经皮冠状动脉腔内成形术和冠状动脉支架植入术中并发症及处理

目的 :探讨经皮冠状动脉腔内成形术 (PTCA)和血管支架植入术 (Stenting)的并发症及处理方法。方法 :1996年 10月至 1999年 10月冠心病 6 5例 ,男 5 8例 ,女 7例 ,不稳定心绞痛 41例 ,心肌梗塞后恢复期 15例 ,劳累心绞痛 9例。冠状动脉造影显示单支病变 16例 ,双支病变 2 8例 ,三支病变 2 1例。A型病变 10例 ,B型病变 30例 ,C型病变 2 5例 ,LVEF36 %～ 92 % ,平均 5 4%。应用介入心脏技术共治疗病变血管 96支 ,46例 5 9支血管植入 73个不同种类的血管支架。结果 :术中发生并发症 9例次 ,包括血管内膜撕裂 (2例 ) ,心室纤颤 (2例 ) ,急性血管闭塞 (2例 ) ,心包填塞 (1例 ) ,支架脱落 (1例 )和钢丝穿破血管 (1例 ) ,并发症发生率 13 8%。 70个支架植入成功 ,3个失败 ,支架植入成功率 95 9%。结论 :血管支架对于冠心病治疗具有很好效果 ,但会发生一些难以预测的并发症 ,及时发现和处理至关重要。     

冠状动脉内支架植入术后并发症的观察及护理

经皮冠状动脉腔内成形术 (ＰＴＣＡ)及支架植入术 (ＣＳ)是目前治疗冠心病心绞痛、心肌梗死的一种较新的介入治疗方法 ,它能较快的增加冠脉血流量 ,缓解心绞痛 ,使梗死相关的冠状动脉获得更早和更完全的再通。但这种介入治疗技术 ,在术中及术后可能发生一些并发症 ,在护理工作中应掌握其临床表现 ,并及早识别各种并发症 ,以便采取相应的措施 ,现将我院 80例患者的情况总结如下 :一、临床资料 :选择我院 2 0 0 1年 2月至 2 0 0 3年 1月期间施行手术的患者 80例为观察对象 ,其中男性 6 2例 ,女性 18例 ,年龄 44岁～ 79岁 ,平均 6 0 9岁 ;其中…     

冠状动脉内支架植入术治疗冠心病

目的：评价冠状动脉内支架植入术治疗冠心病的临床应用价值。方法：对86例102支冠状动脉病变内植入117只支架,其中植入左前降支51只,右冠状动脉46只,左回旋支20只。结果：支架植入后经冠状动脉造影证实狭窄消失,效果良好,其中26例急性心肌梗死患者由于急诊植入支架后,病情转危为安。86例全部植入成功,无一例发生严重的并发症。结论：冠状动脉内支架植入术是治疗冠心病的一种安全可靠、效果好的介入性治疗技术,有良好的应用价值。     

正确应用冠状动脉内支架植入术

正确应用冠状动脉内支架植入术高润霖冠状动脉内支架植入术（ｉｎｔｒａｃｏｒｏｎａｒｙｓｔｅｎｔｉｎｇ）于１９８７年由Ｓｉｇｗａｒｔ首先应用于临床，是近年来冠心病介入性治疗最重要的进展之一。现在用于临床的支架已有十数种，植入成功率达９５％以上，重要并发症...     

直接冠状动脉内支架植入术的可行性研究

目的 :评价直接冠状动脉 (冠脉 )内支架植入术的安全性和可行性。方法 :对 1999年 12月～ 2 0 0 0年 6月接受冠脉内支架植入术的 171例患者中 ,孤立性、狭窄程度≤ 90 %、参考直径≥ 2 .5mm、长度≤ 18mm ;无明显的钙化、扭曲和成角 ,非完全闭塞和分叉处病变者 5 6例行直接冠脉内支架植入术。观察住院期和术后 3个月随访期内不良心脏事件的发生率。结果 :5 6例的 6 0处病变成功 5 5处 (91.7% ) ;1处因支架未能通过狭窄处而改行球囊预扩张后的支架植入术 ,1处在支架植入后因远端血管发生撕裂而需再植入 1个支架 ,3例因支架植入后冠脉造影显示支架扩张不满意而再用高压球囊扩张。住院期和术后随访期内无心源性死亡、心肌梗死、急诊冠脉旁路术发生 ;9例行冠脉造影复查 ,其中 2例因显示再狭窄而行再次经皮腔内冠脉成形术治疗。与经球囊导管预扩张后行冠脉内支架植入术相比 ,直接冠脉内支架植入术费用降低 2 9% ,造影剂用量减少 2 7% ,手术操作和X线照射时间缩短 2 6 %和 2 5 %。结论 :直接冠脉内支架植入术在经选择的病变中安全可行 ,并可降低手术费用 ,减少X线照射。     

冠状动脉内支架植入术在复杂性冠状动脉病变中的应用

对12例17处复杂型冠状动脉病变患者施行了冠状动脉内支架植入术.植入Palmatz-Schatz型支架15个,Gianturco-Roubin型支架4个.支架植入成功率100%,无一例出现局部血管急性井发症.1例术后股动脉穿刺部位血肿,2例口服华法令过程中,出现皮肤瘀斑,1例出现肉眼血尿.无其它并发症.1例术后1.5个月冠状动脉造影示,支架部位血流通畅好,无再狭窄发生.10例患者未再发生心绞痛,另2例置入一只支架的多支病变患者劳累性心绞痛发作次数减少,程度明显减轻.     

