老年冠状动脉慢性完全性闭塞病变患者行逆向介入治疗的可行性

目的 探讨老年冠状动脉慢性完全闭塞（CTO）病变的患者行逆向介入治疗的可行性。方法 选择2004年1月至2015年5月沈阳军区总医院心内科收治的行逆向介入治疗的≥60岁老年CTO患者119例（老年组）及同期行逆向介入治疗的＜60岁CTO患者136例（非老年组），对比分析两组患者逆向介入治疗手术成功率、治疗效果及并发症的发生率。结果 与非老年组比较，老年组更多合并高血压、糖尿病、脑血管疾病（均P＜0.05）；老年组欧洲心血管手术危险因素评分系统（EuroSCORE）评分明显高于非老年组（P＜0.001）。老年组合并双支和三支血管病变患者多于非老年组（均P＝0.000）；而老年组发生单支血管病变患者数低于非老年组（P＝0.000）。老年组SYNTAX评分高于非老年组，差异具有统计学意义（P＜0.001）。非老年组CTO时间为3～12个月的病例明显多于老年组，而老年组CTO时间为6～9年和＞9年的病例明显多于非老年组（均P＝0.000）。结论 本研究的结果表明逆向介入治疗对老年患者是安全有效的方法。     

65例冠状动脉慢性闭塞病变介入治疗临床分析 (英文)

目的：分析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）疗效的影响因素。方法：回顾分析我院2010年1月至2012年12月期间65例患者72处 CTO病变介入治疗的临床资料、病变特征和PCI的疗效。结果：CTO病变 PCI成功率为91.67%（66/72）;CTO病变闭塞时间＞12个月者 PCI成功率显著低于3～12个月者（81.48%比97.78%）,闭塞长度＞15mm的 CTO病变 PCI成功率显著低于闭塞长度≤15mm者（78.26%比97.96%）;断端呈刀切状的 CTO病变 PCI 成功率显著低于鼠尾状者（71.43%比96.55%）,P 均＜0.05;PCI失败有6处,其中4处因导丝未能通过病变,2处因球囊未能通过病变;介入术中并发症发生率为7.69%,住院期间均无主要不良心血管事件;术后心绞痛症状缓解率为90.16%。结论：冠状动脉慢性完全闭塞病变经皮冠状动脉介入治疗成功率与病变特征、CTO病变闭塞时间等因素有关。     

老年冠状动脉慢性完全闭塞病变的临床及影像学特点

目的回顾性分析老年冠状动脉慢性完全闭塞（CTO）的冠心病患者的临床和影像学资料,总结老年CTO病变的临床和影像学特点。方法入选1989年6月至2005年12月诊断冠心病的患者。入院后行常规实验室生化检查及X线胸片、心脏超声等临床辅助检查,并行冠脉造影及左室造影检查。分组标准：≥60岁CTO患者作为老年组,同期〈60岁CTO患者作为对照组。结果经冠脉造影证实有一支以上的CTO病变者共1716例。其中老年组971例,对照组745例。本组老年CTO患者中女性患者占27.4%,而对照组为9.1%;老年CTO患者的吸烟（57.2%）和患高血压比例（61.3%）均高于对照组（分别为26.7%和48.5%）,P〈0.05。老年组有陈旧心肌梗死病史的比例（46.3%）低于对照组（54.5%）,P〈0.05;而老年组合并心律失常（10.4%）、心力衰竭（27.3%）、脑血管病史（6.4%）的比例均高于对照组（分别为6.8%、18.7%和2.7%）,P〈0.05。老年组的肾功能水平高于对照组,P〈0.05。老年组人均CTO支数（1.44±0.35）高于对照组（1.39±0.98）,P〈0.05。老年组合并多支病变的比例（83.9%）高于对照组（71.0%）,P〈0.05。老年患者CTO特征中绝对性（93.9%）、刀切状（37.4%）、长度≥15mm（72.4%）、直径≤2.5mm（13.3%）及桥侧支CTO比例（23.4%）均高于对照组（分别为87.5%、24.4%、36.9%、9.3%和14.9%）,P〈0.05。结论老年CTO病变患者心、脑、肾等重要脏器功能衰竭的程度较非老年CTO患者高,且老年CTO病变复杂程度高、多支病变比例高,增加了介入治疗的难度。     

