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1.
为评价冠状动脉内Palmaz-Schatz支架的临床效果,我们回顾性总结分析了70例冠心病患者74支冠状动脉血管80个Palmaz-Schatz支架植入的临床成功率、并发症及远期疗效。结果:DeNovo支架植入63个,Suboptimal支架植入11个,Bail-out支架植入4个,再狭窄病变支架植入2个。左前降支37处病变植入41个支架,左回旋支11处病变植入11个支架,右冠状动脉25处病变植入27个支架,1处病变植入1个支架。支架植入的成功率为98.7%。术中1例SVG支架植入术中近端血管血栓形成。住院期间无亚急性支架血栓形成或严重出血性并发症。术后3~24个月30例患者共33个支架接受冠状动脉造影随访,6例6个支架节段血管有再狭窄,再狭窄率为18.7%。结果提示:冠脉内Palmaz-Schatz支架是一种安全有效的介入性治疗技术,其成功率高,并发症率低,并可能有降低或延缓血管再狭窄发生的作用  相似文献   

2.
目的 评价国产BuMA生物降解药物涂层冠状动脉支架在冠心病小血管病变经皮冠状动脉介入治疗中的临床疗效及安全性.方法 选择182例行经皮冠状动脉介入治疗(PCI)的冠心病患者,其中小血管病变组102例,大血管病变组80例,均置入BuMA生物降解药物涂层冠状动脉支架,比较观察手术成功率、术中并发症及在1~12个月随访期间的心绞痛、猝死、主要不良心脏事件(MACE)发生率及复查冠状动脉造影情况.结果 大血管病变组和小血管病变组手术即刻成功率均为100%,两组共发现203处靶病变,共置入支架273枚.术中均无严重并发症发生.对入选182例患者进行出院后第1、3、6、12个月门诊随访发现,小血管病变组8例心绞痛复发,其中1例为糖尿病患者.大血管病变组5例复发心绞痛.于术后第6~9个月复查冠状动脉造影证实,小血管病变组2例分别为右冠状动脉主干、左前降支支架内远段再狭窄达75%~80%,大血管病变组1例为左前降支支架近端再狭窄75%.两组心绞痛复发、冠状动脉造影支架内再狭窄及靶病变血运重建主要MACE发生率的差异均无统计学意义.两组均未出现迟发性支架内血栓、无心肌梗死及猝死.结论 国产BuMA生物降解药物涂层冠状动脉支架应用于冠心病小血管病变介入治疗安全、有效,疗效不逊于用于冠心病大血管病变时.  相似文献   

3.
目的探讨影响冠状动脉内支架植入术后再狭窄的因素。方法对2001-2003年成功接受冠状动脉内支架植入术后患者进行定量冠状动脉造影,分析冠状动脉狭窄程度、病变长度及血管直径参数的影响。结果104例病人的138处病变植入152个支架,再狭窄率为35.5%。再狭窄组病变血管植入支架的长度(22±6)mm明显大于非再狭窄组(18±6)mm,(P<0.001)。短支架的再狭窄率显著小于长支架及植入多个支架者(P<0.01)。再狭窄组直径小于3.0mm中小血管的比例明显多于非再狭窄组。BX支架的再狭窄率最高,达46%,Supra-G的再狭窄率最低,为10.5%。结论冠状动脉内支架植入术后再狭窄与支架长度、构型等因素有关,小血管内植入支架仍须慎重。  相似文献   

4.
对28例32处复杂性冠状动脉(冠脉)病变的病人行冠脉内支架置入术,置入PalmatzSchatz型支架32个,Gianturco-Roubin型支架4个,其中2例置入3个支架,2例由于病变较长,故在同一病变部位置入2个支架,2例因置入支架时造成病变近端血管撕裂而重新置入另一个支架,支架置入成功率100%,2例出现局部血管撕裂,1例术后股动脉穿刺部位血肿,2例出院后口服华法令过程中出现皮肤淤斑,1例出现肉眼血尿,无其它并发症。有5例术后半年行冠脉造影示支架部位血流通畅,无再狭窄发生。  相似文献   

