Multi-Link冠状动脉内支架的临床应用和长期随访结果

目的 :评估 Multi- L ink冠状动脉内支架置入术的临床疗效。　　方法 :总结和分析行 Multi- L ink支架置入术的 96例冠心病患者 ,并做长期临床随访和冠状动脉造影复查。　　结果 :共置入 Multi- L ink支架 116只 ,平均每例 1.2 (1～ 4)只。急性心肌梗塞行直接冠状动脉内支架置入术 30只 ,初发原位病变 (De Novo) 34只 ,经皮冠状动脉腔内成形术 (PTCA )效果不满意 38只 ,非阻塞性内膜撕裂 9只和濒临闭塞(bailout) 2只 ,再狭窄病变 3只。手术成功率 99.0 %。住院期间死亡 1例 ,余无其他心脏事件发生。49.0 %患者于术后平均 17± 11个月复查冠状动脉造影 ,再狭窄率为 2 .1%。临床随访 2 7± 8个月 ,无临床心脏事件生存率为 91.6 %。　　结论 :Multi- L ink冠状动脉内支架置入术是一种安全和有效的治疗冠心病的方法。     

冠状动脉支架内再狭窄临床相关因素分析

目的　探讨冠状动脉支架内再狭窄与临床因素的关系。方法　前瞻性选择了冠心病易患因素、靶病变长度、支架术后管腔最小直径等 17项观察指标 ,对成功置入冠状动脉内支架 (coronarystent ,CS)并进行冠状动脉造影随访的 81例病人 (10 6条靶血管、12 2枚支架 )进行临床资料分析。单因素和多因素回归分析上述各种临床因素与再狭窄的关系。结果　 81例中有 2 7例病人的 33处原支架内发生再狭窄 ,靶病变再狭窄率为 2 7 0 %(33/ 12 2 )。单因素分析发现 :再狭窄组病人中空腹血清胰岛素 >15 μU·mL-1、血管病变长度≥ 15mm、支架术后管腔最小直径 <3 0mm者的比率明显高于无再狭窄组 (分别为 5 9 3%、33 3% ,P <0 0 5 ;6 3 6 %、38 2 % ,P <0 0 5 ;5 4 5 %、2 9 2 % ,P <0 0 1)。多元Logistic回归分析发现 :支架术后管腔最小直径 <3 0mm、靶病变长度≥15mm、空腹血清胰岛素 >15 μU·mL-1是CS术后再狭窄的独立危险因素。结论　较小的支架术后管腔最小直径、过长的靶病变、高胰岛素血症是CS术后再狭窄的最重要的独立危险因素。     

高龄冠心病患者择期冠状动脉支架置入术的临床特点及随访结果

目的评价高龄冠心病患者择期冠状动脉支架置入术的临床特点和长期疗效。方法2000年1月至2003年12月经冠状动脉造影证实的80岁以上的冠心病患者84例,分为支架组45例与药物组39例,比较两组的临床特点、住院期间疗效及长期随访结果。结果两组患者性别、年龄等基本临床特征差异无统计学意义,支架组急性心肌梗死患者比例较药物组明显高(40·0%比17·9%,P<0·05)。两组患者病变血管支数、病变类型差异均无统计学意义。支架组置入72枚支架,每例患者平均置入支架1·6枚;支架平均长度18·48±5·15mm,支架平均直径3·14±0·34mm。操作成功率、支架成功率及临床成功率分别为88·9%,95·6%和93·3%。平均随访时间(24·0±11·5)个月,随访率92·86%。随访期间支架组与药物组各发生心源性死亡1例;支架组主要心脏不良事件(MACE)和心绞痛复发的发生时间显著迟于药物组(14·3±5·6个月比9·1±6·0个月,P<0·05);支架组随访期间无MACE和心绞痛复发的生存率显著高于药物组。结论高龄冠心病患者择期支架置入术成功率较高,与单纯的药物组比较,可提高远期无MACE和心绞痛复发的生存率。     

