经皮血管内支架成形术治疗高龄颈动脉狭窄患者的临床研究

目的　对平均80岁以上的高龄颈动脉狭窄患者进行经皮血管内支架成形术治疗的可行性,安全性和效果进行探讨。方法　对18例(年龄76～92岁)单侧颈动脉狭窄和其中1例合并椎动脉狭窄患者经磁共振和数字减影血管造影(DSA)确诊,后行经皮颈动脉支架和椎动脉支架血管内成形手术。结果　19例次支架置放均获成功。DSA显示狭窄段的颈动脉直径明显扩大,同侧颅内脑血管循环时间和染色趋于正常。仅1例出现部分运动性失语。随访3～18个月,无1例再发生脑缺血事件;B超复查未见明显支架内再狭窄。结论　对高龄颈动脉狭窄行经皮血管内成形治疗的安全性高,效果可靠。但需重视预防和及时处理围手术期出现的并发症。     

Early experience of transluminal coronary angioplasty (TCA) by the brachial artery (the sones technique in transluminal angioplasty)

Sixteen translumlnal coronary angioplasty procedures (TCA), eight right coronary artery (RCA) and eight left anterior descending coronary artery (LAD), by the brachial artery cut-down approach, were attempted with 9/16 (56%) immediate successes and 2/16 (12%) early recurrences. The procedure success rate for RCA obstructive lesions, 6/8 (75%) was greater than for LCA obstructions, 3/8 (38%). In six unsuccessful procedures the balloon catheter could not be advanced into the lesion, and in one unsuccessful procedure dissection of the coronary artery proximal to the lesion occurred. The brachial (Sones) technique for transluminal coronary angioplasty permits the use of softer guiding catheters for selective probing and approach to the coronary lesion but may be more likely to induce coronary spasm. Complete and high-resolution pre TCA anglograms with multiple views to disclose the exact anatomy of the coronary artery and Its lesion Is essential to ensure successful dilatation.     

颈动脉狭窄患者血管内支架成形术中麻醉药物的应用

目的探讨颈动脉狭窄患者血管内支架成形术(PTAS)中神经安定镇痛麻醉药物的应用和术中管理。方法颈动脉狭窄患者行PTAS 174例,获得知情同意后分为神经安定镇痛麻醉组(观察组,106例)和单纯局部麻醉组(对照组,68例)。观察两组患者入手术室、股动脉穿刺、球囊扩张、支架置入和术毕时血压、心率、脉搏氧饱和度(SPO2)的变化;对患者意识进行Ramsay镇静分级;记录两组血管活性药物的使用情况。结果支架置入成功率为99.4%;观察组Ramsay镇静分级多在Ⅱ~Ⅳ级(90.6%),对照组多在Ⅰ级(91.2%);两组患者SPO2均高于90%;观察组股动脉穿刺时收缩压与入手术室时比较明显降低(P<0.05);观察组行股动脉穿刺时收缩压与对照组比较明显降低(P<0.05);观察组血管活性药物的使用(51.1%)低于对照组(69.5%,P<0.05)。结论在PTAS中维持患者适宜的镇静程度,有利于维持循环稳定,并减少血管活性药物的使用,是保障手术成功和减少手术并发症发生的关键因素之一。     

Combined brachial and femoral approach to balloon angioplasty in coarctation of aorta

Transfemoral balloon angioplasty of native aortic coarctation was initially not feasible in two patients, because of inability to cannulate the femoral artery percutaneously in one, and to cross the coarctation in the other. The percutaneous brachial approach helped overcome both these problems, after which utilization of intravascular snares allowed successful transfemoral completion of angioplasty. Cathet. Cardiovasc. Diagn. 42:196–200, 1997. © 1997 Wiley-Liss, Inc.     

Robotic‐assisted balloon angioplasty and stent placement with distal embolic protection device for severe carotid artery stenosis in a high‐risk surgical patient

The use of robotic assistance in endovascular interventions may facilitate smoother procedures with fewer device manipulations, improve precision and accuracy of device deployment, and reduce exposure to fluoroscopic radiation. We used the CorPath GRX Robotic System for carotid balloon angioplasty and stent placement in a patient with limited surgical options.     

Percutaneous transluminal angioplasty of ostial lesions of internal mammary artery grafts.