无心肌梗死病史慢性完全闭塞病变冠心病患者的临床特征

目的总结并探讨无心肌梗死(MI)病史的冠状动脉慢性完全闭塞病变(CTO)冠心病患者的临床、影像学和经皮冠状动脉介入治疗(PCI)的特点。方法纳入1995年7月至2014年12月在沈阳军区总医院心内科行PCI的连续性绝对性CTO冠心病患者共2651例,其中无MI病史患者1466例(55.3%,无MI组),有MI病史患者1185例(44.7%,MI组)。结果无MI组患者年龄、女性比例、不稳定型心绞痛比例、高血压病比例、血清三酰甘油水平及左心室射血分数(LVEF)均显著高于MI组,差异均有统计学意义(均P0.05);而无MI组患者心力衰竭比例和血肌酸酐水平均显著低于MI组,差异均有统计学意义(均P0.001)。无MI组患者多支病变比例(81.4%比76.5%,P=0.002)高于MI组;在CTO靶血管分布方面,无MI组患者左前降支比例(36.2%比40.7%,P=0.007)显著低于MI组,而左回旋支比例(17.0%比12.7%,P0.001)、侧支循环良好比例(32.7%比27.0%,P0.001)显著高于MI组,差异均有统计学意义。两组患者CTO靶血管PCI成功率、完全血运重建比例、平均支架置入数、平均支架直径和平均支架总长度比较,差异均无统计学意义(均P0.05)。结论无MI病史的CTO冠心病患者因为年龄、性别、不稳定型心绞痛反复缺血预适应、高血压病等因素,可能促进了侧支循环的建立,使心功能得到保护。     

冠状动脉慢性完全闭塞病变老年冠心病患者149例的临床和影像学资料:PCI治疗的有效性及安全性

目的分析发生冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变的老年冠心病患者的临床和影像学资料,并探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗对患者预后的影响。方法选取2013年2月至2015年11月在文山壮族苗族自治州人民医院接受治疗的346例CTO病变患者,根据年龄分为老年组(≥65周岁)149例和非老年组(65周岁)197例,收集患者的临床特征、冠状动脉造影、手术情况等资料,并通过3年随访记录患者的心血管事件再复发和死亡情况。结果老年组术前血肌酐浓度、吸烟患者比例、三支血管病变患者比例、血管迂曲或钙化患者比例明显高于非老年组,差异有统计学意义(P0.05);PCI治疗开通成功的老年和非老年患者再发心绞痛、急性心肌梗死、心力衰竭以及再次血运重建等心血管事件的总发生率(11.42%、9.62%)明显低于PCI治疗开通不成功患者(29.55%、26.83%),差异有统计学意义(P0.05)。PCI治疗后的老年和非老年患者心血管事件发生率与病死率比较,差异无统计学意义(P0.05)。合并左主干病变是老年冠状动脉CTO患者3年心血管死亡的危险因素(OR=3.196,95%CI:1.203～6.184,P0.05)。结论 PCI治疗可作为老年冠状动脉CTO病变较为安全、有效的治疗方案。合并左主干病变是老年冠状动脉CTO患者3年心血管死亡的危险因素。     

老年支架内慢性完全闭塞介入治疗的疗效及安全性

目的探讨老年患者冠状动脉支架内慢性完全闭塞（ISCTO）病变经皮冠状动脉介入治疗（PCI）的疗效及安全性。方法2000年5月2007年6月入院复查造影发现有ISCTO病变的51例老年患者（年龄≥65岁）及84例非老年患者（年龄<65岁）行再次PCI治疗。对两组患者的临床资料、PCI结果以及围术期并发症和随访期间主要不良心脑血管事件（MACCE）发生率进行回顾性分析。结果老年组高血压比例及表现为无症状心肌缺血和心力衰竭的比例高于非老年组（均P<0.05）。老年组ISCTO中绝对性闭塞、刀切状病变、长度≥15 mm、直径≤2.5 mm、病变处弯曲≥45°或有分支发出的病变比例均高于非老年组（均P<0.05）。两组病变成功率和病例成功率无统计学差异（94%vs93%,96%vs93%）。两组术中无死亡病例,术后住院期间无不良心脏事件发生,无患者进行急诊冠状动脉旁路移植术（CABG）。老年组和非老年组分别随访（17±15）个月和（16±15）个月,老年组心绞痛复发率低于非老年组（P<0.05）,两组MACCE发生率无统计学差异。结论对老年患者的ISCTO病变行介入治疗是安全而有效的。     

