冠状动脉内支架植入前后病变血管的X 线表现

目的　评价内支架对冠状动脉病变血管支撑的影像效果。方法　7例9支冠状动脉病变血管:左前降支1支,左回旋支4支,右冠状动脉4支,各植入1枚支架,共9枚。结果　经冠状动脉造影证实,9支病变血管全部呈管柱状成形,平均狭窄度由术前的8688%降至术后的1077%。无并发症发生。结论　经皮冠状动脉内支架植入术,可明显改善冠状动脉病变血管的形态,获得良好的开通效果,成功率高,并发症低,是治疗冠动脉狭窄,阻塞性疾病的有效方法。     

冠状动脉狭窄支架植入术围手术期护理

2001年10月~2005年6月,我院为67例冠状动脉狭窄患者行支架植入术,取得良好效果。现将护理体会报告如下。1资料与方法1.1临床资料本组男43例,女24例,45~74岁,平均63岁。共植入支架105枚,血管分布为植入左冠状动脉内支架82枚,右冠状动脉内支架23枚。左前降支44枚,左回旋支25枚,左右冠状动脉同时植入两枚以上支架者19例,左冠状动脉内植入两枚以上支架者31例,血管狭窄程度60%~75%以上,支架植入均成功,再通管径残余狭窄<10%。1.2方法实施心电监护,经皮穿刺血管造影评价冠状动脉狭窄程度,将导引钢丝,导管植入,置入球囊,狭窄段扩张、支架植入、整复…     

右冠状动脉开口异常合并左回旋支发育异常1例

患者，男性，62岁，主因发作性胸痛1年，加重2天入院。患者既往体健。心电图示：V1～V4 ST段抬高0．2～0．4mV。入院诊断：急性前壁心肌梗死。于入院后第9天行冠状动脉造影示：右冠状动脉开口于左窦前部（图1），右冠状动脉分支丰富，其近端发出一较大分支近似左回旋支走行，左冠状动脉开口于左窦后部（图2），左主干短，前降支钙化明显，并弥漫斑块浸润，多处狭窄，以近端最重达（99％），左回旋支细而短小。处理：于前降支近端植入支架1枚。     

冠状动脉内支架置入术治疗冠心病206例临床观察

目的：评价冠状动脉内支架置入术在冠心病治疗中的临床效果。方法：对186例240支冠状动脉病变内置入265只支架，其中置入左前降支139只，右冠状动脉84只，左回旋支40只，左主干2只。结果：206例全部置入成功。置入后经冠状动脉造影证实狭窄消失，即刻效果良好。其中22例急性心肌梗死患者急诊置入支架后22例病情迅速缓解。择期冠状动脉支架置入术后死亡1例，死因为颅内出血。其他并发症为股动脉假性动脉瘤1例，术中低血压反应9例。结论：冠状动脉内支架置入术是治疗冠心病的一种安全可靠、效果良好的介入性治疗方法，值得临床广泛应用。     

64 层CT诊断冠状动脉支架内再狭窄准确性的影响因素分析

目的:探讨影响64层CT诊断冠状动脉支架内再狭窄诊断的可能因素.方法:入选131名患者,采用64层CT重建208枚支架血管图像,用4分评分法评估图像质量;冠状动脉造影检查为再狭窄诊断的金标准.结果:208枚支架中发现35例再狭窄.64层CT诊断支架内再狭窄其敏感性为100%,特异性为93.6%,其位于左主干和前降支的图像质量显著优于回旋支和右冠状动脉,而且大直径支架的图像质量也显著优于小直径( ＜ 3.0 mm)支架,此外,支架重叠也因伪影加重而干扰图像的质量.结论:64层CT冠状动脉成像诊断支架内再狭窄具有一定的准确性,尤其可作为左主干、前降支等大直径单支架植入术后的随访检查方法.     

