替罗非班联合低分子肝素对急性心肌梗死介入治疗中急性血栓形成的影响

目的:探讨急诊介入治疗急性心肌梗死(AMI)联合应用替罗非班、低分子肝素防治急性血栓形成的效果及安全性.方法:54例AMI患者随机分为对照组(26例)和替罗非班组(28例),所有患者行急诊经皮冠状动脉介入治疗(PCI),术中、术后替罗非班组联合应用替罗非班、普通肝素、低分子肝素,对照组应用普通肝素和低分子肝素,观察2组患者冠脉内急性、亚急性血栓形成、术后远端血流(TIMI)分级情况,并比较无再流、慢血流发生和术后的出血危险性.结果:替罗非班组术后TIMI为0级及TIMIⅠ～Ⅱ级较对照组有显著下降,TIMI Ⅲ级2组比较差异无统计学意义.对照组术中3例发生急性血栓形成,1例发生亚急性血栓形成,2例术后出现肉眼血尿,3个月后有1例经冠脉造影检查确诊为支架内再狭窄.替罗非班组术中1例发生慢血流,2例术后出现肉眼血尿,1例出现牙龈出血,2例血小板减少,无发生急性、亚急性血栓形成和支架内再狭窄.结论:急诊PCI术中、术后联合应用替罗非班、普通肝素、低分子肝素防治急性、亚急性血栓形成,疗效可靠、安全.     

冠脉腔内支架置入术后联合抗凝的探讨

目的：评价冠脉腔内支架置术后低分子肝素、噻氯匹定和阿司匹联合抗凝的效果和安全性。方法：121例行经皮冠状动脉腔内支架置入术的患者，分成择期组86例，不稳定心绞痛低分于肝素抗凝不佳需行急仍支架入术者为急诊组1共15例，急性心肌梗死20例直接支架入术为急诊组2。急诊组1术前不停用分子肝素，术后低分子肝素0．4ml，每12h1次共7d；噻氯匹定0．25g／次，每天两次和阿司匹林0．1g／d，顿服共1月联合抗凝。结果：三组术后1例出现急性、亚急性闭塞，无严重的出血并发症，一周内无心绞痛发作。结论：冠脉腔内支架置术后低分子肝素、噻氯区定和阿司匹林联合抗凝可预防急性、亚急性闭塞，未增加要后出血的发生，安全性好。     

国产生物降解涂层雷帕霉素洗脱支架在急性ST段抬高心肌梗死急诊经皮冠状动脉介入中的应用

目的探讨急性sT段抬高心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）中应用国产生物降解涂层雷帕霉素洗脱支架（EXCEL）的安全性和有效性。方法69例sTEMI患者69处病变行PcI治疗,共置入82枚EXCEL。观察住院期间和6—12个月随访期间的心血管事件及支架内再狭窄的发生。结果68例PCI取得成功,1例术后第4天死于亚急性血栓形成。临床随访12个月,2例出现心绞痛,1例术后7个月再次行PCI。68例患者中复查冠状动脉造影18例,无支架内再狭窄17例,支架内再狭窄1例,无其他主要不良心血管事件发生。结论EXCEL在STEMI患者急诊PCI中应用有较高的安全性和有效性。     

血管内支架在冠状动脉复杂病变成形术中的临床应用

目的探讨血管内支架在冠状动脉复杂病变成形术中的应用效果及价值.方法对冠心病患者复杂冠状动脉病变在经皮穿刺冠状动脉成形术(PTCA)并发急性血管内闭塞、内膜严重撕裂、术后显著残留狭窄及短期内再狭窄等情况下进行了血管内支架植入术(CASI).结果31例患者CASI均获成功,术后急性血管闭塞和内膜撕裂征象消失,残留狭窄及再狭窄解除,未出现出血和穿刺部位血管并发症及CASI后亚急性血栓形成.随访16例,1例术后13天发生猝死;2例因胸痛复发经造影证实支架血管再狭窄,再次球囊扩张后再狭窄改善;余13例冠状动脉造影示支架血管正常.结论冠心病复杂冠状动脉病变行CASI是解除PTCA急性并发症的安全、有效和可行的方法,并有助于PTCA后再狭窄的防治.     

