佐他莫司药物洗脱支架与雷帕霉素药物洗脱支架治疗冠心病临床疗效与安全性的Meta分析

目的比较佐他莫司药物洗脱支架（ZES）与雷帕霉素药物洗脱支架(SES)在经皮冠状动脉介入治疗术(PCI)中的临床疗效与安全性差异。方法检索Pubmed、Embase、Chocorane library、Science Direct、CNKI数据库、中国生物医学文献数据库以及相关网站(http://scholar.google.com/),收集建库至2016年1月31日公开发表的有关ZES与SES疗效和安全性比较的随机对照实验（RCTs）,按Chochrane系统评价手册对文献质量进行严格评价,对纳入的RCTs进行资料提取,采用RevMen 5.3软件进行Meta分析。结果共纳入9项RCTs,共6 672例患者,其中ZES组3 434例,SES组3 238例。结果显示：ZES组与SES组总病死发生率（RR=0.99,95%CI=0.83～1.19,P=0.93）、心源性猝死率（RR=0.86,95%CI=0.63～1.19,P=0.37）、主要不良心脏事件发生率（RR=1.05,95%CI=0.93～1.20,P=0.43）、心肌梗死发生率（RR=0.84,95%CI=0.68～1.02,P=0.08）、靶血管血运重建率（RR=1.19,95%CI=0.99～1.42,P=0.06）、支架内血栓发生率（RR=0.82,95%CI=0.46～1.46,P=0.50）差异无统计学意义,靶病变血运重建率（RR=1.49,95%CI=1.18～1.89,P=0.0008）差异有统计学意义。结论现有证据表明,两种药物洗脱支架治疗冠状动脉粥样硬化性心脏病（冠心病）的总死亡发生率、心源性猝死发生率、主要不良心脏事件发生率、心肌梗死发生率、靶血管血运重建率、支架内血栓发生率相似;与ZES相比,SES能明显降低支架术后靶病变血运重建的发生率,但敏感性分析显示该结果不稳定。     

佐他莫司药物洗脱支架与西罗莫司药物洗脱支架治疗冠心病有效性与安全性的meta分析

目的评价佐他莫司药物洗脱支架(zotarolimus-eluting stent,ZES)与西罗莫司药物洗脱支架(sirolimuseluting stent,SES)治疗冠心病的有效性与安全性。方法计算机检索中国生物医学文献数据库、中国期刊全文数据库、维普数据库及万方数据库建库至2015年3月,Pubmed 1990年—2015年3月及Cochrane Library 2015年3期与ZES和SES治疗冠心病相关的随机对照研究文献,根据纳入及排除标准筛选文献,采用Jadad改良法制定的量表对文献质量进行评价,应用Rev Man 5.2统计软件进行meta分析。结果本研究最终纳入文献11篇7171例。meta分析结果显示ZES组与SES组心源性死亡发生率[RR=0.71,95%可信区间(CI)(0.42,1.20),P=0.20]、主要不良心脏事件发生率[RR=1.20,95%CI(0.87,1.65),P=0.28]及确定或可能支架内血栓发生率[RR=0.80,95%CI(0.37,1.75),P=0.58)]比较差异均无统计学意义;但ZES组靶病变血运重建率[RR=2.02,95%CI(1.25,3.26),P=0.004]和靶血管血运重建率[RR=1.62,95%CI(1.05,2.52),P=0.03]高于SES组,心肌梗死发生率[RR=0.77,95%CI(0.60,0.99),P=0.04]低于SES组,差异均具有统计学意义。结论在冠心病支架介入治疗中,ZES较SES能显著增加靶病变血运重建率和靶血管血运重建率、降低心肌梗死发生率,但心源性死亡发生率、主要不良心脏事件发生率及确定或可能支架内血栓发生率与SES相似。     

小型猪颈动脉支架和球囊扩张的血管内超声研究

目的 应用血管内超声(IVUS)探讨小型猪颈动脉支架和球囊扩张后冉狭窄机制.方法 12只中国广西巴马小型猪高脂饲养后随机分两组,每组6只.一组于左侧颈动脉置入7枚支架,另一组于左侧颈动脉行球囊扩张,并于术前、术后即刻、术后13周进行一系列IVUS和DSA检查.结果 13周后IVUS显示支架组和球囊组血管面积分别狭窄(18.31±7.79)%和(37.28±7.89)%.支架内再狭窄与支架内膜增生明显相关(r=0.897,P<0.05);球囊扩张后再狭窄与外弹力膜面积减少显著相关(r=0.856,P <0.05).结论 支架再狭窄与血管内膜过度增生有关,球囊扩张再狭窄与外弹力膜减少有关.     