5.
Jin ZN  Chen YD  Lü SZ  Song XT  Zhu HG  Li H 《中华心血管病杂志》2006,34(12):1093-1096
目的探讨冠心病合并糖尿病患者支架术后再狭窄发生的危险因素,建立冠心病合并糖尿病患者支架术后再狭窄发生概率的预测模型,为中国冠心病合并糖尿病患者药物洗脱支架的合理使用提供循证医学证据。方法分析我院2002-2004年1126例冠状动脉内非药物洗脱支架置入术患者(2376处病变),使用多元逻辑回归分析比较术后出现再狭窄组和无再狭窄组冠心病合并糖尿病患者临床数据和造影资料,并使用上述数据库建立支架术后再狭窄发生概率预测表。结果在889例(78.9%)有6个月随访冠状动脉造影资料的患者中,151例(17%)有糖尿病。再狭窄定义为支架内及前后5mm范围内狭窄≥50%参考管腔直径。在非糖尿病组(738例),再狭窄的发生率为21.2%,糖尿病组(151例)再狭窄的发生率为35.9%(P〈0.001)。多元逻辑分析结果显示参考血管直径(≤3.0mm),病变长度(〉15mm)和胰岛素治疗是冠心病合并糖尿病患者术后再狭窄的可预见危险因素(P〈0.05)。支架术后再狭窄发生概率的预测表结果显示冠心病合并糖尿病患者再狭窄发生概率首要依赖于参考血管直径。结论冠心病合并糖尿病患者支架术后再狭窄发生概率显著增加。参考血管直径、病变长度和需要胰岛素治疗是冠心病合并糖尿病患者支架术后再狭窄的可预见危险因素。非糖尿病患者合并短病变(〈15mm)而无论参考血管直径,糖尿病患者合并冠状动脉大直径血管(〉3.0mm)合并短病变(〈15mm)预期再狭窄发生率〈15%,可以考虑使用金属裸支架。除此之外,建议使用药物洗脱支架。  相似文献   

6.
背景和目的PTCA术后再狭窄的发生率约17%~60%。重复PTCA后再狭窄的发生率仍高达25%~40%。虽然近年来冠状动脉内支架的植入应用以指数速度增长,但是冠状动脉内支架值人后对再狭窄预防作用尚无定论,以往文献报道单个支架植入后再狭窄的发生率历16%,多个支架植入后再狭窄的发生率高达60%。本研究对PtcA术后再狭窄的病人植入支架,以评定冠状动脉内支架对PICA术后再狭窄的治疗作用。方法和结果从1989年至1994年有723例冠心病患者行pTCA术,本研究选择其中128例病人术后发生再狭窄并行冠状动脉内支架植入术,在139处病变部位植入…  相似文献   

7.
目的评价西罗莫可(雷帕霉素)药物洗脱支架治疗小冠状动脉病变(<3.0mm)的临床疗效。方法选择2004年1月—2004年12月入院的98例冠心病病人,常规行冠状动脉造影,获得直径小于3.0mm的病变血管共107支,前降支49支,回旋支18支,右冠状动脉15支,对角支18支,钝缘支7支,血管直径2.74mm±0.23mm。107支病变血管共植入Cypher支架118个。结果107支病变血管中,75支血管经球囊预扩张后植入支架,32支血管行直接支架术,手术成功率100%,无急性/亚急性支架内血栓形成。术后全部病例症状消失。随访14个月±3个月,全部存活。其中53例在术后10个月接受冠状动脉造影随访,5例经造影证实为支架内再狭窄,再狭窄率9.4%。4例出现新部位血管病变,再次经皮冠状动脉成形术(PTCA)治疗,随访6个月,无心绞痛症状发生。结论雷帕霉素药物洗脱支架可以明显降低小冠状动脉病变支架内再狭窄率,临床疗效肯定。  相似文献   

