血管造影检查显示脑血管均无再次闭塞。术后15例患者肢体偏瘫症状均有不同程度改善。1d后脑计算机断层扫描血管造影显示,大脑中动脉无再次闭塞13例（86.7%）,症状好转;大脑中动脉再次闭塞2例（13.3%）,且患者肢体、语言、意识障碍等功能障碍进行性加重。结论 Solitaire AB支架取栓治疗大脑中动脉急性闭塞血管再通率高,操作简单,但仍有部分患者会出现大脑中动脉再次闭塞。     

单分支支架血管植入技术在急性A型主动脉夹层全弓替换加支架象鼻植入术中的应用

目的 探讨单分支支架血管植入技术简化急性A型主动脉夹层全主动脉弓替换的可行性.方法 2008年6月至2009年9月,福建医科大学附属协和医院心外科23例急性A型主动脉夹层患者接受升主动脉及全主动脉弓人造血管替换和单分支支架血管植入术.当体外循环鼻咽温度降至20℃时,停止下半身灌注,横断左颈总动脉并缝闭其近端开口.于左颈总动脉和无名动脉间横断主动脉弓,将单分支支架血管植入近端胸降主动脉真腔内,并将其分支植入左锁骨下动脉.应用三分支人造血管替换升主动脉和主动脉弓,并与无名动脉、左颈总动脉相连接.结果 术中均能顺利地植入单分支支架血管.平均体外循环时间、心肌阻断时间、下半身停止灌注时间和选择性脑灌注时间分别为( 161±32)、(97±20)、(21 ±4)和(31±6)min.术后无并发症,均痊愈出院.术后3个月电子束CT检查结果示:主干支架血管和分支支架血管通畅,周围无血流,单分支支架血管植入部位的主动脉夹层假腔闭合.结论 应用单分支支架血管直视植入来简化急性A型主动脉夹层全主动脉弓替换是可行的;这种方法避免了常规主动脉弓替换术中较深部位的左锁骨下动脉吻合和左锁骨下动脉远端的远端人造血管-降主动脉吻合.     

Successful Treatment of Coronary Artery Perforation with Emergency Intracoronary Coated Stent Implantation

Coronary artery perforation is a rare but catatrophic complication of percutaneous coronary intervention.We report a case of type Ⅲ coronary artery perforation following stenting at calcified mid-segment of left anterior descending artery.The perforation was successfully covered using a PTFE-coated stent with an excellent clinical and angiographic outcomes.     

Endovascular exclusion of aberrant splenic artery aneurysm with covered stent

The splenic artery arising from the superior mesenteric artery is an uncommon anatomical variant. This aberrant origin may rarely be associated with an aneurysm. Previous cases have been managed with surgery and combined surgical/endovascular or endovascular techniques, with the latter involving occlusion of the aneurysm with coils. We report a case of aberrant splenic artery aneurysm that was excluded with a balloon-mounted covered stent, and discuss the technical issues encountered in using this approach. A follow-up computed tomography performed six months after the covered stent placement showed persistent exclusion with marked shrinkage of the aneurysm sac.     

冠心病患者冠状动脉内成形及支架术前后QT离散度的变化

目的 体表心电图ＱＴ离散度（ＱＴｄ）增大在冠心病患者是预测室性心律失常事件的有用指标。旨在估价冠心病患者经皮冠状动脉腔内成形主支架术（ＰＴＣＡ＋ｓｔｅｎｔ）前后对ＱＴ离散度的影响。方法 对６０例冠心病患者行ＰＴＣＡ＋ｓｔｅｎｔ术前后ＱＴ离散度进行分析。男性４６例,女性１４例,平均年龄５７岁,患者为单支血管病变３６例,多支血管病２４例。本组对ＰＴＣＡ＋ｓｔｅｎｔ术前后同步３导联的标准１２导联心电图Ｑ     