不同药物洗脱支架在糖尿病患者中应用的比较

目的 对比雷帕霉素、紫杉醇两种不同药物洗脱支架(DES)在糖尿病患者中应用的长期安全性和有效性.方法 入选成功行经皮冠状动脉介入治疗(PCI)术的272例糖尿病患者,根据植入支架类型分为雷帕霉素洗脱支架组(sirolimus-eluting stent,SES,n=133例,189病变),紫杉醇洗脱支架组(paclitaxel-eluting stent,PES,n=139例,288处病变),对比随访6个月时的冠状动脉造影结果和随访2年时的主要不良心血管事件(major adverse cardiacevents,MACE)的发生率.结果 随访6个月时,复查冠状动脉造影发现,SES组最小管腔直径(2.59±0.61) mm vs (2.21±0.92) mm(P＜0.01)显著大于PES组,支架内再狭窄率(16.57±14.24)％ vs (30.75±24.16)％(P＜0.01)和晚期管腔丢失(0.48±0.51) mm vs (0.93±0.72) mm,P＜0.05)显著低于PES组;随访2年时,SES组的总死亡(11.3％ vs 20.1％,P＜0.05)、靶病变重建(target lesion revascularization,TLR)(9.8％ vs 21.6％,P＜0.01)、靶血管重建(target vessel revascularization,TVR)(17.3％ vs 32.4％,P＜0.01)、TVR-MACE(20.3％ vs 35.3％,P＜ 0.01)也显著低于PES组.多因素回归分析显示:应用PES是糖尿病患者PCI术后总死亡(OR=2.453,95％CI=1.012～5.932,P＜0.05]、TLR(OR=2.403,95％ CI =1.051～5.503,P＜0.05)、TVR-MACE(OR=2.296,95％CI=1.237～4.261,P＜0.01)发生的独立危险因素.结论 在临床上对于糖尿病患者PCI术中选择SES相较于PES,可显著降低PCI术后不良心血管事件的发生.     

药物洗脱支架和裸支架在病变静脉桥血管中远期丢失的比较

背景:尽管多项研究证实药物洗脱支架能在病变静脉桥血管中应用,但作者所查目前报道资料较少.目的:回顾性观察药物洗脱支架和裸支架在病变静脉桥血管治疗中管腔晚期丢失和心脏事件发生的关系.设计、时间及地点:分组对照,随访观察,于2002-01/2007-02在北京市通州区潞河医院和北京市安贞医院进行.对象:选择静脉桥血管患者97例,其中药物洗脱支架治疗50例,裸支架治疗47例.方法:行标准的经皮支架置入,置入后即刻进入临床随访,置入后12个月复查桥血管造影.主要观察指标:管腔晚期丢失.心脏事件(死亡,心肌梗死,靶血管和,或靶血管重建).结果:两组性别、年龄、桥血管年龄、合并症等基线资料比较,差异无显著性意义(P>0.05),具有可比性.①药物洗脱支架组50例患者.在59处病变中置入了71枚药物支架,裸支架组47例患者存59处病变中置入了62枚裸支架.药物洗脱支架组操作成功率为94.0%.裸支架组为93.6%(P=0.43).②12个月临床随访,约物洗脱支架组心脏事件发生率明显低于裸支架组(12.05.29.8%.P=0.03).共有54例患者进行了造影随访,其中药物洗脱支架组26例,裸支架组28例,药物洗脱支架组管腔晚期丢失明显低于裸支架组[(0.32±0.65)mm vs.(0.79±1.23)mm,p=0.01].药物洗脱支组架靶血管重建率为6.0%,裸支架组为19.1%(P=0.05).③Cox回归分析表明12个月随访时心脏事件的独立预测因子足裸支架(OR:2.86;CI/:0.98 to 8.34;P=0.05),每一处病变所置入的支架数目(OR:2.92;CI:1.25 to 6.82;P=0.01)和糖尿病(OR:2.37;CI:0.95 to 5.88;P=0.064).结论:和裸支架相比,药物洗脱支架治疗病变静脉桥血管可以明显地降低晚期管腔丢失,从而减少心脏事件的发生.     

