64排螺旋CT冠状动脉成像在无保护左主干冠脉病变PCI中的应用价值

目的 探讨64排螺旋CT冠状动脉成像（CTA）在冠状动脉无保护左主干病变（UPLM）介入治疗中的应用价值.方法 随机选取25例2012年1月至2014年1月在粤北人民医院心血管内科临床诊断为冠心病,并进行经导管冠脉造影（CAG）,确诊为UPLM的患者.其中12例患者术前进行了CTA检查;13例患者术前未进行CTA检查,而直接进行CAG及PCI.结果 12例介入诊疗前进行CTA检查的患者,CTA检查阳性预测值为100％,介入治疗均成功,手术成功率100％,术中未出现低血压及慢血流等并发症情况,PCI平均操作时间（30±5）min.13例术前未进行CTA检查的患者,有11例选择行PCI并成功,PCI成功率100％.但其中有6例患者在CAG及PCI术中出现低血压（46％）,2例患者术中出现冠脉慢血流（15％）,整体并发症发生率为61％,与CTA组比较差异有统计学意义（P＜0.01）;PCI平均操作时间（50±9）min,较CTA组明显增加（P＜0.01）.另外2例患者术前未行CTA检查,行CAG后放弃PCI治疗,择期行CABG（15％）.结论 冠心病患者术前行CTA检查,有助于提前发现UPLM,从而提高UPLM患者介入手术成功率,减少术中并发症.     

冠状动脉慢性完全闭塞病变介入治疗成功的影响因素探讨

目的 探讨冠状动脉慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)后院内结果以及介入治疗成功的影响因素.方法 连续收集2004年1月至2008年12月冠状动脉造影示完全闭塞病变1485例,其中CTO病变638例.对接受介入治疗的447例CTO患者的临床、病变影像特征、介入治疗资料以及院内结果进行分析.结果 CTO病变的PCI成功率为85.5%(382/447).术中出现C-F型冠状动脉夹层或冠状动脉穿孔27例(6.0%),心包填塞6例(1.3%),术后再次靶病变血运重建2例(0.4%),院内死亡2例(0.4%).与PCI成功患者比较,PCI失败患者年龄较大[(62.9±10.4)岁比(65.9±9.9)岁,P＜0.05],近端血管中重度迂曲(16.2%比38.5%,P＜0.01)、闭塞端缺如(47.1%比80.0%,P＜0.01)和中重度钙化(36.9%比72.3%,P＜0.01)的比例较高.多元逐步logistic回归分析(后退法)显示,中重度钙化(OR:3.866,P＜0.01)、闭塞端缺如(OR:3.346,P＜0.05)以及病变近端血管中重度迂曲(OR:3.055,P＜0.01)与CTO病变介入治疗成功呈负相关.结论 CTO介入治疗安全、可行,其成功率与闭塞病变特点相关.

Abstract：

Objective To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention(PCI)for patients with chronic total occlusion(CTO)using contemporary techniques. Methods A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed. Results Procedure success was achieved in 382 patients(85.5%).Coronary perforation(C-F type dissection or coronary perforation)occurred in 27 patients(6. 0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients(0.4%)received in-hospital repeat revascularization. Two patients(0. 4%)died post PCI: one died of acute stent thromobosis and the other one died of refractory heart and respiratory failure. Compared with patients of successful recanalization,patients failure to recanalization were more aged[(62.9 ± 10.4)years vs.(65.9 ± 9.9)years, P ＜ 0.05]and excessive tortuosity(16.2% vs. 38.5% ,P ＜0.01),absence stump(47.1% vs. 80. 0% ,P ＜0. 01)and excessive calcification(36.9% vs. 72.3%, P ＜0.01)were more common. Multiple logistic regression analysis revealed that excessive calcification(OR: 3. 866, P ＜ 0. 01), absence stump(OR: 3. 346, P ＜0.05)and excessive tortuosity(OR:3.055, P ＜ 0.01)were independent predictors for the procedural failure. Conclusions PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.     

