血管内支架成形术治疗椎动脉开口部狭窄的临床观察

目的观察血管内支架成形术治疗椎动脉开口部粥样硬化性狭窄患者的安全性和疗效。方法对20例有症状的椎动脉开口部粥样硬化性狭窄的患者行血管内支架成形术,并随访6个月。结果椎动脉狭窄由(71.0±8.8)%下降至(7.0±5.4)%。技术成功率95%,未发生围手术期并发症。在1、3、6个月随访时按Malek评分,疗效极好17例,较好2例,1例在2个月后死亡。19例患者术后6个月超声检查未发现支架部位明显再狭窄和支架形态改变。结论血管内支架成形术治疗椎动脉开口部狭窄安全可行,有一定的疗效。     

药物洗脱支架在防治颅内外支架成形术后再狭窄的作用

目前,有症状颅内外动脉狭窄支架置入术多使用裸金属支架,但再狭窄发生率较高。药物洗脱支架治疗冠状动脉粥样硬化病变的研究表明,再狭窄发生率显著降低。虽然颅内外动脉狭窄的药物洗脱支架支架置入术也是安全的,但是还需大样本前瞻性随机对照试验证实其安全性和有效性。     

经皮腔内血管成形术联合血管内支架治疗老年下肢动脉硬化闭塞症患者的疗效

目的探讨经皮腔内血管成形术(PTA)联合血管内支架治疗老年下肢动脉硬化闭塞症(ASO)的临床疗效。方法收集28例老年患者、31条肢体,共53处病变部位行血管形成术联合支架植入术(PTAS)进行治疗,术后1个月对患者的跛行距离及踝肱指数进行监测,同时对术后病变部位的血管通畅率进行随访。结果行PTAS手术后,髂动脉的成功率为100%,股腘动脉的成功率为95.24%;术后1个月,患者的踝肱指数由术前的(0.35±0.11)增加至术后的(0.95±0.09),间歇性跛行距离由术前的(117.3±29.9)m增加至术后的(518.4±122.7)m,手术前、后比较差异显著(P0.05);术后2年髂动脉的血管通畅率为91.67%,股腘动脉的血管通畅率为80.95%。结论 PTA联合PTAS治疗下肢动脉ASO手术成功率高、创伤性小、安全有效,且能有效改善缺血区的血液供应,再狭窄可能性减小。     

髂动脉支架联合股深动脉成形术治疗下肢动脉硬化闭塞症12例回顾性分析

下肢多平面多节段动脉硬化闭塞是老年人下肢缺血的主要原因，经典的动脉旁路术是有效的治疗手段，但是对于远端流出道不佳或伴有严重心脑肺肾等重要脏器功能不全的老年病人，不适合行创伤较大的动脉旁路手术治疗，部分病人因而丧失治疗机会而被截肢，严重影响了老年人的生活质量。随着血管腔内介入治疗技术的巨大进步，腔内介入治疗与腔外手术相结合已成为新的研究发展方向。我院于2003年7月至2005年11月，应用术中髂动脉球囊扩张和支架植入结合股深动脉成形术治疗高危重症老年人下肢多平面动脉硬化闭塞症12例，现将回顾性分析结果报道如下。     

切割球囊处理下肢动脉支架术后再狭窄的临床应用

目的观察切割球囊处理下肢动脉支架术后再狭窄的临床效果,评价其应用价值。方法对28例下肢动脉支架术后再狭窄的患者,选择对侧股动脉穿刺或同侧股动脉逆行穿刺,在导引钢丝通过病变后,根据血管大小选择合适切割球囊10~14 atm扩张再狭窄病变1~3次,术后及6个月随访评价其治疗效果。结果28例患者,27例(96.42%)患者手术成功,除1例(3.57%)患者出现假性动脉瘤外,无严重并发症发生。6个月随访,24例(85.71%)患者缺血症状明显改善,22例(81.48%)血管处于开放状态,7例(25.92%)患者切割球囊术后再狭窄。结论切割球囊处理下肢动脉支架术后再狭窄安全、可靠、再狭窄率较低,有较高的临床应用价值。     

股浅动脉闭塞支架术后再狭窄的危险因素分析

目的:研究卢瑟福分级为3~6级股浅动脉闭塞支架治疗术后支架内再狭窄(ISR)的相关危险因素。方法:回顾性分析我院自2009年1月1日至2013年12月31日,因股浅动脉闭塞行镍钛金属裸支架置入术的85例患者(卢瑟福3~6级)93例患肢。术后定期行下肢动脉彩超、Doppler或CTA检查观察支架内通畅情况,并收集相关临床资料加以统计分析。结果:全组手术技术成功率为100%。共为93例患肢置入173枚镍钛金属裸支架。术后第1天,复查彩超示无残余狭窄、无支架内血栓形成、无支架两端夹层形成;复查Doppler示患肢踝肱比(ABI)平均为(0.95±0.18),较术前0.48±0.18明显提高(t=-21.694,P=0.000)。术后平均随访时间16.0±15.0(0.27~58.0)个月,第3、6、12个月的一期通畅率分别为83.9%、67.1%、49.4%。病变总长度(P=0.031)、TASC II C/D级病变(P=0.034)和糖尿病(P=0.031)与ISR的发生密切相关。结论:股浅动脉病变总长度、TASC II C/D级病变及糖尿病是卢瑟福分级为3~6级股浅动脉闭塞支架术后ISR的危险因素。     

