右冠状动脉开口巨大斑块脱落致无复流1例

1 病例资料患者刘某,男性,77岁,因“发作性胸闷、胸痛3个月余,     

血栓抽吸联合重组人尿激酶原对急性心肌梗死急诊PCI术后慢血流或无复流的影响

目的:探讨血栓抽吸联合重组人尿激酶原对急性ST段抬高型心肌梗死(STEMI)高血栓负荷患者经急诊冠状动脉介入术(PCI)治疗后发生慢血流或无复流现象的影响。方法:回顾性分析2015-01-2018-08于河北省人民医院心脏中心行急诊PCI治疗的高血栓负荷STEMI患者279例,其中80例经血栓抽吸导管行血栓抽吸(血栓抽吸组),62例通过指引导管冠脉内应用重组人尿激酶原(冠脉溶栓组),65例行血栓抽吸后通过血栓抽吸导管靶血管内应用重组人尿激酶原(联合治疗组),72例直接PCI治疗(直接PCI组)。观察4组患者慢血流或无复流发生情况,应用单因素分析方法筛选与慢血流或无复流相关的临床指标,进一步行多因素logistic回归分析急诊PCI后发生慢血流或无复流的独立危险因素。结果:4组患者慢血流或无复流现象发生率均差异有统计学意义,联合治疗组慢血流或无复流的发生率低于另外3组(均P0.05);多因素logistic回归分析显示,再灌注时间(OR=2.986,95%CI:2.160～4.129,P0.001)、BMI(OR=1.698,95%CI:1.416～2.036,P0.001)及直接PCI(OR=7.255,95%CI:2.492～21.123,P0.001)是STEMI患者急诊PCI术后出现慢血流或无复流现象的独立危险因素,血栓抽吸联合重组人尿激酶原治疗(OR=0.224,95%CI:0.061～0.829,P=0.025)是慢血流或无复流的保护性因素。结论:血栓抽吸联合重组人尿激酶原治疗可降低STEMI高血栓负荷患者急诊PCI术后慢血流或无复流的发生率。     

重组人尿激酶原对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后无复流现象的预防作用研究

背景 经皮冠状动脉介入治疗(PCI)是ST段抬高型心肌梗死(STEMI)的首选治疗方式,但临床发现,部分患者PCI后存在再灌注异常,出现慢血流或无复流现象,影响其预后.目的 分析重组人尿激酶原对STEMI患者PCI后无复流现象的预防作用.方法 选取2016年7月—2020年6月保定市第二中心医院收治的行择期PCI的ST...     

PCI术后冠状动脉无复流患者内皮细胞损伤情况及意义

将86例行经皮冠脉介入术（PCI）的AMI患者根据术后血流分级（TIMI分级）分为两组,冠状动脉前向血流≤TIMI2级42例为无复流组。TIMI3级44例为对照组。检测两组冠状窦血中NO、内皮素（ET）和外周循环内皮细胞（CEC）水平,以此判断内皮细胞受损情况。结果无复流组冠状窦血中NO明显减少,而ET和CEC显著增加,与对照组比较,P均〈0．05。提示在PCI后AMI患者出现无复流现象者较血流恢复正常者冠状动脉内皮损伤更严重,其机制可能是前者微血管内皮细胞受到损伤。应引起临床重视。     

冠状动脉无复流：识别、预防和处理

一、无复流的定义及分类 冠状动脉（冠脉）无复流（no-reflow）是指心外膜冠脉狭窄或闭塞被解除后心肌组织水平无灌注的现象。冠脉无复流最早于1966年通过实验模型提出,之后在1985年心肌梗死再灌注的临床试验中得到证实。在导管室,无复流现象是指冠脉诊疗过程中排除了冠脉机械性梗阻（急性闭塞、残余狭窄、严重夹层、高度痉挛或血栓形成等）存在,冠脉造影表现为前向血流畸形减慢。     

冠状动脉无复流现象的研究进展

冠状动脉无复流是指血管造影无血管机械性阻塞的证据,而冠状动脉循环所支配的节段心肌灌注不足的一种现象。现对无复流的概念、分类及可能的机制,诊断及防治方法做一综述。     

冠状动脉无复流现象研究进展

冠状动脉无复流现象指的是血管造影无血管机械性阻塞的证据而冠状动脉循环所支配的节段心肌灌注不足的一种现象,与冠状动脉介入术和心肌梗死再灌注治疗密切相关.目前治疗上最主要的是冠脉内血管扩张剂和抗血栓剂对症使用,最近临床上血栓栓塞的病因研究进展,提供了一个防治的方向即远端保护装置的使用.     