老年冠心病患者经皮桡动脉行多支血管支架术临床疗效研究

目的 探讨经皮桡动脉行多支血管支架术治疗老年冠心病患者的近期及远期临床疗效.方法 2003年12月～2009年3月所有经冠脉造影术明确为冠心病并行支架置入治疗225例老年患者,分为置入单支血管组（n=83）和多支血管组（n=142）,多支血管组再分为经皮桡动脉（TRI）组（n=103）和经皮股动脉组（TFI）组（n=39）两个亚组.所有患者均完成了至少一年的临床随访.结果 多支血管组,经皮股动脉途径较经皮桡动脉途径支架置入成功率（97.4% vs 97.1%,P=1.00）无明显统计学意义,而经皮股动脉较经皮桡动脉出血并发症增多（15.4% vs 3.9%,P=0.02）、术后住院时间明显延长（10.5±2.61d vs 7.9±1.15d,P=0.00）,差异有统计学意义.一年随访结果显示,不管经桡动脉入路还是股动脉入路,多支血管组较单支血管组发生主要不良心血管事件（14.8% vs 10.8%,P=0.401）、靶病变血运重建（7.0% vs 6.0%,P=0.76）、支架内再狭窄（4.9% vs 3.6%,P=0.91）均有所增多,但差异无统计学意义.结论 老年冠心病患者经皮桡动脉行多支血管支架术临床预后佳.     

血管内超声对支架后再狭窄的初步探讨

目的：研究血管内超声指导支架置入，改进支架放置是否能降低支架置入后再狭窄，方法：54例患者接受支架置入，所有患者均接受血管内超声检查以达到理想的支架放置，达到预定的血管内超声标准，,澡则将使用高压或较大球囊进一步扩张。术后及6个月后行血管内超声测量，分别测量支架及参考血管的最小腔内径，外弹力膜面积，腔面积及面积狭窄百分率，术后仅用阿司匹配及抵克力得低替过度抗凝治疗。结果：血管内超声检查表明术后再狭窄组的最小腔内径腑腔面积小于非狭窄组，6个月后，再狭窄组的最小腔内径缩小伴随面积再狭窄率的增加及腔面积的下降，11例再狭窄发生于支架内最小腔内径（术后）＜3mm，而32例支架内最小腔内径（术后）≥3mm中仅1例发生再狭窄（3．1％）， 血管内超声发现12例支架边缘内膜撕裂及8例斑块脱垂，其中8例发生于最小腔内径＜3mm者都发展为再狭窄。10例再狭窄位于支架边缘，结论：支架后超声检查显示支架最小内径未达3mm者，支架内斑块脱垂者，支架两端有内膜撕裂者术后6个月再狭窄率上升。     

国产可降解雷帕霉素药物洗脱支架置入的疗效评价：与金属裸支架比较

背景：药物洗脱支架明显降低了再狭窄率,但永久聚合物涂层在抑制血管平滑肌细胞增生的同时,阻碍血管完全内皮化进程,促使再狭窄发生,且永久聚合物涂层可引发晚期血栓等并发症。目的：观察冠心病合并糖尿患者置入国产可降解药物洗脱支架后的远期疗效和安全性,并与置入金属裸支架患者进行比较。方法：实验组选择冠心病合并2型糖尿病患者136例,首次经皮冠状动脉成形治疗,置入国产可降解药物洗脱支架（EXCELTM）,并以同期行金属裸支架置入治疗的冠心病合并2型糖尿病患者87例为对照组,随访12个月以上,记录主要不良心血管事件发生情况,并复查冠状动脉造影。结果与结论：实验组129例,对照组83例完成（13.5±3.5）个月随访,实验组及对照组分别有8例及12例患者发生不良心血管事件,两组间差异有显著性意义（P=0.045）,对照组靶血管血运重建及再发心绞痛多于实验组（P〈0.05）。两组患者随访冠状动脉造影的定量分析提示实验组最终丢失指数小于对照组（P〈0.05）,再狭窄率低于对照组（P〈0.05）。说明对于冠心病合并糖尿病患者,应用国产可降解药物洗脱支架可降低不良心血管事件发生率,减少再狭窄,改善患者远期预后,安全性能良好。     