The internal mammary artery (IMA) is currently the best graft for coronary bypass surgery and is therefore preferentially anastomosed to major arteries, usually the left anterior descending (LAD) artery. This graft may develop a stenosis, most often at the distal anastomosis. Ostial stenoses are rare and their pathophysiology uncertain. While angioplasty of distal anastomotic lesions provides adequate results, the very small number of published cases of angioplasty of ostial lesions explains the lack of knowledge on results of this type of procedure. The authors report six procedures of this type on five patients, including two with stenting. The primary success rate was 100%, with only one hospital complication in the form of pulmonary edema. Mean follow-up for 35 months revealed one sudden death due to probable restenosis, another death 3 years after angioplasty from rapid fatal shock without complementary investigation, and one case of unstable angina secondary to intrastent restenosis. These results suggest that this type of angioplasty is technically feasible with low risk, and that the restenosis rate seems relatively high, potentially presenting as sudden death, in the same way as unprotected dilatation of the native left main artery. A very close clinical follow-up of these patients is therefore necessary, with angiographic control in case of suspected ischemia.     

Percutaneous transluminal angioplasty of a large septal artery

A severely stenotic, large-caliber, first septal artery was successfully dilated in a patient with refractory angina and nonsurgical, multivessel coronary artery disease. The success of this dilatation was related to favorable coronary anatomy and to the availability of a guidewire-directed dilatation catheter. Septal artery stenosis with or without surgically accessible stenoses in other coronary vessels represents a potential indication for percutaneous transluminal coronary angioplasty.     

Balloon angioplasty of the internal mammary artery trunk for early postoperative ischemia: A case report

In this case report kinking of the internal mammary artery graft with possible superimposed spasm is described. Angiographic diagnosis was made 72 hrs following coronary artery bypass surgery and the lesion was successfully dilated with balloon angioplasty. © 1996 Wiley-Liss, Inc.     

经皮血管内支架成形术治疗颈动脉狭窄

目的　探讨经皮血管内支架成形术治疗颈动脉狭窄的手术方法、适应证及操作技巧。方法　本组 2 2例颈动脉狭窄患者均采用经股动脉入路 ,对颈动脉颈段狭窄者应用自膨式支架进行血管成形 ,对位于颈动脉海绵窦段的狭窄则使用管状支架治疗。结果　 2 0例患者术后的颈动脉狭窄段直径较术前扩大 ,达到正常管径的 6 0 %以上 ,2例达到 30 %。 2 2例患者临床缺血体征术后明显改善 ,没有发生并发症。随访 2～ 2 4个月未见脑缺血发作。结论　经皮血管内支架成形术是治疗颈动脉狭窄的简便安全方式之一。但是缓慢及准确的操作仍是手术成功的关键。     

Carotid stenting in patients older than 65 years with inoperable carotid artery disease: A single‐center experience

Carotid angioplasty and stenting to treat extracranial carotid stenosis is an alternative (as yet not widely accepted) to high‐risk surgery, but its safety and efficacy are little known, especially in elderly patients. We reviewed our 3‐year experience of treating 100 elderly patients (> 65 years old) considered to be inoperable (76 men, 24 women, mean age 76 ± 10 years, mean follow‐up 18 ± 9.2 months) and present two case histories. Most (85%) were symptomatic (transient ischemic attacks in 60, stroke in 25); 80 had concomitant coronary artery disease (severe in 30 [defined by > 70% stenosis in two or more epicardial coronary arteries or the left main coronary artery]) and 25 had severe left ventricular dysfunction (ejection fraction ≤ 20%). The procedure was technically successful in all patients; there was one major stroke and no patient died. Postprocedure, 15% had minor complications: reversible neurological deficit (5%), pulmonary edema (3%), prolonged hypotension (3%), vascular access complications (3%), and neck hematoma (1%). Over 90% of patients were discharged home within 24 hr. Cathet. Cardiovasc. Intervent. 50:1–8, 2000. © 2000 Wiley‐Liss, Inc.     

Updated review of the global carotid artery stent registry.

The purpose of this article was to review and update the current status of carotid artery stent placement in the world. Surveys of major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent updates from these 24 centers in addition to 29 new centers have been obtained to bring up to date the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 12392 procedures involving 11243 patients. There was a technical success of 98.9% with 12254 carotid arteries treated. Complications that occurred during the carotid stent placement or within a 30-day period following placement were recorded. Overall, there was transient ischemic attack rate of 3.07%, minor strokes of 2.14%, major strokes of 1.20%, and procedure-related deaths of 0.64%. The combined minor and major strokes and procedure-related death rate was 3.98% based on procedure number. With nonprocedure-related death rate of 0.77%, the total stroke and death rate was 4.75%. Subsets of questions were directed at the new use of distal embolic protection devices; there were 6753 cases done without protection and which incurred a 5.29% rate of strokes and procedure-related deaths. In the 4221 cases with cerebral protection, there was a 2.23% rate of strokes and procedure-related deaths. Restenosis rates of carotid stenting have been 2.7%, 2.6%, and 2.4% at 1, 2, and 3 years, respectively. The rate of neurologic events after stent placement has been 1.2%, 1.3%, and 1.7% at 1, 2, and 3 years, respectively. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients who are high risk for standard carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have shown an improvement with technological developments, including distal embolic protection.     