远端血管弹性对冠状动脉慢性完全闭塞病变开通后无复流的影响

目的利用血管内超声(IVUS)评价冠状动脉远端血管弹性对慢性完全闭塞(CTO)病变开通后出现无复流或血流减慢的影响。方法回顾性分析2017年10月至2018年12月在首都医科大学附属北京安贞医院急诊中心行经皮冠状动脉介入治疗并成功置入支架完成IVUS检查的CTO病变患者34例。支架置入后远端血流正常组26例[心肌梗死溶栓治疗试验(TIMI)血流分级≥Ⅱ级],血流减慢组8例(TIMI血流分级0级或Ⅰ级)。分析可能导致无复流的病变形态学特点。结果两组患者血管钙化、中膜血肿、导丝行走于内膜下等比较,差异均无统计学意义(均P>0.05)。血流正常组的远端参考管腔面积[(4.09±1.71)mm2比(2.70±0.86)mm2,P=0.036]、远端血管收缩面积比[(15.96±3.95)%比(7.26±1.62)%,P=0.020]显著高于血流减慢组。logistic回归分析显示,远端血管弹性差(OR 13.75,95%CI 1.946~97.178,P=0.009)是支架置入后远端无复流及血流受限的独立预测因素。结论IVUS观察的CTO病变远端血管弹性是影响CTO病变开通后远端出现无复流的独立危险因素。     

冠状动脉无复流机制及评估方法研究进展

冠状动脉无复流现象在急性心肌梗死罪犯血管血运重建发生率较高。其主要病理生理机制包括心肌缺血损伤、心肌再灌注损伤、冠状动脉远端栓塞和微循环损伤等。无复流可加重心肌缺血,引起梗死面积扩大,加快心室重构及心力衰竭的发生,阻滞心脏传导系统,甚至引发心源性猝死。目前无复流的评估方法主要以心脏核磁共振成像、心肌声学造影、TIMI血流分级等为主。     

冠状动脉介入治疗术中无复流的处理对策

经皮冠状动脉(冠脉)介入治疗(PCI)合并无复流现象(no-reflow phenome non),即在冠脉病变处理后虽无明显夹层、血栓形成、痉挛或者严重残余狭窄的存在,但冠脉血流严重减少,血流无灌注或仅有微量灌注。     

基底动脉闭塞溶栓后迟发性再通一例

患者男,51岁。主因“突发右侧肢体麻木、乏力,饮水呛咳3周”于2009年6月30日以“脑梗死”收入外院。患者于3周前无明显诱因突然出现右侧肢体麻木、乏力,饮水呛咳,声音嘶哑,伴头晕;无头痛,无恶心、呕吐,无意识障碍,无肢体抽搐。既往有高血压病史10年。体检：血压170／90mmHg,意识清楚,查体合作,轻度构音障碍,双侧瞳孔等大等圆,     

巨大冠状动脉瘤合并慢性完全闭塞病变一例

<正>1 临床资料患者男性,66岁,因"反复胸闷3年余"于2018年5月8日入院。患者于2015年3月底开始反复出现阵发性胸骨后憋闷不适,每次持续约5～10 min,可自行缓解,发作频率3次/周至2次/d不等,多在劳累后出现,偶在夜间睡眠中出现,严重时伴有大汗、心悸,无胸痛,无放射痛。患者就诊我院心内科门诊,以"稳定性心绞痛"收入院。既往体健,否认高血压、糖尿病病史,否认烟酒史,无心脑血管疾病家族史。入院查体:体温36.7℃,心率78次/     

Successful recanalization of in-stent coronary chronic total occlusion by subintimal tracking

Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) caused by in-stent restenosis (ISR) is sometimes very difficult due to the presence of hard occlusive components that prevent wire passage. We report a case of CTO caused by ISR (ISR-CTO) in which the occlusion was crossed with the wire subintimally along the outside of the stent and was successfully re-stented. Subintimal tracking along the outside of the stent can be considered as another approach for PCI of ISR-CTO in cases where conventional approaches fail.     

