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1.
目的:探讨嗜酸性粒细胞阳离子蛋白(eosinophil cationic protein, ECP)与药物洗脱支架(drug eluting stent, DES)晚期支架内再狭窄(in-stent restenosis, ISR)的相关性。方法:选取2014年12月至2016年7月在复旦大学附属中山医院植入DES并超过1年后返院复查造影患者202例,根据复查造影结果分为ISR组(100例)和无ISR组(102例),应用夹心酶联免疫吸附(ELISA)法测定血清ECP水平并比较其在2组间差异。在ISR组和无ISR组,根据支架载药涂层,进一步分为永久涂层-DES组(DP-DES亚组)及可降解涂层-DES组(BP-DES亚组),分析血清ECP水平与载药涂层的关系。结果:ISR组血清ECP水平明显高于无ISR组(P=0.003)。手术年龄和ECP水平是晚期ISR形成的独立危险因素。ISR组DP-DES亚组血清ECP水平高于无ISR组DP-DES亚组(P=0.002)。结论:血清ECP水平在晚期ISR患者中显著升高,可能与支架药物涂层有关。  相似文献   

2.
Aims  Drug-eluting stents have been reported to effectively reduce in-stent restenosis (ISR). However, the effectiveness and safety have yet been investigated only in small trials or case series. The aim of this prospective large scale registry was to show that treatment of ISR with sirolimus eluting stents (SES) is safe, effective and feasible in daily routine. Methods and results  The German Cypher registry prospectively enrolled 6,555 patients undergoing implantation with SES for various indications, including 1,533 patients treated for ISR. Follow-up data (median 6.6 months) of this cohort was available for 1,531 patients (99.8%). Of these patients 75.8% were male. Of these patients 36.5% (n = 552) presented with acute coronary syndromes. In total, 1,932 SES were used with successful implantation in 98.9%. MI during hospitalization was observed in 0.7% (n = 11) while in-hospital mortality was only 0.1% (n = 2). MACE-rate at follow-up was 13.8% (n = 211) including a mortality of 1.3% (n = 20) and MI in 1.9% (n = 29). Total revascularization procedures including CABG (1.7%) were necessary in 12.3% (n = 186). Target vessel revascularization (TVR) rate was 9.3% (n = 139) and thus similar to patients with de novo lesions (8.1%, P = 0.69). Ten patients (0.65%) suffered from subacute stent thrombosis Vs. 0.24% observed in patients with de novo lesions (P = 0.03). Conclusion  This large registry confirms that treatment of ISR with sirolimus-eluting-stents is effective and save with good clinical results at index procedure and follow-up. TVR was not different from de novo lesions.  相似文献   

3.
目的 比较不同造影分型对大脑中动脉支架内再狭窄(ISR)的影响.方法 选择行大脑中动脉支架置入术的患者116例作为研究对象,按照部位-形态学-路径分型(LMA分型)进行造影分型(部位分型分为7个亚型,形态学分型分为3个亚型,路径分型分为3个亚型),随访患者再狭窄发生情况,并分析大脑中动脉ISR的LMA分型影响因素.结果...  相似文献   

4.
Introduction: Although drug-eluting stents (DES) have significantly reduced the incidence and prevalence of coronary in-stent restenosis (ISR), ISR still occurs in approximately 10% of patients in real-world practice.

Areas covered: The development of newer generations of DES, drug-coated balloons (DCB) and increased use of intracoronary imaging have improved our treatment options for and pathophysiologic understanding of ISR. These technological advancements have also largely supplanted older modalities for treatment of ISR, such as brachytherapy, bare metal stents, conventional and cutting balloon angioplasty, and atherectomy devices. This article reviews the presentation, pathophysiology, and treatment of coronary artery ISR, with a focus on recent clinical data and emerging therapies for this difficult to treat clinical problem.