冠状动脉内支架植入术的护理体会

目的：探讨冠状动脉内支架植入术的护理要点,方法：我科2000年4－8月为7位患实行了冠状动脉内支架植入术,为之加强护理,并总结其护理经验,结果：7例患手术顺利,术后恢复良好。结论：对病人宣传有关疾病知识,加强护理可避免发生合并症。     

冠状动脉内支架置入术的并发症及术后再狭窄的防治

冠状动脉内支架置入术 (CASI)是在球囊扩张术的基础上发展起来的一项技术 ,目前已成为介入治疗冠心病的主要手段之一。据统计 ,现在冠心病介入治疗中支架置入的比例占 70 %～ 80 % 〔1〕。随着CASI临床应用的广泛开展 ,其术后并发症和再狭窄的病例也会随之增多 ,应引起重视。1　CASI的常见并发症1 .1 　 急性及亚急性血栓形成急性及亚急性血栓形成发生率约 1 % 〔2〕,其发生率与术者经验、支架种类、血管病变本身情况及抗凝治疗等许多因素有关〔3〕,急性血栓形成较少见 ,常发生在患者术后 2 4h内。亚急性血栓形成多在安放支架后 2～ 1 …     

冠状动脉内支架植入术患者的围手术期护理

2001-2004年，我院为30例冠心病患者施行冠脉内支架植入术，均取得较满意疗效。现将护理体会介绍如下。     

急诊冠状动脉支架植入术后并发症的预防及护理

急诊冠状动脉内支架植入术（PCI）是在急性心梗起病3小时～6小时最多12小时内，使闭塞的冠状动脉再通，心肌得到再灌注，濒临坏死的心肌可能得以存活或使坏死范围缩小，对梗死后心肌重塑有利，改善愈后，是一种积极的治疗措施，也是一种创伤小、安全性强的介入手术，本文总结急诊冠状动脉支架植入术102例，     

冠状动脉支架术后医生电话随访对患者依从性的影响

目的探讨医生电话随访对冠状动脉粥样硬化性心脏病(冠心病)患者戒烟依从性、服药依从性及冠状动脉支架术后复查造影的依从性的影响。方法将160例冠状动脉支架术后患者按随机数字表法随机分为随访组(80例)和对照组(80例)两组。出院时都叮嘱入选患者术后必须戒烟、长期服药和1年内返院复查冠状动脉造影。出院后只对随访组进行电话随访,出院1年后评定两组患者的依从性。结果随访组患者的戒烟依从性[90.32%(56/62)vs.75.00%(45/60),χ2=5.02,P<0.05]、服药依从性[91.25%(73/80)vs.77.50%(62/80),χ2=5.74,P<0.05]及冠状动脉支架术后复查造影依从性[90.00%(72/80)vs.76.25%(61/80),χ2=5.39,P<0.05]均较对照组高,差异有统计学意义(P<0.05)。结论医生电话随访对提高冠心病患者戒烟依从性、服药依从性及冠状动脉支架术后复查造影的依从性具有一定的临床意义。     

Intravascular stenting of the right internal mammary artery

Despite its tortuous course and small caliber, percutaneous transluminal coronary angioplasty of the internal mammary artery can be performed with a high initial success rate (82–94%). The successful deployment of a balloon expandable coll stent at the mid-right internal mammary artery in a patient with recurrent stenosis of that graft is reported.     

Initial experience with the Cordis stent: Analysis of serial angiographic follow-up

To evaluate the efficacy of the more flexible Cordis stent, a prospective angiographic follow-up study was performed. Implantation of the Cordis stent was attempted in 99 consecutive patients with 103 native coronary lesions from January 1994 to July 1995. Clinical success, defined as final diameter stenosis of <50% without death, bypass surgery, or Q-wave myocardial infarction, was achieved in 88% of the patients. There were no in-hospital deaths. In-hospital subacute stent occlusion occurred in only one case. Follow-up angiograms were obtained in 86 (95%) eligible lesions. The minimal luminal diameter improved from 1.03 ± 0.31 to 2.82 ± 0.31 mm, but started to decrease at 1 mon (2.57 ± 0.24 mm), and continued to decrease throughout the 6 mon (2.00 ± 0.61 mm), the biggest reduction being between 1 and 3 mon (−0.57 ± 0.50 mm). Angiographic restenosis (stenosis ≥50%) occurred in 23% of the lesions; a revascularization procedure of the target lesion was required in 12% of the patients. Multivariate analysis identified age, diabetes mellitus, and preprocedural reference diameter to be predictors of angiographic restenosis. In conclusion, the Cordis stent can be implanted successfully with a low complication rate and a clinical outcome at least comparable to other stent studies. Cathet. Cardiovasc. Diagn. 42:166–172, 1997. © 1997 Wiley-Liss, Inc.     

