远端血管保护装置GuardWire在急性心肌梗死急诊介入治疗中的应用

目的　评价GuardWire在急性心肌梗死 (AMI)急诊介入治疗时应用的价值。方法　连续观察 4 8例AMI急诊介入治疗并应用了GuardWire的患者 ,记录术中心电图变化及血流情况等 ,分析该装置的操作、造影和手术成功率 ,以及住院期间和术后 30d内的心血管事件发生率。结果　操作成功率、造影成功率和手术成功率均为 10 0 %。远端球囊阻塞时间平均 (8 1± 6 8)min ,所有患者均能良好耐受。 93 8%的患者吸引出肉眼可见的血栓 /斑块碎片 ,术中未出现因远端血管阻塞而引起的血液动力学或心电图、症状变化 ,未出现远端血管栓塞或无血流现象。住院期间和术后 30d内的心血管事件发生率均为 0。结论　该装置容易操作 ,可安全地应用于冠状动脉系统 ,有效防止AMI急诊介入治疗中可能出现的远端血管栓塞。     

远端保护装置AngioguardTM在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用

目的　评价STEMI急诊PCI中应用AngioguardTMDPD的疗效和安全性。方法　自 2 0 0 2年 7月至 12月 ,共 4 0例接受急诊PCI治疗的STEMI患者纳入研究 ,其中AngioguardTMDPD组 2 1例 ,对照组 19例。比较两组间的基础临床状况、造影情况、介入治疗结果以及住院期间随访情况 ,病变血管术后均行TIMI分级、TIMI计帧和心肌Blush分级。结果　AngioguardTM DPD组中 ,19例获得成功(90 4 % ) ,网篮内均有多少不等的血栓样物质。两组间的基础临床状况、术前造影情况和术后TIMI3级 (10 0 %和 84 % ,P =0 2 3)差异均无显著性。但DPD组与对照组间发生远端小血管栓塞为 (5 2 %和36 8% ,P =0 0 4 2 ) ;两组的TIMI帧数为 (19 9± 5 7和 30 3± 9 6 ,P <0 0 0 1) ;Blush 3级获得率为(73 7%和 31 6 % ,P =0 0 2 2 )。DPD组术后CK峰值浓度较低 ,ST段回落幅度大 ,近期左室射血分数高 ,均优于对照组 (P <0 0 5 )。两组住院期间均无主要心血管事件发生。结论　在某些STEMI病人中 ,急诊PCI时应用AngioguardTM DPD安全可行 ,可改善患者术后的远端心肌血流灌注 ,提高患者的心功能。应用TIMI计帧法和Blush分级法优于应用TIMI分级法。     

远端血栓保护装置在经皮冠状动脉介入治疗中的应用

远端血栓栓塞是高危病变如急性心肌梗死 ,尤其是大隐静脉 (SVG)移植血管的介入治疗过程中较常见的并发症 ,可导致“无血流”或“慢血流”现象和心脏不良事件 (MACE)发生率的显著增高 ,是介入治疗后远期死亡和MACE发生强烈的独立预测因子[1] 。而且 ,一旦远端血栓栓塞 ,无论冠状动脉内应用尿激酶、GPⅡb/Ⅲa还是血栓清除术 (如Angiojet)都不能显著改善患者近期或远期临床预后[2 ] 。为此 ,我们在高危病变经皮冠状动脉介入治疗 (PCI)中应用了新颖的远端血栓保护装置(PercuSurgeGuardwire) ,评价其有效性与完全性。一、资料与方法1 临…     

急性心肌梗死介入治疗中远端保护装置的应用进展

远端血管栓塞以及无复流现象是介入治疗的研究热点问题。远端保护装置在减少这一现象中发挥着重要作用,现就远端保护装置的作用做一简要阐述。     

Percusurge远端保护装置在急性ST段抬高心肌梗死介入治疗中的应用

目的:评价Percusurge远端保护装置(DPD)在急性ST段抬高心肌梗死(STEMI)患者冠状动脉介入治疗中的有效性及安全性。方法:104例接受急诊PCI治疗的STEMI患者分2组,DPD组48例,对照组56例。比较2组间的基础临床状况、造影情况、介入治疗结果。病变血管术后均行TIMI分级、TIMI计帧。结果:DPD组48例全部抽出肉眼可见的红色、白色碎屑或红色血栓条。2组间的基础临床状况、术前造影情况均差异无统计学意义。但DPD组与对照组间术后TIMI2～3级为91..7%和76.8%(P<0.05),发生无复流现象为4.2%和16.1%(P<0.05);远端小血管栓塞为8.3%和23.2%(P<0.05);2组的TIMI帧数为20.2±2.8和31.2±4.4(P<0.05);住院期间均无主要心血管事件发生。结论:PercusurgeDPD能有效保护远端血管,吸出冠状动脉内血栓,避免远端血管栓塞。该方法无严重并发症发生,在急性心肌梗死等冠状动脉内存在大量血栓的情况下行介入治疗时具有良好的治疗效果。     

