药物洗脱支架与血管内放射治疗在支架内再狭窄中运用的Meta分析

目的 比较药物洗脱支架与血管内放射治疗在支架内再狭窄治疗中的疗效及安全性.方法 利用文献检索方法收集国内外治疗支架内再狭窄的对比研究,对符合入选条件的文献采用RevMan 5.1软件进行Meta分析.结果 入选13篇文献,共纳入病例2 312例,其中药物洗脱支架组1 259例,血管内放射治疗组1 053例.Meta分析显示:药物洗脱支架组再发支架内狭窄(P ＜0.000 01)、晚期管腔丢失(P ＜0.000 01)、靶血管血运重建(P=0.03)和主要不良心血管事件(P=0.004)均明显低于血管内放射治疗组.药物洗脱支架组晚期支架血栓发生率和死亡率与血管内放射治疗组相比差异均无统计学意义.结论 Meta分析显示,药物洗脱支架治疗支架内再狭窄在降低支架再次狭窄、减少晚期管腔丢失、靶血管血运重建方面明显优于血管内放射治疗,但不能减少晚期支架血栓形成及降低患者的死亡率.     

国产药物洗脱支架在冠心病中的临床应用

目的评价国产药物洗脱支架(Firebird)临床应用的安全性和有效性。方法对110例冠心病患者置入Firebird支架治疗,术后对患者进行随访,观察有无胸痛复发、心电图异常改变、重要心脏不良事件发生等。结果110例患者共置入Firebird支架146枚,手术即刻成功率100%。对患者至少随访3个月,平均8个月,无重要心脏不良事件发生,38例患者6个月后复查造影2例出现再狭窄,再狭窄率5.2%。结论Firebird支架置入即刻成功率高,能有效预防PCI术后再狭窄,治疗冠心病安全、有效。     

依维莫司洗脱支架与西罗莫司洗脱支架治疗冠心病的Meta分析

目的：比较依维莫司洗脱支架（everolimus-elutingstents,EES）与西罗莫司洗脱支架（sirolimus-elutingstents,SES）治疗冠心病的有效性和安全性。方法：计算机检索PubMed、EMbase、Cochrane图书馆、CNKI全文数据库,收集2000－2012年公开发表的关于EES和SES比较治疗冠心病的疗效和安全性的随机对照试验（randomizedcontrolledtrials,RCTs）。对纳入的研究进行资料提取和方法学质量评价后,采用RevMan5.0软件进行Meta分析。结果：共纳入10个RCTs,12937例患者,其中EES组6378例,SES组6559例,Jadad评分均≥3分。Meta分析结果显示,EES组在明确的支架内血栓形成率方面明显低于SES组（OR=0.47,95%CI=0.26~0.85,P=0.01）,而在靶病变血运重建率（OR=0.85,95%CI=0.70~1.03,P=0.11）、靶血管血运重建率（OR=0.92,95%CI=0.77~1.09,P=0.33）、心源性死亡率（OR=0.91,95%CI＝0.69～1.20,P=0.52）、主要心脏不良事件（OR=0.89,95%CI＝0.78～1.02,P=0.09）以及心肌梗死再发生率方面（OR=0.95,95%CI＝0.75～1.19,P=0.63）,2组差异无统计学意义。结论：相比于SES,EES可以有效降低明确的支架内血栓发生率。     

生物可吸收支架与药物洗脱支架治疗冠状动脉小血管病变的比较研究

目的:系统评价生物可吸收支架(BVS)与药物洗脱支架(DES)治疗冠状动脉小血管病变的安全性和有效性.方法:系统检索PubMed、中国知网、万方等数据库中对比BVS与DES的随机对照试验研究文献,时间跨度为2009年1月至2020年3月.根据改良Jadad量表评价文献质量.采用RevMan 5.3软件进行Meta分析....     