药物涂层球囊在下肢动脉硬化闭塞症支架内再狭窄治疗中的应用观察

目的 观察药物涂层球囊(DCB)在下肢动脉硬化闭塞症支架植入术后支架内再狭窄(ISR)治疗中的应用效果.方法 选取ISR患者30例(30条肢体),均接受DCB治疗.观察术后12个月靶血管初级通畅情况,治疗6、12月时Rutherford分级改善情况及治疗12月时临床驱动的靶病变血运重建(CD-TLR)和踝肱指数(ABI...     

内膜下血管成形术治疗下肢动脉硬化闭塞症12例临床观察

采用内膜下血管成形术治疗下肢动脉硬化闭塞症12例,应用球囊在闭塞段动脉内膜下扩张再建血流通道,根据术中造影情况决定是否置入支架,术后复查踝肱指数并随访.结果 本组12例中11例成功.术后复查踝肱指数0.25～1.08(平均0.77),与术前(0.14～0.43,平均0.27)比较,P＜0.01.11例手术成功者术后随访1～12个月,1例在1周后截肢,1例术后8个月截肢,其余9例均保持通畅.认为内膜下血管成形术是治疗下肢动脉硬化闭塞症的一种新的有效方法.     

射频球襄成形术预防动脉腔内成形术后再狭窄的实验研究

本文将射频球囊成形术应用于动脉粥样硬化狭窄模型，观察球囊表面电极直接释放射频能量并结合压力对动脉粥样硬化狭窄的作用，同时以单纯球囊成形术为对照。结果表明，射频球囊成形术后血管狭窄程度从平均６０％以上降低至平均１７％以下，明显低于对照组（Ｐ＜０．０５），术后４周再狭窄程度明显低于对照组。超微结构也显示，射频球囊成形术后血管平滑肌细胞增殖数量减少，提示该项技术对防止动脉腔内成形术后再狭窄可能是一项有希望的措施。     

经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症

目的探讨经腘动脉入路逆行内膜下血管成形术治疗股浅动脉长段硬化性闭塞症的可行性和近期效果。方法回顾性分析17例因股浅动脉/腘动脉近端完全闭塞接受经腘动脉入路逆行内膜下血管成形术/支架置入术患者的资料,总结技术成功率和近期临床疗效,分析术中术后并发症发生情况及防治方法。结果腘动脉穿刺成功率和手术即时成功率为100%。踝臂指数(ABI)从术前的0.43±0.23上升至0.89±0.26(P<0.01)(出院前),6个月(0.86±0.25)及12个月(0.81±0.23)(P<0.01)时保持改善状态。术后6个月的初次通畅率为94.7%(16/17);12个月时初次通畅率为76.5%(13/17),再次通畅率为100%。并发症(3例,17.6%)主要有腘动脉穿刺点假性动脉瘤、股动脉穿刺点出血及肢体远端动脉急性栓塞,根据情况给予了相应处理。结论对于长段股浅动脉/腘动脉近端闭塞性病变,在腔内顺行开通失败的情况下运用经腘动脉入路逆行内膜下血管成形术/支架置入术是一种安全有效的补救措施。     

髂动脉及股动脉内支架植入术的长期临床

目的 本项研究分析了经皮腔内成形术及支架植入术治疗髂动脉及股动脉动脉硬化性狭窄的早期及晚期临床疗效。方法和结果 从１９９４年１２月至１９９７年３月,为３３名患者的３７条髂、股动脉血管内植入４３个Ｗａｌｌｓｔｅｎｔ支架,手术全部成功。临床随访（２６±１４）个月,术后间歇性跛行及休息痛等症状均消失。２３例患者中的１７例（２０条血管）进行血管造影随访,随访时间（１０ ± ５）个月。血管造影随访时髂动脉支架内再狭窄率为０（０／８）;股动脉再狭窄率为３３％（３／９）,全部３例患者的３条再狭窄的股动脉,均成功地再次行ＰＴＡ。结论 髂动脉和股动脉ＰＴＡ和支架术是一种安全有效的方法,成功率高,并发症少。     

