冠状动脉内支架置入术的临床应用：附三例报告

作者报告了３例冠状动脉血管成形术（ＰＴＣＡ）术中发生急性血管闭塞，或严重内膜剥脱致血管夹层，形成威胁性闭塞时，采用冠状动脉内支架置入术治疗的结果。３例病人均为术中决定置入冠脉内架，经快速抗凝等准备，一次放置成功。支架置入后残余狭窄为０￣１０％，获得了满意的管径增大效果。３例病人均无急性或慢性血栓形成的严重并发症，术后无心绞痛发作，临床经过顺利。作者认为冠脉内支架置入术，是处理ＰＴＣＡ术中急性血管闭     

冠状动脉夹层

探讨冠状动脉夹层的造影表现，分型与临床预后的关系。１４例中男１３例，女１例。临床诊断冠心病，其中９例有心肌梗塞史。冠状动脉造影均显著涔膜撕裂瓣片形成的线样透亮线。其中１２例为ＰＴＣＡ术后。轻度内膜撕裂３例，平行夹层分离４例，局限型夹层分离５例，螺旋型分离２例。１４例中９例假腔内造影剂排空正常或轻度排空延迟，真腔无明显受压，病人无重要临床并发症。     

数字电影冠状动脉造影的临床应用

目的：介绍数字电影冠状动脉造影临床应用的经验。材料和方法：分析１９６例数字电影冠状动脉造影检查图像。其中５例为ＰＴＣＡ术,１６例为ＰＴＣＡ＋支架植入术。结果：数字电影技术操作简便。图像质量高,可清晰地显示冠状各级分支、侧血管及钙化等。结论：数字电影在冠状动脉造影及介入治疗方面具有较高的应用价值。     

准分子激光冠状动脉成形术的初步临床应用经验

目的：介绍准分子激光冠状动脉成形术（ＥＬＣＡ）治疗冠状动脉狭窄的临床应用经验。材料和方法：１０例冠心病患者作冠状动脉造影确认有１４支冠状动脉狭窄（狭窄率７０％～７５％者５支，９０％～１００％者９支）。全部病例均作ＥＬＣＡ手术。ＥＬＣＡ采用脉冲间期为１８０－２２０ｍｓｅｃ，光导纤维直径为１．３～１．６ｍｍ，能量密度１４．５～２１．０ｍＪ，激光频率为２０Ｈｚ。ＥＬＣＡ术后辅以球囊扩张血管成形术（ＰＴＣＡ）。结果：９例１３支狭窄动脉中，９支狭窄率＞９０％者，作ＥＬＣＡ＋ＰＴＣＡ成功，其中７支动脉狭窄率减至１５％以下，２支减至４０％～４５％，１例因术中导丝头断裂，失败。成功的９支动脉术后冠状动脉造影示：内膜光滑４支，毛糙３支，夹层动脉瘤１支（２月后随访消失），术中出现血栓１支。术后６个月内造影随访，３例动脉再度狭窄。结论：准分子激光冠状动脉成形术可用于ＰＴＣＡ难以成功的有钙化硬斑、挟窄段较长（＞２．０ｃｍ）和闭塞的冠状动脉，安全有效。但它并不能避免术后再狭窄的发生。     

冠状动脉夹层(附14例报告)

目的：探讨冠状动脉夹层的造影表现、分型与临床预后的关系。材料和方法：１４例中男１３例、女１例。临床诊断冠心病，其中９例有心肌梗塞史。冠状动脉造影均显示内膜撕裂瓣片形成的线样透亮线；其中１２例为ＰＴＣＡ术后。结果：轻度内膜撕裂３例、平行夹层分离４例、局限型夹层分离５例、螺旋型分离２例。１４例中９例假腔内造影剂排空正常或轻度排空延迟，真腔无明显受压，病人无重要临床并发症。５例假腔造影剂排空延迟，真腔中－重度受压，其中３人出现急性心肌缺血和心肌梗塞体征。结论：结合临床预后冠状动脉夹层可分为真腔受压和真腔无明显受压两大类，后者一般不产生严重临床症状和体征；而前者可产生严重临床并发症，需要紧急治疗。     