Percusurge远端保护装置在急性心肌梗死介入治疗中的应用--附3例报告

目的　评价Percusurge远端保护装置在急性心肌梗死患者冠状动脉介入治疗中的有效性及安全性。方法　 3例急性心肌梗死患者 ,其中 2例分别于发病后 2h、7h行直接血管成形术 ,1例于发病后 17d行择期冠状动脉成形术 ,术中均使用Percusurge远端保护装置保护病变远端血管并对梗死相关血管行负压抽吸。结果　 3例患者介入治疗均取得成功 ,血管内吸出大量血栓 ,术后达到TIMI 3级血流 ,患者症状迅速缓解 ,其中 1例有轻度血管内膜撕裂 ,但不影响远端血流 ,未予特殊处理。结论　Percusurge远端保护装置能有效保护远端血管 ,吸出冠状动脉内血栓 ,避免远端血管栓塞。该方法无严重并发症发生 ,在急性心肌梗死等冠状动脉内存在大量血栓的情况下行介入治疗时具有良好的治疗效果。     

急性心肌梗死患者介入治疗中应用PercuSurge远端保护装置安全性和疗效的研究

目的评价PercuSurge远端保护装置在急性心肌梗死患者冠状动脉介入治疗（PCI）中的疗效及安全性。方法自2003年12月至2005年12月,共174例接受急诊PCI治疗的急性心肌梗死患者纳入研究,根据是否使用PercuSurge远端保护装置分为远端保护装置（DPD）组78例和对照组96例。比较两组间的基础临床状况、造影情况、介入治疗结果。病变血管术后均行TIMI分级、心肌染色分级。结果DPD组78例中72例抽出肉眼可见的红色、白色碎屑或红色血栓条。两组间的基础临床状况、术前造影情况差异均无统计学意义。DPD组PCI术后TIMI分级≥2级（94.9%比79.2%）和心肌染色分级（2.65±0.68比2.22±0.94）明显高于对照组（均为P〈0.05）,对照组PCI术后无复流现象发生率（5.1%比16.7%）、远端血管栓塞现象发生率（5.1%比18.8%）和30天不良心血管事件发生率（2.6%比7.3%）均明显高于DPD组（均为P〈0.05）。与PCI术前比较,血栓抽吸术后TIMI血流分级（0.43±0.80比2.92±0.28）、心肌染色分级（0.22±0.63比2.27±0.73）和最小管腔直径（0.12±0.23mm比1.97±0.66mm）均明显增加（均为P〈0.0001）。结论在急性心肌梗死等冠状动脉内存在大量血栓的情况下应用PercuSurge远端保护装置行PCI是安全有效的。     

急性心肌梗死急诊经皮冠状动脉介入治疗中远端保护装置的应用

目的评价在急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)过程中,应用远端保护装置GuardWire PlusTM的安全性及有效性。方法自2004年9月至2006年5月共72例AMI接受急诊PCI治疗的患者分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)的峰值变化、术后1周内及3个月后左室射血分数(LVEF)。结果两组全部病例均成功地置入支架。GW组全部成功放置GuardWire PlusTM保护装置。GW组ST段回落50%的百分比明显高于NGW组(68·4%比41·2%,P<0·05)。GW组CK-MB高峰于发病后8·63±2·42h出现,NGW组的高峰出现在发病后11·18±2·26h,GW组峰值低于NGW组(63·30±9·82ng/mL比74·28±6·15ng/mL,P=0·000)。GW组CTnI高峰于发病后10·16±2·96h出现,NGW组的高峰值出现于发病后12·35±2·06h,两组高峰值有明显差别,GW组低于NGW组(18·01±7·21ng/mL比21·48±5·61ng/mL,P=0·027)。GW组的LVEF明显高于NGW组。结论急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。     

血栓抽吸对急性心肌梗死患者直接经皮冠状动脉介入术罪犯血管血流的影响

[摘要]【目的】 分析血栓抽吸对急性心肌梗死（AMI）患者直接经皮冠状动脉介入术（PPCI）罪犯血管血流的影响。【方法】 收集我院收治的90例行PPCI术的AMI患者的临床资料。按是否进行血栓抽吸分为对照组（单纯PPCI术，n=40）与研究组（血栓抽吸联合PPCI术，n=50），比较两组临床治疗结果、罪犯血管血流变化及术后1周与术后远期不良心血管事件发生率。【结果】 ①术后，两组0-2级所占比例明显降低，与术前对比差异有统计学意义（P<0.05），研究组术后0-2级所占比例明显低于对照组（P<0.05）。②研究组术后ST段回落良好所占比例为60.00%，略高于对照组，但对比差异无统计学意义（P>0.05）；研究组术后1周左室射血分数（LVEF）高于对照组，左室舒张末期内径（LVEDD）低于对照组（P<0.05）。③研究组术后1周不良时间发生率与对照组比较差异无统计学意义（P>0.05），其随访远期总不良事件发生率略低于对照组，但比较差异无统计学意义（P>0.05）。【结论】 血栓抽吸可改善AMI患者PPCI术后罪犯血管血流灌注，改善患者左室功能，降低患者远期心血管不良事件发生率。     