老年冠心病患者冠状动脉慢性完全闭塞病变介入治疗及预后分析

目的:探讨老年冠心病患者合并冠状动脉慢性完全闭塞病变(CTO)行经皮冠状动脉介入治疗(PCI)的疗效。方法:回顾性分析我院经冠脉造影检查证实CTO并行PCI治疗的患者232例,按年龄分组,对比分析老年组108例,年龄≥60岁,平均(66.6±5.4)岁,中青年组124例,年龄60岁,平均(51.3±6.3)岁患者的临床特征、冠状动脉造影血管病变特点、闭塞血管开通率、围术期并发症及预后情况。结果:老年组患者冠心病家族史比例低于中青年组,与PCI相关的心肌梗死的发生率较中青年组高(P0.05)。但2组患者的闭塞病变血管支数及部位、平均造影剂用量、手术时间、应用导丝数量及球囊数量、支架植入数、闭塞病变开通率、随访术后心功能改善情况、主要不良心血管事件发生率差异均无统计学意义(P0.05)。结果:老年冠心病患者合并CTO病变行介入治疗的手术成功率以及主要不良心血管事件发生率与中青年CTO患者比较无差异,但术后心功能明显改善。     

左主干合并慢性完全闭塞病变介入治疗效果及三年随访分析

目的:探讨左主干(LM)合并慢性完全闭塞(CTO)病变患者经皮冠状动脉介入治疗(PCI)的效果及长期预后。方法:回顾性纳入2004年1月至2015年12月于中国医学科学院阜外医院行冠状动脉LM介入治疗的患者3 960例,按照LM病变是否合并CTO病变,分为LM合并CTO病变组(n=91)和LM不合并CTO病变组(n=3 869),比较两组患者的临床特点和长期预后。结果:与LM不合并CTO病变组患者相比,LM合并CTO病变组患者既往心肌梗死比例较高(26.1%vs. 40.7%),左心室射血分数较低[(63.1±7.7)%vs.(59.6±10.4)%],病变长度[(27.1±19.3)mm vs.(40.9±25.5)mm]及置入的支架长度[(31.9±19.8)mm vs.(45.8±27.1)mm]均较长,SYNTAX评分[(22.9±7.2)分vs.(27.2±7.3)分]较高,再狭窄病变(2.8%vs. 6.6%)、LM钙化病变(12.5%vs. 19.8%)、血栓性病变(1.1%vs. 13.2%)比例及主动脉内球囊反搏应用率(7.4%vs. 16.5%)、介入操作并发症发生率(2.0%vs. 5.5%)均较高,上述差异均有统计学意义(P均0.05)。所有患者中3年全因死亡率为3.5%。Kaplan-Meier生存分析显示,LM合并CTO病变组3年全因死亡率(11.0%vs. 3.4%)和心肌梗死发生率(13.2%vs. 4.1%)均明显高于LM不合并CTO病变组(P均0.05)。结论:PCI对适宜的LM病变是可选择的治疗方法,但对于LM合并CTO病变患者,PCI并发症发生率较高,不良心脏事件明显增加,因此此类患者应慎行PCI。     

冠状动脉慢性完全闭塞病变PCI后支架内再狭窄的预测因素分析

目的:探讨冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的预测因素。方法:选择241例成功行PCI的CTO患者,分为ISR组(43例)和非ISR组(198例),分析导致ISR的可能性因素。结果:ISR组和非ISR组在糖尿病、既往行PCI术、既往心肌梗死、慢性肾功能不全、冠状动脉完全闭塞长度≥20mm、支架总数、支架总长度、平均支架直径、血管内超声(IVUS)引导、成功逆向介入方面,差异均有统计学意义(均P0.05)。多因素logistic回归分析显示,糖尿病、慢性肾功能不全、既往PCI术、既往心肌梗死、成功逆向介入、支架总数、平均支架直径是CTO病变ISR的独立预测因子。结论:CTO病变PCI后ISR发生率较高,糖尿病、慢性肾功能不全、既往PCI术、既往心肌梗死、成功逆向介入、支架总数、平均支架直径是其独立预测因素。     

经皮冠状动脉介入治疗慢性完全闭塞病变对患者心脏功能的影响

目的:观察行经皮冠状动脉介入(PCI)治疗成功开通慢性完全闭塞(CTO)病变是否能改善患者的心脏功能.方法:回顾性纳入我院2016年1月-2018年1月行冠状动脉造影证实单支CTO病变且接受PCI治疗的患者132例,根据CTO是否开通,将所纳入患者分为开通组(70例)和未开通组(62例).收集患者的基本临床资料,记录并...     