冠状动脉内长和短支架及多个支架置入后再狭窄的血管造影随访研究

目的　比较单个短和长支架及多个支架置入的远期血管造影再狭窄发生率。方法　回顾性分析1996年5月至1998年10月在我院接受冠状动脉内支架置入并有血管造影随访的77例病人的临床及血管造影资料。单个短支架组（A组支架长度≤20mm）37例,39支血管;单个长支架组（B组支架长度>20mm）22例,25支血管;多个支架组（C组）18例,18支血管置入39个支架。结果　　病变长度在B和C组明显长于A组［（23.66±12.78)mm和(26.42±13.60)mm与(10.30±4.67)mm,P<0.001］;支架长度C组>B组>A组,P<0.001和0.002。随访时最小管腔开放直径(MLD)和管腔晚期丢失在A和C组间有明显差异,P<0.01和0.02,而在A和B组,B和C组间无统计学差异。三组的再狭窄率分别为28.2%、36%和61.1%,C组明显高于A组（P<0.05）,而B组又高与A组、C组高于B组的趋势,但统计学上无明显差异。Logistic多因素回归分析证实多个支架置入是再狭窄的唯一的独立预测因素（OR=3.29,P<0.05）。结论　多个冠状动脉内支架置入是发生晚期血管再狭窄的唯一独立预测因素;而与单个短支架置入相比,单个长支架置入的再狭窄率也有增高的趋势。     

西罗莫司和紫杉醇洗脱支架治疗支架内再狭窄的临床近期及10个月疗效

目的比较西罗莫司洗脱支架（Cypher或Cypher select）和紫杉醇洗脱支架（TAXUS）治疗支架内再狭窄的临床近期及10个月疗效。方法自2002年12月至2005年3月,对253例支架内再狭窄的患者采用了药物洗脱支架（DES）治疗并完成了10个月的临床随访和冠状动脉造影复查。253例中男性218例,女性35例,年龄30～80岁,平均年龄57．2岁。结果253例（262处病变）中152例使用Cypher支架176个,101例使用TAXUS支架132个。使用的Cypher和TAXUS支架的平均直径分别为（2．96±0．27）mm和（3．05±0,35）mm,P=0．04,平均长度分别为（23.31±6．68）mm和（23．56±6．54）mm,P=0．745。支架内再狭窄表现为100％闭塞29处,≥90％狭窄143处,〈90％狭窄90处。病变类型为A、B1、B2和C型各为9处、45处、73处和135处。PCI的成功率两组均为100％,住院期间无死亡,Cypher组主要心脏不良事件（MACE）发生率为2．63％,TAXUS组为2．97％,P=0．872。10个月临床造影显示在Cypher支架和TAXUS支架组中造影再狭窄率分别为14．0％和29．4％,P=0．075,MACE发生率分别为6．7％和16．0％,P=0．031。结论应用Cypher和TAXUS支架治疗支架内再狭窄有良好的近期临床疗效,10个月疗效Cypher支架优于TAXUS支架。     

国产冠状动脉支架的临床应用

目前国内冠心病介入治疗中仍以应用欧美进口支架为主。本研究回顾性总结国产支架临床应用的即刻及2年随访结果。资料与方法2 0 0 1年3月～2 0 0 3年6月我院共对118例住院冠心病患者应用国产预装型佩格斯支架(北京微斯曼医疗器械公司生产)置入术治疗,其中男93例,女2 5例,年龄38～75 (6 3 1±12 3)岁。发病12h内AMI行急诊介入治疗37例(其中合并心原性休克4例) ,不稳定性心绞痛76例,稳定性心绞痛5例。既往曾行冠状动脉旁路移植术(CABG) 1例,陈旧性心肌梗死38例,合并高血压病5 8例、糖尿病30例、高脂血症32例。心功能不全2 9例(2 4 6 % )。…     

冠状动脉内支架再狭窄的多因素回归分析

目的分析与冠状动脉内支架再狭窄有关的临床和血管造影及其处理因素。方法回顾性分析了在我院成功冠状动脉内支架置入和６个月后有冠状动脉造影随访的７４例病人的临床和血管造影及处理资料。用单因素和多因素回归分析方法分析了病人年龄、冠心病易患因素、靶病变形态学、及术后最小管腔开放直径（ＭＬＤ）等３２个变量与再狭窄的关系。结果在单因素分析中发现：术前血管参照直径和术后ＭＬＤ在再狭窄组明显低于非再狭窄组（３．１±０．３ｍｍｖｓ３．３±０．４ｍｍ和２．９±０．４ｖｓ３．２±０．４ｍｍ（Ｐ＜０．０５和０．０１）。支架直径小于３．５ｍｍ组的再狭窄率明显高于支架直径大于３．５ｍｍ组的再狭窄率（４１．７％ｖｓ１０．８％，Ｐ＜０．０５）。多元Ｌｏｇｉｓｔｉｃ回归分析发现：术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是再狭窄的独立危险因素。结论术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是最重要的支架再狭窄的独立危险因素     