急性心肌梗死的治疗 急性心肌梗死的直接经皮冠状动脉介入术治疗

急性心肌梗死的基本病理变化,是在冠状动脉粥样硬化的基础上血管内斑块破裂形成血栓,引起冠状动脉供血急剧减少和中断,进而出现心     

Prevention of No-flow With Distal Protection Device in Patients Underwent Percutaneous Coronary Intervention

Objectives To evaluate the feasibility and safety of distal protection device (PercuSurge) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. Methods From October 2004 to August 2007, 40 patients with high risk acute coronary syndrome who received primary coronary intervention were included in this study. Patients were divided into two groups according to whether PercuSurge was attempted during PCI. The basic clinical characteristics, angiographic results, and follow-up data before discharge were compared. Coronary arteries blood flow thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion (TMP) grade and the rate of no-reflow were performed in all cases after PCI. Results There was no significant difference between the two groups in basic clinical characteristics and angiography before PCI (P>0.05). All patients underwent PCI successfully in both groups. In the PercuSurge group, PCI with PercuSurge guardwire protection was performed successfully in 18 patients. There was significant difference between the two groups in TIMI 3 flows gained in target vessels after PCI. Better percentage of TMP grade 3 of target vessels was achieved in PercuSurge group. Less no-reflow were found in PercuSurge group. There were lower peak troponin I and serum MB isoenzyme of creatine kinase levels, higher left ventricular ejection fraction and smaller left ventricular end-diastolic dimension in the PercuSurge group after PCI at the date before discharge (P<0.05). There was no major adverse cardiac events in PercuSurge group, only one patient died in the control group. Conclusions This study demonstrates that using the PercuSurge Guardwire system during PCI in high risk acute coronary syndrome patients to prevent no-reflow is feasibility and safety.     

A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound

Objectives

The aim of this study was to evaluate the utility of distal protection during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes at high risk for distal embolization.

Effect of distal protection device on prognosis of acute myocardial infarction combined with emergency percutaneous coronary intervention

Background The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes.Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GPⅡ/Ⅲ or direct thrombectomy can't improve short or long-term clinical outcomes,So we evaluated the safety and efficacy of distal protection device(GuardWire PlusTM)in the acute myocardial infarction(AMI)combined with percutaneous coronary intervention(PCI).Method S...     

Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease

The debate over coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with stent placement for the treatment of stable multivessel coronary artery disease (CAD) continues in spite of numerous studies investigating the issue. This paper reviews the most recent randomized control trials (RCT) and meta-analyses of pooled RCT data to help address this issue. General trends demonstrated that CABG was superior in all-cause mortality and fulfilling the need for repeat revascularization. These advantages tended to be more pronounced in multivessel CAD and diabetes, and less so in left main CAD. PCI showed a consistently lower rate of cerebrovascular events. CABG continues to offer significant advantages over PCI, even as drug-eluting stent technology continues to evolve. The ideal endpoint for comparing PCI and CABG remains to be determined. Furthermore, additional research is required to further refine patient selection criteria for each intervention.     

急性心肌梗死后非梗死相关动脉狭窄的介入治疗策略

急性心肌梗死多支病变患者急诊冠脉介入手术开通梗死相关动脉后,残余的非梗死相关动脉狭窄的介入治疗问题一直存在争议。现就如何评价非梗死相关动脉狭窄及如何选择最能从分期冠脉介入术中获益的患者等问题进行综述。     

急性心肌梗死经皮冠脉介入治疗后无再流现象的研究进展

急性心肌梗死的急诊经皮冠脉介入治疗可并发无再流现象,是目前再灌注治疗时代的难点。已成为界内人士研究和关注的焦点。本文综述了无再流现象以下几个方面:(1)无再流的定义;(2)检测方法,其中介绍了心肌分级、心肌声学造影等;(3)临床相关因素,包括梗死面积、血脂、梗死前心绞痛的发生时间、血管斑块成分及血液的抗氧化因子;(4)可能的发生机制,主要是冠脉微循环在缺血时的变化和远端的栓塞;(5)最新的治疗方法。由此,我们对冠脉介入治疗中的无再流现象有一系统了解。     

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.     

Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock

Background

Recent trials demonstrated a benefit of multivessel percutaneous coronary intervention (PCI) for noninfarct-related artery (non-IRA) stenosis over IRA-only PCI in patients with ST-segment elevation myocardial infarction (STEMI) multivessel disease. However, evidence is limited in patients with cardiogenic shock.