冠状动脉CT血管成像及血管内超声诊断冠脉钙化病变的比较

目的:比较冠状动脉CT血管成像(CTA)与血管内超声(IVUS)诊断冠状动脉钙化病变的效果。方法:选择经我院临床诊断为冠心病或疑似冠心病患者50例为研究对象,所有患者均行冠状动脉CTA、IVUS检查,观察冠状动脉斑块特征、不同类型斑块CT值,以血管内超声为对照,评估冠状动脉CTA诊断效果。结果:两种检测方法在斑块面积、斑块负荷、管腔面积方面比较差异无统计学意义;钙化斑块CT值明显高于纤维斑块和脂质斑块[(725.68±68.42)Hu比(58.12±7.05)Hu、(60.21±6.78)Hu,P均<0.01];冠状动脉CTA诊断钙化斑块灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为92.86%、92.86%、92.86%、81.25%、97.50%。结论:冠状动脉CT血管成像在冠状动脉钙化病变定性定量检测中,具有较高的诊断效果,可以作为筛查的首选方法。     

冠脉内注射纤维蛋白特异溶栓剂有助于冠脉慢性完全闭塞病变的血运重建

目的:观察冠脉慢性完全闭塞病变(CTO)首次经皮冠脉介入(PCI)失败后,再次手术前冠脉内注射纤维蛋白特异溶栓剂的有效性、安全性及手术成功的预测因子。背景:慢性完全闭塞病变的介入治疗由于导丝无法通过病变而致失败的概率很高,是巨大的挑战。方法:85个CTO介入治疗失败患者,在再     

老年冠心病患者慢性闭塞病变介入治疗特点及预后分析

【】 目的 分析我院老年冠心病患者合并冠状动脉慢性闭塞病变(coronary chronic total occlusion ,CTO)经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的临床特点及预后,以此探讨老年冠心病患者CTO病变行PCI治疗的可行性和安全性。方法 回顾性分析我院2012年01月至12月住院经冠脉造影检查证实冠状动脉慢性闭塞并行PCI治疗的患者232例,按年龄分组,对比分析老年组[年龄≥60岁,平均(66.6±5.4岁]108例及中青年组[年龄＜60岁,平均(51.3±6.3)岁]124例患者的临床特征、冠状动脉造影血管病变特点、闭塞血管开通率、围术期并发症及预后等情况。结果 老年组患者冠心病家族史比例低于中青年组,与PCI相关的心肌梗死的发生率较中青年组高,差异具有统计学意义(P<0.05)。但两组患者的闭塞病变血管支数及部位、平均造影剂用量、手术时间、应用导丝数量及球囊数量、支架植入数、闭塞病变开通率、随访术后心功能改善情况、主要心血管事件发生率差异均无统计学意义(P>0．05)。结论 老年冠心病患者合并CTO病变行介入治疗的手术成功率和中青年CTO患者相当,手术并发症少,术后心功能明显改善, 老年冠心病患者CTO病变的介入治疗安全可行。     

血管内超声指导的真腔寻径与跟踪技术治疗复杂冠状动脉慢性完全闭塞病变的回顾性分析

目的:目前冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI),前向或逆向技术的关键和难点均在于使导丝通过病变至远端血管真腔。本研究报道一种血管内超声指导的真腔寻径与跟踪(IVUS-TST)的前向新技术,用于前向治疗复杂CTO病变或介入失败的患者。方法:总结2013-01-01至2013-12-31同一介入术者所完成的全部CTO病例,分为造影引导组(n=49)和IVUSTST组(n=67)两组,对比成功率、并发症率并分析失败原因。复杂CTO病变定义为日本J-CTO评分≥1分。介入成功定义为经对侧造影或血管内超声(IVUS)证实的导丝位于闭塞段远端真腔,至少完成了球囊扩张治疗。结果:140例患者148个CTO病变中,去除32例32个简单CTO病变(J-CTO评分1分,PCI成功率100%)后,共108例患者[男性90例,女性18例,平均年龄(56.71±11.89)岁]的116个复杂CTO病变[J-CTO评分平均为(2.18±0.80)分]纳入分析。与造影引导组相比,IVUS-TST组J-CTO评分显著更高[(2.33±0.84)分vs(1.98±0.69)分,P=0.019],病变显著更长(37.99±22.51)mm vs(31.43±20.20)mm,P=0.034],差异均有统计学意义。两组相比,IVUS-TST组较造影引导组PCI成功率有提高趋势(65.7%vs 49.0%,P=0.071);冠状动脉穿孔(9.0%vs 18.4%,P=0.136)和窦部损伤(0%vs 6.1%,P=0.073)比例也有降低趋势,但差异无统计学意义。所有患者均无住院死亡或行急诊冠状动脉旁路移植手术。多因素回归分析显示,IVUS-TST技术(比值比=2.756,95%可信区间1.019~7.453,P=0.046)是提高复杂CTO介入治疗成功的独立预测因素。复杂CTO介入失败的主要原因为导丝入口即进入假腔(43.8%)或不能再穿入真腔(43.8%);IVUS-TST技术的优势在于能使导丝从入口直接穿进真腔(33.8%),或引导内膜下导丝再穿入真腔(35.3%)。结论:以真腔为目标的IVUS-TST技术是一种有效治疗复杂CTO病变的新方法,可望提高手术成功率,减少严重并发症发生。     