核素显像评价冠心病患者PTCA疗效

对经皮冠状动脉腔内成形术 (ＰＴＣＡ)结果的评价多根据患者的症状和常规心电图 ,缺乏更加客观的依据。本研究通过对ＰＴＣＡ患者术前、术后99Ｔｃｍ 甲氧基异丁基异腈 (ＭＩＢＩ)心肌灌注断层显像和核素心室显像及定量分析的对比研究 ,以探讨其评价ＰＴＣＡ疗效的价值 ,现报道如下。资料与方法一、临床资料31例冠心病住院患者 ,男 2 5例 ,女6例 ,年龄 (36～ 78,平均 5 7.6± 3.5 )岁。其中不稳定性心绞痛 8例 ,急性心肌梗死 (ＡＭＩ) 19例 ,陈旧性心肌梗死 (ＯＭＩ) 4例。术前均行常规冠状动脉造影 ,示 1支血管病变 2 2例 ,2支血管病变 9例…     

潘生丁核素心肌断层显像评价PTCA的疗效

用潘生丁核素心肌断层显像随访３０例由经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗的冠心病患者，９７．８％术前心肌显像呈缺血表现的室壁节段在术后缺血消失或改善，而术前心肌显像仅表现为梗塞的节段术后无变化．术后１个月３０例患者治疗有效率为７６．７％，在术前心肌显像有缺血改变的２４例患者治疗有效率为９５．８％．半年复查治疗有效率分别为６６．７％及８３．３％．半年内１２．５％病例心肌显像发生再缺血并经冠状动脉造影证实．表明此法可以作为ＰＴＣＡ后短、长期疗效的评价手段，为ＰＴＣＡ选择合适的病例及合适的病变血管．     

数字减影血管造影在经皮冠状动脉腔内成形术中的应用（附10例报道）

作者采用ＤＳＡ对９２例冠状动脉硬化性心脏病施行冠状动脉（冠脉）造影，其中５２例（７１支）冠脉（ＣＡ）发现不同程度的狭窄；选择其中１０例ＣＡＳ患者行经冠脉腔内成形（ＰＴＣＡ），８例成功，狭窄管腔均获明显扩张（＞３０％），２例失败。文中着重讨论了ＤＳＡ在ＰＴＣＡ应用中的价值、限度与采取的措施。     

经皮冠状动脉腔内球囊扩张成形术的监测与护理

经皮冠状动脉腔内球囊扩张成形术（ＰＴＣＡ），是近年来用于临床的新的介入性治疗技术，成为冠心病血运重建的有效方法。护理人员在ＰＴＣＡ中的监测及术后护理应从以下几个方面注意。１、心绞痛症状的监测，在ＰＴＣＡ中当扩张处内膜撕裂或夹层形成以及血栓形成都是造成急性冠状动脉闭塞的原因。临床上由此引起的心绞痛往往发病是突然的，患者出现大汗，烦燥，护理人员应立即给氧气吸入，按医嘱给杜冷丁５０ｍｇｉｍ，并准备好除颤器及抢救物品，如果应用硝酸甘油不能缓解，此时应用冠状动脉灌注导管进行紧急处理。２、心律失常的监测，护…     

PTCA后冠状动脉再狭窄的血管内支架治疗

目的：采用血管内支架经皮腔内冠状动脉成形术（ＰＴＣＡ）后冠状动脉再狭窄，利用运动试验来追踪评价其１年疗效。材料与方法：观察３２例ＰＴＣＡ成功病例，其中６例在术后１～８个月被诊断为再狭窄，选择Ｇｉａｎｔｕｒｃｏ－Ｒｏｕｂｉｎ型支架做再成形治疗，在术后第１、６、１２个月测定其运动试验结果，将所测定指标与单纯ＰＴＣＡ组病例做同期对照。结果：６例血管造影均为原部位的单支血管再狭窄，经支架成形处理后，狭窄度由９０．５％±３．４％（ｘ±ｓ）下降为１０．２％±６．７％；术后１年追踪运动试验表明，支架成形组较单纯ＰＴＣＡ组在运动耐量和运动时间方面占优势。结论：再狭窄的发生除了与血管内膜增生反应相关外，还与血管壁的慢性回缩和结构重塑相联系；血管内支架可对抗这一过程的发生，从而提高中远期疗效。     