8.
目的:随着经皮冠状动脉腔内成形术(PTCA)操作者经验的积累,支架置入技术的提高和术前、术后药物治疗方案的改进,已使大的冠状动脉(直径≥3.0 m m )置入支架后支架内血栓形成和闭塞的危险性明显降低,但是在小血管中(直径< 3.0 m m )置入支架是否也有同样好的结果尚不十分清楚,本文旨在检验在小血管中置入支架的安全性与有效性。  方法:我们在79 例病人的83 支小冠状动脉中置入了84 个支架,采用的支架置入技术为支架置入后用稍大一点或相同大小的非顺应性球囊高压扩张,术前、术后予以阿司匹林和噻氯匹定(抵克力得)联合治疗。  结果:成功的支架置入使病变直径狭窄从(79.07±15.59)% 降至(- 0.38±7.17)% ,无支架内血栓形成,使并发症发生率降低,66 例病人在6 个月的临床随访中,大部分病人(89.0% )仍保持无症状;在冠状动脉造影随访中,支架内再狭窄率为29.6% 。  结论:在直径< 3.0 m m 的小冠状动脉中置入支架手术成功率高,有明显的即刻血管腔扩大,支架内血栓形成和术后出血并发症发生率低,并有可接受的再狭窄率,是安全有效的  相似文献   

9.
目的:探讨经皮冠状动脉介入治疗(PCI)对冠状动脉复杂病变的疗效。方法:回顾性分析3年来对63例冠状动脉复杂病变患者进行介入治疗的成功率、并发症及预后。结果:61例复杂病变(包括慢性闭塞、分叉病变、长病变和再狭窄)病人成功置入支架(96.82%),无残余狭窄或残余狭窄〈10%。2例病人放置支架后出现侧支血管阻塞,3例出现动脉夹层,2例支架内形成再狭窄。未见其他严重并发症。结论:研究表明,介入治疗对于冠状动脉复杂病变是安全有效的。  相似文献   

10.
目的:探讨经皮冠状动脉腔内成形术(PTCA)和冠脉内支架植入术治疗冠心病的可行性和安全性。方法:分析43例PTCA和冠脉内67个支架植入术的资料。其中8处病变行单纯PTCA,12处病变直接植入支架;植入支架类型包括Cordis支架49个,NIR支架16个,CVD1个,AVE1个,靶血管病变特征;A型病变35处,B型30处,C型10处,支架植入病变血管分布为左主干1个,左前降支31个,对角支2个,左回旋支16个,右冠状动脉17个,结果:手术成功率100%,术前冠脉狭窄程度为80-95%,术后残余狭窄小于5%,管腔通畅,血流恢复TIMI Ⅲ级,随访2-36个月,4例患有支架内再狭窄,再狭窄率9.3%,结论:PTCA和冠脉内支架植入术成功率高,疗效显,是治疗冠心病心绞痛和心肌梗死的重要而有效的手段。  相似文献   

11.
The safety, efficacy, angiographic and histological effects of a new 316 L, SS seamless stainless steel tubular stent (V-Flexa, Global Therapeutics, Broomfield, Colorado) was evaluated in a porcine coronary and peripheral artery model. Implantation in the right coronary artery was successful in all 16 pigs. Eight pigs were angiographically controlled after 6 weeks and then sacrificed for morphometric analysis. All stented coronary vessels were widely patent at this moment and morphometric analysis showed only a mild fibromuscular neointimal hyperplasia resulting in a neointimal hyperplasia of 1.15 +/- 0.38 mm2. The remaining 8 pigs were controlled and sacrificed at 12 weeks. At that time, all stented vessels were patent and neointimal hyperplasia was 1.22 +/- 0.34 mm2. Comparison with the Palmaz-Schatza coronary stent (Cordis, Miami, Florida) in a porcine peripheral artery model demonstrated significantly less neointimal hyperplasia at 6 weeks (1.11 +/- 0.73 vs. 2.40 +/- 0.36, p = 0.001) and at 12 weeks (1.53 +/- 0.42 vs. 2.47 +/- 0.63, p = 0.003) for the V-Flex stent. In conclusion, V-Flex coronary stent implantation in a porcine coronary and peripheral arteries results in a high procedural success rate without subacute thrombotic occlusions, despite no further anticoagulation nor antiplatelet therapy. Six and 12 week histopathological and morphometric evaluation demonstrated only a mild fibromuscular neointimal hyperplasia. Comparison with the Palmaz-Schatz coronary stent in a peripheral artery model showed significantly less neointimal hyperplasia in the V-Flex stent.  相似文献   

