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1.
目的比较冠状动脉造影后即刻支架术与择期支架术的成功率和并发症发生率,从而探讨即刻支架术的临床应用价值。方法对2005年1—12月在我科行冠状动脉造影后即刻支架术(即刻组,n=115例)和择期支架术(择期组,n=172例)患者的资料进行分析。结果A型和B型病变的成功率和并发症率两组间差异无统计学意义(P〉0.05),而C型病变的成功率即刻组低于择期组(P〈0.01),而并发症率高于择期组(P=0.05)。结论A型和B型病变冠状动脉造影后即刻支架术是临床可行的,而C型病变不宜冠状动脉造影后即刻支架术。因此,冠状动脉造影后即刻支架术有一定的临床应用价值。 相似文献
2.
闭塞性冠状动脉病变PTCA成功率及影响因素 总被引:4,自引:0,他引:4
目的探讨完全闭塞性和几乎完全闭塞性病变PTCA成功率及其影响因素。方法对35例发生过心肌梗塞和21例未发生心肌梗塞的完全或几乎完全闭塞性病变施行了PTCA。结果完全闭塞性病变心梗发生后1周内PTCA成功率为100%,2周~3个月为66.7%,3个月以后为42.9%;无桥侧支的几乎完全闭塞性病变PTCA成功率为100%,桥侧支丰富的几乎完全闭塞性病变PTCA成功率为62.5%。结论心肌梗塞早期PTCA成功率明显高于心肌梗塞晚期PTCA成功率(P<0.05),无桥侧支的几乎完全闭塞性病变PTCA成功率明显高于桥侧支丰富的几乎完全闭塞性病变的成功率(P<0.05) 相似文献
3.
不稳定性心绞痛临床与冠状动脉造影分析 总被引:15,自引:0,他引:15
为了解不同类型不稳定性心绞痛的冠状动脉(冠脉)造影特点,对388例不稳定性心绞痛患者进行临床及冠脉造影对照分析。结果表明:初发劳力型心绞痛单支血管病变占69.64%,较其他各型多见(P<0.05);静息型心绞痛三支血管病变和左主干病变较其他各型多见(P<0.05),复杂性病变和C型病变检出率也较其他各型高(P<0.05);恶化劳力型心绞痛病变特征介于上述二者之间;梗塞后早期心绞痛“罪犯”病变多为次全闭塞或完全闭塞,较其他各型多见(P<0.05);变异型心绞痛多半仅有轻度冠脉狭窄;梗塞后早期心绞痛血栓比初发、恶化型多见(P<0.05)。提示静息时心绞痛发作者病变更严重,应予积极治疗,对梗塞后早期心绞痛患者应加强抗凝治疗。 相似文献
4.
测量100例(男86例,女14例,平均年龄56.1±5.6岁)冠状动脉造影者的体表心电图QT离散度(QTd),结果显示:冠状动脉狭窄组QTd较冠脉正常组明显延长(P<0.01)。在狭窄程度大于或等于75%组和狭窄小于75%组间,QTd差异显著(P<0.05),说明QTd与冠脉狭窄程度有关(P<0.01)。本文讨论了单支冠脉病变、多支冠脉病变及左室射血分数(LVEF)与QTd的关系,其中单支病变和多支病变的QTd无明显差异(P>0.05),而LVEF>40%和LVEF≤40%两组间,QTd差异非常显著(P<0.01),表明QTd与左室射血功能有关 相似文献
5.
经皮冠状动脉腔内成形术后再狭窄与介入前病变形态学的关系 总被引:3,自引:0,他引:3
目的:探讨国人冠心病经皮冠状动脉腔内成形术(PTCA)后再狭窄与冠状动脉(冠脉)病变类型、部位和病变血管数的关系。 方法:冠心病介入治疗352 例,选择其中65 例(86个病变)术后3~16个月造影随访者,按随访结果分为再狭窄组(n= 38),非再狭窄组(n= 27),分析再狭窄与病变形态学的关系。 结果:再狭窄与多个易患因子、多支病变、病变类型和前降支病变呈正相关,与支架置入呈负相关。再狭窄组C型、钙化病变多见,前降支病变内径丢失比回旋支、右冠脉病变大(P< 0.05),半年内一支血管病变再狭窄率(10.27% )低于二支(41.10% )和三支(48.50% )血管病变再狭窄率(P< 0.0001)。 结论:再狭窄与冠脉病变类型、部位和血管支数相关,C型及钙化、多支和前降支病变再狭窄率高 相似文献
6.