血管内超声与冠状动脉造影指导冠状动脉支架置入术对比分析

目的 研究分析血管内超声和冠状动脉造影指导冠状动脉支架置入术的临床效果.方法 选取2014年9月—2015年9月该院收治行支架置入手术冠心病患者160例,随机分为两组,各80例.观察组给予血管内超声指导下治疗,对照组给予动脉造影指导下治疗.对比两组手术效果.结果 观察组置入率和不达标率分别为93.75%、5.33%,均优于对照组的76.25%、16.39%,差异有统计学意义(P<0.05).观察组心绞痛复发率、再狭窄率8.75%、11.25%,与对照组的7.50%、12.50%相比,差异无统计学意义(P>0.05);观察组术后死亡率2.50%,显著低于对照组的10.00%,差异有统计学意义(P<0.05).结论 在冠状动脉支架置入术中采用血管内超声指导相比于冠状动脉造影指导,可有效提高置入率,扩大置入支架后血管总截面积和斑块面积,降低死亡率,值得临床推广.     

血管内超声与传统指导药物涂层支架内再狭窄的临床结局比较

目的比较血管内超声(IVUS)与传统指导药物涂层支架内再狭窄(ISR)的临床结局。方法纳入2014年1月至2015年6月因药物涂层支架ISR于我院行再次经皮冠状动脉介入治疗的冠心病患者100例。把患者随机纳入血管内超声组(IVUS组)或传统组,每组各50例。IVUS组的患者经造影检查确诊ISR后,马上行IVUS评定ISR的分型,根据分型结果指导治疗。造影检查时记录两组患者的直径狭窄百分数,回顾分析此前两组患者的病变靶血管、支架直径、支架长度以及病变长度。两组患者在出院后3、6、9月电随访患者的全因死亡、主要心血管事件、典型心绞痛发作次数、再次住院次数等情况。出院12月,两组患者均住院再次行造影检查和IVUS检查,再并继续记录上述不良事件的发生情况。结果造影检查的结果显示,两组患者直径狭窄百分数的差异没有统计学意义,两组患者的病变靶血管、支架直径、支架长度以及病变长度的差异均没有统计学意义,可认为两组患者在临床基线水平的支架植入情况相当。12月后所有患者复查造影检查和IVUS检查,造影检查的结果显示,IVUS组的直径狭窄百分数和支架再狭窄均显著低于传统组,而IVUS结果则显示,两组患者在平均支架面积、平均管腔面积、最小支架面积以及平均支架体积的差异均没有统计学意义,IVUS组的平均内膜增生面积、平均内膜增生面积百分数、内膜增生面积百分数、平均内膜增生容积以及平均内膜增生容积百分数均显著少于传统组。两组患者在12个月的随访期内,均没有发生全因死亡或主要心血管事件,其中IVUS组典型心绞痛发作89人次,再住院10人次,传统组典型心绞痛发作151人次,再住院21人次,但差别没有统计学意义。结论与传统指导比较,IVUS指导ISR的治疗,前者可降低支架再狭窄,同时减少患者典型心绞痛的发生次数和再住院次数,这可能与IVUS指导治疗策略的选择能有效抑制血管内膜的增生有关。     

国产药物洗脱支架治疗冠心病的造影随访结果

目的通过复查冠脉造影观察国产药物洗脱支架择期治疗冠心病的临床疗效。方法择期接受Firebird支架(雷帕霉素洗脱支架)治疗的57例冠心病患者,78支病变血管的90处罪犯病变置入98枚Firebird支架,随访6~9个月并复查冠脉造影。结果支架内再狭窄率为3.51%。结论国产药物洗脱支架具有良好的临床疗效。     