New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler.

BACKGROUND: Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5%-2.5% following coronary angiography but 15%-85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to find feasible parameters of this syndrome. METHODS AND RESULTS: Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 +/- 0.19 mm in diastole and 0.52 +/- 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 +/- 8.8%. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 +/- 0. 54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of -22. 2 +/- 13.2 cm. s(-1). Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42 +/- 13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. CONCLUSION: Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.     

Quantification of intracoronary volume by videodensitometry: Validation study using fluid filling of human coronary casts

Changes in intracoronary volume reflect the hemodynamic significance of progression or regression of diffuse coronary artery disease where intracoronary catheters cannot be applied for direct measurements due to small vessel dimensions. We have validated the videodensitometric measurement of intracoronary volume with epoxy casts of postmortem human coronary arteries. The volume of 31 coronary segments (cross-sectional areas in a range of 2–13 mm²) measured by fluid-filling using a precision dispenser was compared with the respective single plane intracoronary volume assessments obtained by the videodensitometric algorithm of the new generation Cardiovascular Angiography Analysis System (CAAS II). The true and measured values of volume were compared by calculation of the mean of the signed differences ± standard deviation and by linear regression analysis. Videodensitometric measurement of intracoronary volume correlate well with fluid-filling of human coronary artery casts (correlation coefficient: r = 0.99, y = 1.96 + 0.99x, standard error of estimate: SEE = 3.96) with a significant trend towards overestimation of true volume values (mean difference = 1.73 ± 3.64 mm³, P<0.05). Intracoronary volume estimations can be used to measure changes of luminal dimensions of coronary arteries and may offer a new approach to assessment of progression or regression of diffuse coronary artery disease. © Wiley-Liss, Inc.     

Clinical effects and utility of intracoronary diltiazem

Coronary artery spasm is a known complication of coronary interventions, for which intracoronary nitroglycerin (ICN) is the treatment of choice. Some forms of intense spasm are resistant to ICN. Calcium channel antagonists are also known to be effective for coronary artery spasm, including nitroglycerin-resistant spasm. Here we describe a protocol for the clinical use of intracoronary diltiazem (ICD). By this protocol, ICD can be safely given without disturbing the clinical status of patients. ICD (2.5 mg) given slowly over 1 minute produced no vasodilitation of normal vessel segments but did produce significant dilatation of stenotic segments above and beyond the effects of nitrates. Mean minimum lumen diameter increased 18%, from 0.89 ± 0.06 mm to 1.06 ± 0.07 mm (mean ± SEM, P < 0.001). ICD produced clinically Insignificant changes in systolic blood pressure, diastolic blood pressure, heart rate, and PR, QRS, and QT intervals. This protocol has been employed to safely use ICD to relieve both nitroglycerin-resistant epicardial artery spasm and nitroglycerin-resistant distal microvascular spasm (the no-reflow phenomenon). © 1995 Wiley-Liss, Inc.     

Coronary compression caused by stenting a right pulmonary artery conduit

Extrinsic compression of the left main coronary artery is a rare and life‐threatening complication of endovascular stenting of pulmonary artery conduits. This case report describes fatal myocardial infarction caused by compression of the left main coronary artery due to stent placement in a stenosed right pulmonary artery conduit. © 2009 Wiley‐Liss, Inc.     

Arterial autologous graft-stent for treatment of coronary artery disease: A new technique

The radial artery has been used as a free bypass graft with excellent results. An autologous vein graft-coated stent, a novel type of stent developed at our institution, has been applied successfully under both experimental and clinical conditions. To extend the spectrum of biological linings for coated stents, we used an arterial graft. We describe the first application of the radial artery as an autologous coating for a conventional stent to be used in treatment of coronary artery disease. Cathet. Cardiovasc. Diagn. 40:302–307, 1997. © 1997 Wiley-Liss, Inc.     

Endovascular stenting of an unprotected left main coronary artery stenosis in a heart transplant patient

Endoluminal revascularization of left main coronary artery vessels is considered to be relatively contraindicated because of a high procedural mortality and restenosis rate. This report describes the first successful case of endovascular stenting in an unprotected left main coronary artery stenosis in a heart transplant patient.     

Acute occlusion of the left main coronary artery following intracoronary ultrasound examination

Intracoronary ultrasound (ICUS) is generally considered as safe procedure, with a low complication rate. We describe a nearly fatal complication of a diagnostic ICUS study that was treated succesfully with stent implantation in the left main coronary artery and discuss the indications and remaining risks of this procedure. Cathet. Cardiovasc. Intervent. 47:181–184, 1999. © 1999 Wiley-Liss, Inc.