冠状动脉完全闭塞病变的经皮腔内冠状动脉成形术 总被引:1,自引:0,他引:1
我们自1987年12月至1993年10月对55例58支冠状动脉完全闭塞病变(TO)行经皮腔内冠状动脉成形术(PTCA),占同期PTCA总数的18.2%。患者平均年龄56.4±7.5岁,心绞痛患者19例,心肌梗塞患者36例,其中梗塞后10小时内行急诊PTCA2例,1个月内和1个月以后行PTCA分别为6例和28例。TO平均时间68.4±46.6天。完全闭塞和次全闭塞各占65.5%和34.5%。结果显示:病例成功率为89.1%,病变成功率为87.9%;完全闭塞成功率为89.5%,次全闭塞成功率为85.0%。闭塞类型、闭塞时间、闭塞长度等特征对成功率无显著性影响(P>0.05);血管并发症率为12.1%(7/58),处理成功6处,死亡1例。 相似文献
7.
对比分析了老年急性心肌梗塞(AMI)患者行持续灌流法冠状动脉球囊成形术(CPPTCA)20例(36支)和常规冠状动脉球囊成形术(PTCA)18例(24支)的疗效。两组患者术前冠状动脉狭窄的严重程度及左心室功能相似(P>0.05)。与PTCA组比较,CPPTCA对术中阻断血流的心肌有重要保护作用,且术中并发症少(0比38.9%,P<0.01),残余狭窄轻(12%±8%比28%±18%,P<0.05),再狭窄率(0比22%,P<0.05),再梗塞率(5%比33%,P<0.05)及病死率(0比22%,P<0.05)低。 相似文献
8.
目的:观察复杂性冠状动脉病变的腔内成形术的效果,探讨影响其成功的因素。方法:手术按Gruentzig方法进行,术前、后常规服用阿司匹林、抵克力得。结果:90例患110处复杂病变,成功扩张99处,成功率90.0%,B型病变成功率为94.3%(50/53);C型为86.0%(49/57),两无差异(P>0.05)。在27例次完全闭塞性病变中,急性闭塞性病变成功率为92.9%(13/14),慢性闭塞性病变成功率为53.8%(7/13),两差异显(P<0.01)。所有患中死亡1例。结论:影响复杂性冠状动脉病变腔内成形术成功的因素主要有:(1)慢性完全闭塞性病变;(2)导管系统的选择;(3)术操作技术的熟练程度及经验。 相似文献
9.
完全闭塞性冠脉血管成形术中冠脉内支架的应用及其限制因素 总被引:1,自引:0,他引:1
目的 评价冠状动脉(冠脉)内支架在完全闭塞性冠脉血管成形术(PTCA)中应用的指征及其限制因素。方法 82 例冠脉完全闭塞接受PTCA 患者,根据血管病变性质,决定是否给予置入支架治疗。分析支架应用的指征及其限制因素。术后随访6 个月,发生心脏事件者行血管造影复查。结果 82例中,66 例相关冠脉再通成功,成功率为80.5% 。66 例中,A 组23 处病变单纯球囊PTCA 后取得“支架样”效果,其中B1 组30 处病变置入支架,支架置入率45.5% ,B2 组13 处病变存在支架置入的限制因素而未置入支架,占19.7% 。临床随访期间,A 组5 例发生心脏事件,血管造影复查,2 例再狭窄;B1 组仅2例发生心脏事件,造影复查2 例均再狭窄,需再次PTCA;B2 组 5 例发生心脏事件,3 例造影发现再狭窄。闭塞冠脉再通未成功16 例中3 例出现心脏事件,其中1 例死亡。结论 闭塞冠脉再通成功达支架样效果或置入支架有助于改善临床预后,但部分病变存在支架置入的限制因素,不适宜置入支架 相似文献
10.
老年冠心病患者经皮冠状动脉腔内成形术结果评价 总被引:6,自引:1,他引:6
目的评价一组老年冠心病患者行经皮冠状动脉腔内成形术(PTCA)的疗效。方法将65例老年(89支血管)和117例老年前期(149支血管)冠心病患者的PTCA结果作对比研究。结果老年组血管扩张成功率94.4%,临床成功率92.3%,主要并发症发生率为6.1%,再狭窄发生率为32.5%。以上结果与老年前期组比较差异均无显著性。术后症状改善率两组相同,都在90.0%以上。仅老年组再次PTCA频率明显高于老年前期组(x2检验,P值<0.05)。结论对于老年冠心病患者,PTCA是一种有效及安全的冠脉血管重建措施。 相似文献
11.