药物涂层球囊与药物洗脱支架治疗急性心肌梗死的Meta分析

目的 对比药物涂层球囊和药物洗脱支架在接受急诊冠状动脉介入治疗的急性心肌梗死(acute myocardial infarction, AMI)患者中的疗效。方法 通过计算机检索万方、中国知网、PubMed、Cochrane Library等数据库,筛选符合条件的临床研究。采用Rev-Man 5.4软件进行统计学分析。结果 最终纳入7项研究,共905例患者,包括球囊组418例,支架组487例。Meta分析结果表明,两种治疗方案在主要心血管不良事件(OR=1.00, 95%CI:0.55～1.82,P=1.00)、心源性死亡(OR=1.04, 95%CI:0.32～3.34,P=0.95)、再发心肌梗死(OR=1.11, 95%CI:0.38～3.21,P=0.85)、靶血管血运重建(OR=4.93, 95%CI:0.83～29.39,P=0.08)、靶病变血运重建(OR=0.51, 95%CI:0.19～1.38,P=0.18)等方面比较差异无统计学意义;球囊组患者晚期管腔丢失优于支架组(MD=-0.22, 95%CI:-0.32～-0.12,P<0.001)。结论 药物涂层球囊...     

血管内超声与冠状动脉造影对指导冠状动脉支架置入术的对比研究

目的探讨血管内超声(IVUS)在冠状动脉粥样硬化性心脏病(冠心病)支架置入术中的指导价值。方法选择2012年4月至2013年12月南昌市第一医院收治的需行支架置入术的冠心病患者120例,按随机数字表法分为IVUS指导下治疗的IVUS组及冠状动脉造影(CAG)指导下的CAG组,每组60例,比较两组患者支架置入情况及术后12个月的随访结果。结果 CAG组支架置入率显著低于IVUS组[76.7%(46/60)比93.3%(56/60),P<0.05];术后IVUS检查CAG组支架不达标率为13.0%(6/46),IVUS组为5.4%(3/56),两组不达标率比较,差异无统计学意义(P>0.05);CAG组及IVUS组两组术后平均支架直径分别为(4.0±0.6)mm,(4.2±0.6)mm,两者术后平均支架直径比较,差异无统计学意义(P>0.05)。12个月随访结果,临床心绞痛复发率、再狭窄率、心脏事件发生率比较,差异均无统计学意义(均P>0.05)。结论 IVUS可以更好地识别组织学特征以及辨别粥样斑块性质,从而提高支架置入的成功率。     

冠脉病变中血管内超声与冠脉造影的比较

目的:比较和评价血管内超声及冠脉造影对冠脉病变的诊断价值.方法:88例诊断为冠心病或可疑冠心病患者(98处病变)进行冠脉造影及血管内超声检查,对病变的最小血管径、直径狭窄率、病变长度及病变形状进行比较.根据超声检查结果,冠脉病变分为钙化斑块、硬斑块及软斑块.钙化斑块为斑块的回声比血管管壁外膜回声强并伴有声影,其范围大于90°;硬斑块为斑块的回声与血管管壁外膜回声大致相同,但后方无声影;软斑块为斑块的回声比血管管壁外膜回声弱.结果:冠脉造影示病变血管狭窄程度(直径狭窄率)及病变长度分别为(32.2±8.7)%,(13.2±6.6)mm,明显低于血管内超声结果(41.4±9.6)%,(22.8±8.5)mm,对于钙化、偏心等病变,血管内超声比较敏感.结论:冠脉造影低估了冠脉病变的严重程度,血管内超声可以明确狭窄冠脉的性状,对冠心病特别是可疑冠心病患者的诊断及介入治疗有重要价值.     

Incidence of thrombosis after implantation of drug-eluting stents in patients with coronary artery disease

Background Randomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents （DES） implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease （CAD） in China.
Methods From December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up： 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird, After two years of follow-up, there were 2176 patients （1245 Cypher, 558 Taxus and 373 Firebird）. All patients were treated with aspirin and clopidogrel over at least 9 months.
Results Among 8190 patients, 17 patients had acute stent thrombosis （0.24%）： 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis： 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%： 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%： 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%： 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up.
Conclusion The first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.     