逆向导丝技术开通右冠状动脉慢性完全闭塞病变并发双侧冠状动脉穿孔一例

正1病例资料患者男性,76岁,因"阵发性胸痛5个月"于2014年6月10日入院。患者5个月来快步行走时发生胸痛,位于心前区,手掌大小,程度较剧烈,尚能忍受,伴出汗,无放射痛,持续3~5 min,休息后缓解。既往高血压病史10余年,未正规服药,血压最高达170/100 mmHg,控制不理想,无家族史。入院查体:血压150/70 mmHg,双肺呼吸音清,心率56次/min,律齐,未闻及杂音。心电图示窦性心律,Ⅲ、aVF导联T波倒置(图1)。入院诊断:冠心病稳定型劳累性心绞痛,心功能1级,高血压2级。给予阿司匹林100 mg和氯吡     

Intravascular ultrasound-guided recanalization of a coronary chronic total occlusion located in a stent implanted subintimally: a case report

Successful percutaneous recanalization of coronary chronic total occlusion (CTO) results in improved survival, as well as enhanced left ventricular function, reduction of angina, and improved exercise tolerance. The procedural success rate has increased over time, but CTO recanalization does still fail in about 20% of cases. Different strategies and specific devices for CTOs have been developed with various degrees of success. We report the case of CTO after a first unsuccessful treatment attempt during which subintimal wire positioning without reentry into the distal lumen, and stent implantation were done. At the second revascularization, intravascular ultrasound guidance allowed reentry of the distal true lumen through the stent, restoring normal flow.     

Successful coronary intervention of chronic total occlusion of the right coronary artery by ipsilateral injection via an isolated conus artery

A conus artery is sometimes a good collateral source for the left anterior descending coronary artery and the right coronary artery (RCA). In some cases, the conus artery arises independently of the RCA from a separate orifice, which is called an isolated conus artery. The conus artery is often missed by angiography for RCA if a catheter is deeply engaged. This case report describes a percutaneous coronary intervention of chronic total occlusion of the proximal RCA with good collateral circulation from an isolated conus artery by super-selective ipsilateral injection via the artery.     

Pancreatoduodenectomy after coronary artery bypass grafting using the right gastroepiploic artery: a case report

We herein report the case of an advanced ampullary cancer developed 80 months after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) and successfully treated by pancreaticoduodenectomy (PD) with revascularization using the great saphenous vein. A 69-year-old Japanese male was admitted for examination with one-month history of nausea and appetite loss. He underwent three vessel CABG, involving bypassing between the right coronary artery and RGEA about 80 months before. The preoperative diagnosis with CT scan and gastric endoscope was carcinoma of the papilla of Vater. Preoperative abdominal angiography showed the RGEA graft remained well patent. He underwent PD with regional lymph node dissection after revascularization of the RGEA. The postoperative clinical course was uneventful. The histopathological examinations of the resected specimen revealed adenocarcinoma of the ampulla, pT2, pN0, M0 stage IB. The patient is currently alive without any further signs of ischemic heart disease several months after his operation. This case report demonstrates that the radical PD with revascularization using other vein graft can be safely performed after CABG using the RGEA.     

Stingray系统用于冠脉慢性闭塞病变介入治疗术后冠脉夹层1例

正1对象和方法1.1对象患者,男性,50岁,陕西省勉县定军山镇左所村人。主因发作性胸痛先后4次入我院诊治。患者于2014年9月出现心前区疼痛,胸闷,休息不能缓解,经当地医院检查,诊断为急性心肌梗死,并行冠脉造影检查,提示冠脉三支重度狭窄性病变,遂转入我科。既往有高血压病史20年,口服硝苯地平控释片,酒石酸美托洛尔,北京降压0