Rapidly aggravated dissecting flap by angiography during percutaneous stent placement for acute isolated superior mesenteric artery dissection

Acutely aggravated dissecting flap and consequent occlusion of the superior mesenteric artery (SMA) by simple contrast passage during initial angiography for percutaneous stent placement is a uncommon event, which usually is not reported. After analysis of many factors that underlie development of such complications, we present herein one case of successful treatment of isolated SMA dissection and its complications with favorable outcomes during 25 months follow-up after percutaneous stent placement.     

G蛋白β3亚单位基因C825T多态性与PTCA支架内再狭窄

目的 探讨G蛋白β3亚单位基因C825T多态性与PTCA支架植入后再狭窄之间的相关性。方法 采用多聚酶联反应结合限制性内切酶片断长度多态性分析方法(PCR-RFLP)检测50例经PTCA支架植入术后半年内发生再狭窄的患者和85例经PTCA支架植入在半年内未发生再狭窄的患者之间G蛋白β3亚单位基因C825T多态性。结果 再狭窄组G蛋白β3亚单位基因型频率(CC 14％、CT 54％、TT 32％),等位基因频率(C 41％、T 59％)与未狭窄组G蛋白β3亚单位基因型频率(CC31.8％、CT 44.7％、TT 23.5％),等位基因频率(C 54.2％、T 45.8％)比较统计学上有差异。结论 G蛋白β3亚单位基因C825T多态性可能与PTCA支架内再狭窄有关。     

药物洗脱冠状动脉支架系统动物实验研究

目的通过观察在猪动脉中置人心畅可降解聚合物涂层药物洗脱冠状动脉支架（天津百畅公司开发）及对照组支架后的植入后管腔丢失、内皮化、炎症反应、损伤及血栓形成情况来评价国产可降解聚合物涂层药物洗脱支架临床应用的可行性。方法将2种共60枚支架分别置入30头猪冠状动脉的前降支、回旋支以及右冠状动脉。支架植入后的2,5,12,25周,将不同数量的猪处死行组织形态学检查,观察炎症、血栓形成情况和内皮化评价。结果支架置入术后的冠脉通畅,无明显狭窄;支架贴血管内壁良好,血管内腔表面光滑;2种支架均无血栓形成,心畅可降解聚合物涂层药物洗脱支架炎症反应及内皮化与对照组无明显差异,其管腔丢失较对照组轻或无明显差异。结论实验提示心畅可降解聚合物涂层药物洗脱支架置入后有良好的血液相容性,生物性能稳定,支架内表面迅速内皮化,血管有良好的开通率。说明可降解聚合物涂层药物洗脱支架是安全、有效的。     

Spontaneous coronary artery dissection mimicking aortic dissection

A 51-year-old woman suffered rapidly irreversible cardiogenic shock with left hemiparesis. Transesophageal echocardiography, which represents an essential imaging tool in the emergency room, ruled out aortic dissection involving branch vessels but did not allow an in vivo diagnosis of spontaneous coronary dissection. The in vivo diagnosis of spontaneous coronary dissection is rather difficult because of the dramatic clinical presentation and selective coronary angiography requirement.     

The ureteral lumen during peristalsis

This study concerns the size and shape of the ureteral lumen and an assessment of its enlargement during peristalsis. To stop the action of the living dog ureter, it was flooded with isopentane close to its freezing point (? 160° C). The ureter remained frozen until completion of all technical procedures. Photographs of the cut end of active ureters also provided evidence of its luminal characteristics and a movie was achieved of its continuous action. The totally collapsed lumen is stellate in form, epithelial surfaces being in virtual contact. As the lumen opens the points of the stars are last to go, but a square shape and finally a circle result. In a typical experiment, the collapsed lumen had a cross sectional area of 0.12 mm², enlarging to 2 mm² in diuresis. This × 17 enlargement occurred over a 3 cm length of the peristaltic wave. Enlargement of the lumen is largely accommodated by thinning of the muscle coats and attenuation of the mucous membrane, there being relatively little gross enlargement of the total segment. Direct photography of the cut end of the proximal segment of the ureter completely confirms the section studies.     

Self-expandable nitinol stent placement in homocysteinemic porcine aorta

PURPOSE: To compare aortic intimal thickening of normal and hyperhomocysteinemic pigs (induced with a methionine-rich diet) following placement of a self-expanding nitinol stent. METHODS: Eighteen Macau pigs were used. They were older than eight weeks in age and had an average weight of 30 kg. Pigs were randomly divided into two groups. The first, Group C (control), was fed a regular diet, and the second group, Group M, was fed a methionine-rich diet for 30 days to induce hyperhomocysteinemia. The self-expandable nitinol stents were 25mm in length and 8 mm in diameter after expansion. Blood samples were collected to measure total cholesterol, triglycerides, HDL and homocysteine concentrations. All animals were subjected to angiography. Thirty days after the procedure, the animals were sacrificed, and the abdominal aorta was removed for histological and digital morphometry analysis. RESULTS: Under microscopic evaluation, the intima was significantly thicker in Group C than in Group M. When groups were compared by digital morphometric analysis, intimal thickening of the vessel wall was higher in Group C than in Group M. There was no significant change in total cholesterol, triglycerides or HDL concentrations in either group. In group C the levels of plasma homocysteine ranged from 14,40 to 16,73 micromol/l; in Group M, plasma homocysteine levels ranged from 17.47 to 59.80 micromol/l after 30 days of a methionine-rich diet. CONCLUSION: Compared to normal pigs, less intimal hyperplasia was observed in the abdominal aortas of hyperhomocysteinemic pigs thirty days after the insertion of a self-expandable nitinol stent.     