Expert commentary: DCB and second-generation DES are the most effective treatment options for ISR. Most trials support a slight superiority of second-generation DES, while DCB have the advantage of not adding another metal layer. The role of bioresorbable vascular scaffolds will be determined in the near future.  相似文献   


5.
目的研究白细胞介素-18(IL-18)基因多态性对冠心病患者经皮冠状动脉介入术(PCI)术后支架内再狭窄(ISR)易感性的潜在影响。方法将PCI术后的241例有再发缺血临床症状的冠心病患者作为研究对象,并根据冠状动脉造影结果分为支架内再狭窄(ISR)组(ISR组,n=68)和非ISR组(n=173),另选择109例排除冠心病的人群作为对照组。采用聚合酶链反应对IL-18基因型进行检测,同时测定血清IL-18浓度。结果 ISR组、非ISR组患者G等位基因频率分别为0.93、0.83,二者明显高于对照组(0.73,P〈0.01),ISR组患者的G等位基因频率明显高非ISR组(P〈0.01)。ISR组、非ISR组患者GG基因型频率分别为0.87、0.69,二者明显高于对照组(0.54,P〈0.01),ISR组患者GG基因型频率明显高非ISR组(P〈0.01)。ISR组、非ISR组患者血清IL-18浓度分别为(309.39±86.75)、(245.37±59.04)ng/L,明显高于对照组[(138.41±47.28)ng/L](P〈0.01),ISR组患者血清IL-18浓度明显高于非ISR组(P〈0.01)。结论 IL-18启动子-137G/C基因多态性可能会影响血清IL-18浓度及PCI术后再狭窄发生的易感性。  相似文献   

6.
《Annals of medicine》2013,45(8):679-683
Abstract

Background. The best treatment option for drug-eluting stent (DES) restenosis has not been established. We performed a meta-analysis to assess the clinical efficacy of drug-coated balloon (DCB) for the treatment of DES restenosis.

Methods. Trials were identified through a literature search from January 2005 through April 2014. All randomized controlled trials were eligible for inclusion if they compared DCB with a control treatment (plain old balloon angioplasty [POBA] or DES) in patients with DES restenosis.

Results. Five studies and a total of 864 patients were included in this analysis. Most end-points were significantly reduced for DCB compared with the control groups. For major adverse cardiac events, the relative risk (RR) was 0.49 (P = 0.012); for target lesion revascularization, it was 0.50 (P = 0.044); for recurrent restenosis, it was 0.41 (P = 0.002). There was a lower mortality for DCB (RR 0.29; P = 0.017). The incidence of myocardial infarction was numerically lower, but without statistical significance (RR 0.76; P = 0.55). The DCB effect was more pronounced when compared with POBA than when compared with DES.

Conclusions. This meta-analysis showed that DCB was superior to POBA and comparable to DES for treatment of DES restenosis. The findings in this meta-analysis cannot be extrapolated to DCB in general, because all DCB used in trials included was a single brand of paclitaxel-coated balloon.  相似文献   

7.
Background  We are presenting an extension of a previously published trial on the efficacy and safety of a paclitaxel-coated balloon in coronary ISR in a larger patient population and after a complete follow-up of 2 years. Methods  Hundred eight patients were enrolled in two separately randomized, double-blind multicenter trials on efficacy and safety using an identical protocol. Patients were treated by the paclitaxel-coated (3 μg/mm2 balloon surface; Paccocath) or an uncoated balloon. The main inclusion criteria were a diameter stenosis of ≥70% and <30 mm length with a vessel diameter of 2.5–3.5 mm. The primary endpoint was angiographic late lumen loss in-segment. Secondary endpoints included binary restenosis rate and major adverse cardiovascular events (MACE). Results  Quantitative coronary angiography revealed no differences in baseline parameters. After six months in-segment late lumen loss was 0.81 ± 0.79 mm in the uncoated balloon group vs. 0.11 ± 0.45 mm (P < 0.001) in the drug-coated balloon group resulting in a binary restenosis rate of 25/49 vs. 3/47 (P < 0.001). Until 12 months post procedure 20 patients in the uncoated balloon group compared to two patients in the coated balloon group required target lesion revascularization (P = 0.001). Between 12 and 24 only two MACE were recorded, a stroke in the uncoated and a target lesion revascularization in the coated balloon group. Conclusion  Treatment of coronary ISR with paclitaxel-coated balloon catheters persistently reduces repeat restenosis up to 2 years. (ClinicalTrials.gov Identifier: NCT00106587, NCT00409981).  相似文献   