49例冠状动脉介入治疗再狭窄高危患者药物洗脱支架的临床应用

目的:分析经皮冠状动脉介入治疗(PCI)后再狭窄高危患者应用两种药物洗脱支架的临床疗效.方法:在17个月期间对49例再狭窄高危患者行雷帕霉素(Cypher)和/或紫杉醇(Taxus)药物洗脱支架置入术.24例患者接受Cypher支架置入术;25例患者接受Taxus支架置入术.结果:24例患者26支血管的27处病变共置入27个Cypher支架;25例患者36支血管的42处病变共置入42个Taxus支架.对49例患者平均随访7.3个月(1个月～17个月),没有1例发生术后再狭窄或进行靶血管重建或靶病变重建,但有2例在PCI后5 d(Cypher支架)和45 d(Taxus支架)分别发生了亚急性支架内血栓形成.结论:药物洗脱支架置入术即刻成功率高,在再狭窄高危患者的术后近期再狭窄发生率很低,但是术后亚急性支架内血栓形成是一个需要引起特别关注的问题.     

PTCA术后低分子肝素早期抗凝疗效观察

经皮腔内冠状动脉成形术（PTCA）及支架植入术后最重要的并发症是急性和亚急性血栓形成，从而导致急性血栓闭塞。因此，术后早期抗凝治疗非常重要。我们对41例PTCA和支架植入术后患者分别用低分子肝素（LMWH）及普通肝素（SH）进行早期抗凝治疗，以探讨LMWH在PTCA及支架术后早期抗凝的作用．     

因管内支架在冠状动脉复杂病变成形术中的临床应用

目的 探讨血管内支架在冠状动脉复杂病变成形术中的应用效果及价值。方法 对冠心病患者复杂冠状动脉病变在经皮穿刺冠状动脉成形术（ＰＴＣＡ）并发急性血管内闭塞、内膜严重撕裂、术后显著残留狭窄及短期内再狭窄等情况下进行了血管内支架植入术（ＣＡＳＩ）。结果 ３１例患者ＣＡＳＩ均获成功,术后急性血管闭塞和内膜撕裂征象消失,残留狭窄及再狭窄解除,未出现出血和穿刺部位血管并发症及ＣＡＳＩ后亚急性血栓形成。随访１６     

血管内支架在冠状动脉复杂病变成形术中的临床应用

本文报道了 31例冠心病患者冠状动脉复杂病变在经皮冠状动脉成形术 (PTCA)并发急性血管内闭塞、内膜严重撕裂、术后显著残留狭窄及短期内再狭窄等的情况下行冠状动脉内支架植入术 (CASI) ,均获成功 ,术后急性血管闭塞和内膜撕裂征象消失 ,残留狭窄及再狭窄解除 ,未出现出血和穿刺部位血管并发症及CASI后亚急性血栓形成。随访 2 6例 ,1例术后 1 3天发生猝死 ,2例因胸痛复发经造影证实支架血管再狭窄 ,再次球囊扩张后再狭窄有所改善 ,余 2 3例冠状动脉造影示支架血管正常 ,结果表明 ,冠心病复杂冠状动脉病变行CASI是解除PTCA急性并发症的安全有效的方法 ,亦有助于PTCA后再狭窄的防治。     

多个药物支架植入安全性和可行性的临床研究

目的 评估多药物支架植入术的近期疗效及安全性.方法 对我院从2004年6月到2005年12月共34例多个药物支架(≥3枚)植入术进行回顾性分析,对照组为单个支架植入组(n=64)和两支架植入组(n=53),随访术后6月冠状动脉内急性及亚急性血栓形成的发生率、再狭窄和心血管事件的发生率.结果 151例患者PCI治疗均成功.介入治疗1个月随访结果显示,多支架组、两支架组及单支架组均没有发生冠状动脉内血栓形成(P＞0.05),介入治疗6个月随访结果显示,再狭窄及心血管事件发生率均无统计学差异(P＞0.05).结论 多个药物支架植入治疗,并不增加近期血栓形成和心血管事件的发生率.     

