Retrieval of dislodged coronary stent from left renal artery by gooseneck snare

A rapamycin-eluting stent was dislodged during attempt of implantation at the proximal right coronary artery,which was found by fluoroscopy to have migrated into the anterior trunk of the left renal artery.We chose a 5 mm diameter Amplatz gooseneck snare and successfully retrieved the lost stent from the lodging vessel.     

Hypersensitivity to drug-eluting stent and stent thrombosis：Kounis or not Kounis syndrome?

With the utilization of coronary-stents, coronary remodeling and restenosis were reduced compared with balloon angioplasty alone,t However, the risk of restenosis is still in the range of 15% to 20%. Drug-eluting stents （DES）, which could release antiproliferative pharmacological agents after deployment, were designed to inhibit the response to injury reaction after hare-metal stent （BMS） implantation.     

Triple antiplatelet therapy for clopidogrel resistance with stent malapposition: a case report

Drug-eluting stent thrombosis has become a major safety concern after percutaneous coronary intervention （PCI） because of its close association with sudden death or ST-elevation myocardial infarction. The occurrence rate of stent thrombosis ranged from 0.6%-2.6% after selective PCI, and increased dramatically with premature cessation of antiplatelet treatment. Recent PCI guidelines generally recommend dual antiplatelet therapy with aspirin and clopidogrel for at least one year for all drug-eluting stent recipients at low risk of bleeding. However, whether dual antiplatelet therapy is sufficient for preventing late or very late stent thrombosis remains unclear. Here we reported a patient who suffered several episodes of drug-eluting stent thrombosis even on dual antiplatelet therapy.     

Vascular brachytherapy revisited for in-stent restenosis in the drug-eluting stent era: current status and future perspective

Percutaneous coronary intervention （PCI） with drug-eluting stents （DESs） has revolutionized the management of atherosclerotic coronary artery disease. However, in-stent restenosis （ISR） has been the downside of all coronary interventions with the devices that have been tested so far, even in the DES era. The impact of ISR is still an important issue due to the recurrent costs from need for repeat PCI and bypass surgery in some patients who underwent PCI with DES. A safe and cost-effective method is desired to overcome this unfavorable burden following PCI with DES. Vascular brachytherapy （VBT） is one of the approved indications and has evolved over a decade as a valuable alternative to treat ISR. Although VBT has been regarded as a standard therapy in ISR, it has cumbersome logistics and global applicability is decreasing, leading more extensive introduction of DES.     

Vascular stent as a treatment for refractory cervical stenosis

Cervical stenosis is a clinical condition involving partial or complete obstruction of the endocervical canal.In 1996,Bauldauf proposed that the definition of cervical stenosis is a cervical canal into which a 2.5# Hegar dilator cannot be inserted.1 Acquired cervical stenosis can be a complication of surgical procedures such as conization,trachelectomy,and curettage.It is a serious complication because of the clinical repercussions,which can include amenorrhea,hematometra,dysmenorrhea,infertility,infection,and endometriosis.Various surgical techniques are used in dilation and cervix reconstruction.However,in some cases,unsuccessful dilation with refractory recurrent stenosis may lead to hysterectomy.A successful case in which a self-expanding nitinol vascular stent was used to treat cervical stenosis was described by Grund et al.2 Here we report two additional cases in which vascular stents were used to treat patients with recurrent cervical stenosis after cervical surgeries.     

Subacute coronary stent thrombosis in a patient with angina treated with double antiplatelet drugs for six days

Stent implantation has been a great advance in percutaneous coronary intervention （PCI）, decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type： bare-metal stent （BMS） and drug-eluting stent （DES）. According to the timing after initial PCI, stent thrombosis is considered as acute when occurring between 0 hour and 24 hours after stent implantation, subacute between 24 hours and 30 days,     

Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials

Background Drug eluting stents （DESs） made with biodegradable polymer have been developed in an attempt to improve clinical outcomes.However,the impact of biodegradable polymers on clinical events and stent thrombosis （ST） remains controversial.Methods We searched Medline,the Cochrane Library and other internet sources,without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES.Safety endpoints were ST （definite,definite/probable）,mortality,and myocardial infarction （MI）.Efficacy endpoints were major adverse cardiac event （MACE） and target lesion revascularization （TLR）.Results We identified 15 randomized controlled trials （n=17 068） with a weighted mean follow-up of 20.6 months.There was no statistical difference in the incidence of definite/probable ST between durable polymer-and biodegradable polymerDES; relative risk （RR） 0.83; 95% confidence interval （CI） 0.62-1.11; P=0.22.Biodegradable polymer DES had similar rates of definite ST （RR 0.94,95% CI 0.66-1.33,P=0.72）,mortality （RR 0.94,95% C/0.82-1.09,P=0.43）,MI （RR 1.08,95% CI 0.92-1.26.P=0.35）,MACE （RR 0.99,95% CI 0.91-1.09,P=0.85）,and TLR （RR,0.94,95% CI 0.83-1.06,P=0.30） compared with durable polymer DES.Based on the stratified analysis of the included trials,the treatment effect on definite ST was different at different follow-up times：≤1 year favoring durable polymer DES and 〉1 year favoring biodegradable polymer DES.Conclusions Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES.Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.     