8.
目的:分析冠心病患者经皮冠状动脉介入术后支架内再狭窄的影响因素,并探讨其规律。方法:回顾性分析本院行冠状动脉介入治疗术后再次行冠状动脉造影的167例患者临床资料,分析急性心肌梗死组和非心肌梗死组、有症状组和无症状组冠状动脉支架再狭窄的发生率。结果:急性心肌梗死组患者支架术后支架再狭窄率高于非心肌梗死组患者(P<0.05);合并糖尿病患者再狭窄率高于未合并糖尿病患者(P<0.05);术后有可疑心绞痛症状者支架内再狭窄率高于无症状定期随访者(P<0.05)。结论:(1)急性心肌梗死、糖尿病可能由于其本身的病变特征,易致冠状动脉介入治疗术后支架内再狭窄。(2)根据临床症状可以初步诊断支架内再狭窄。  相似文献   

9.
经皮冠状动脉介入治疗(PCI)技术日趋成熟,已经在很大程度上提高了冠心病患者的生存率及生存质量。近10余年来,随着药物洗脱支架(DES)的普遍应用,介入治疗进入了新的阶段。然而,支架内再狭窄(ISR)的处理仍然是治疗的难点。药物洗脱球囊(DEB)能够将抗增生药物输送至靶病变部位,同时由于避免植入支架,减少了植入物刺激血管壁引起的炎症反应及内膜过度增生,从而降低了再狭窄率。因此,DEB在ISR等特殊病变治疗中具有特殊的优势。  相似文献   

10.
目的比较准分子激光与旋磨及常规球囊对冠状动脉支架内再狭窄治疗的效果。方法将461例单支冠状动脉病变支架内再狭窄患者分别用准分子激光、旋磨术与常规球囊进行扩张治疗,并在治疗后即刻及6个月时再次行冠状动脉造影并进行定量分析。结果介入治疗前各组间支架内再狭窄情况无明显区别;准分子激光和旋磨后加PTCA即刻所获得的冠状动脉支架内最小血管直径(MLD)显著高于常规球囊治疗组(P<0.05),且旋磨与准分子激光组间无明显差异(P>0.05);6个月后准分子激光及旋磨组治疗组冠状动脉支架内血管直径明显低于常规球囊治疗组(P<0.05),且旋磨及准分子激光组无显著性差异(P>0.05)。旋磨与准分子激光及常规球囊治疗组支架内血管直径狭窄率分别为57.17%、54.78%及38.31%;准分子激光及旋磨组后期血管丢失量高于常规球囊治疗组(P<0.05)。结论准分子激光及旋磨对冠状动脉支架内再狭窄即刻疗效明显优于常规球囊治疗组,但6个月后支架内再狭窄率高于常规球囊治疗组,因而不宜首选用作支架内再狭窄的治疗。  相似文献   

11.
Background : We tested the hypothesis that plasma levels of plasminogen activator inhibitor-1 (PAI-1) are influenced by percutaneous coronary intervention (PCI) with the implantation of drug eluting stents (DES) and are able to predict the occurrence of in-stent restenosis (ISR). Methods and results : PAI-1 active antigen plasma levels were determined in 75 patients before and 24 h after PCI with DES implantation. Patients with ISR after six to eight months (16%) showed significantly lower PAI-1 plasma levels before PCI (ISR, 11.7 ± 8.1 ng mL−1; non-ISR, 22.8 ± 18.8 ng mL−1; P  < 0.05). PAI-1 levels in the lowest tertile were associated with a 9.5-fold increased risk of ISR, independent of clinical risk factors, angiographic or procedural characteristics, compared to the highest tertile ( P  <   0.05). The induced change of PAI-1 active antigen 24 h after PCI was significantly higher in patients with ISR (ISR, +5.6 ± 8.0 ng mL−1; non-ISR, −3.2 ± 12.1 ng mL−1; P  <   0.05) with positive correlation to late lumen loss ( r  =   0.30; P  <   0.05). Conclusions : ISR after DES implantation is significantly related to plasma levels of PAI-1 active antigen before and after PCI. If confirmed by larger multicenter studies, the determination of PAI-1 plasma levels might be clinically helpful in the identification of patients at high risk of developing of ISR, even after DES implantation.  相似文献   