Clinical significance of exercise induced ST segment depression after successful percutaneous transluminal coronary angioplasty--assessment by thallium-201 SPECT

To evaluate the clinical significance of ST segment depression during repeated Treadmill exercise after successful PTCA, Thallium-201 SPECT was performed. The Thallium-201 SPECT was performed before, one week after and 3-6 months after PTCA. All thirty-five patients had one vessel disease and positive Thallium-201 exercise test. During follow-up period for 3-6 months, 11 of 35 patients had persistent ST segment depression. Restenosis of dilated coronary lesion was demonstrated in 6 of 11 patients. In another 3 of 35 patients, exercise induced ST segment depression was disappeared during follow-up Treadmill exercise. In 14 patients with persistent or transient ST segment depression after PTCA, Thallium-201 SPECT demonstrated transient ischemia in 5 of 6 patients with restenosis. In other 8 patients without restenosis, SPECT images did not demonstrate myocardial ischemia and coronary arteriographic findings could not verify side branch stenosis or intimal dissection which might cause myocardial ischemia. The etiology of ST segment depression after successful PTCA in one vessel disease is not produced by exercise induced myocardial ischemia but still unknown mechanisms may be present.     

冠脉内支架在冠脉病变中的应用价值

目的 探讨支架在冠脉病变治疗中的应用价值。方法对１９例冠心病患者植入冠脉支架,冠脉造影示Ａ型病变１例,Ｂ型１３例及Ｃ型５例。支架樾入用于预防ＰＴＣＡ后再狭窄１４例,治疗ＰＴＣＡ急性并发症（内膜撕裂和急性闭塞）５例。樾主支架２０个,其中前降支１０个,回旋支２个,右冠８个。结果 术后冠脉扩张效果满意,无残余狭窄。无一例发生急性和亚急性心脏事件,临床症状均明显改善。结论支架植入对复杂冠脉病变和急性冠脉并     

Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease

BACKGROUND AND PURPOSE: The safe performance of percutaneous transluminal cerebral angioplasty for intracranial atherosclerotic lesions requires that the risk of complications, such as acute occlusion or symptomatic dissection, and restenosis be reduced. Our purpose was to assess the effectiveness, safety, and short-term arteriographic and clinical outcome of cerebral angioplasty and stenting (CAS) for intracranial vertebrobasilar and distal internal carotid atherosclerotic occlusive lesions. METHODS: Between March 1998 and November 1998, 10 patients with 12 intracranial atherosclerotic lesions of the vertebrobasilar artery and the distal internal carotid artery underwent treatment with flexible balloon-expandable coronary stents. RESULTS: Although in two of the 10 patients CAS was not successful because of the inability to access the site of arterial stenosis, 10 lesions in eight patients were successfully dilated with stents. No complications occurred during or after the procedure and no neurologic ischemic events or restenoses occurred during the follow-up period. CONCLUSION: CAS appears to be a safe and effective means for treating intracranial atherosclerotic occlusive disease, yielding a favorable arteriographic and clinical outcome.     

Percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) has revolutionized the treatment of patients with coronary disease. As many as 25 per cent of those requiring myocardial revascularization can now undergo PTCA instead of bypass surgery. This article reviews PTCA techniques, clinical results, case selection, complications, recent advances in equipment design, restenosis rate, use in acute myocardial infarction, and PTCA of coronary bypass grafts.     