双对吻挤压术与即兴支架置入术治疗冠状动脉分叉病变的对比研究

背景：多种分叉病变的治疗焦点仍然在于最佳置入方法是单支架置入还是双支架置入。 目的：比较双对吻挤压与即兴支架置入治疗冠状动脉分叉病变的疗效和安全性。 设计、时间及地点：非随机对照前瞻性试验，于2006—08／2007—04于南京市第一医院完成。 对象：入选62例真性分叉病变需行经皮冠状动脉介入治疗的急性冠状动脉综合征患者（目测分支血管直径〉2．0mm）。其中32例患者接受即兴支架置入治疗，30例患者接受双对吻挤压技术治疗。 方法：主支血管及分支血管所置入支架均选用雷帕霉素药物洗脱支架。即兴支架组主支常规置入支架，如果球囊对吻后分支仍然有大于50％残余狭窄或有影响前向血流的夹层出现则根据术者经验采取T支架、Culotte支架或Reverse crush支架术。双对吻挤压组按常规置入支架。 主要观察指标：比较两组患者支架置入后即刻及置入后6-9个月的冠状动脉造影结果。随访终点为1年内主要不良心脏事件。 结果：两组患者基线特征具有可比性（P〉0．05）。冠状动脉造影测得支架置入后即刻双对吻挤压组分支血管开口部位最小管腔直径明显大于即兴支架组（P〈0．01），同时双对吻挤压组残余狭窄度显著小于即兴支架组（P〈0．01）。6-9个月造影随访结束，双对吻挤压组分支血管最小管腔直径显著大于即兴支架组（P〈0．01），残余狭窄度小于即兴支架组（P〈0．01）。即兴支架组晚期管径丢失较双对吻挤压组有增高趋势，但差异无显著性（P〉0．05）。住院期间两组均无主要不良心脏事件，1年随访期间双对吻挤压组发生1例主要不良心脏事件，即兴支架组发生4例主要不良心脏事件（P〉0．05）。 结论：双对吻挤压与即兴支架置入治疗冠状动脉真性分叉病变均有良好的疗效及安全性。由于双对吻挤压可以有效降低分支血管再狭窄率及主要不良心脏事件的发生率，故具有潜在优势。     

血管内超声在冠脉内支架植入术中的临床应用

目的:通过血管内超声(IVUS)评价冠脉内支架植入前后动脉壁形态学改变及斑块形态对支架膨展的影响,探讨该技术在支架植入术中的临床应用价值.方法:15例冠心病患者在支架植入前后靶病变处,使用30MHz、2.9F机械旋转式超声导管施行IVUS成像.测量支架植入前后靶病变处外弹力膜横截面积、斑块+中膜面积及腔面积,并评价血管壁的形态学特点.结果:15处靶病变在支架植入前后血管造影直径狭窄百分比由76±11%降至8±10%.超声上,外弹力膜面积由支架植入前的10.8±3.6mm2增至14.1±2.9mm2,斑块面积则从8.3±1.4mm2降至6.5±1.6mm2(P均＜0.01),而管腔面积由于外弹力膜面积增加及斑块面积的缩小,由植入前的4.5±1.8mm2增至6.5±2.3mm2(P＜0.05).15处靶病变中,钙化斑块、纤维混合斑块、软斑块分别为3例,8例,4例.偏心班块占73.3%,同心斑块26.7%.IVUS发现PTCA后87%(13/15)存在夹层,其中一些伴有管腔内的小内膜片,而造影则为40%(7/15).符合IVUS支架植入最佳标准者占27%(4/15).有3例(20%)在支架边缘处发现存在内膜撕裂或小裂隙.1例在操作过程中冠脉痉挛,导管后撤及冠脉内注入硝酸甘油后消失.结论:IVUS在发现PTCA术后血管夹层方面比CAG更加敏感.冠脉支架植入后,血管的伸展和斑块的减少均参与了管腔的增加.钙化病变影响支架的最佳膨展.此技术安全可行,可用来指导支架的植入.     