12.
Summary— Restenosis after coronary angioplasty, the main limitation of interventional cardiology, remains an unsolved issue. The failure to-date of all pharmacological attemps at prevention has prompted the development of alternative strategies. A mechanistic approach to the problem of restenosis is based on the assumption that creating a more satisfactory acute angioplasty result would reduce the development of restenosis. With the exception of coronary stenting, however, none of the new angioplasty devices have convincingly reached this goal. Furthermore, recent advances in the field of vascular biology have opened new avenues for a molecular approach of restenosis. Better understanding of the pathophysiology of restenosis, in conjunction with high-pace development of catheter, polymer, and virus technologies, provide opportunities to deliver agents — drugs, genes, or antisense oligonucleotides — locally, at the site of angioplasty to interfere specifically with the restenosis process. Some of these molecular strategies are currently being investigated in animal models. Clinical application of a molecular approach to prevent restenosis, however, will require close collaboration between physicians, molecular biologists, and bio-engineers.  相似文献   

13.
Drug-eluting stents: trading restenosis for thrombosis?   总被引:1,自引:0,他引:1  
Summary.  Within the last 6 years, it has been demonstrated that drug-eluting stents (DES) reduce significantly angiographic and clinical restenosis after percutaneous coronary interventions. These results are consistent across several clinical randomized controlled trials comparing these new devices with bare metallic stents (BMS), which themselves have already markedly improved the results obtained with balloon angioplasty in the early days of this method of myocardial revascularization. Nevertheless, some concerns have been raised regarding a delayed endothelialization of the coated prostheses leading to late stent thrombosis occurring mainly when antiplatelet therapy is discontinued in the follow-up. The most recent data show that, in comparison with BMS, there is a small excess of late (> 1 year) stent thrombosis but this is not associated with an increased risk of death or myocardial infarction or all cause mortality. These concerns do not outweigh the strong benefits of DES in preventing restenosis but require a number of measures concerning a longer dual antiplatelet treatment (than initially expected), to control patient treatment compliance and to provide a complete education of patients and physicians. Future devices dealing with the two issues (antiproliferative properties with rapid controlled endothelialization preventing thrombosis) would be the next major advance in this rapidly evolving field.  相似文献   