冠状动脉内支架植入术321例分析

目的：评价冠状动脉内支架的临床价值。材料与方法：321例冠心病患者冠状动脉内植入451个支架，植入成功率97．8／，其中79．1％（254例）为B2型以上复杂性病变，因DeNovo及Suboptimal病变植入的支架占56.7％（182／321），Bail－out病变16．5％（53／321），再狭窄病变26.8％（86／321）。结果：28例曾行冠状动脉搭桥水患者的28文静脉移植血管（SVG）内植入49个支架，16例急性心肌梗塞患者接受原发支架植入。多支架植入99例，其中植入3个以上支架者26例。支架类型：Palmaz－schatz支架占69.7％（314个），NIR支架占20．6％（93个），其它支架占9．8％（44个）。多数病例使用高压球囊扩张，住院期间发生急性支架血栓形成6例（1．9％），亚急性支架血栓形成2例，其中1例因心肌梗塞死亡，无严重出血并发症。21例（6.5％）术后2－11个月胸痛复发者支架部位再狭窄，再次PTCA。结论：冠脉内支架是一种安全有效的介入性治疗技术．其扩大了PTCA的适应症，成功率高，并发症低，并减少再狭窄的发生。     

经皮冠状动脉腔内成形术和支架术的临床应用

对7例冠心病患者进行了经皮冠状动脉腔内成形术(PTCA),共扩张12支血管的16处病变,其中2例置入冠脉内支架3个。7例病人中5例为双支血管13处病变,1例单支血管2处病变,1例左前降支完全阻塞病变,16处病变成功地扩张13处,造影结果满意,成功率81.3％(13/16),3个支架植入获成功。术后近期和远期追踪12个月,临床有效率85.7％(6/7),无严重并发症发生。该方法是治疗冠心病的有效手段。     

HSRA联合PTCA或支架成形术治疗老年钙化性冠状动脉狭窄

目的:探讨高速冠状动脉旋磨术(HSRA)联合经皮冠状动脉腔内血管成形术(PTCA)或支架置入术对治疗老年冠心病患者钙化性冠状动脉狭窄近期和远期效果。方法:对30例老年冠心病患者经冠状动脉造影诊断为钙化性狭窄的31处靶血管行高速冠状动脉旋磨术,并行补充性PTCA或支架置入术,观察近期疗效、并发症发生率、远期随访结果。结果:由术前狭窄(83.6±5.6)％减至术后残余狭窄(7.0±9.4)％,血管造影成功率100％,操作成功率96.7％,急性期无死亡、Q波心肌梗死、急诊冠脉搭桥(CABG),1例无Q波心肌梗死,随访期内1例心肌缺血症状复发,心源性死亡1例,再次血管重建2例,无CABG病例。结论:高速冠状动脉旋磨术联合PTCA或支架置入术治疗老年患者钙化性冠状动脉狭窄安全可行,成功率高,并发症少,远期效果好。     

Renal complications of polyarteritis nodosa: CT findings

Three patients with multiple renal complications of polyarteritis nodosa are described. The arteriographic findings in these patients were multiple arterial aneurysms and tissue infarctions, with the development of spontaneous intrarenal, subcapsular, and perirenal hemorrhagic complications. Computed tomography showed the hemorrhages and multiple renal infarcts; acute and late forms could be differentiated on the basis of contrast medium enhancement and scar formation.     

Relationships between coronary calcification detected at electron beam computed tomography and percutaneous transluminal coronary angioplasty results in coronary artery disease patients

Our objective was to assess the relationship between coronary artery calcification and outcomes of percutaneous transluminal coronary angioplasty (PTCA). Electron beam computed tomography (EBCT) was performed in 80 patients with coronary artery disease (CAD) who underwent PTCA. The calcium score in each coronary artery vessel was estimated (in Agatston units) and compared with the occurrence of complications and restenosis. Angioplasty had been performed in 96 coronary artery segments with stenosis in 80 patients. The average calcium score in the unsuccessful PTCA segments was significantly higher than in ones with successful results. For complications these values were 65.0±79.9 and 27.0±44.7, respectively (p=0.02), and for restenosis 63.9±87.9 and 27.3±41.3, respectively (p=0.03). Applying receiver operating characteristics analysis we determined sensitivity and specificity of EBCT for forecasting complications and restenosis. The best cut-off value of calcium score in segment of PTCA for prediction of restenosis was 27 (sensitivity 73%, specificity 67%), and for prediction of complications 29 (sensitivity 80%, specificity 74%). Coronary segments with extensive calcification were not optimal target lesions for PTCA. Analysis of coronary calcium score should be taken into consideration during planning of endovascular coronary interventions. Electronic Publication