心绞痛患者冠状动脉造影与血管内超声的对比分析

目的：应用选择性冠状动脉造影和血管内超声（IVUS）对心绞痛患者的冠状动脉病变进行临床对比分析。方法：对125名有典型心绞痛的患者进行选择性冠状动脉造影和血管内超声检测,按心绞痛性质分为稳定型心绞痛组（SA组）和不稳定型心绞痛组（UA组）,比较两组患者冠状动脉狭窄程度、斑块形态和性质的差异。结果：冠状动脉造影显示的病变血管及狭窄程度两组比较差异无统计意义,但是血管内超声显示,UA组病变以脂质斑块多见,SA组病变则以纤维斑块和钙化斑块多见,UA组病变自发性内膜撕裂和血栓形成的比例明显高于SA组。结论：IVUS对于不稳定型心绞痛患者的冠状动脉粥样硬化斑块病变特点的诊断明显优于冠状动脉造影,对冠状动脉介入手术方案的选择至关重要。     

血管内超声在直接支架置入术治疗冠状动脉狭窄的临床研究

目的通过血管内超声(IVUS)指导下对进行直接支架置入术治疗冠状动脉狭窄的可行性及疗效的评价进行临床研究。方法对于42例冠状动脉造影显示为A、B1型病变,小于10mm病变、非严重成角病变(多个弯曲>45°)、非钙化病变的病变血管在IVUS的指导下进行冠状动脉内直接支架置入术。结果所有患者均进行了冠状动脉造影和IVUS检查,并在基础IVUS检查后成功地在狭窄病变部位进行了直接支架置入术。患者的病变术后的前向血流均为TIMI3级,在支架置入后均获得满意的冠状动脉造影结果,残余狭窄<10%,没有出现冠状动脉造影可见的夹层,未出现与IVUS相关的严重并发症。住院期间均未发生主要心血管事件。结论在严格掌握好手术的适应证和禁忌证的情况下,血管内超声指导下进行直接支架置入术比传统冠状动脉造影相比,在选择合适的病变血管、达到最佳的置入效果、节省球囊的使用、成功率和安全性等方面都有明显的优势。     

Comparison of two and three dimensional quantitative coronary angiography to intravascular ultrasound in the assessment of left main coronary artery bifurcation lesions

Background Angiographic evaluation of left main coronary artery （LMCA） bifurcation lesions is often limited, twodimensional （2D） quantitative coronary angiography （QCA） with segmental analysis provides accuracy for quantificationof the degree of stenosis in the main vessel and side branch ostium but can be affected by foreshortening and variablemagnification. The accuracy of three dimensional （3D） QCA has recently developed to overcome 2D QCA limitations,however, accuracy and precision of 3D bifurcation QCA measurements in LMCA bifurcation lesions has not beenestablished.Methods We investigated whether such 3D and 2D bifurcation QCA measurements differ in their accuracy in assessingsignificant LMCA bifurcation lesions defined by intravascular ultrasound （IVUS） as a minimum luminal area （MLA） 〈6 mm2of LMCA and MLA 〈4 mm2 of proximal left anterior descending （LAD） and/or proximal left circumflex （LCX）Results LMCA bifurcation lesions were assessed in 44 patients undergoing elective percutaneous coronary intervention.From 2D QCA measurements, MLA correlated moderately with threshold intravascular ultrasound MLA for LMCA （r=0.81,P 〈0.000 1）, LAD 0=0.54, P=0.000 1） and LCX （r=0.58, P 〈0.000 1）. Severity of lesion as MLA by derived 3D QCA,correlated moderately with threshold intravascular ultrasound MLA for LMCA （t=0.84, P 〈0.000 1）, LAD （t=0.53, P=0.000 2）;LCX （r=0.66, P 〈0.000 1）. Overall, the C statistics tended to be slightly higher for 3D QCA and 2D QCA measurementsin LMCA segment compared with proximal LAD and LCX segments, and there were no significant predictive power ofpercent diameter stenosis and percent area stenosis on 3D QCA for LCX IVUS MLA 〈4 mm2 （percent diameter stenosis：area under curve 0.55, cutoff 23%, sensitivity 88%, specificity 37%, P=0.618 6; percent arer stenosis： area under curve0.56, cutoff 41%, sensitivity 83%, specificity 38%, P=0.518 4, respectively）.Conclusions The accuracy of 3D bifurcation QCA in detecting significant LMCA bifurcation lesions is limited, especiallythe proximal LCX ostium. When IVUS is not available or contraindicated, 3D QCA may assist in the evaluation ofintermediate LMCA lesions with MLA.     

