国产雷帕霉素药物洗脱支架在急诊PCI中的疗效分析

目的 探讨国产雷帕霉素药物洗脱支架在急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性.方法 对41例急性心肌梗死患者罪犯血管行急诊PCI,共置入了46枚国产雷帕霉素药物洗脱支架.其中前壁心肌梗死18例,下壁心肌梗死21例,高侧壁心肌梗死2例.结果 41例急诊PCI均获成功,38例置入支架,3例仅行单纯球囊扩张,未发生与PCI相关的并发症,住院期间1例因输液反应导致支架内亚急性血栓形成死亡,其余未发生主要不良心血管事件.随访12个月,有1例术后8个月再次行冠状动脉血运重建术,其余未发生主要不良心血管事件.结论 国产雷帕霉素药物洗脱支架在急诊PCI应用中有较高的安全性和有效性.     

国产药物洗脱支架对急性ST段抬高心肌梗死患者的疗效观察

目的探讨国产雷帕霉素药物洗脱支架Firebird在急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性。方法选择STEMI且在发病12h内接受急诊置入Firebird支架的患者96例,记录住院期间、术后9个月时不良心脏事件(MACE)的发生率。结果96处梗死相关病变置入150枚Firebird支架,支架置入成功率为100%,介入治疗后血流TIMI3级86例(89.6%),无复流现象3例,其中术中死亡1例;心脏破裂死亡2例;早期支架内血栓形成2例,其中死亡1例。住院期间MACE发生率为5.2%(5/96),PCI临床成功率为86.5%(83/96)。对82例患者进行了6～24个月的随访,平均(9.6±3.4)个月,因心力衰竭死亡2例,随访时MACE发生率2.4%(2/82)。结论国产雷帕霉素药物洗脱支架Firebird在STEMI急诊PCI中应用安全有效。     

老年急性冠脉综合征患者介入治疗的临床分析

目的:探讨老年急性冠脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)的临床价值.方法:70岁以上老年ACS患者50例,对持续性胸痛伴(或)ST段抬高心肌梗死患者(AMI 2例,UA2例)行急诊PCI;对非ST段抬高ACS患者经规范内科治疗病情平稳1周后行PCI.结果:对70支罪犯血管进行PTCA术后置入81枚支架.49例患者随访8～24个月无心绞痛发作;1例术后2个月冠脉造影显示支架内再狭窄,经支架内再支架置入术后随访5个月无心绞痛发作.结论:对老年ACS患者及时进行PCI可获得良好效果,临床安全程度高.     

药物洗脱支架(cypherTM)在急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗中的应用

目的　探讨雷帕霉素药物洗脱支架 (cypherTM)在急性ST段抬高心肌梗死 (STEMI)急诊经皮冠状动脉介入治疗 (PCI)中应用的安全性和有效性。方法　选择 2 0 0 2年 11月至 2 0 0 4年 2月的STEMI患者 96例 ,随机分为两组 :药物洗脱支架组 ( 4 8例 )和普通支架组 ( 4 8例 ) ,所有患者均于发病12h内行急诊PCI治疗 ,一组置入cypherTM ,另一组置入普通支架。结果　 96例患者急诊PCI治疗均获得成功。 4 8支梗死相关血管 (IRA)的 4 8处罪犯病变置入 4 9枚药物洗脱支架 ,另 4 8支IRA的 4 9处病变置入 4 9枚普通支架。未发生与介入治疗有关的并发症 ,其中 1例置入cypherTM 者术后出现脑梗死 ,于第 7天死于多器官功能衰竭。药物支架组和普通支架组相比较 ,PCI后造影结果和临床结果差异均无显著性。随后对 95例病人进行了 1～ 9个月随访 (平均 4 5± 2 6个月 ) ,药物支架组患者未发生任何心血管事件 ,普通支架组有 2例发生心绞痛。结论　cypherTM 在STEMI急诊PCI中应用与普通支架一样有较强的安全性和有效性     