一体式分叉型覆膜支架治疗肾下型腹髂动脉疾病87例临床分析

  目的  探讨使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病的临床经验。  方法  回顾性分析2015年8月至2019年10月昆明医科大学附属延安医院血管介入科使用一体式分叉型覆膜支架实施腔内隔绝术治疗肾下型腹髂动脉疾病87例的临床资料，评价其疗效。  结果  87例患者均成功植入一体式分叉型覆膜支架，成功率100%。术中仅置入1个一体式分叉型覆膜支架15例，接1条腿支架36例，接2条腿支架29例，接3条腿支架4例，接4条腿支架3例。因腹髂动脉角度大、扭曲，于一体式分叉型覆膜支架髂支内置入裸支架5例，远端接裸支架3例，一体式分叉型覆膜支架上方接直筒Cuff覆膜支架1例，先行髂内动脉栓塞术14例，保留双侧髂内动脉13例，保留一侧髂内动脉51例，双侧髂内动脉均封闭23例。术后均使用球囊扩张支架两端及接头。手术时间35～122 min，平均52 min；术中出血10～50 mL，平均23 mL。87例均顺利完成手术。术后1例因肾衰竭、多器官功能衰竭自动出院后死亡，其余均好转出院。术后随访85例2～24个月，均健在，失访1例。术后3～6月复查CTA:支架形态位置良好，无内漏、移位，病变封闭良好  。结论  使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病具有微创、疗效确切、操作简便、成功率高、缩短手术时间、安全、并发症少、术后恢复快等优势，近期、中期疗效较好，远期疗效仍有待观察。     

血管内支架成形术治疗颈动脉狭窄患者的疗效观察

目的探讨应用血管内支巢成形术治疗症状性颈动脉狭窄患者的可行性及安全性。方法对72例症状性颈动脉狭窄患者予以颈动脉支架成形术治疗。结果全组技术成功率100％,术前平均狭窄率为81.7％,术后残余狭窄率〈20％。术后1周内患者症状及神经功能缺损体征有所改善。术中及术后发生心率减慢23例,血压下降15例,血管痉挛7例,发生脑栓塞、高灌注综合征各1倒。随访3个月-1年,共有9例复查了DSA,1例出现轻度再狭窄;未发现支架移位,未发生缺血性脑卒中。结论血管内支架成形术是治疗症状性颈动脉狭窄安全、有效的方法,严格掌握适应证和熟练操作可降低手术风险。     

A case of a zotarolimus-eluting stent fracture in the left anterior descending artery in a patient undergoing hemodialysis

Although stent fracture after implantation of a drug-eluting stent (DES) is a rare complication, it has been suggested to be a cause of restenosis. To date, most DES fractures have been associated with sirolimus-eluting stents. We describe here a case of a zotarolimus-eluting stent fracture after 8 months of stent placement in a calcified left anterior descending artery lesion in a patient undergoing hemodialysis.     

Transvaginal Oocyte Retrieval Complicated by Life-Threatening Obturator Artery Haemorrhage and Managed by a Vessel-Preserving Technique.

We report the case of a 36-year-old woman with secondary infertility who underwent routine transvaginal oocyte retrieval as part of IVF treatment. Four days following the procedure she presented with life threatening haemorrhagic shock. She underwent surgical laparotomy followed by CT and selective angiography, which demonstrated haemorrhage from a pseudoaneurysm of the obturator artery. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent.     

冠状动脉支架内二次血栓形成的原因分析

目的:探讨冠状动脉支架内二次血栓形成(ST)的相关因素、预后及预防措施。方法:对我院2000年3月～2009年12月3854例行冠状动脉介入治疗(PCI)中4例二次血栓形成病人的临床特征、冠状动脉造影及支架置入情况、预后及预防措施等进行回顾性分析。结果:3854例者行冠状动脉支架治疗,4例病人发生二次血栓形成(0.1%),均为急性冠脉综合征病人。其中,男女各2人,吸烟史2例,合并糖尿病3例,高脂血症3例,高血压2例。血栓相关血管累及前降支近段4例,累及右冠状动脉近段1例(1例患者为2个支架内均有血栓形成)。最终造影显示TIMI血流达3级3例。停用波立维1例,血小板聚集率明显增高1例。结论:二次血栓防治策略是积极控制危险因素、治疗原发病、充分的预扩张、血管内超声的应用、应用高压球囊使支架贴壁良好及合理的使用抗血小板药物。