Assessment of potential relationship between wall shear stress and arterial wall response after bare metal stent and sirolimus-eluting stent implantation in patients with diabetes mellitus

BACKGROUND: Wall shear stress (WSS) has been associated with neointimal hyperplasia (NIH) following bare metal stent (BMS) implantation. Drug-eluting stents (DES) almost abolish NIH. Conversely, diabetes mellitus amplifies NIH response. The association between WSS and arterial wall response following DES and BMS implantation in diabetic patients remains to be evaluated. METHODS: The study involved 20 diabetic patients randomized to BMS (n = 9) or sirolimus-eluting stent (SES; n = 11) implantation in native coronary arteries. A computational fluid dynamic model applied 3D intravascular ultrasound (IVUS) and two-plane angiographic to measure WSS (Pa). IVUS assessments were performed post-procedure and at 9-months follow-up. The target segment encompassed the stent plus 5 mm distal and proximal edges. A total of 93 subsegments were evaluated: in-stent segments divided in three subsegments (proximal, mid and distal; n = 60) and proximal and distal edges (n = 33). RESULTS: Stent length was similar between BMS (17.4 +/- 7.3 mm) and SES (19.8 +/- 6.8 mm) groups. NIH was observed in all BMS subsegments (n = 27) versus one subsegment in the SES group (n = 33). WSS ranged from 0.52 to 4.20 Pa in the BMS and from 0.42 to 3.06 Pa in the SES group. There was no correlation between WSS and NIH in either stent group. In addition, there were no correlation between the change of external elastic membrane (EEM) or plaque growth at the edges and WSS. CONCLUSION: WSS was not associated with NIH after implantation of SES or BMS in diabetic patients. Plaque growth or the change of EEM at the edges were not associated with WSS either.     

Serial changes of minimal stent malapposition not detected by intravascular ultrasound: follow-up optical coherence tomography study

Morphologic changes of small-sized post-stent malapposition have not been sufficiently evaluated. We investigated serial changes of minimal post-stent malapposition with a follow-up optical coherence tomography (OCT) study. Post-stent OCT and intravascular ultrasound (IVUS) and follow-up OCT were performed in 26 patients with minimal post-stent malapposition. Serial changes of number and percent of malapposition struts, and mean extra-stent malapposition area were measured in OCT analysis. Zotarolimus-eluting stent (ZES), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES) were deployed in 17, 7 and 2 patients, respectively. Mean durations of the follow-up OCT study were 5.7 ± 3.0 months. The minimal post-stent malapposition cannot be detected by the IVUS, but be visualized with an OCT examination. According to different drug-eluting stents, malapposed stent struts were defined as the struts with detachment from the vessel wall ≥160 μm for SES, ≥130 μm for PES, and ≥110 μm for ZES. The percent of malapposition struts significantly decreased from 12.2 ± 11.0% post-stent to 1.0 ± 2.2% follow-up (P < 0.001). There was a significant decrease in the mean extra-stent malapposition area from 0.35 ± 0.16 mm² post-stent to 0.04 ± 0.11 mm² follow-up (P < 0.001). Complete disappearance of stent malapposition was also observed in 22 (85%) patients. In conclusion, minimal stent malapposition which is not detectable by IVUS may disappear or decrease in follow-up OCT evaluation.     

Comparison of intravascular ultrasonic imaging with versus without incomplete stent apposition at follow-up after drug-eluting stent implantation