12.
在猪的冠状动脉和周围血管支架模型上 ,通过血管造影和组织病理学检查评价一种新型的 316L不锈钢管型冠状动脉支架V -FlexTM的安全有效性。将 16个支架置入 16只猪的右冠状动脉 ,8只猪观察 6周 ,另 8只猪观察 12周。血管造影显示所有右冠状动脉通畅 ,6周时 16只猪的右冠状动脉造影定量分析显示直径狭窄平均为9% ;6周时 8只猪的组织病理学分析显示右冠状动脉内膜增生为 1.15± 0 .38mm2 ,12周时 8只猪的组织病理学分析显示内膜增生为 1.2 2± 0 .34mm2 。同Palmaz -Schatz冠状动脉支架在周围动脉上比较 ,V -FlexTM引起的内膜增生较轻 (6周 :1.11± 0 .37mm2 比 2 .40± 0 .36mm2 ;12周 :1.5 3± 0 .42mm2 比 2 .47± 0 .6 3mm2 ,P均 <0 .0 5 ) ,血管损伤、炎症反应及血栓反应亦较轻。研究结果表明 ,V -FlexTM冠状动脉支架在猪的冠状动脉和周围动脉上引起的新生内膜增生轻 ,血管损伤小 ,且炎症反应、血栓反应亦较轻 ,有较好的生物相容性  相似文献   

13.
The NIR stent is an expandable cellular coronary prosthesis with high flexibility and excellent trackability. the very low crossing profile, associated to the high flexibility, makes this stent suitable for complex and distal lesions. The aim of this study was to evaluate the feasibility, safety, and long-term (clinical follow-up) efficacy of elective and/or urgent deployment of the NIR stent in a broad patient group with coronary artery disease. Between June 1996 and May 1997, 986 NIR stents were implanted in 781 vessels (de novo or restenotic lesions in native vessels, saphenous vein grafts and internal mammary conduits) of 709 consecutive patients (498 men, 211 women) undergoing coronary angioplasty in two Villa Maria Group Catheterization Laboratories. Procedural angiographic success was achieved in 98.4% of all the lesions treated, ranging from 100% success rate in type A lesion to 97.6% in type C lesions (overall procedural success, 98.4%). Major adverse cardiac events (MACE) were considered from PTCA/stenting time to the patient discharge. The in-hospital MACE were limited and occurred in 15 patients: urgent surgical revascularization 0.8%, death 0.7%, sub-acute stent thrombosis 0.5% (overall in-hospital MACE rate 2.1%). Clinical follow-up data were obtained at 8.6±2.8 months following the stenting procedure. The event-free survival rate was 87.9%. The late MACE rate evaluation showed death, target lesion revascularization 9.9% (over-all late MACE rate 12.1%). The NIR stent performances in this broad patient population were excellent, showing very high procedural success rate both in normal and complex coronary anatomy. On the basis of the previous data, we can define NIR stent a safe multifunctional device suitable both for easy and complex situations. The clinical late results are very promising in term of event-free survivals and late MACE.  相似文献   

14.
BACKGROUND: Although it is widely accepted that stenting confers favorable angiographic and clinical results in coronary arteries >/=3.0 mm in diameter, the outcome of stent placement in smaller vessels remains largely unclear. METHODS AND RESULTS: We sought to specifically determine the early and long-term clinical outcomes in a large series of 197 consecutive patients who underwent stent placement in 207 vessels <3.0 mm in diameter. Procedural success, accomplished in 97.3%, was accompanied by a significant reduction in lesion severity from 85% +/- 9% before to 3% +/- 7% diameter stenosis after the procedure (P =.0001) and a 0.5% incidence of subacute stent thrombosis. At 1 and 2 years of follow-up, survival rate without major target lesion-driven events was observed in 77.3% and 73.9% of patients, respectively. Repeat revascularization procedures accounted for most of these events; cardiac deaths (including those related to subacute stent thrombosis) and late (>30 days) myocardial infarctions were infrequent (2.4% and 1.0%, respectively). The 6-month angiographic binary instent restenosis rate was 30.1%. On multivariate analysis, diabetes mellitus (P =. 0275), small baseline reference vessel size (P =.0300), and stent size 相似文献   