冠状动脉计算机体层成像血管造影在冠状动脉疾病的临床应用

冠状动脉计算机体层成像血管造影是诊断冠状动脉疾病的一个优秀无创评价测试工具。虽然冠状动脉造影是冠状动脉粥样硬化性心脏病的金标准,但有充分的证据来支持冠状动脉计算机体层成像血管造影的性价比,而且它的临床应用范围广。本次综述的目的是对冠状动脉计算机体层成像血管造影在冠状动脉疾病临床应用中的诊断准确性和预测价值的概述;对冠状动脉计算机体层成像血管造影的新兴领域,包括双源计算机体层成像、多排螺旋计算机体层成像进行讨论,以及冠状动脉计算机体层成像血管造影的局限性和突出展示其未来的发展方向。     

An Additional Angiographic Sign for Determining Coronary Artery Dominance in Obstructive Coronary Artery Disease

An additional angiographic sign for determining coronary artery dominance is proposed. This sign is based on the anatomic pattern of the infraventricular branches in the left anterior oblique view. It is especially helpful in patients in whom the right coronary and/or left circumflex coronary arteries are completely occluded and distal vessels are filled via collaterals.     

Echocardiography and Coronary CT Angiography Imaging of Variations in Coronary Anatomy and Coronary Abnormalities in Athletic Children: Detection of Coronary Abnormalities that Create a Risk for Sudden Death

In a recent publication, Maron et al. reported the causes of sudden death in athletes from data collected in the US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry. It is not surprising that in this study, cardiovascular disease is reported as the most common cause of sudden death in athletes (56%). The most frequently encountered cardiac pathology was hypertrophic cardiomyopathy (36% of the population who died of cardiac disease). Coronary artery anomalies of wrong sinus origin were next in frequency (17%). Less common causes attributed to coronary pathology were Kawasaki disease, origin of the left coronary artery from the pulmonary artery, atherosclerotic coronary artery disease, and myocardial bridging of the left anterior descending artery. Echocardiographic imaging along with color and pulsed‐wave Doppler has been widely employed to visualize the anatomy and function of the heart and proves to be a valuable instrument in the identification of coronary artery abnormalities. Moreover, coronary CT angiography provides additional confirmatory information. This article will discuss the scope, importance, and implications of echocardiographic and coronary CT angiography imaging of the major coronary anomalies and abnormalities in young athletes who are at risk of sudden death and who otherwise have a structurally normal heart.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.     

Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Single Coronary Artery Anomaly

We report on a case of an adult male patient with previously unknown coronary anomaly and acute myocardial infarction in the territory of the left anterior descending artery (LAD). The coronary angiography showed a single coronary artery with intertruncal course, arising from the right coronary sinus, and thrombotic occlusion of the LAD. Successful transradial percutaneous coronary intervention was done with implantation of an intracoronary stent in the occluded artery. The postprocedural course was complicated by ventricular tachycardia, congestive heart failure, and mild transient renal failure. In conclusion, transradial percutaneous coronary intervention is safe and feasible in rare coronary artery anomalies even in an emergent setting. The finding of an anomalous coronary artery should not be a reason to decline performing coronary intervention. Copyright © 2009 Wiley Periodicals, Inc.     

Coronary artery quantitation and data management system for paired cineangiograms

A computerized system designed to optimize the quantitation of coronary vessels on 35 mm cineangiograms is described and validated. Because the system has two cine film digitizers, it processes paired coronary arteriograms for the evaluation of serial changes in coronary arteries. A database system was specifically designed for the storage of coronary artery quantitation data which resides on a file server in a local area network and may be accessed by multiple workstations. In radiographic phantom studies of nine contrast-filled lucite cylinders of known size, the overall accuracy and precision for the measured diameters were 0.069 mm and 0.066 mm respectively. Measurements of minimum diameter and percent diameter stenosis of 21 coronary lesions selected from 17 routine cineangiograms showed high degree of intraobserver and interobserver reproduclbllity.