脂蛋白a水平与冠状动脉支架内再狭窄关系的临床随访研究

目的 探讨脂蛋白a水平对经皮冠状动脉介入治疗（PCI）患者支架内再狭窄（ISR）的影响。方法 纳入2019年1月至2020年12月于中国科学技术大学附属第一医院心血管内科首次行PCI的患者2342例,收集患者基线资料及测定脂蛋白a水平。根据脂蛋白a中位数将患者分为低脂蛋白a组和高脂蛋白a组两组。1年后对所有患者进行随访,随访结局指标为出现ISR。采用Kaplan-Meier方法估计生存函数,采用log-rank检验对生存曲线的差异进行分析,Cox比例风险回归模型用于探索脂蛋白a与PCI术后ISR之间的独立关联。结果 患者平均随访时间18.11±3.63月,低脂蛋白a组ISR患者共65例（5.5%）,高脂蛋白a组ISR患者共87例（7.4%）,两组差异无统计学意义（P=0.063）。随访24个月后无ISR生存率依次为：第一四分位组75%、第二四分位组79%、第三四分位组69%、最高四分位组69%。在校正了年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、血管钙化、高密度脂蛋白胆固醇、总胆固醇水平后,相对于低脂蛋白a组,高脂蛋白a组患者2年内发生ISR风险的HR为1.39(95%CI:1.0...     

冠状动脉支架植入术后再狭窄与临床血清学指标的关系探讨

目的探讨冠状动脉内药物涂层支架置入术后支架内再狭窄与临床血清学指标的关系。方法214例冠状动脉内药物涂层支架置入术后患者因胸痛再发或常规行冠脉造影随访,以原靶病变管腔直径狭窄≥50%为支架内再狭窄,比较与无狭窄患者的临床血清学指标。结果214例患者共278处病变置入药物涂层支架,支架内再狭窄发生90例(110处病变)。再狭窄占42.1%,与无再狭窄组比较,血脂蛋白a、直接胆红素、谷丙转氨酶、谷草转氨酶、胆碱酯酶、纤维蛋白原等无显著统计学差异;再狭窄组患者血LDL/HDL、总胆汁酸、尿酸、碱性磷酸酶和γ-谷氨酰转移酶水平高于无再狭窄组,总胆红素低于无再狭窄组,均有显著统计学意义(P<0.05)。logistic多因素回归分析结果显示,糖尿病(OR=1.038)、高LDL/HDL(OR=1.542)、高胆汁酸(OR=1.197)、高尿酸(OR=1.113)、长病变(OR=1.331)是再狭窄的危险因素(P<0.05),而高总胆红素(OR=0.891)是再狭窄的保护因素(P<0.05)。结论血总胆红素、总胆汁酸、尿酸、LDL/HDL等临床血清学指标与药物涂层支架术后支架内再狭窄密切相关。     

雷帕霉素洗脱支架治疗多支冠状动脉病变的临床研究

目的:探讨多支冠状动脉病变患者置入雷帕霉素洗脱支架(Cypher支架)预防再狭窄的疗效及安全性。方法:2001年12月-2004年5月连续725例接受多支冠状动脉支架置入术的冠心病患者,剔除急性心肌梗死及再次血运重建患者。Cypher支架组187例,普通金属支架(普通支架)组538例。比较两组支架术后的近期及远期结果。结果:除糖尿病患者比例在Cypher支架组较高外,两组患者冠心病危险因素、心功能、冠状动脉病变严重程度、介入手术成功率及并发症发生率均无显著差异。690例患者平均随访(18.8±11.7)个月,Cypher支架组和普通支架组造影随访率分别为52.4%vs58.2%(P>0.05)。尽管Cypher支架组患者冠心病危险因素多、平均年龄63.5岁、不稳定性心绞痛占66.3%、糖尿病占41.6%、3支血管病变占57.8%、B2/C型复杂病变占86.2%,但造影复查再狭窄率和主要不良心脏事件(MACE)发生率均明显低于普通支架组(3.1%vs16.6%,5.5%vs16.7%,P均<0.01),心功能改善率高于普通支架组(63.1%vs30.6%,P<0.01)。两组完全血运重建率无显著差异(81.3%vs86.8%,P>0.05),但发生MACE的患者中,Cypher支架组不完全血运重建者比例高于普通支架组(60.0%vs23.5%,P<0.05);两组发生MACE的患者中完全血运重建患者比例均低于本组总的完全血运重建率(Cypher支架组:40.0%     

冠状动脉内V—FLEX支架的临床应用

目的　评价球囊释放V FLEX支架在临床应用的疗效。方法　对 92例 (男 84例 ,女 8例 )冠心病患者 (年龄5 4 11岁± 16 11岁 ) ,将 10 3只V FLEX支架置入 97处冠状动脉病变部位。结果　 91例患者均一次成功植入支架 ;无 1例发生急性心脏事件及需要紧急外科冠脉搭桥术 ;6个月复查冠脉造影再狭窄率 17 0 7%。结论　冠状动脉内植入V FLEX支架在临床应用即时效果好 ,远期疗效有待于进一步临床大规模观察及长期随访追踪。     