Long-term effects of biodegradable versus durable polymer- coated sirolimus-eluting stents on coronary arterial wall morphology assessed by virtual histology intravascular ultrasound

Background  The durable presence of polymer coating on drug-eluting stent (DES) surface may be one of the principal reasons for stent thrombosis. The long-term coronary arterial response to biodegradable polymer-coated sirolimus-eluting stent (BSES) in vivo remained unclear.

Methods  Forty-one patients were enrolled in this study and virtual histology intravascular ultrasound (VH-IVUS) was performed to assess the native artery vascular responses to BSES compared with durable polymer-coated SES (DSES) during long-term follow-up (median: 8 months). The incidence of necrotic core abutting to the lumen was evaluated at follow-up.

Results  With similar in-stent late luminal loss (0.15 mm (0.06–0.30 mm) vs. 0.19 mm (0.03–0.30 mm), P=0.772), the overall incidence of necrotic core abutting to the lumen was significantly less in BSES group than in DSES group (44% vs. 63%, P <0.05) (proximal 18%, stented site 14% and distal 12% in BSES group, proximal 19%, stented site 28% and distal 16% in DSES group). The DSES-treated segments had a significant higher incidence of necrotic core abutting to the lumen through the stent struts (73% vs. 36%, P <0.01). In addition, more multiple necrotic core abutting to the lumen was observed in DSES group (overall: 63% vs. 36%, P <0.05). Furthermore, when the stented segments with necrotic core abutting to the lumen had been taken into account only, DSES-treated lesions tended to contain more multiple necrotic core abutting to the lumen through the stent struts than BSES-treated lesions (74% vs. 33%), although there was no statistically significant difference between them (P=0.06).

Conclusions  By VH-IVUS analysis at follow-up, a greater frequency of stable lesion morphometry was shown in lesions treated with BSESs compared with lesions treated with DSESs. The major reason was BSES produced less toxicity to the arterial wall and facilitated neointimal healing as a result of polymer coating on DES surface biodegraded as time went by.

     

稳定性及不稳定性心绞痛患者冠状动脉病变血管内超声的对比研究

目的探讨稳定性心绞痛(stable angina,SA)及不稳定性心绞痛(unstable angina,UA)患者冠脉斑块在血管内超声(intravascular ultrasound,IVUS)下的表现特征.方法对经冠状动脉造影确诊的7例SA患者、29例UA患者的共55支病变冠脉行IVUS检查.结果SA组主要为稳定型、纤维性斑块,UA组主要为不稳定型、脂质性斑块.钙化性斑块在两组中的分布类似.UA组偏心指数(EI)显著高于SA组(P＜0.05),有以正重构为主的趋势.SA组的血管外弹力膜面积显著高于UA组(P＜0.01).结论SA患者及UA患者的冠脉斑块在性质及结构特点上差异显著.     