不稳定型与稳定型心绞痛冠状动脉成形术的比较 总被引:2,自引:0,他引:2
目的 比较不稳定型心绞痛 (UA)与稳定型心绞痛 (SA)患者接受冠状动脉成形术 (PTCA)的疗效。方法 行PTCA的心绞痛患者 2 0 4例 ,分组比较UA与SA患者冠状动脉造影结果及PTCA术的近期和中期疗效。结果 ①分组 :2 0 4例病人中 ,UA组 112例 (5 5 % ) ,SA组 92例 (45 % )。其中UA组心绞痛分级高于SA组 (P <0 0 5 )。②UA组复杂病变血管支数为 74(3 3 % ) ,SA组复杂病变血管 43支(2 0 % ) ,两组比较差异显著 (P <0 0 1) ;而SA组多支血管病变的发生较UA组为多 (P <0 0 5 )。③支架植入情况 :UA组有 114支血管共植入支架 143枚 ,占病变血管数的 5 1% ;SA组 5 4支血管共 67枚 ,占 2 5 % ,两组比较差异显著 (P <0 0 1) ,共 15 6例病人接受支架术。④术后 3 0d内无重大并发症发生 ,UA组复发胸痛较SA组高 (9%vs 3 % ,P <0 0 5 )。⑤随访 3~ 9个月 ,发生心肌梗死 3例 ,其中UA患者2例。复发胸痛两组分别为 12例和 16例 ,占 13 %和 14% ;临床再狭窄发生率分别为 2 0 %和 2 2 % ,均无显著差别。结论 PTCA/支架术对不稳定型与稳定型心绞痛患者的疗效相似 ,即刻成功率高 ,中期疗效满意 相似文献
12.
经皮桡动脉冠状动脉造影及冠状动脉成形术的临床应用 总被引:5,自引:0,他引:5
目的 :评价经皮桡动脉冠状动脉造影术与冠状动脉腔内成形术 (PTCA)的临床应用价值。方法 :有选择性的对 37例患者行经皮桡动脉途径冠状动脉造影及冠状动脉成形术 ,观察其疗效和血管并发症。结果 :1 桡动脉穿刺成功率为 93 8% (有 2例失败 )。 2 14例冠状动脉造影正常 ,17例冠状动脉造影显示 2 6处存在≥ 70 %的狭窄病变 ,适合行冠状动脉介入手术。 2 6处病变有 4处PTCA疗效满意 ,2 2处行PTCA +支架术 ,植入支架 31只。狭窄从 (81± 12 ) %降低至 (10 6± 7 4 ) % ,最小血管直径由 (0 86± 0 12 )mm增加至 (3 0 8± 0 32 )mm。 6例病人行冠状动脉旁路移植术。 3 所有患者术后即拔导管鞘 ,局部压迫 4h。术后并发症的发生率为 3 3% (1例术后的桡动脉闭塞 )。结论 :经桡动脉途径行冠状动脉造影及冠状动脉成形术安全可行 ,其具有穿刺部位出血少、住院时间短的特点 ,可选择性的应用于某些冠心病患者。 相似文献
13.
A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study). 总被引:4,自引:0,他引:4
T Dill U Dietz C W Hamm R Küchler H J Rupprecht M Haude J Cyran C Ozbek K H Kuck J Berger R Erbel 《European heart journal》2000,21(21):1759-1766
AIMS: Rotablation is a widely used technique for the treatment of complex coronary artery lesions but is so far only poorly supported by controlled studies. The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and rotablation in patients with angiographically pre-defined complex coronary artery lesions. METHODS AND RESULTS: At seven clinical sites 502 patients with pre-defined complex coronary artery lesions were assigned to either PTCA (n=250) or rotablation (n=252). Primary end-points were procedural success, 6-month restenosis rates in the treated segments, and major cardiac events during follow-up. Procedural success was achieved in 78% (PTCA), and 85% (rotablation) (P=0.038) of cases. Crossover from PTCA to rotablation was 4% and 10% vice versa (P=0.019). There was no difference between PTCA and rotablation with respect to procedure-related complications such as Q wave infarctions (2.4% each), emergency bypass surgery (1.2% versus 2.4%), and death (1.6% versus 0.4%). However, more stents were required after PTCA (14.9% versus 6.4%, P<0.002), predominantly for bailout or unsatisfactory results. Including bail-out stents as an end-point, the procedural success rates were 73% for angioplasty and 84% for rotablation (P=0.006). At 6 months, symptomatic outcome, target vessel reinterventions and restenosis rates (PTCA 51% versus rotablation 49%, P=0.33) were not different. CONCLUSION: Complex coronary artery lesions can be treated with a high level of success and low complication rates either by PTCA with adjunctive stenting or rotablation. The long-term clinical and angiographic outcome is comparable. 相似文献
14.