15.
The objective of this study was to assess the angiographic and clinical outcome of patients with coronary in-stent restenosis treated with balloon angioplasty with provisional stenting. The study included 375 consecutive patients with in-stent restenosis managed with balloon angioplasty alone or combined with stenting. Clinical events were recorded during a 1-year follow-up period and quantitative analysis was performed on 6-month angiographic data. Of the 373 patients (451 lesions) with a successful procedure, 273 were treated with angioplasty alone and 100 with additional stenting. Target lesion revascularization was required in 23.7% of the patients: 20.7% in patients with angioplasty and 31.0% in patients with stenting. Angiographic restenosis rate was 38.9%: 35.8% in the angioplasty group and 47.7% in the stent group. Stenting in small vessels was associated with a much higher restenosis rate than in larger vessels (65.6% vs. 37.5%, respectively; P = 0.01). Thus, repeat balloon angioplasty with provisional stenting for in-stent restenosis is a safe treatment strategy associated with a relatively favorable long-term outcome. However, the long-term results might be improved if additional stenting is avoided especially in small vessels. Cathet. Cardiovasc. Intervent. 48:151-156, 1999.  相似文献   

16.
Procedural and 1-month outcome data following implantation of the V-Flex Plus stent in our first 54 consecutive patients (35 male; mean age, 62 years) are described. Sixty-four stents were implanted for 60 mainly complex lesions; 48% were left anterior descending; 20%, circumflex; 27%, right coronary artery; and 5%, saphenous vein graft. The indication for stenting was elective in half of the patients and for a suboptimal result or as a bailout procedure in the other half. The stents were deployed at a mean of 12 atm (range, 6–18) and postdilated to a mean of 15 atm (range, 8–20). Pre- and postdilatation balloon sizes were 2.96 ± 0.57 mm and 3.16 ± 0.34 mm, respectively. The procedural success rate was 98%. There were no deaths or Q-wave myocardial infarctions. One patient suffered a non–Q-wave myocardial infarction and another developed a femoral false aneurysm. At 1-month follow-up, there were no additional events, in particular no revascularization procedures. Eighty-nine percent of patients were free of angina. Implantation of the V-Flex Plus stent is safe and effective with an excellent early success rate comparable to that of published randomized trials and registries of carefully selected patients. Cathet. Cardiovasc. Intervent. 47:504–508, 1999. © 1999 Wiley-Liss, Inc.  相似文献   

17.
冠心病合并糖代谢异常患者的临床研究   总被引:1,自引:0,他引:1  
目的分析冠心病合并糖代谢异常患者的冠状动脉病变特点和糖代谢异常对经皮冠状动脉介入治疗(PCI)操作及住院期不良事件的影响。方法对184例糖代谢异常及147例糖代谢正常的冠心病患者进行回顾性分析。分析患者的冠状动脉病变特点,计算血管造影成功率、操作成功率以及临床成功率,分析糖代谢异常对住院期临床事件的影响。结果糖代谢异常组患者多支病变检出率明显高于糖代谢正常组患者,冠状动脉病变范围更广泛、程度更重、病变更复杂,更易累及小血管(P<0.05)。糖代谢异常组与糖代谢正常组之间的血管造影成功率、操作成功率和临床成功率差异无统计学意义(分别为91.8%vs.93.9%,88.0%vs.91.8%及85.3%vs.90.5%,P均>0.05)。Logistic多元回归分析显示糖代谢异常不是PCI术住院期发生不良事件的独立危险因素(OR=0.999,95%IC:0.242~9.172,P>0.05)。结论糖代谢异常患者冠状动脉病变比糖代谢正常患者更复杂、严重;糖代谢异常不是PCI术住院期发生不良事件的独立危险因素。  相似文献   