Compensatory enlargement in transplant coronary artery disease: an intravascular ultrasound study

Background It is unclear to what extent the “Glagov phenomenon” occurs in transplant coronary artery disease (TCAD). The objective of this study was to evaluate the relationship between intimal hyperplasia and compensatory enlargement in TCAD. Methods Intravascular ultrasound imaging was performed on 190 cardiac transplant recipients at (1.4±0.6) months and again (12.1±0.7) months after cardiac transplantation. Studies 1 year apart were matched at 625 sites. There were 345 coronary artery sites that had an increase in intimal area &gt;10% from baseline to one year, and this comprised the data set of the present study. Results At the first year, 91% of coronary artery sites with intimal growth had a total cross-sectional area stenosis ≤40%, but 38% of the sites showed a decrease of &gt;10% in lumen area. Receiver operating characteristic curve demonstrated that the change in cross-sectional area stenosis cut-off level at year 1 was 8% with a sensitivity of 75% and a specificity of 82% in predicting lumen loss. At a total cross-sectional area stenosis of 20%, sensitivity was 65% with a specificity of 81% in predicting lumen loss. Conclusions In TCAD, vessel enlargement as a compensatory mechanism for plaque growth is generally inadequate. Instead of continued vessel expansion, luminal narrowing develops when there is more than 8% cross-sectional area filled with intimal hyperplasia. In distinction to native coronary artery atherosclerotic disease, the transition point in transplant vasculopathy where the lumen is diminished by increasing intimal growth, occurs at a lower threshold, 20% vs 40% of vessel cross-sectional area.     

Comparison of the incidence of late stent thrombosis after implantation of different drug-eluting stents in the real world coronary heart disease patients: three-year follow-up results

Background Late stent thrombosis （LST） is still concerned by interventions cardiologists in daily clinical practice. This study aimed to compare the incidence of LST after implantation of different drug-eluting stents （DES） in coronary heart disease （CHD） patients in the real world.Methods From December 2001 to February 2009, a total of 11 875 consecutive CHD patients undergone DES implantation were enrolled in this single-center registery study. Patients with acute ST-segment elevation myocardial infarction, mixed DES implantation, restenosis lesions, and patients who could not take dual antiplatlet medication and those who were contraindicated for coronary interventional treatment were excluded. All patients were treated with completed dual antiplatelet medications for at least 9 months after DES deployment. The follow-up was completed by outpatient visits, letter correspondence, phone calls and coronary angiography. Definite LST was diagnosed auording to the Academic Research Consortium （ARC） definition.Results Cypher or Cypher Select stents were implanted in 4104 cases, Taxus or Taxus Liberty stents in 2271 cases and Firebird stents （Chinese rapamycin-eluting stents） in 5500 cases. One-year follow-up was completed in 9693 patients, including 3346 cases with Cypher or Cypher Select stents, 1529 cases with Taxus or Taxus Liberty stents and 4818 cases with Firebird stents. Two- and three-year follow-up results were obtained in 7133 and 4353 patients, respectively, including 2410 and 1760 cases with Cypher or Cypher Select stents, 1285 and 900 cases with Taxus or Taxus Liberty stents as well as 3438 and 1693 cases with Firebird stents. One-year follow-up results showed that the incidence of LST was 1.08% in patients with Cypher or Cypher Select stents, 1.24% in those with Taxus or Taxus Liberty stents and 0.71% in those with Firebird stents; there was no significant difference between those with Cypher or Cypher Select and Firebird stents, but there was significant difference between those with Taxus or Taxus Liberty and Firebird stents （P=0.044）. The incidence of LST at the 2- and 3-year follow-up was 1.33% and 1.70% in those with Cypher or Cypher Select stents, 1.40% and 1.70% in those with Taxus or Taxus Liberty stents, and 0.83% and 0.95% in those with Firebird stents, respectively. There were no significant differences among the three groups.Conclusions This study indicates that first-generation DES are acceptable to treat complex coronary lesions, and there is no significant difference of LST for three different DES.     

Coronary bifurcation lesions treated with double kissing crush technique compared to classical crush technique: serial intravascular ultrasound analysis

Background The double kissing (DK) crush technique is a modified version of the crush technique.It is specifically designed to increase the success rate of the final kissing balloon post-dilatation,but...