药物洗脱支架术后支架内亚急性血栓的发生和原因分析

目的分析冠状动脉药物洗脱支架（drug—eluting stent,DES）置入术后支架内亚急性血栓形成的因素及治疗措施。方法回顾性分析2004年12月至2008年4月我院心内科冠心病患者行药物洗脱支架置入术后11例患者发生支架内亚急性血栓的好发时间、部位及相关危险因素。结果2004年12月至2008年4月,我院共完成PCI术596例,其中DES置入术455例,术后发生支架内亚急性血栓11例,发生率为2．42％,血栓形成时间为3—15d,平均（6．9±4．1）d。其中冠脉3支病变患者5例,2支血管病变4例;左前降支病变6例;置入多支架8例;支架贴壁不良2例。支架置入术后突然出现无其他原因可以解释的明显胸痛者7例;心衰低血压状态2例;以心脏骤停发病者2例,均院外死亡。心电图提示支架段血管支配区域心肌缺血加重或急性心梗2例,造影复查证实原支架内闭塞伴血栓影像7例,术后突然出现无其他原因可以解释死亡2例。4例因停用氯吡格雷而致血栓形成;2例可能支架贴壁不良。经单纯球囊扩张,冠脉内注入血小板GPⅡb／Ⅲa受体拮抗剂等治疗,7例患者存活出院,4例患者死亡（病死率36．4％）。结论亚急性支架内血栓形成与患者临床病变特点、介入操作因素和支架本身、抗凝治疗等有关,多发生在AMI、合并糖尿病或心功能不全、多支血管病变、前降支病变、B／C型复杂病变等患者。急诊再次介入治疗是治疗支架内血栓的首选。     

肝素化支架在头颈部动脉狭窄治疗中的应用

目的：探讨肝素化血管内支架在头颈部动脉狭窄治疗中的安全性和有效性。方法：39例反复短暂性脑缺血发作（TIA）、动脉狭窄程度在50％以上且药物治疗无效的头颈部动脉狭窄患，均采用直接肝素化BX冠状动脉支架植入治疗，术后未予肝素化治疗。结果：本组39例患均成功地植入支架，无手术相关并发症。25例患狭窄血管恢复正常直径，10例狭窄程度减少90％以上，4例残余狭窄10％－25％。临床随访3－18个月，33例症状完全缓解，5例明显好转，1例症状无改善。19例DSA随访6－12个月，无1例发生支架内血栓或再狭窄。结论：肝素化支架在头颈部动脉狭窄的治疗中是安全的，可有效降低血栓和再狭窄的发生。     

A comparison of clinical and angiographic outcomes after Excel bioabsorbable polymer versus Firebird durable polymer rapamycin-eluting stent for the treatment of coronary artery disease in a “real world” setting: six-month follow-up results

Background Several clinical trials have shown that rapamycin-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention (PCI). The Firebird stent and the Excel stent (coated with bioabsorbable polymer) are two different types of rapamycin-eluting stents made in China, both have been recently approved for clinical use in China by State Food and Drug Administration. However, it is unclear whether there are differences in safety and efficacy between the two types of stents in daily practice. Methods In the month of June 2006, a total of 190 consecutive patients were treated exclusively with Firebird stents (n=93, Firebird group) or Excel stents (n=97, Excel group) in our center and were included in this study. The frequency of major adverse cardiac events (MACE, a composite of death, myocardial infarction or target lesion revascularization), binary restenosis, and late lumen loss and stent thrombosis during a six-month follow-up period were compared between the two groups.Results Patient and lesion characteristics were comparable between the groups. Major adverse cardiac event rates were low in hospital and at 6 months (2.1% in the Excel group and 0% in the Firebird group, P﹥0.05). The 6-month angiographic in-stent restenosis rate was 0% in both groups, with an associated late loss of (0.15 ± 0.21) mm versus (0.14 ± 0.20) mm (P=0.858) and the in-segment restenosis rate was also 0% for the Excel group and the Firebird group. There was no definite stent thrombosis identified in either group during the six-month follow-up period and only one patient in the Excel group had probable stent thrombosis in hospital. Conclusions Results from this mid-term, single-center study showed that both of the Firebird and the Excel rapamycin eluting stent had similar effects on reducing the incidence of MACE and the risk of restenosis (both in-stent and in-segment binary restenosis) after PCI in daily practice.     

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.     

Long-term clinical outcomes after bioabsorbable polymer- and durable polymer-based sirolimus-eluting stents implantation: two-year follow-up results from a large single-center database