Transpharyngeal echocardiographic detection of a left internal carotid artery stent

This case report describes a patient in whom a left internal carotid (LIC) artery stent was detected using a transpharyngeal approach during a transesophageal echocardiographic (TEE) study. Using pulsed-Doppler interrogation, flow through and beyond the stent was characterized and restenosis was ruled out.     

Percutaneous transluminal angioplasty of radial artery grafts

The radial artery is being used with increasing frequency to replace the saphenous vein as a coronary artery bypass graft, in the belief that it will provide improved long-term patency. Several centers have confirmed that the early results of surgery using the radial artery seem to be better than those obtained with saphenous grafts. Despite these apparent gains, early failure of the radial artery graft can occur and is frequently associated with symptomatic myocardial ischemia. Percutaneous angioplasty is an alternative to reoperation to treat lesions occurring on radial artery grafts. We report on 4 patients who underwent angioplasty of radial artery grafts. Cathet. Cardiovasc. Diagn. 45:400–404, 1998. © 1998 Wiley-Liss, Inc.     

肾动脉纤维肌性发育不良的介入治疗

目的 :探讨肾动脉纤维肌性发育不良(FMD)所致肾血管性高血压的临床特点、介入治疗及预后情况。方法:纳入2009—2013年我科收治的FMD所致肾血管性高血压患者共22例,均进行了经皮肾动脉介入治疗,回顾分析患者的临床特点,评价并随访其介入治疗的疗效及预后。结果:22例患者平均年龄(25±5)岁,其中女性16例(72.7%)。介入治疗采用单纯球囊扩张术18例(81.8%),行肾动脉支架植入术4例(18.2%)。患者平均诊室血压由术前(163±22)/(101±15)mm Hg(1 mm Hg=0.133 k Pa)下降至(122±15)/(80±10)mm Hg。其中12例(54.5%)治愈,10例(45.5%)血压得到改善,降压有效率为100%。术前患者血清肌酐水平为(75±25)μmol/L,术后为(74±21)μmol/L,无统计学差异(P=0.69);其中有8例患者行核素99m锝肾小球滤过率(99m Tc-GFR)随访,显示患侧肾脏99m Tc-GFR由术前(25.2±4.8)m L/min上升至(39.4±8.2)m L/min,术后有明显改善(P=0.001)。随访发现2例(9.1%)患者出现了再狭窄,并再次施行了球囊扩张术,术后血压得到了改善。结论:FMD患者经皮肾动脉成型术降压安全、有效,并能改善患侧肾功能,可作为临床首选治疗方法。     

Abciximab for the treatment of acute distal embolization associated with internal carotid artery angioplasty.

Carotid artery angioplasty and stent placement (CAS) can be complicated by procedure-related distal embolization and thrombus formation, potentially resulting in neurological sequelae. Patient A had CAS of left internal carotid artery and had loss of vision in the left eye with no flow in the left ophthalmic artery. Patient B had CAS of right internal carotid artery and developed left sided hemiparesis with total occlusion of the right middle cerebral artery. A selective intra-arterial injection of 5 mg of abciximab locally followed by a bolus of 5 mg of abciximab intravenously resulted in complete resolution of the filling defect on repeat angiography after 10 min in both patients.     

In-hospital outcome of percutaneous transluminal coronary angioplasty for long lesions and diffuse coronary artery disease

We performed coronary angioplasty on 151 long or diffuse lesions (120 long and 31 diffuse) in 141 patients (86% male, mean age 50 ± 9 years). Long lesions were defined as lesions 11-20 mm in length and diffuse lesions as lesions longer than 20 mm, or three or more lesions in the same vessel. One or more adverse morphologic features were present in 131 (93%) lesions. Long balloons were used in 44%, significantly more often for diffuse disease (long lesions 39% and diffuse disease 64%; P = 0.004). Newer devices including the rotational atherectomy device (9 lesions), stents and perfusion balloons were employed in 18 (12%) lesions, more often for diffuse lesions (long lesions 8% vs. diffuse lesions 26%; P = 0.017). Lesion severity was comparable in the two groups (long lesions: 88 ± 7%; diffuse lesions: 88 ± 8%), but diffuse lesions were associated with significantly higher residual stenosis (long lesions: 6 ± 8%; diffuse lesions: 12 ± 13%, P = 0.01). Major complications occurred in five (3.5%) patients, including one death (0.7% mortality). The angiographic and clinical success rates for all patients were 99% and 96%, respectively, and were comparable for long and diffuse lesions. Judicious case selection and the use of long balloons and newer interventional devices permit coronary angioplasty for long lesions and diffuse disease with excellent success and a low risk of complications. Diffuse lesions are associated with more frequent use of long balloons and newer devices, especially rotational atherectomy and slightly higher residual stenosis as compared to long lesions. © 1995 Wiley-Liss, Inc.     