冠心病患者行经皮冠状动脉内支架植入术前后C-反应蛋白的变化

为观察炎症因子C 反应蛋白在经皮冠状动脉内支架植入术前后的变化 ,探讨C 反应蛋白在急性冠状动脉综合征的意义 ,我们回顾性分析了 10 5例行冠状动脉内支架植入术患者及同期 2 4 2例行冠状动脉造影患者的资料 ;利用散射比浊法测量其术前术后C 反应蛋白。结果发现 ,行经皮冠状动脉内支架植入术的患者术后C 反应蛋白明显高于术前 (6 .7± 0 .5比 17.6± 1.0 ,P <0 .0 1) ,而冠状动脉造影组术前术后C 反应蛋白则无明显变化 (3.5±0 .7比 3.6± 0 .8,P >0 .0 5 )。因此 ,C 反应蛋白作为炎症的反应蛋白 ,在经皮冠状动脉内支架植入术后明显升高 ,可能与冠状动脉内支架术治疗后斑块撕裂、内皮损伤以及局部血管炎症有关 ,推测C 反应蛋白升高是急性冠状动脉综合征的一个表现。     

The role of acute wall recoil and late restenosis: results of the OCBAS trial (Optimal Coronary Balloon Angioplasty with Provisional Stenting versus Primary Stent)

Early deterioration of minimal luminal diameter immediately after PTCA, has been associated with an increase of late restenosis. Lesions with no early loss after PTCA have a low restenosis rate. Coronary stents reduce restenosis in lesions exhibiting early wall recoil. The purpose of the OCBAS study was to compare two strategies during coronary interventions; provision vs. elective stenting. 116 patients with good PTCA results were randomized to stent ( n = 57) or to optimal PTCA ( n = 59). After randomization in PTCA group, 13.5% of the patients crossed over to stent due to early loss (provisional stenting). Baseline demographic and angiographic characteristics were similar in both groups of patients. At 7.6 months, 96.6% of the entire population had a follow-up angiographic study; 98.2% in the stent and 94.9% in the PTCA group. Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group (1.95 vs. 1.5 mm; P < 0.03). However, late loss was significantly higher in the stent than the PTCA groups (0.63 &#45 0.59 vs. 0.26 &#45 0.44, respectively; P = 0.01). Hence, net gain with both techniques was similar (1.32 &#45 0.3 vs. 1.24 &#45 0.29 mm for the stent and PTCA groups respectively; P = NS). Angiographic restenosis rate at follow-up (19.2% in stent vs. 16.4% in PTCA; P = NS) and TVR (17.5 in stent vs. 13.5% in PTCA; P = NS) were also similar. Furthermore, event-free survival was 80.8% in the stent versus 83.1% in the PTCA group ( P = NS). Overall costs (hospital and follow-up) were US$591,740 in the stent versus US$398,480 in the PTCA group ( P < 0.02). The strategy of the PTCA with delay angiogram and provisional stent if early loss occurs, had similar restenosis rate and TVR than universal use of bare stents.     

9种类型冠状动脉支架的临床应用体会

对 4 0例冠心病患者的 4 1支冠状动脉 4 2处病变植入 51枚冠脉内支架。植入的支架类型包括 :Bestent支架 ,BardXT支架 ,Angio支架 ,AVE支架 ,Devon支架 ,Multi-link支架 ,Wiktor支架 ,CVD支架及Gianturco -RoubinⅡ支架等 9种。支架选择按靶病变长度、近端血管内径大小及病变特点进行。支架释放压力为 6～ 14个atm ,时间为 30～ 6 0秒 ,之后经 2个以上的相互垂直平面造影证实支架充分扩展 ,远端血流达TIMIⅢ级为手术成功 ,手术成功率 96 .1%。其中 5例病人拔除动脉鞘管后压迫股动脉时出现窦缓伴血压下降 ,经静脉推注阿托品后好转 ,2例穿刺部位出现血肿。术后随访 1～ 2 9个月 ,有 4例再发心绞痛 ,其中 3例经造影证实植入支架血管血流正常 ,其它支发生再狭窄导致。我们认为冠状动脉支架术是安全而有效的冠心病介入性治疗方法 ,手术成功率高 ,并发症少。根据靶血管病变特征合理选用不同类型的支架是保证支架植入成功的重要环节。     

Angiographic results of the cobalt chromium Vision and Mini-Vision stents

BACKGROUND:

Drug-eluting stents (DES) have been shown to reduce repeat revascularizations compared with their bare-metal stent (BMS) platforms. Modern BMS may be associated with better angiographic results compared with the older BMS platforms. In the Basel Stent Kosten Effektivitats Trial (BASKET), target vessel revascularization after six months was nonsignificantly different between DES and BMS with clinical follow-up.