国产药物支架在急性心肌梗死急诊介入中的疗效观察

目的评价国产药物支架(Firebird)在急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)的安全性及临床疗效。方法诊断ST段抬高AMI患者38例,平均年龄(61±8.3)岁,男性23例,女性15例。发病12h内急诊行PCI治疗,开通梗死相关血管(IRA)后,根据病变原则上行药物支架置入。观察住院期间(15.6±4.2)d心脏主要事件发生情况。结果共置入药物支架42枚,手术成功率100%,IRA为前降支l9例,左回旋支8例,右冠状动脉11例。即刻的前向血流TIMI3级34例,占89.7%,TIMI2级3例,占8.4%,3例术后出现不同程度左心衰,1例患者术后因心源性休克而死亡。结论研究显示国产药物支架在AMI患者行急诊PCI是一种安全有效的治疗方法。     

老年急性冠脉综合征患者介入治疗的临床分析

目的：探讨老年急性冠脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)的临床价值。方法：70岁以上老年ACS患者50例,对持续性胸痛伴(或)ST段抬高心肌梗死患者(AMI 2例,UA2例)行急诊PCI；对非ST段抬高ACS患者经规范内科治疗病情平稳1周后行PCI。结果：对70支罪犯血管进行PTCA术后置入81枚支架。49例患者随访8～24个月无心绞痛发作；1例术后2个月冠脉造影显示支架内再狭窄,经支架内再支架置入术后随访5个月无心绞痛发作。结论：对老年ACS患者及时进行PCI可获得良好效果,临床安全程度高。     

98例急性冠状动脉综合征患者介入治疗临床分析

目的观察急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)的安全性和有效性。方法98例ACS患者,其中不稳定型心绞痛62例,非ST段抬高心肌梗死13例,ST段抬高心肌梗死23例。经右桡(股)动脉穿刺,常规选择性冠状动脉造影,确定病变后,沿指引导管插入0.014英寸导丝,选择合适的球囊预扩张后,再置入合适的支架。结果98例患者,病变血管共135支,单支病变68例、双支病变23例、三支病变7例,慢性完全闭塞病变4例。介入干预病变血管105支,置入支架109枚,全部成功(TIMI血流均为3级)。结论PCI是ACS患者安全而有效的治疗方法。     

国产西罗莫司洗脱支架早期介入治疗非ST段抬高急性冠状动脉综合征

目的分析国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征的疗效。方法采用回顾性分析研究方法,在88例非ST段抬高的急性冠状动脉综合征患者置入国产西罗莫司洗脱支架,随访住院及术后1年内主要心脏不良事件发生率和无心脏事件生存率。结果随访1年中,不稳定心绞痛复发8例,非ST段抬高心肌梗死1例,再次冠状动脉内支架治疗2例,无死亡病例。结论国产西罗莫司洗脱支架早期介入治疗非ST段抬高的急性冠状动脉综合征安全、有效,并发症少,再狭窄率低。     

国产雷帕霉素洗脱支架在急性ST段抬高型心肌梗死中的应用

目的:评价国产雷帕霉素支架在急性ST段抬高型心肌梗死中应用的安全性和有效性,并观察其近、中期临床疗效. 方法:将147例急性ST段抬高型心肌梗死、发病12h以内在我院接受急诊介入治疗的患者随机分为2组,分别植入国产药物支架(Firebird支架组,n=78)和金属裸支架(Driver支架组,n=69).2组年龄、性别、发病时间、病变特征等基础临床情况无显著差异.78支罪犯血管植入Firebird支架83枚,69支罪犯血管植入Driver支架72枚.比较2组住院期和1年随访期的临床转归. 结果:2组所用支架长度、内径、术中扩张峰值压力及操作时间无明显差异;术后患者达TIMI 3级血流的比例相似.住院期间手术成功率无统计学差异(93%对95 %,P>0.05).1年随访期内Firebird组与Driver组造影随访率分别为53%和49 %,Driver支架组再狭窄率高于Firebird组(24%对2.5%,P<0.05),2组均未发生支架内血栓及心源性死亡. 结论:国产药物支架对急性ST段抬高型心肌梗死有较好的安全性和临床近、中期疗效.     