Drug-coated balloon angioplasty versus balloon angioplasty for treating patients with in-stent restenosis in the femoropopliteal artery: A meta-analysis

Background:The introduction of endovascular surgery has led to frequent stent use, although in-stent restenosis (ISR) remains a challenging issue. Drug-coated balloon (DCB) and conventional balloon angioplasty (BA) are common endovascular procedures for addressing ISR in the femoropopliteal artery. However, there is controversy regarding which procedure provides the greatest benefit to patients.Methods:The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for prospective controlled trials that compared DCB and BA for patients with ISR in the femoropopliteal artery. The study has been approved by Ethics Committee of Wuhan Central Hospital.Results:The meta-analysis included 6 prospective trials with 541 patients. We found that DCB use was associated with significant reductions in binary restenosis at 6 months (relative risk [RR]: 0.45, 95% confidence interval [CI]: 0.33–0.63; P < .00001), binary restenosis at 1 year (RR: 0.44, 95% CI: 0.34–0.57; P < .00001), target lesion revascularization (TLR) at 6 months (RR: 0.36, 95% CI: 0.20–0.65; P = .0006), and TLR at 1 year (RR: 0.38, 95% CI: 0.27–0.54; P < .00001). The DCB group also had significantly better clinical improvement (RR: 1.39, 95% CI: 1.13–1.71; P = .002), although we did not detect inter-group differences in terms of death, target vessel thrombosis, or ipsilateral amputation. The brand of DCB may a cause of heterogeneity.Conclusion:Relative to BA, DCB use increases the durability of treatment for ISR in the femoropopliteal artery, based on significant reductions in binary restenosis and TLR at 6–12 months after the procedure. Furthermore, DCB use was associated with better clinical improvement. However, additional randomized controlled trials are needed to validate these findings.     

Coronary artery vasomotion after percutaneous transluminal coronary angioplasty

Substantial evidence of postangioplasty vasoconstriction is available, both at the dilated site and distal to balloon injury, demonstrating its frequent occurrence. It is likely that even mild or moderate vasoconstriction at the site of balloon injury may create flow turbulence, promoting platelet aggregation and contributing to thrombotic vessel closure. The regulation of arterial smooth muscle tone is a complex process and should be distinguished from elastic recoil, which occurs at the site of balloon injury due to passive elastic properties of the artery, generally immediately after balloon deflation. The contribution of a variety of messengers generated by humoral, neurogenic, myogenic, and endothelium-derived factors in this regulatory process has been implicated. The possible mechanisms of post-percutaneous transluminal coronary angioplasty vasoconstriction at the dilated site (local) and in segments of coronary artery beyond the dilated site (distal) are reviewed in this article.     

Bladed balloon angioplasty for peripheral pulmonary artery stenosis.

Treatment for peripheral pulmonary artery stenosis is challenging, and conventional balloon angioplasty has not proved to be universally effective. Evaluated was the efficacy of bladed balloon (BB) dilation to address vessels resistant to conventional high-pressure (10-15 atm) balloon angioplasty (BA). Thirty-one procedures were performed on 14 children with age range 1 month to 15 years. The diameter of the BB ranged from 3 to 8 mm. After BB dilation, all children had subsequent conventional BA (balloon size range, 3-10 mm). The minimal lumen diameter (MLD) before and after the procedure, whether there was a waist at initial BA, and BB diameter-to-MLD ratio before the procedure were measured. A > 50% increase in MLD was considered successful. Four children had Williams syndrome, two children Alagille syndrome, five children Fallot's tetralogy, and three miscellaneous lesions. The resistant stenosis was located in the right central pulmonary artery in 6, right branch pulmonary artery in 7, left central pulmonary artery in 6, and left branch pulmonary artery in 12 lesions. Median BB diameter was 253% (117-440%) of the MLD and increased from 2.0 +/- 0.7 to 3.2 +/- 0.8 mm (P < 0.0001), with a mean increase of 73% +/- 62%. There was an inverse relationship between the MLD before and increase after the procedure (r = 0.75; P < 0.001). The BB diameter-to-MLD ratio before procedure was significantly associated with the increase in MLD (r = 0.70; P < 0.001). After the procedure, 18 of the 31 procedures were considered successful. In all successful procedures, the BB diameter was greater than twice the MLD before the procedure. Comparing children with Williams and Alagille syndrome with the remaining eight children, there were no significant differences in the increase in MLD. A small aneurysm and thrombus were noticed in two and three children, respectively, but no fatal complications were reported. BB angioplasty is effective for resistant peripheral pulmonary artery stenosis when conventional BA fails. The diameter of the BB should be larger than twice the minimal luminal diameter of the stenotic lesion.