BACKGROUND: Incomplete stent apposition (ISA) at follow-up has been reported to be more common after drug-eluting stent (DES) implantation than after bare-metal stent (BMS) implantation. The aim of this study was to use intravascular ultrasound (IVUS) to evaluate the coronary characteristics after drug-eluting stent implantation in patients with ISA at follow-up. METHODS: From the IVUS database of our institute, a total of 89 patients with 125 native lesions who underwent DES implantation into de novo lesions with IVUS imaging at 6-month follow-up were identified, and 15 (16.9%) patients had documented ISA at follow-up by IVUS. The ISA group was compared with a matched control group of patients (n = 30) who had no evidence of ISA at follow-up. RESULTS: Of the 15 documented ISA at follow-up after DES implantation, two located at the edge (within 5 mm from stent margin) while 13 in the body of the stent. The maximum area and arc of ISA measured 5.3 +/- 2.2 mm(2) and 163 +/- 67 degrees , respectively. In patients with ISA, the maximum EEM area of stent segment with ISA was significantly larger than the adjacent stent segment without ISA (24.1 +/- 3.3 vs. 20.1 +/- 3.1 mm(2), P = 0.002), while stent area, plaque plus media (P&M) area and intrastent lumen area were comparable (P > 0.05). Compared to the matched control cohort without ISA at follow-up, the maximum EEM area was also significantly larger (24.1 +/- 3.3 vs. 18.8 +/- 4.2 mm(2), P < 0.001), while the areas of reference EEM and lumen, stent, P&M behind the stent, intimal hyperplasia and intrastent lumen were all comparable between the two groups (P > 0.05). CONCLUSION: ISA at follow-up after DES implantation for de novo coronary lesions was associated with a larger EEM area.     

Serial angiographic and intravascular ultrasound evaluation to interrogate the presence of late ��catch-up�� phenomenon after cypher? sirolimus-eluting stent implantation

Despite the expressive reduction in the intimal hyperplasia (IH) formation after DES implantation at the mid-term, late restenosis has been recently noticed. Our objective was to determine, by means of serial angiography (QCA) and intravascular ultrasound (IVUS) at two different time points, whether the occurrence of the "late catch-up" phenomenon occurs after sirolimus-eluting stent (SES) implantation. Thirty-eight non-complex patients treated with a single 18-mm SES who had systematic serial QCA and IVUS analyses at mean 8 and 20?months were enrolled. Primary endpoint is to evaluate the temporal course of IH formation after SES implantation, by comparing QCA in-stent late loss and IVUS percent IH obstruction between the invasive follow-ups. Mean cohort age was 59.3?years and 31.6% were diabetics. Baseline reference vessel diameter was 2.8 ± 0.4?mm and lesion length was 11.5 ± 3.5?mm. Left anterior descending artery was the most frequent target vessel (55.3%). Between 8 and 20?months, a non-significant increase in in-stent late loss from 0.10 ± 0.18 to 0.15 ± 0.30?mm (P?=?0.38) was observed. By IVUS, a slight increase in the percent IH obstruction (1.03 ± 2.13 to 1.76 ± 1.87%, P?=?0.12) was detected between the two evaluations. Interestingly, all the neoformed tissue accrued from 8 to 20?months accumulated in the distal portion of the stent. In the non-complex scenario, SES implantation was associated with a minimal, non-significant increase in the IH volume between 8 and 20?months.     

Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study

This study was designed to compare neointimal hyperplasia and peri-stent arterial remodeling after implantation of everolimus-eluting stent (EES) versus sirolimus-eluting stent (SES) using intravascular ultrasound (IVUS). The study population was a subgroup of 278 patients from the EXCELLENT trial, a randomized study comparing EES to SES in de novo coronary artery lesions (total n = 1,443, 3:1 randomization) who underwent post-PCI and 9-month follow-up IVUS evaluation. There were 209 patients in the EES group and 69 in the SES group. Baseline clinical and angiographic characteristics were similar between the two groups except for age and target lesion locations. At 9 months, percent neointimal volume obstruction did not differ between EES and SES (2.6 ± 4.0 % vs. 2.5 ± 4.8 %, p = 0.814). However, the relative change in the vessel (4.3 ± 13.7 % vs. 8.8 ± 18.6 %, p = 0.030) and plaque volume index (4.2 ± 17.4 % vs. 10.5 ± 22.3 %, p = 0.016) of the stented segment from post-intervention to follow-up was significantly less with EES than with SES. In addition, positive peri-stent vascular remodeling defined as an increase in vessel volume index >10 % (27.8 vs. 42.0 %, p = 0.027) and late acquired stent malapposition (LASM, 1.9 vs. 15.9 %, p < 0.001) were observed less frequently with EES than SES. EES and SES were similarly effective in reducing neointimal hyperplasia. However, positive peri-stent vascular remodeling and LASM occurred less frequently with EES than SES.     