18.
Although polymer coating of coronary stents enables sufficient loading and release of incorporated drugs, it has also been associated with potentially negative effects. This study compared the clinical, angiographic, and intravascular ultrasound (IVUS) outcomes of patients treated with polymer- versus nonpolymer-based paclitaxel-eluting stents (PESs). Sixty-five consecutive patients (70 de novo lesions) treated with polymer-based PESs (TAXUS, 1 microg/mm2 of paclitaxel; Boston Scientific Corp.) and 65 consecutive patients (65 de novo lesions) treated with nonpolymer-based PESs (V-Flex Plus, 2.7 microg/mm2 of paclitaxel; Cook, Inc.) were enrolled in the study. Six-month angiographic follow-up was performed on 54 lesions of the polymer-based PES group and 51 lesions of the nonpolymer-based PES group. IVUS at angiographic follow-up was performed in 61 of the first 70 included lesions. At 6-month IVUS follow-up, mean intimal hyperplasia cross-sectional area was 2.36 +/- 1.60 mm2 in the nonpolymer-based PES group versus 0.62 +/- 0.41 mm2 in the polymer-based PES group (p = 0.003). Implantation of polymer-based PESs resulted in significantly lower in-stent late lumen loss (0.22 +/- 0.27 vs 0.74 +/- 0.61 mm, respectively, p <0.001). In-stent binary restenosis rate was 5% versus 20%, respectively (p <0.001). Target lesion revascularization rate was 9% after implantation of polymer-based PES versus 18% (p = 0.128) after implantation of nonpolymer-based PES, and the major adverse cardiac event rate was 9% versus 23%, respectively (p = 0.032). In conclusion, polymer-based PESs result in superior angiographic and IVUS follow-up findings compared with nonpolymer-based PESs.  相似文献   

19.
The ACS Multilink (ML) stent is a novel second-generation stent. The largest amount of information available on the long-term outcome of coronary stenting is based on the use of Palmaz-Schatz stents. Fewer data exist on long-term follow-up results of ML coronary stents implantations. The authors present the long-term (> 3 years) clinical and angiographic follow-up results of the ACS Multilink coronary stents implanted in their institution. From May 1996 to December 1997, 125 patients underwent 133 coronary ML stent implantations. Stented vessels were as follows: 49% left anterior descending artery, 31% right coronary artery, and 20% left circumflex coronary artery. Indications for stent implantations were elective in 64%, because of suboptimal result from percutaneous transluminal coronary angioplasty (PTCA) in 26%, and bailout from PTCA in 10% of patients. The mean reference diameter of stented vessels was 3.2 +/- 0.2 mm. The mean percentage stenosis was 80 +/- 11% and 3 +/- 5% before and after stent implantation, respectively. Long-term clinical follow-up was completed in 75% (80 men, mean age 53 +/- 10 years) of the patients (either by interview or phone), and angiographic follow-up (37 +/- 12 months) was completed in 58% of the patients. There were no baseline clinical or angiographic differences between those angiographically followed up and the remaining patients. Angiographic restenosis (> 50% diameter stenosis) was detected in 22% of stents. Target lesion revascularization was 12%, nontarget lesion revascularization was 14% in angiographically followed up patients. During the follow-up period death and new myocardial infarction occurred in 12% and 6% of patients, respectively, and survival rate was 88%. This study provides long-term follow-up results of intracoronary Multilink stent implantations for native coronary artery lesions. These data show that clinical and angiographic benefits of ML stents are comparable to those of the first-generation stents, especially to the Palmaz-Schatz stents, of which results have been reported previously. A considerable rate of nontarget lesion revascularization occurs during the follow-up period.  相似文献   

20.
Clinical and angiographic outcomes after Tsunami coronary stent placement   总被引:1,自引:0,他引:1  
STUDY AIM: The aim of this study was to determine six months restenosis rate measured by off-line quantitative coronary angiography, and to assess the efficacy and safety of newly developed six cells Tsunami stent system for the treatment of symptomatic, de novo, native coronary artery lesions. STUDY DESIGN AND METHODS: Between January and August 2001, 100 patients with 120 lesions were included at four clinical sites in this prospective, non-randomized, single arm study. In 35% of the patients two or more stents were implanted, 15% of the lesions were stented with more than one stent and 46% of the lesions were in small vessels (相似文献   

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