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。     

老年男性冠心病患者冠状动脉病变特点

目的探讨老年与中青年男性冠心病患者冠状动脉病变特点的不同。方法对475例经过冠状动脉造影检查诊断为冠心病的男性患者,其中老年组260例;中青年组215例。对比分析两组冠状动脉病变的不同特点。结果在老年组中,不稳定型心绞痛患者平均冠状动脉病变支数（1.9±0.1vs1.6±0.1）与冠状动脉积分（45±6vs27±3）均显著高于中青年组,老年组与中青年组稳定型心绞痛患者冠状动脉病变支数相同（1.9±0.1vs1.9±0.1）,冠状动脉积分（46±5vs44±5）接近。老年男性急性心肌梗死（AMI）患者冠状动脉病变支数（2.4±0.1vs2±0.1）和冠状动脉积分（68±4vs56±4）显著高于中青年AMI患者。两组之间的病变血管的分布无显著性差异。老年组单支病变显著低于中青年组（31.9%vs44.7%）,3支病变（43.8%vs33.0%）和4支病变显著高于中青年组（2.5%vs1.0%）。结论老年患者不稳定型心绞痛和AMI冠状动脉病变程度高于中青年,而稳定型心绞痛和陈旧性心肌梗死两者病变程度相似。     

不同年龄段急性心肌梗死患者冠状动脉介入治疗术的临床评价

目的：评价不同年龄对急性心肌梗死经皮冠状动脉介入（PCI）治疗的安全性和临床疗效的影响。方法回顾性分析急性心肌梗死患者348例,按年龄分为3组,青中年组、年轻老年组及老年组,比较各组临床特征、冠状动脉病变特点及PCI成功率及手术并发症。结果老年组非ST段抬高型心肌梗死（NSTEMI）、行主动脉球囊反搏术（IABP）比例均高于青中年组（均P＜0.05）。青中年组患者病变多为单支病变,以前降支病变为主,病变类型中血栓型病变多见,单支病变例数及血栓例数与老年组比较差异均有统计学意义（均P＜0.05）;老年组患者的冠状动脉病变多为多支病变,与年轻老年组及青中年组比较差异均有统计学意义（均P＜0.05）,病变类型中中重度钙化病变多见,与青中年组比较差异有统计学意义（P＜0.05）。PCI术中、术后并发症老年组高于青中年组及年轻老年组,PCI成功率老年组低于青中年组,死亡率高于青中年组及年轻老年组（均P＜0.05）。结论老年急性心肌梗死患者PCI成功率下降,并发症增加。     

长闭塞时间冠状动脉慢性完全闭塞病变患者 介入治疗的效果及安全性

目的 回顾性分析长闭塞时间冠状动脉慢性完全闭塞（CTO）病变介入治疗的疗效及安全性。方法 2006年1月~2007年6月入院行冠脉造影检查发现有CTO病变并行经皮冠脉介入（PCI）治疗的358例患者。分组标准:病变闭塞时间≤12个月组（135例）,病变闭塞时间>12个月组（223例）。对两组患者临床资料、PCI结果以及围术期并发症和随访期间主要不良心脏事件（MACE）进行回顾性分析。结果 与病变闭塞时间≤12个月比较,闭塞时间>12个月组的CTO患者老年患者（≥60岁）、糖尿病患者比例高（P<0.01）,女性患者、高血压患者比例也高于闭塞时间≤12个月组（P<0.05）。闭塞时间>12个月组的CTO病变绝对性闭塞比例高(P<0.01),刀切状病变、长度≥15 mm或并发桥状侧支循环形成的CTO比例也均高于闭塞时间≤12个月组（均P<0.05）。两组病变和病例成功率无统计学差异（91% vs 95%, 93% vs 97%）。两组术中无死亡病例,术后住院期间无主要不良心脏事件（MACE）发生,无患者进行急诊冠状动脉旁路移植术（CABG）。术后MACE发生率1年随访结果无统计学差异。结论 PCI治疗闭塞时间较长的CTO病变也可获得较高的成功率和较好的近期临床效果。     

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.     

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).     

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.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

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.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

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.     

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.