14.
目的 探讨冠状动脉药物洗脱支架内再狭窄的危险因素.方法 对157例行冠状动脉药物洗脱支架植入术患者的临床资料进行回顾性分析,按照冠状动脉造影结果分为再狭窄组33例和无再狭窄组124例,采用单因素及Logistic多因素回归分析其临床及冠状动脉造影特征与药物洗脱支架内再狭窄的相关性.结果 再狭窄组33例,糖尿病18例(54.5%),术后反复心绞痛26例(78.8%);无再狭窄组124例,糖尿病31例(25.0%),术后反复心绞痛72例(58.1%),组间差异有统计学意义(χ2=10.60,P<0.01;χ2=4.77,P=0.03).2组慢性完全闭塞分别为11例(19.3%)、12例(7.6%),分叉病变12例(21.1%)、16例(10.2%),弥漫病变15例(26.3%)、19例(12.1%),组间差异有统计学意义(χ2值分别为5.92、4.34、6.32,P均<0.05).再狭窄组植入支架57枚,无再狭窄组植入157枚.Logistic多因素分析显示糖尿病、术后反复心绞痛、慢性完全闭塞、分叉病变、弥漫病变和支架长度与支架内再狭窄相关(OR分别为3.52、2.59、3.05、3.14、3.08、0.93,95%CI分别为1.56~7.90,1.02~6.59,1.11~8.36,1.30~7.59,1.34~7.05,0.88~0.98,P均<0.05).结论 冠状动脉药物洗脱支架植入术后,糖尿病史、术后反复发生心绞痛、慢性完全闭塞、分叉病变、弥漫病变及支架长度为支架内再狭窄的危险因素.
Abstract:
Objective To investigate the risk factors of in-stent restenosis (ISR) after coronary implantation of drug-eluting stent Methods One hundred and fifty-seven patients including 118 males and 39 females,who underwent successful implantation of drug-eluting stent, were recruited in the study. The patients were divided into the restenosis group (33 patients) and non-restenosis group ( 124 patients) according to the angiographic results. The associations of ISR with clinical and coronary angiographic characteristics were analyzed using univiriate analysis and logistic regression. Results In the restenosis group,there were 18 cases of diabetes mellitus ( 54. 5% ), 26 cases of frequency angina ( 78. 8% ), which were significantly higher than those of 31 cases of diabetes (25.0%) and 72 case of frequent angina (58. 1% ) in the non-restenosis group (χ2 = 10. 60, P < 0. 01, χ2 = 4. 77, P = 0. 03 for diabetes mellitus and frequent angina, respectively). Compared to non-restenosis group, the occurrence rates of chronic total occasion, bifurcatus lesions, diffuse lesions were significandy higher in the restenosis group ( 19. 3% vs 7. 6% χ2 =5.92,21.1% vs 10. 2% χ2 =4. 34,26. 3%vs 12. 1% χ2 =6. 32,Ps <0. 05). Fifty-seven stents were implanted into the restenosis group,and one hundred and fifty-seven into the non-restenosis group. Logistic regression analysis showed that diabetes, frequent angina,chronic total occlusion lesions, bifurcatus lesions, diffuse lesions, stent length and diameter were significantly associated with restenosis ( OR value were 3.52,2. 59,3.05,3. 14,3.08,0. 93,95% CI were 1.56 - 7.90,1.02 - 6. 59,1.11 - 8. 36,1.30 - 7.59,1.34 - 7.05,0. 88 - 0. 98 respectively, Ps < 0. 05 ). Conclusion After implantation of drug-eluting stent, diabetes mellitus, chronic total occasion lesions, frequent angina, diffuse lesions, bifurcatus lesions and stent length and diameter are associated with follow-up restenosis.  相似文献   

15.
The long-term efficacy of percutaneous coronary interventions is still hampered by restenosis. Restenosis is the result of a complex pathophysiological process, which is thought to be caused by an exaggerated healing response induced by the vascular injury caused by the percutaneous coronary interventions and the implantation of a foreign body (the stent). There is increasing evidence that inflammation plays an important role in the initiation and development of neointimal hyperplasia and subsequent restenosis. Dexamethasone (Decadron®, Merck Sharpe and Dohme Ltd) is a glucocorticoid with well-known potent anti-inflammatory and antiproliferative properties. Early studies using either systemic or local delivery of dexamethasone have shown limited beneficial effects on restenosis. The dexamethasone-eluting stent (Dexamet?, Abbott Vascular Devices Ltd) is one of the first generation of drug-eluting stents for local drug delivery to prevent restenosis. Preclinical studies demonstrated that implantation of dexamethasone-loaded coronary stents was safe and had a beneficial effect on stent implantation-related inflammation. A pilot trial suggested a beneficial effect on restenosis. Large randomized trials are underway to confirm these findings. This article reviews the potential role of inflammation in the pathogenesis of restenosis and the efficacy of dexamethasone in the prevention of restenosis.  相似文献   

16.
目的 探讨血清尿酸(UA)水平与冠状动脉支架植入后再狭窄的相关性.方法 2005年2月至2010年8月对行冠状动脉支架植入术,并于术后1年行冠状动脉造影随访的患者797例,以支架植入段内径狭窄≥50%为再狭窄,分为再狭窄组(153例)和对照组(644例),回顾性分析两组患者的血清UA及其他临床生化指标的差异.结果再狭窄组的血清UA水平为(406.54±78.18) μmol/L,明显高于对照组(343.78±76.64) μmol/L,且差异有统计学意义(P<0.01).多因素logistic逐步回归分析显示,高尿酸血症是支架内再狭窄的独立危险因素(OR=1.653).结论 高尿酸血症与冠状动脉支架内再狭窄明显相关,降低血UA浓度可能减少再狭窄的发生.  相似文献   