Experience of percutaneous transluminal coronary angioplasty in orthotopic cardiac transplant recipients. 总被引:1,自引:0,他引:1
P A Mullins L M Shapiro D A Aravot J P Scott S R Large J Wallwork P M Schofield 《European heart journal》1991,12(11):1205-1207
We evaluated the role of percutaneous transluminal coronary angioplasty (PTCA) in a series of orthotopic cardiac transplant recipients with severe epicardial coronary occlusive disease. Ten orthotopic cardiac transplant patients treated by PTCA up to March 1990 were reviewed. All had significant epicardial coronary artery lesions (greater than 70% stenosis compared with the adjacent healthy artery) and exercise electrocardiogram or isotope perfusion evidence of myocardial ischaemia in the relevant region. Primary angiographic PTCA success was achieved in 12 of the 16 lesions attempted (75%). Mean stenosis improvement was from 80% of adjacent healthy artery (range 70-90%) to 12% (range 0-20%). Median angiographic follow-up of 9 months (2-25 months) is available for all patients. The mean recurrence rate is 33% (4 of 12 successfully treated lesions) defined as greater than 50% reduction in the original gain at the PTCA. We have shown that PTCA is technically possible in a series of cardiac transplant recipients. The primary success and recurrence rates are comparable to the use of PTCA in conventional atherosclerotic coronary disease. 相似文献
15.
One hundred and ninety five patients who underwent successful percutaneous transluminal coronary angioplasty (PTCA) for single vessel disease and have been followed up for more than 6 months are being reported. Angiography was done routinely in first 20 patients (Group 1) 8 to 15 weeks (mean 9.6 weeks) after PTCA. Restenosis (loss of 50% of the initial improvement in luminal diameter) was seen in 4 patients (20%). The remaining 175 patients (Group II) have been followed up clinically and subjected to serial exercise testing. Coronary angiography was performed only if symptoms and/or objective evidence of ischemia recurred. In this group, restenosis suspected clinically and confirmed by angiography occurred in 37 patients (21%), 2 to 23 weeks (mean 12.5 weeks) after PTCA. The restenosis rate for the entire patient population was 21%. In general the restenosed lesions were longer and tighter than the lesions before PTCA. A comparison of 41 patients with restenosis with those who did not have clinical restenosis revealed a proximal left anterior descending artery (LAD) involvement (66% vs 31%, p = 0.01), crescendo unstable angina (37% vs 16% p = 0.05), length of pre PTCA stenotic lesion greater than or equal to 1 cm (41% vs 27.5%, p less than 0.05), absence of intimal haziness in immediate post PTCA angiogram (27% vs 16%, p less than 0.05) and residual stenosis greater than or equal to 25%, (34% vs 14% p less than 0.05) in the restenosis group. Repeat PTCA was done in 30 patients with a 96% success rate; 4 patients required coronary artery bypass grafting (CABG). Restenosis after PTCA is a significant problem in our experience.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
16.
慢性冠状动脉闭塞置入支架术与球囊扩张术的比较 总被引:3,自引:0,他引:3
目的为了解冠状动脉内支架及经皮冠状动脉腔内成形术(PTCA)治疗完全闭塞性冠状动脉血管的临床及冠状动脉造影效果。方法95例完全冠状动脉闭塞的病人随机分成为:置入支架组(A组48例);单纯PTCA组(B组47例),观察二组病人发生临床事件及6个月后的冠状动脉造影效果。结果6个月后两组病人完成临床及冠状动脉造影随访的共85例,随访率为89%,A组42例,B组43例。A组:1例于术后10天内出现心肌梗塞,无1例死亡,其再狭窄率为28.5%,血管再闭塞率为119%,最终重复血管重建术为19%。B组:1例死亡,2例发生急性心肌梗塞,再狭窄率为58%,血管再闭塞率为22%,最终重复血管重建术达45%。两组之间临床疗效差异均有显著性(P<0.001)。结论冠状动脉慢性闭塞的病人PTCA成功后选择性置入支架比单纯PTCA的近期及远期临床疗效预后要好(发生临床事件及重复血管重建术明显下降)。 相似文献
17.