OBJECTIVES:

To evaluate angiographic results of the cobalt chromium Vision and Mini-Vision stents (Abbott Vascular, USA).

METHODS:

A total of 247 consecutive patients with 293 de novo lesions in native coronary arteries were treated with cobalt chromium Vision (n=184; stent diameter 2.75 mm to 4.0 mm) or Mini-Vision stents (n=109; stent diameter 2.0 mm to 2.5 mm), and scheduled for six months of angiographic follow-up. The primary end point was in-stent late loss after six months.

RESULTS:

Acute coronary syndromes were present in 83.4% (n=206) of patients. The preinterventional reference diameter of Vision stents was 2.70±0.34 mm and for Mini-Vision stents, it was 2.13±0.27 mm (P<0.001). Clinical and angiographic follow-up was 98.0% and 51.2%, respectively. In the Vision group, in-stent late loss was 0.64±0.67 mm and the binary rest-enosis rate was 17.9%. In the Mini-Vision group, in-stent late loss was 0.82±0.71 mm and the restenosis rate was 45.4%. No difference in occurrence of restenosis within the segments proximal or distal to the stent was observed. The restenotic pattern was predominantly focal with a short length of 7.9±4.4 mm.

CONCLUSIONS:

The use of the cobalt chromium Vision stent for the treatment of de novo lesions was associated with a low late loss and binary angiographic restenosis rate.     

Firebird支架治疗冠心病140例临床观察

观察国产Firebird支架在冠心病患者介入治疗中的临床疗效。方法共140例冠心病患者常规冠状动脉造影后行经皮冠状动脉介入(PCI)治疗,其中64例患者植入Firebird支架,76例患者置入普通支架,术前术后除常规使用阿司匹林和波立维外,同时给予严格的内科强化治疗,术后进行随访。结果冠状动脉造影显示2支以上血管病变占70.56%,一共植入Firebird支架114枚,普通支架105枚,所有患者均获得成功。平均随访(10.2±3.3)个月,其中药物支架组复发心绞痛18例,10例发生心肌梗死;普通组复发心绞痛40例,16例发生心肌梗死。部分患者行冠脉造影复查,Firebird支架组发生再狭窄2例,普通支架组发生再狭窄8例,均进行了靶病变重建术。结论Firebird支架对冠心病患者近期疗效确切,能减少再狭窄的发生。     

Iron status and clinical outcome in patients with coronary artery disease after coronary stenting

BACKGROUND AND AIM: So far, no studies have assessed whether there is an association between iron status and the incidence of major adverse cardiac events or restenosis after coronary stenting. We conducted this study to investigate whether there is an association between body iron status and clinical outcome in patients with coronary artery disease after coronary stenting. METHODS AND RESULTS: The study included 664 patients with coronary artery disease who underwent coronary stent implantation. The soluble transferring receptor/ferritin ratio (sTfR/ferritin ratio) was used as an index of iron status. Patients were divided into three groups according to the tertiles of sTfR/ferritin ratio: lower tertile (<11.9; n = 221), middle tertile (11.9-27.8; n = 221) and upper tertile (>27.8; n = 222). The combined incidence of major adverse cardiac events (death, myocardial infarction and target vessel revascularization) was the primary end point of the study. Patients in the lower tertile of the sTfR/ferritin ratio presented more often with unstable angina or acute myocardial infarction and had longer lesions and higher grade of stenosis than the patients in the middle or upper tertile of the sTfR/ferritin ratio. Angiographic restenosis at 6-month angiography was also evaluated. The cumulative event rate of composite end point of death, myocardial infarction or target vessel revascularization was 27.6% in patients in the lower tertile, 24.4% in patients in the middle tertile and 28.4% in patients in the upper tertile of the sTfR/ferritin ratio (p = 0.68). Restenosis was found in 27.8% (n = 45) in the lower tertile, 25.8% (n = 42) in the middle tertile and 27.5% (n = 38) in the upper tertile of the sTfR/ferritin ratio (p = 0.90). CONCLUSIONS: Our study showed no association between iron status and the incidence of major adverse cardiac events or angiographic coronary restenosis in patients with coronary artery disease after coronary stenting.