17.
目的 探讨多巴酚丁胺负荷超声心动图(DSE)评价行经皮经腔冠状动脉成形术(PTCA)及支架植入术后再狭窄的临床应用价值.方法 39例行PTCA或支架植入术后1~12个月的患者,在造影前1周内接受DSE检查,多巴酚丁胺剂量递增方案为5、10、20、30、40μg·kg-1·min-15个级别,每级负荷维持3分钟.比较DSE和造影检查结果的一致性.结果 DSE评价PTCA及支架植入术后再狭窄的敏感度为75.0%,特异度为92.6%,准确度为87.2%.结论 DSE评价PTCA及支架植入术后再狭窄具有准确、安全可行的特性.  相似文献   

18.
Objective To evaluate the application value and efficacy on stent place for Budd-Chiari syndrome (BCS).Methods From January 1990 to May 2017, 2228 patients with BCS were admitted to our institution. The mean age was 43.3 years. Stents were placed in inferior vena cava (IVC), hepatic vein (HV), or both after balloon dilation. During follow-up period, the patency of stent was evaluated by ultrasound regularly and the clinic sign was surveyed by letter, telephone or clinic visit. The restenosis of stent were treated with balloon dilatation and thrombolysis to restore the its function.Results IVC type was diagnosed in 1492 cases, HV type in 510 cases, and mixed type in 226 cases. Eighteen patients aborted treatment because of economic reasons, advanced liver cancer, severe scoliosis, or both bilateral iliac veins and total IVC occlusion. Among the other 2210 cases who underwent endovascular therapy, stents were implanted into IVC in 339 cases, HV in 97 cases, mixed type in 64 cases. The rate of restenosis in IVC stent was 11.50% (39/339). After repeat angioplasty, the long-term patency rate reached to 98.12%. The incidence of HV occlusion caused by IVC stent was 12.09% (n = 41). Restenosis occurred in 47 cases (48.45%) after HV stent placement. However, the 5-year patency rate was 91.75% (89/97) after repeat dilatation and stent re-implantation. The incidence of IVC obstruction caused by HV was 3.33% (3 cases).Conclusion IVC stent placement appears to be an effective treatment for the cases of IVC segmental occlusion, and at the same time, the stent has the dual role of compression and fixation of thrombus and support of lumen. The HV and accessory hepatic vein obstruction could happen when the IVC stent crossed these veins ostium. The incidence of the stent restenosis in the HV was higher than that in the IVC.  相似文献   

19.
Animal studies have indicated that olfactomedin 2 (OLFM2) is involved in the process of vascular remolding. The aim of the present study was to investigate circulating OLFM2 levels in lower extremity arteriosclerosis obliterans (LEASO) patients and the association of OLFM2 with postoperative restenosis in patients. A total of 203 LEASO patients were enrolled in the present study. Plasma OLFM2 was measured before and 6?h after interventional therapy. After 6?months, patients were divided into a restenosis group and a non-restenosis group. Inter-group and intra-group differences in plasma OLFM2 were compared. The correlation between plasma OLFM2 and the severity of restenosis was analyzed by Spearman’s correlation analysis. An receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of plasma OLFM2 on restenosis. Logistic regression was used to determine the risk factors for restenosis. Postoperative OLFM2 in the restenosis group was significantly higher compared with the non-restenosis group (34.07?±?5.76?ng/mL vs. 19.53?±?2.99?ng/mL). No significant difference in preoperative plasma OLFM2 levels was identified between the two groups (10.92?±?2.49?ng/mL vs. 11.54?±?3.18?ng/mL). Postoperative OLFM2 levels were positively correlated with the severity of restenosis (r?=?0.728, p?相似文献   

20.
目的 探讨冠状动脉支架内再狭窄患者中运用药物涂层球囊(DCB)处理的有效性及安全性.方法 对60例经冠脉造影证实冠状动脉内支架再狭窄患者,36例予以药物涂层球囊治疗,24例予以药物洗脱支架(DES)治疗,随访6个月并复查冠脉造影进行对比.结果 两组患者基线资料上差异无统计学意义(P>0.05);两组患者术后即刻药物洗脱...  相似文献   

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