Pathological features of in-stent restenosis after sirolimus-eluting stent versus bare metal stent placement

A 70-year-old man developed diffuse restenosis in the right coronary artery, in which a bare metal stent (BMS) and two sirolimus-eluting stents (SES) were deployed sequentially. He underwent directional coronary atherectomy (DCA) for in-stent restenosis (ISR) lesions 13 months after both BMS and SES stenting. Further 4 months later, that is, 17 months after stent implantation, however, ISR recurred just at the SES site alone. Then we performed second DCA for the ISR lesion at SES site. The tissue materials obtained from debulking were compared histologically. In the first DCA specimen, accumulation of inflammatory cells such as T lymphocytes and macrophages was observed densely in ISR lesions at SES site but not in those at BMS site, and endothelial coverage was absent in ISR lesions at SES site but present in those at BMS site. In the second DCA specimen, ISR lesions at SES site showed less inflammatory cells, compared with first DCA specimen. ISR lesions after drug-eluting stenting showed persistent signs of delayed or incomplete wound healing and relapsed inflammation, compared with BMS. Thus, the mechanism of restenosis after drug-eluting stenting may be different from that after BMS placement.     

支架置入术治疗颈动脉狭窄的临床研究

目的 观察颈动脉支架植入治疗颈动脉狭窄的疗效及其安全性。方法 72例颈动脉狭窄患者进行了经皮腔内血管成形和支架植入术治疗。结果 所有患者均经DSA血管造影汪实有颈内动脉狭窄，手术成功率100％，治疗后残余狭窄率均低于30％：72例患者中有2例出现可逆性小卒中；3例出现术中球囊扩张时对侧肢体局灶性癫痫发作；3例血管痉挛；25例出现低血压、心动过缓；1例出现术后高灌注综合征；5例出现其它部位出血。结论 血管内支架成形术是一种治疗颈动脉狭窄安全有效的方法，提高术者操作技巧及围手术期监护可以降低手术并发症和死亡率，提高安全性。     

Angiographic follow-up after placement of a self-expanding coronary-artery stent

BACKGROUND. The placement of stents in coronary arteries after coronary angioplasty has been investigated as a way of treating abrupt coronary-artery occlusion related to the angioplasty and of reducing the late intimal hyperplasia responsible for gradual restenosis of the dilated lesion. METHODS. From March 1986 to January 1988, we implanted 117 self-expanding, stainless-steel endovascular stents (Wallstent) in the native coronary arteries (94 stents) or saphenous-vein bypass grafts (23 stents) of 105 patients. Angiograms were obtained immediately before and after placement of the stent and at follow-up at least one month later (unless symptoms required angiography sooner). The mortality after one year was 7.6 percent (8 patients). Follow-up angiograms (after a mean [+/- SD] of 5.7 +/- 4.4 months) were obtained in 95 patients with 105 stents and were analyzed quantitatively by a computer-assisted system of cardiovascular angiographic analysis. The 10 patients without follow-up angiograms included 4 who died. RESULTS. Complete occlusion occurred in 27 stents in 25 patients (24 percent); 21 occlusions were documented within the first 14 days after implantation. Overall, immediately after placement of the stent there was a significant increase in the minimal luminal diameter and a significant decrease in the percentage of the diameter with stenosis (changing from a mean [+/- SD] of 1.88 +/- 0.43 to 2.48 +/- 0.51 mm and from 37 +/- 12 to 21 +/- 10 percent, respectively; P less than 0.0001). Later, however, there was a significant decrease in the minimal luminal diameter and a significant increase in the stenosis of the segment with the stent (1.68 +/- 1.78 mm and 48 +/- 34 percent at follow-up). Significant restenosis, as indicated by a reduction of 0.72 mm in the minimal luminal diameter or by an increase in the percentage of stenosis to greater than or equal to 50 percent, occurred in 32 percent and 14 percent of patent stents, respectively. CONCLUSIONS. Early occlusion remains an important limitation of this coronary-artery stent. Even when the early effects are beneficial, there are frequently late occlusions or restenosis. The place of this form of treatment for coronary artery disease remains to be determined.     

管腔内支架人工血管治疗主动脉夹层

目的 探讨应用腔内支架人工血管植入治疗DeBakeyⅢ型主动脉夹层的适应症、操作技巧及并发症防治。方法 对18例DeBakeyⅢ型主动脉夹层在全麻下行腔内支架人工血管植入术，经左上肢置入造影导管造影，经股动脉导入支架人工血管植于夹层破口处封闭破裂口。结果18例共植入支架人工血管20只，2例发生内漏，均经加放一只支架人工血管封堵成功。操作成功率100％，无手术死亡。近期、中期效果良好。结论 支架人工血管植入术治疗DeBakeyⅢ型主动脉夹层具有创伤小，恢复快的特点，尤其适用于病人体质差，有合并症及外科手术禁忌的病人，近期效果良好．远期效果有待观察。     

Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.