64层螺旋CT对冠状动脉起源异常及预后的评价

目的：探讨64层螺旋CT诊断冠状动脉起源异常的价值及对预后的评价。方法：对1211例冠状动脉CT血管成像（CTA）资料进行回顾性分析。结果：1211例完整冠状动脉CTA结果中，共检出冠状动脉起源异常18例，检出率为2.17%。包括右冠状动脉起源于左窦5例，伴前降支和回旋支单开口1例；右冠状动脉起源于升主动脉1例；圆锥动脉单开口4例；左冠状动脉主干起源于右窦3例；回旋支起源于右窦1例。前降支和回旋支单开口4例；共有8例冠状动脉分别起源于对侧窦，其中有3例该段有50%左右狭窄。结论：64层螺旋CT是冠状动脉起源异常安全和有效的确诊方法，并可对预后做出评估。     

经皮冠状动脉腔内成形术和支架置入术65例的护理

2007—01／2008—06我们对65例冠心病患者实施介入治疗,现将护理体会报告如下。1临床资料1．1一般资料本组男47例,女18例,年龄43～75（平均59．8）岁;急性心肌梗死28例,心绞痛37例。冠状动脉造影显示：冠状动脉单支病变20例,双支病变27例,三支病变18例;左冠状动脉前降支34例,右冠状动脉25例,回旋支6例。患者均行PTCA及支架植入术治疗。     

经皮冠状动脉成形术与支架植入术91例临床分析

目的分析经皮冠状动脉成形术(PTCA)与支架植入术(支架术)治疗冠心病的临床疗效。方法91例冠心病患者,稳定型心绞痛20例,不稳定型心绞痛29例,心肌梗死42例。单支血管病变29例,双支血管病变41例,三支血管病变21例。共处理病变血管176处,置入支架170枚。其中左前降支88处,右冠46处,左回旋支35处,第一对角支6处,左室后支1处。观察PTCA与支架术的成功率及临床成功率。结果PTCA与支架术成功率100%,临床成功率98.3%。结论PTCA与支架术是一种安全、有效的介入性治疗技术,成功率高,疗效良好,并发症少。     

冠状动脉造影术286例护理体会

目的：探讨冠状动脉造影术的护理，减少并发症发生，提高检查成功率。方法：通过286例冠状动脉造影术病例护理进行分析、评价。结果：示冠状动脉单支病变174例，其中左冠状动脉前降支病变71例，双支病变62例，三支病变37例。无发现异常13例。并发症有：发生室颇28例，窦性心动过缓25例，皮下血肿9例，低血压5例。经即时处理除8例室颤并休克死亡外其余恢复正常。结论：冠状动脉造影术是诊断冠心病有效方法．严格完善的护理保证检查顺利进行，明显降低并发症发生率，促进患者康复。     

MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

统一体位在16排螺旋CT评价冠状动脉狭窄中的应用

目的通过建立统一的重组图像体位,研究16层螺旋CT(MSCT)诊断冠状动脉狭窄的准确性。方法对55例临床可疑冠心病患者16层MSCT心电门控增强扫描。用舒张期增强扫描图像行统一体位的最大密度投影(MIP)及容积显示(VR)重组,分析应用CT血管成像(CTA)7个MIP重组体位和9个VR重组体位评价冠状动脉狭窄≥50%的情况,将结果与常规X线冠状动脉造影作对照。结果共分析55例患者的220个血管分支,常规冠状动脉造影发现62个血管分支狭窄≥50%,综合7个MIP重组体位和9个VR重组体位,CTA发现58个血管分支狭窄≥50%(左主干5个,前降支21个,回旋支14个,右冠状动脉18个)。CTA诊断冠状动脉狭窄≥50%的敏感性为94%(58/62),特异性为92%(146/158)。结论 16层MSCT诊断冠状动脉狭窄有较高的敏感性和特异性;建立统一的成像体位有利于CTA与常规X线冠状动脉造影结果对照。     