光学相干断层成像对冠状动脉支架植入后高压球囊后扩张的指导作用

目的 评价光学相干断层成像(OCT)在冠状动脉支架植入后高压球囊后扩张的作用.方法 回顾性分析2007年7月至2009年7月连续在本研究所住院并行冠状动脉介入治疗的冠心痛患者29例,年龄40～77岁,平均(59.2±4.5)岁.按标准方法行冠状动脉造影术及支架植入术,分别在支架命名压扩张和高压球囊后扩张后行OCT检查,分析支架小梁贴壁情况和内膜脱垂及微小夹层的发生情况.结果 29例患者均顺利完成OCT检查,围手术期内无心绞痛和心衰并发症的发生.高压球囊后扩张后支架小梁与血管壁的距离(94.00±22.42)μm明显短于支架命名压扩张后的距离(137.38±26.80)μm,差异有统计学意义(P<0.01).高压后扩张后内膜脱垂和微小夹层的发生(分别为14处和0处)明显少于支架命名压扩张后内膜脱垂和微小夹层的发生(分别为32处和5处),两者差异均有统计学意义(P<0.05).结论 OCT时支架植入术后行高压球囊后扩张有一定的指导作用.     

冠状动脉介入术中支架影像增强显影技术与血管内超声对照研究

目的探讨支架增强显影技术(stentboost,SB)在评价支架植入效果和指导支架内球囊后扩张与血管内超声(intravascular ultrasound,IVUS)的相关性。方法 26例患者在支架植入、支架内球囊后扩张时,完成了冠状动脉造影定量分析(quantative coronary angiography,QCA)、SB技术、IVUS检查,植入支架35枚。分别通过QCA、SB、IVUS获取支架植入、支架内球囊后扩张完成时支架直径,计算支架偏心指数;各项检查所测支架植入、支架内球囊后扩张完成时支架直径和支架偏心指数的自身对照,检查之间所测数据进行相关性分析。结果 QCA、SB、IVUS测量的支架内球囊后扩张完成时支架直径均较支架植入时明显增加,支架偏心指数[(最大支架直径-最小支架直径)/最大血管直径]降低。SB与IVUS测量的支架植入时、支架内球囊后扩张完成时的支架平均直径具有最好的相关性(r=0.982,P0.01;r=0.985,P0.01);而且QCA与IVUS也具有较好的相关性(r=0.975,P0.01;r=0.978,P0.01);QCA与SB也明显相关(r=0.972,P0.01;r=0.976,P0.01)。结论支架内球囊后扩张完成时支架偏心指数较支架植入时更低,与QCA相比,SB与IVUS测量的支架植入时、支架内球囊后扩张完成时的支架平均直径有更好的相关性。     

雷帕霉素洗脱支架与紫杉醇洗脱支架在急性心肌梗死直接经皮冠状动脉介入治疗中的疗效比较

目的 比较雷帕霉素洗脱支架(Firebird)与紫杉醇洗脱支架(Coroflex)在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗中的有效性和安全性.方法 连续入选220例急性ST段抬高型心肌梗死患者,随机分入Firebird组(112例)和Coroflex组(108例),分析患者冠状动脉的靶血管特点、手术成功率及术后随访情况.主要终点为术后12个月主要不良心脏事件(包括死亡、心肌梗死和靶血管重建),次要终点为9个月晚期管腔丢失和支架内再狭窄.结果 手术成功率100％;术后9个月冠状动脉造影随访Firebird组与Coroflex组支架内晚期管腔丢失和支架内再狭窄的发生率差异无统计学意义(P＞0.05);术后12个月Firebird组和Coroflex组死亡(2.7％ vs 1.8％,P＞0.05)、心肌梗死(2.7％ vs 1.8％,P＞0.05)、靶血管重建(2.7％ vs 2.8％,P＞0.05)、主要不良心脏事件(4.5％ vs3.7％,P ＞0.05)及支架内血栓形成(2.7％ vs 1.8％,P＞0.05)的发生率差异均无统计学意义.结论 Firebird支架与Coroflex支架在直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死中的近期疗效和安全性是一致的.