Maximizing benefit of drug-eluting stent by direct coronary stenting because of further reduction of inflammatory response

Coronary stents have been used as standard mechanical devices for percutaneous coronary intervention （PCI） in patients with coronary artery disease （CAD）.They provide vessel wall scaffolding and prevent early elastic recoil and restenosis, which are major limitations of balloon angioplasty. Consequently, coronary stenting has a higher successful rate of PCI and improves the clinical outcome of the patients with CAD. Because of the permanent nature of metallic stents, however, their presence on the intimal surface of a coronary artery poses a risk associated with the continuous interaction between the metal and the surrounding tissue. This can lead to long-term endothelial dysfunction or chronic inflammation and may result in many potential concerns such as in-stent neointimal hyperplasia and thrombogenesis7     

Recurrent acute myocardial infarction after 32 months: very late stent thrombosis after sirolimus-eluting stent implantation

Recent analyses have suggested that implantation of drug-eluting stents （DES） is associated with a higher rate of very late stent thrombosis when compared with bare metal stents （BMS）. According to Academic Research Consortium （ARC） definition,1 very late stent thrombosis refers to events occurring more than 12 months following stent placement. This complication is evident with sirolimus-eluting stents （SES） as well as polymer-based paclitaxel-eluting stents （PES）,     

Mediastinoscopy after stent implantation: a good method for diagnosis and treatment of severe superior vena cava syndrome

Superior vena cava syndrome （SVCS） is a clinical syndrome caused by compression or invasion of the superior vena cava or thrombus formation within the superior vena cava.SVCS is typically the most common emergency associated with tumors.The rapid progression of the disease necessitates immediate treatment.     

Progress of research on the biomechanics of aorta and stent graft

With improvements in the technology of clinical diagnosis of aortic diseases, more and more cases have been found on such vascular lesions as aortic dissection and abdominal aortic aneurysm, which lead to aortic biomechanical changes. Aortic biomechanics research will become a hot spot in the near future. At the same time, stent grafts （SGs） are widely used in the endovascular treatment of vascular diseases. The biomechanical properties of SGs will also become a focus of research. Understanding the relation between the aorta and SGs will better cater to clinical services by improving the success rate of surgery for aortic diseases and reducing intraoperative and postoperative complications. This article reviews researches on the biomechanics of the aorta and SGs.     

Current status of assessment of fractional flow reserve

Coronary angiography presently remains the main method tor the diagnosis and instruction of epicardial coronary disease. However, precise characterization of the significance for any given stenosis is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In clinical practice, in addition to the assessment of the anatomical details of vessel narrowing, a more impediment to coronary precise assessment of the blood flow has become extremely important. At present, several physiological parameters have been introduced to improve discrimination in functional coronary lesion severity during cardiac catheterization. Of these parameters, myocardial fractional flow reserve （FFR） has been the most frequently used and is being increasingly applied to assess the functional significance of intermediate lesions. FFR can provide important information, both for decision making in diagnostic angiography and for monitoring and evaluating coronary interventions.     

Risk factors for perioperative major cardiac events in Chinese elderly patients with coronary heart disease undergoing noncardiac surgery

Background Few studies have investigated perioperative major adverse cardiac events (MACEs) in elderly Chinese patients with coronary heart disease (CHD) undergoing noncardiac surgery.This study examin...     

Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery： a Meta-analysis of Randomized Controlled Trials

Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting （CABG） surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients＇ perioperative data, including patients＇ baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference （WMD） and 95% confidential interval （C/）. For dichotomous data, treatment effects were calculated as odds ratio （OR） and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity （Q test P〈0.05）. Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P〈0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups （all P〉0.05）. Patients randomized into sevoflurane group had higher post-bypass cardiac index （WMD=0.39, 95% CI： 0.18 to 0.60, P=0.0003）, lower troponin I level （WMD=-0.82, 95% CI：-0.87 to -0.85, P=0.0002）, lower incidence of myocardial ischemia （OR=0.37, 95% CI： 0.16 to 0.83, P=0.02）, shorter ICU and hospital stay length （WMD=-10.99, 95% CI： -12.97 to -9.01, P〈0.00001; WMD=-0.78, 95% CI： -1.00 to -0.56, P〈0.00001, respectively）. Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.     