Background Several clinical trials have shown that sirolimus-eluting stents significantly reduce the risk of restenosis after percutaneous coronary intervention （PCI）. The FIREBIRD stent （coated with durable polymer） and the EXCEL stent （coated with bioabsorbable polymer） are two different types of sirolimus-eluting stents made in China; both have been approved for clinical use in China by the State Food and Drug Administration. The mid-term （6-month） angiographic and clinical results of both stents have been confirmed exciting perspective outcomes. However, it is unclear whether there are differences in the long-term safety and efficacy between the two types of stents in daily practice.
Methods All consecutive patients undergoing elective PCI with EXCEL or FIREBIRD stents between June 1,2006 and December 31, 2006 at Fu Wai Hospital in Beijing were included. Patients were classified from the index admission according to stent types （EXCEL or FIREBIRD） used. Clinical and procedural risk factors were collected prospectively. With propensity score matching without replacement, the frequency of major adverse cardiac events （MACE, a composite of death, myocardial infarction or target vessel revascularization） and stent thrombosis during a 2-year follow-up period were compared between the two groups.
Results A total of 474 patients were treated with EXCEL, and 640 were treated with FIREBIRD. Three hundred and ninety-seven EXCEL patients were matched to 397 FIREBIRD patients, 2-year risk-adjusted MACE rates were 6.1% in EXCEL group and 7.6% in FIREBIRD group （HR 0.84, 95%CI0.50-1.43）, whereas the respective rates for mortality, myocardial infarction and target-vessel revascularization were 2.3% vs 2.8% （HR 0.74, 95%CI0.30-0.85）, 1.8% vs 1.3% （HR 1.41,95%CI 0.45-4.43） and 2.5% vs 4.0% （HR 0.62, 95%CI0.28-0.37）, respectively. Cumulative incidence of stent thrombosis at 2 years was 1.8% in the EXCEL group vs 1.3% in the FIREBIRD group （P=0.5610）, whereas the rate of very late stent thrombosis was 0.5% vs 1.3% （P=0.2550）.
Conclusions Results from this long-term, relatively large size, single-center study showed that both of the EXCEL and the FIREBIRD sirolimus-eluting stent had similar and lower incidence of MACE after PCI in daily practice.     

冠状动脉支架内急性亚急性血栓形成的诊治体会

目的探讨冠状动脉支架内急性亚急性血栓形成的原因和处理方法。方法回顾性分析我院开展冠脉介入手术以来发生的诊断明确的冠脉支架内急性亚急性血栓形成的5例患者的病历资料。结果 9年间总共有928例患者行冠脉介入手术,共发生冠脉支架内急性亚急性血栓形成5例,发生率0.54%。冠脉支架内急性亚急性血栓形成与冠脉血管病变长,严重钙化病变,血管细小,支架膨胀不全,支架贴壁不良,支架未完全覆盖病变,支架重叠连接处未重整,术后未坚持应用双联抗血小板药物及抗血小板药物抵抗有关。冠脉支架内急性亚急性血栓形成对溶栓效果不佳,需急诊行PTCA、血栓抽吸导管开通相关血管,并强化抗凝抗血小板治疗。结论冠脉支架内急性、亚急性血栓形成与患者血管病变特点及介入操作等因素有关。再次急诊PTCA、血栓抽吸导管开通相关血管是治疗支架内血栓形成的首选方法。     

冠状动脉药物洗脱支架与支架内血栓

支架内血栓是冠状动脉支架术后少见但却严重危及生命的并发症。药物洗脱支架由于降低了再狭窄率而使冠状动脉粥样硬化性心脏病介入治疗领域发生了革命性的变化,但对其增加晚期血栓的顾虑成为目前关注的热点。支架内血栓的形成除了支架本身的致栓作用外,还与患者、病变及手术等因素相关。此外,过早中断双联抗血小板治疗、延迟再内皮化及晚期支架贴壁不良等均与支架内血栓密切相关。本文就支架内血栓的定义、发生机制及对策等进行综述。     

国产Firebird药物涂层支架与裸支架治疗急性心梗的比较

目的通过对比研究的方法评价国产Firebird药物涂层支架与裸支架在急性心肌梗死患者中应用的安全性和有效性。方法将诊断为急性sT段抬高型心肌梗死（且发病在6h以内）的患者随机分为接受Firebird药物涂层支架治疗的Firebird组64例及接受裸支架治疗的裸支架组42例。观察两组住院期间和出院后长期随访的心血管终点事件及支架内再狭窄的发生情况。结果住院期间两组均无急性、亚急性血栓形成及心绞痛事件发生。Firebird组长期随访1例死于脑出血,1例于家中发生猝死,两例发生心绞痛,1例死于车祸,余59例患者长期随访无不良事件发生。裸支架组长期随访7例复发心绞痛,1例死于肺癌,余34例患者无其他不良终点事件。结论药物涂层支架应用于急性心梗具有较好的安全性和有效性。