生物可降解涂层药物洗脱支架在急性心肌梗死中的应用

目的探讨国产生物可降解涂层药物洗脱支架(Excel支架)在急性ST段抬高心肌梗死急诊PCI中应用的安全性和有效性。方法选择确诊为急性ST段抬高心肌梗死患者35例,于发病12h内行急诊冠状动脉造影和PCI治疗,冠状动脉造影后明确病变,然后于梗死相关血管的靶病变置入Excel支架。术后常规口服阿司匹林和氯吡格雷两联抗血小板药。观察术中、住院、出院后1个月和6个月及12个月随访终点时的主要心脏不良事件发生率、支架内血栓发生率、支架内再狭窄发生率。结果 35例患者急诊PCI治疗均获成功,35支梗死相关血管的35处病变共置入Excel支架42枚,手术过程中未发生与介入治疗有关的并发症。1个月随访终点时无死亡病例,无支架内亚急性血栓病例,主要心脏不良事件发生率0%。出院后12个月随访终点时无死亡病例,其中有1例因心功能不全入院,主要心脏不良事件发生率2.7%,支架内血栓发生率0%;共有34例患者在支架术后12个月复查冠状动脉造影,支架内再狭窄发生率0%。结论生物可降解涂层药物洗脱支架在急性ST段抬高心肌梗死急诊PCI中应用是安全和有效的。     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Concept of the homemade coronary stent: Experimental results and initial clinical experience

To defray the escalating cost of coronary stenting, we handmade a balloon expandable coil stent with stainless steel wire. Preliminary comparison with the Palmaz-Schatz stent showed that, when implanted in porcine illac arteries, there was no difference in immediate angiographic results or in the degree of foreign body reaction at 6 wk. Subsequently, a total of 73 stents were implanted in 52 patients, either as a bailout device (54%) or for suboptimal angiographic results (46%). All but two implantations were successful. The postprocedural regimen consisted of heparin 1,000 IU/hr, aspirin 250 mg daily, and ticlopidine 500 mg daily. In-hospital complications were limited to two groin hematomas, one necessitating blood transfusion. Importantly, stent thrombosis was not observed. While 6-mo follow-up is pending, we already conclude that a balloon expandable coil stent can be handmade easily at low cost and implanted safely in patients. © 1996 Wiley-Liss, Inc.     

Terminology and anatomy of angulated coronary arteriography

Angulated views in coronary arteriography have been increasingly utilized because of their superiority in demonstrating lesions not well seen in standard right and left oblique projections. The importance of these angulated views has been repeatedly demonstrated. It is the purpose of this article to review some basic coronary anatomy angulation terminology, and then to describe the particular advantages of the angulated views in coronary arteriography. Illustrations of these particular views of both coronary systems will be provided.     

Nonatherosclerotic causes of coronary artery narrowing—Part II

Part II of this three-part article on nonatherosclerotic causes of coronary heart disease focuses on myocardial bridges, coronary artery aneurysms, emboli, coronary dissection, and spasm as causes of luminal narrowing.     

Coronary artery-left ventricular communications: A report of two cases and review of the literature

Two patients with chest pain had angiographically-demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo-dynamic effect of the shunt flow than often suspected angiographically.     

Association of coronary calcification with obstructive disease in coronary arteries in Indian patients

A total of 1150 consecutive patients (1052 males and 98 females; age 51.2 +/- 10.1 years) with suspected coronary artery disease (Group I) were subjected to fluoroscopy for detection of coronary artery calcification (CAC) and coronary angiography. Another group (Group II) of 120 patients (95 males and 25 females; age 51.4 +/- 9.4 years) catheterized for cardiac diseases other than coronary artery disease (CAD) were subjected to the same protocol of fluoroscopy and coronary angiography to exclude incidental CAD in view of their age. CAC was present in 240 patients (20.0%) in Group I. Of these, 200 (83.4%) had triple-vessel disease (TVD); 20 (8.3%) had double-vessel disease (DVD); 19 (7.9%) had single-vessel disease (SVD); and 37 (15.4%) patients had left main coronary disease (LMCAD). Only one of these patients had insignificant CAD considered as "normal" coronary arteries (NC). Incidence of LMCAD, TVD, DVD, SVD, and NC in patients without CAC was 4.4%, 56.3%, 18.2%, 14.0%, and 11.5%, respectively. Incidence of CAC in patients with LMCAD, TVD, DVD, SVD, and NC was 48.1%, 28.1%, 10.8%, 13.0%, and 1.0% respectively. In Group II (n = 120), 24 patients (20%) had CAD, CAC was present in 5 patients with CAD (20.9%), and in two patients without CAD (2%). CAC is relatively uncommon in Indian CAD patients. Its presence, however, indicates severe multivessel disease.