Polytetrafluoroethylene-covered stent implantation with double guiding catheter technique for the treatment of type III coronary perforation after stenting

Coronary artery perforation is a life-threatening , complication during percutaneous coronary intervention （PCI） although it occurs rarely in contemporary era with incidence ranging from 0.1% to 0.8%. The overall mortality remains quite high and varied with thestype of perforation, with higher risk in type Ⅱ and Ⅲ     

Efficacy and safety of a novel nano-porous polymer-free sirolimus-eluting stent in pigs

Background Drug-eluting stents represent a major advance in interventional cardiology. However, the current drug- eluting stents have significant limitations. One of the major problems is very late stent thrombosis, which is likely caused by inflammation and a hypersensitivity reaction related to a polymer on the stent. A polymer-free sirolimus-eluting stent with a unique nano-porous surface has been developed. This study aimed to evaluate this novel polymer-free sirolimus- eluting stent for its efficacy and safety in a pig model. Methods Stents were directly coated with sirolimus （a drug concentration of 2.2 μg/mm2 on the stent surface）. The polymer-free sirolimus-eluting stents （PFSES） were compared to standard polymer-coated sirolimus-eluting stents （PCSES） and bare-metal stents （BMS） in 18 pigs. Results At one month the degree of neointimal hyperplasia was similar between the two sirolimus-eluting stent groups and was significantly less compared to BMS （（1.93±0.51） mm2, （1.57±0.69） mm2 vs. （4.45±1.05） mm2, P 〈0.05）At three months, PFSES maintained the low level of neointima （（2.41±0.99） mm2 vs. （4.32±1.16） mm2, P 〈0.05）, whereas PCSES had developed significant neointimal proliferation similar to BMS. The inflammation level was significantly higher in PCSES when compared with BMS three months post-implantation （2.50±0.55 vs. 0.83±0.75, P 〈0.05） whereas PFSES showed a low level of inflammation comparable to PCSES （1.33±0.52 vs. 2.50±0.55, P 〈0.05）. Conclusion The PFSES is effective and safe. and appears to be suoerior to standard PCSEs.     

Renoprotective effect of alprostadil in combination with statins in patients with mild to moderate renal failure undergoing coronary angiography

Background The role of alprostadil and statins in contrast-induced acute kidney injury (CI-AKI) is controversial.The purpose of this study was to explore the efficacy of combined therapy with alprostad...     

Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%＇ Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent （BMS） implantation is the standard treatment for ostial renal     

Twelve years’ experience and clinical results of using the radial artery for coronary revascularization

Background The radial artery （RA） is becoming a popular conduit for coronary artery bypass grafting （CABG）,yet data reporting the long-term results are rare.We reported our clinical,angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.Methods A total of 118 radial artery conduits were harvested in 87 males and 6 females,age from 28 to 66 （mean 49.9） years.An ＂intra-operative Allen＇s test＂ was developed to safeguard blood supply to the arm and hand.A ＂double-clip ＆ scissors-cut＂ technique was carried out to minimize the thermal injury to the radial artery from the diathermy.The left radial artery was used in 67 patients,the right in one,and bilateral radial arteries in 25 patients.One hundred and twenty-two out of 272 distal anastomoses （44.9％） were constructed with radial arteries,with an average of 2.9 grafts per patient （range 2-6）.Results Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months （mean 59 months） revealed a 93.1％ RA patency.String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50％.The patency for the internal mammary artery was 96.4％.Conclusions The RA is an excellent conduit that broadens the options for total arterial CABG surgery.Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels.     

Role of BKCa channels in diabetic vascular complications

Objective This review focuses on the role of the large conductance calcium-activated potassium （BKCa） channels in diabetic vascular complications.Data sources Relevant articles published in English or Chinese from 1981 to present were selected from PubMed.The search terms were ＂BKCa channels＂ and ＂diabetes＂.Important references from selected articles were also retrieved.Study selection Articles regarding the role of BKCa channels in diabetic vascular complications and relevant mechanisms were selected.Results The BKCa channels are abundantly expressed in vascular smooth cells and play an important role in regulation of vascular tone.Multiple studies indicated that the expression and function of BKCa channels are altered by different mechanisms in diabetic vascular diseases such as coronary arterial disease,cerebral arterial disease,and diabetic retinopathy.Conclusion BKCa channels may play an important role in diabetic vascular complications and may be an effective therapeutic target for relieving and reducing the burden of diabetic vascular complications.