Le Feuvre C Helft G Beygui F Zerah T Fonseca E Catuli D Batisse JP Metzger JP 《Journal of interventional cardiology》2003,16(3):195-199
AIM: The safety and efficacy of ad hoc PTCA has been previously reported and this approach is performed in many angioplasty centers as a routine procedure. The aim of this study is to examine whether this approach reduces the length, and cost of hospital stay. METHODS AND RESULTS: To determine the hospital costs we studied 2,440 PTCAs over 11 years in our institution (1990-2000). Urgent PTCA for acute coronary syndromes refractory to medical treatment were excluded. In 1809 patients (74%) angioplasty was performed immediately after coronary angiography, while separate procedures were performed in 631 patients. Indication for PTCA was unstable angina in 1342 patients (55%). In the ad hoc PTCA group, 92% of the culprit lesions were successfully treated; complications included myocardial infarction (2%), urgent bypass surgery (0.6%) and death (0.9%). The rate of combined procedure progressively increased from 54% in 1990 to 88% in 2000, with a significant decrease in the rate of complications. After adjusting for clinical and angiographic differences between combined and separate procedures, angiographic success and complication rates were not statistically different in the two groups. Mean length of hospital stay decreased all along the years, and was 45% less in the ad hoc PTCA group (11.4 +/- 6.9 vs 18.2 +/- 7.7 in 1990, 5.4 +/- 4.3 vs 10.8 +/- 5.7 in 2000, P < 0.0001). The cost was 40% lower in the ad hoc PTCA group. For patients with stable angina, the savings were 49%, and for those with unstable angina, they were 29%. CONCLUSION: In the era of coronary stenting, ad hoc PTCA can be performed in most of the patients as safely and successfully as a separate procedure. It reduces the length, and the cost of hospital stay in patients with stable or unstable angina. 相似文献
18.
Vascular injury resulting from percutaneous transluminal coronary angioplasty (PTCA) and subsequent thrombus formation are important factors in the pathogenesis of coronary arterial restenosis. The present study was undertaken to determine whether infusions of tissue plasminogen activator (tPA), beginning immediately after PTCA, would decrease the renarrowing of the coronary arterial lumen. Patients were randomized and divided into two groups: one group (15 patients, 16 lesions) received continuous, 3-day, intravenous infusions of tPA (0.25 mg/kg/day in 0.9% saline), beginning immediately after successful PTCA, while the other group (17 patients, 17 lesions) received saline alone. Coronary angiography was performed before, immediately after, 24 hours after, and 3 months after PTCA. Coronary stenosis (%), reference diameters, and minimum luminal diameters were measured by quantitative coronary angiography. The incidence of restenosis tended to be lower in the tPA group than in the placebo group (tPA group, 13%; placebo group, 41%; NS), although diameter stenoses before and immediately after PTCA were not significantly different in the two groups. Three months later, however, diameter stenoses were significantly smaller in the tPA group (35.6 +/- 13.3 vs 47.7 +/- 18.9%; P<0.05). Thus, intravenous tPA infusion beginning immediately after successful PTCA may inhibit renarrowing of the coronary arterial lumen. 相似文献
19.
普通球囊与切割球囊成形术对冠状动脉支架内再狭窄的近远期疗效 总被引:3,自引:1,他引:3
目的 对切割球囊成形术 (CBA)与普通球囊成形术 (POBA)支架内再狭窄病变的近远期血管造影结果比较 ,评价 CBA对支架内再狭窄病变的有效性。方法 37例 ,共 39处病变 ,2 3处进入 CBA组 ,16处进入 POBA组。分别比较术后即刻及远期定量冠状动脉造影最小血管径 (ML D)、狭窄度 (DS)、再狭窄率、即刻管腔获得 (AL G)、即刻血管弹性回缩 (AR)及弹性回缩率 (ARR)。结果 术后即刻 ML D、DS、AL G两组差异无显著性。 CBA组最大扩张压、AR及 ARR均较 POBA组低 (P<0 .0 5或 P<0 .0 0 1)。随访造影结果 ,CBA组 ML D明显大于 POBA组 (P<0 .0 5 ) ;DS及再狭窄率均小于 POBA组 (P<0 .0 1)。结论 CBA组的低压扩张治疗支架内再狭窄病变是有效的 ,对血管损伤小于 POBA,且获得较 POBA低的再狭窄率 ,值得进一步探讨 相似文献