BACKGROUND: The treatment of thoracic aortic dissection is guided by prognostic and anatomical information. Proximal dissection requires surgery, but the appropriate treatment of distal thoracic aortic dissection has not been determined, because surgery has failed to improve the prognosis. METHODS: We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent-graft insertion in 12 consecutive patients with descending (type B) aortic dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic dissection was diagnosed by magnetic resonance angiography. In each group, the dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent-graft was placed by unilateral arteriotomy. RESULTS: Stent-graft placement resulted in no morbidity or mortality, whereas surgery for type B dissection was associated with four deaths (33 percent, P=0.09) and five serious adverse events (42 percent, P=0.04) within 12 months. Transluminal placement of the stent-graft prosthesis was successful in all patients, with no leakage; full expansion of the stents was ensured by balloon inflation at 2 to 3 atm. Sealing of the entry tear was monitored during the procedure by transesophageal ultrasonography and angiography, and thrombosis of the false lumen was confirmed in all 12 patients after a mean of three months by magnetic resonance imaging. There were no deaths or instances of paraplegia, stroke, embolization, side-branch occlusion, or infection in the stent-graft group; nine patients had postimplantation syndrome, with transient elevation of C-reactive protein levels and body temperature plus mild leukocytosis. All the patients who received stent-grafts recovered, as did seven patients who underwent surgery for type B dissection (58 percent) (P=0.04). CONCLUSIONS: These preliminary observations suggest that elective, nonsurgical insertion of an endovascular stent-graft is safe and efficacious in selected patients who have thoracic aortic dissection and for whom surgery is indicated. Endoluminal repair may be useful for interventional reconstruction of thoracic aortic dissection.     

Stent-graft and double-guiding catheter technique to rescue iatrogenic coronary perforation

IntroductionCoronary artery perforation (CAP) is an infrequent, yet life-threatening complication of percutaneous coronary interventions, posing a major risk of cardiac tamponade and mortality.MethodsWe report on effective management of Ellis type III CAP with use of double-guiding catheter technique and stent-graft implantation.ResultsProlonged balloon inflation via the first guiding catheter allows for temporary closure of the bleeding site. At the same time, stent-graft is inserted via the second guiding catheter to seal the perforation. After rapid deflation of the balloon, the stent is immediately advanced and expanded.ConclusionsThe procedure minimises the time between deflation of the balloon and implantation of the stent-graft, allowing for successful bleeding cessation.     

完全生物可降解冠状动脉支架的研究现况与展望

文章对完全生物可降解冠状动脉支架设计概念作了说明,就生物可降解冠状动脉支架材料如镁合金、铁、聚合材料等研究进展作详细论述,介绍了完全生物可降解冠状动脉支架临床应用进展,探讨其在临床治疗上的发展前景.     

血管内支架植入术治疗左肾静脉压迫综合征的疗效

目的 观察血管内支架植入术治疗左肾静脉压迫综合征的临床疗效.方法 2002年6月至2011年7月本院本科采用血管内支架植入术治疗6例左肾静脉压迫综合征患者.患者术前、后进行了尿常规分析等实验室检查、彩色多普勒超声检查和(或)计算机断层扫描(CT)检查.结果 6例患者都成功植入了自膨式支架.术前和术后左肾静脉受压狭窄段的直径分别为(1.88±0.95)mm、(5.24±0.61) mm,差异有统计学意义(P＜0.05).术中左肾静脉测压为(11.00±4.34) mm Hg(1 mm Hg=0.133kPa),植入支架后为(6.00±2.55) mmHg,差异有统计学意义(P＜0.05).患者术后2～6个月肉眼或镜下观察血尿消失,尿液常规分析结果正常.术后随访6～60个月,肉眼或镜下观察患者血尿无复发;彩色多普勒超声或CT检查显示支架血流通畅,无再狭窄或血栓形成;2例左精索静脉曲张的患者完全缓解.结论 血管内支架植入术治疗左肾静脉压迫综合征有满意的临床疗效.     

Sudden death from coronary artery dissection.

Spontaneous dissection of the coronary arteries is an uncommon condition that may lead to sudden, fatal coronary artery occlusion. Three cases of sudden death attributable to coronary artery occlusion are presented. Dissection was associated with Marfan's syndrome in the first case, and occurred three weeks postpartum in the second case. In case 1, dissection occurred within the intima, and was not associated with an inflammatory cell infiltrate. In cases 2 and 3, dissection occurred between the tunica media and the external elastic lamina, and was associated with a mixed inflammatory infiltrate, rich in eosinophils, T lymphocytes, and histiocytes. The spatial limitation of the inflammatory infiltrate to the adventitial compartment, together with the absence of inflammation in case 1, suggests a reactive origin rather than a causative role for the inflammatory cells. Detailed examination of serial blocks of any coronary artery occlusion is essential in young patients.