经桡动脉途径行冠状动脉造影和腔内成形术及其并发症处理

目的:探讨经桡动脉途径行冠状动脉造影及介入治疗及并发症处理方法。方法:对486例冠状动脉病变患者进行选择性冠状动脉造影,术前进行Allen试验阳性后选右侧桡动脉为穿刺点,行左右冠状动脉造影。结果:造影示冠状动脉正常85例(其中肌桥25例),单支病变192例,双支血管病变137例,多支病变72例。植入支架378例,其中329例(87.04%)经桡动脉途径手术成功,另外49例改经股动脉途径手术成功。术中、术后并发症较少,术后桡动脉搏动正常。结论:经桡动脉途径行经皮冠状动脉造影及介入治疗是安全、有效,是股动脉穿刺冠状动脉造影介入治疗的有效补充。     

Transthoracic coronary Doppler vibrometry in the evaluation of normal volunteers and patients with coronary artery stenosis

Coronary artery vibrometry is a new transthoracic Doppler ultrasound method for the detection of coronary artery stenosis. It detects audio-frequency vibrations generated by coronary artery luminal diameter reduction. We studied 31 patients with known or suspected stenosis using coronary artery vibrometry and quantitative coronary angiography and 83 normal volunteers. A tissue vibration difference index (TVDI) was calculated from the left anterior descending, circumflex, left main and right coronary arteries. Accuracy for coronary artery stenosis detection using TVDI was assessed. Sensitivity for detecting coronary stenosis equal or greater than 25% diameter reduction was 89% in the left anterior descending coronary artery (16/18, 95% confidence interval [CI] = 64%-98%), 87% in the right coronary artery (13/15, 95% CI = 58%-98%), 83% in the circumflex coronary artery (5/6, 95% CI = 36%-99%) and 100% in the left main artery (3/3, 95% CI = 31%-100%). The median TVDI increased with severity of stenosis, suggesting that this measure might be used to track progression/regression of coronary artery stenosis.(E-mail: kwbeach@u.washington.edu)     

Fate of collateral circulation after successful coronary angioplasty of total occlusion assessed by coronary angiography and myocardial contrast echocardiography.

A well-developed collateral circulation is frequently observed in patients with total coronary occlusion. However, the fate of the collateral circulation after successful percutaneous transluminal coronary angioplasty (PTCA) has not been fully characterized. The purpose of this study was to compare the efficacy of coronary angiography and myocardial contrast echocardiography (MCE) in the evaluation of the collateral circulation after PTCA and to assess the temporal changes of the collateral circulation after successful PTCA of a totally occluded artery by using these 2 diagnostic methods. The study group was comprised of 20 consecutive patients (16 male, mean age 54 years) who underwent elective PTCA for total coronary occlusion. Coronary angiography was performed before, immediately after, and 24 hours after PTCA. MCE was also performed before, immediately after, and 24 hours after PTCA, by the intracoronary injection of sonicated radiographic contrast medium. According to the angiographic findings, the collateral circulation was graded on a scale of 0 to 3 as follows: 0 = no visible filling; 1 = collateral filling of side branches; 2 = partial collateral filling of the epicardial artery; 3 = complete filling of the epicardial artery. By MCE, myocardial perfusion by the collateral circulation was assessed by scoring the contrast pattern of collateral-dependent myocardial segments as follows: 0 = none; 0.5 = patchy or epicardial; 1 = homogeneous. The left anterior descending artery was occluded in 12 patients and the right coronary artery in 8 patients. Coronary angiographic collateral grades before PTCA were grade 2 in 5 patients and grade 3 in 15. PTCA with stenting was successfully performed in all patients without significant residual stenosis. Coronary angiography showed collateral circulation disappeared after PTCA in all patients. However, residual collateral perfusion was observed in 7 patients by MCE, performed immediately after PTCA (score 1 in 3 patients; score 0.5 in 4 patients). This residual collateral perfusion could be demonstrated even 24 hours after PTCA by MCE in 3 patients (all patients were 0.5 in myocardial perfusion score). In conclusion, successful PTCA with stenting of a totally occluded coronary artery leads to a disappearance of collateral vessels by coronary angiography in most of the patients. However, although angiographically not visible, coronary collateral circulation may persist even 24 hours after successful PTCA of a totally occluded artery demonstrated by MCE.     

冠状动脉痉挛的血管造影表现(附37例报告)

目的：冠脉造影中的痉挛为病理自发性及导管造影刺激引起，使狭窄病变危险增加，须以重视及予以处理。方法：本组按Judlkins法行选择性冠状动脉造影中出现37例痉挛，男23女14，年龄43至60岁（平均47岁），自发性心绞痛15例。痉挛经硝酸甘油冠脉内注射处理后均缓解。结果：单发痉挛多见，表现为（1）左冠脉前降支近中段12例，右冠脉近中段5例，均在10mm以上，呈“长桥”状改变，缩窄达50%-65%，累及分支开口；（2）右冠脉开口鸟咀样缩窄3例；（3）右前降支及回旋支不规则轻度局限偏心型各4例。（4）右冠脉多发痉挛5例，左前降支4例。合并狭窄者19例，痉挛与粥样硬化部位对应。结论：由导管造影刺激引起的痉挛无胸闷和心电图改变。自发痉挛的年龄段与冠心病高发增长期相符，提示为心梗前期病变可能；影像学特征有助于鉴别。     

64层螺旋CT冠状动脉成像质量及对冠状动脉疾病的诊断价值 （附562例应用体会）

目的：评价64层螺旋CT冠状动脉成像（64SCTCA）在诊断冠状动脉疾病中的临床价值。方法：收集562例临床可疑冠心病患者SCTCA的完整资料，其中48例与近期选择性X线冠状动脉成像（CCA）结果进行了对照分析，并对64层SCTCA显示的冠状动脉主干及主要分支情况进行了分级评估。结果：562例患者中有48例经CCA证实，48例720个节段中有687个节段可做定量评价，SCTCA发现98个节段有狭窄，CCA发现92个节段有狭窄，SCTCA诊断狭窄的敏感性为94.5%，特异性为98.1%，阳性预测值为88.7%，阴性预测值为99.2%。结论：64SCTCA对于冠状动脉狭窄的评估具有较高敏感性和特异性，适用于冠心病的筛查，具有重要的临床价值。     

Successful nitinol stent implantation in a large coronary aneurysm: post-interventional patency assessment by magnetic resonance imaging

Nitinol stents are thought to exhibit reduced occurrence of artifacts and may be suitable for magnetic resonance imaging (MRI) evaluation of stent localization and in-stent patency even in coronary-sized stent grafts. A 54-year-old male patient presented with a large coronary post-stenotic aneurysm of the right coronary artery (RCA) beside significant stenoses of the left circumflex coronary artery (LCX) and the left anterior descending coronary artery (LAD) with aneurysm formation. After implantation of stent grafts to the LAD and LCX, two polymermembrane-covered nitinol stent grafts were placed into the RCA. A control MR examination 7 days following the RCA intervention showed successful occlusion of the former aneurysm, no post-interventional endoleak, and bright signal within the stent indicating stent patency. Thus, coronary MRI after nitinol stent implantation in coronary aneurysms is feasible for post-interventional early imaging control at least as far as the exclusion of possible endoleaks is concerned.     

Anatomical variations of coronary ostia, aortocoronary angles and angles of division of the left coronary artery of the human heart

Classic anatomical dissection of 150 heart specimens from adults aged 18 - 80 years was performed. Anatomical variations were studied in: (i) the position of the ostium of the left coronary artery; (ii) the angle between the proximal segment of the left coronary artery and the longitudinal axis of the aorta and between the circumflex and the anterior descending branches; (iii) the angle between the anterior descending artery and the diagonal branches, and between the diagonal and circumflex branches in trifurcation of the left coronary artery; (iv) the position of the ostium of the right coronary artery in the right coronary sinus of Valsalva; (v) the angle between the initial part of the right coronary artery and the longitudinal axis of the aorta; and (vi) the position of the initial part of the left coronary artery relative to the coronary groove. Knowledge of and the ability to recognize and identify the variety of sites of origin of coronary arteries, aortocoronary angles and angles of division of the left coronary artery of the human heart may help to overcome potential difficulties in cardiosurgical procedures, such as aortic valve replacement and reinsertion of coronary arteries.