冠心病患者支架置入和经皮冠状动脉腔内成形术治疗后再狭窄的比较

目的　旨在分析冠心病患者冠状动脉 (冠脉 )支架置入和单纯球囊扩张 (PTCA)后晚期冠脉内径丢失及 6个月再狭窄发生率的差异 ,证实支架置入降低再狭窄作用并探讨可能机理。方法　冠心病介入治疗 35 2例中 ,选择连续 6 5例 (86个冠脉狭窄病变 )术后 6个月随访重复冠脉造影者 ,冠脉定量分析 (QCA)术前、术后和随访复查冠脉造影图象 ,并分析随访时内径丢失与支架置入和单纯球囊扩张的关系及术后 6个月再狭窄发生率。结果　冠脉内支架置入后随访期病变血管最小内径较大 ,而绝对内径丢失、相对内径丢失、绝对管腔面积丢失和内径丢失指数均低于单纯PTCA ,支架置入组再狭窄病变内径丢失百分比小于单纯PTCA组 ;再狭窄发生和支架置入呈负相关 (RR 0 86 ,95 %CI0 6 3～ 1 16 ,P <0 0 5 ) ;6个月 41例支架置入再狭窄 12例 (2 9 3% ) ,2 4例单纯PTCA再狭窄 12例(5 0 0 % ,P =0 0 6 9) ;5 3个支架置入病变再狭窄 14个 (2 6 4% ) ,33个单纯PTCA病变再狭窄 16个(48 5 % ,P =0 0 37)。结论　国人冠心病患者冠脉内置入支架可能减少晚期冠脉再狭窄发生     

小冠状动脉支架植入的安全性与疗效观察

目的 在直径小于3mm的冠状动脉进行支架植入，观察其安全性与近期疗效。方法 136例患，147支小于3mm的病变血管，选择冠状动脉支架植入术，并与随机选择同期的214例236支血管管腔≥3mm的普通支架组相比较，测量术前和术后参考血管直径，狭窄程度和最小管腔直径，记录术中球囊长度，直径，扩张压力，次数及支架长度，直径，最大扩张压力，并观察术后30d严重的临床事件，Q波或非Q波心肌梗死，急诊冠脉搭桥和死亡情况。结果 支架植入时较高的充盈压力，术后获得较大管腔直径，残余狭窄的直径为零，147支血管共成功植入149个支架，植入成功率100%，术后1个月未出现临床Q波或非QI皮心肌梗死，冠脉搭桥和死亡发生，6个月内有42例病人随访共48支血管，有9支血管发生临床狭窄，再狭窄率为18.7%，结论 小冠状动脉支架植入具有较高安全性，避免了PTCA有可能产生的急性并发症。     

急性心肌梗死行经皮腔内冠状动脉成形术及支架术前静脉溶栓与否的临床比较

目的 :比较rt PA(5 0mg)静脉溶栓后即刻行经皮腔内冠状动脉成形术 (PTCA)与直接冠状动脉支架术治疗急性心肌梗死 (AMI)的临床疗效。方法 14 0例AMI患者 ,随机分为A、B两组。A组 75例行rt PA半量 (5 0mg)静脉溶栓后即刻行冠状动脉造影 (CAG)、PTCA及冠状动脉支架术。B组 6 5例直接行CAG、PTCA及冠状动脉支架术。术后观察 2 0d。结果 :①首次冠状动脉造影显示 :A组梗死相关动脉 (IRA) 83支 ,开通率 5 2 % ;B组IRA 71支 ,开通率 15 %。两组开通率相比差异有非常显著性意义 (P <0 .0 1)。②A、B两组行PTCA加支架置入术后IRA恢复TIMIⅢ级血流效果基本相同 ,A组 10 0 % ,B组 98.6 % ,两者相比差异无显著性意义 (P >0 .0 5 )。③患者住院 10～ 2 0d ,二维超声心动图显示 ,左室射血分数达到或超过 6 0 %者 ,A组为 94 .7% ,而B组仅占 4 3.9%。两者相比差异有显著性意义 (P <0 .0 5 )。④脑卒中或大出血并发症两组病例均未发生。⑤住院病死率 ,A组 4 .0 % (3/ 75 ) ,B组 3.1% (2 / 6 5 ) ,两者相比差异无显著性意义 (P >0 .0 5 )。结论 :A组较B组具有更早地使IRA前向血流再灌注 ,从而具有较好的左室保护功能 ,且不增加不良事件的发生。     

全反式维甲酸防治经皮腔内冠状动脉成形术后再狭窄的研究进展

经皮腔内冠状动脉成形术 (PTCA)是目前治疗冠心病的有效措施之一 ,但术后 3 0～ 5 0 %病变血管再狭窄发生率 ,已严重地影响了 PTCA术后的远期疗效 ,临床上目前尚无有效预防 PTCA术后再狭窄发生的药物。全反式维甲酸 (ATRA)是一种具有广泛生物学效应维生素 A类衍生物 ,可明显抑制细胞增殖 ,近年来一些研究表明 ,该药在防治 PTCA术后再狭窄发生方面具有多种抑制作用 ,本文就此方面的研究进展作一综述     

Current PTCA practice and clinical outcomes in The Netherlands: the real world in the pre-drug-eluting stent era.

AIMS: To document the practice of interventional cardiology and the clinical restenosis rate, as well as the risk factors for clinical restenosis in an unselected population of patients in daily practice and to provide a perspective for the need of new devices such as drug-eluting stents. METHODS AND RESULTS: A total of 3177 consecutive patients, who underwent successful percutaneous transluminal coronary angioplasty (PTCA) in the Netherlands, were included. Patients with acute myocardial infarction were excluded. The pre-defined end-point of clinical restenosis was defined as cardiac death, myocardial infarction and revascularisation of the target vessel. Follow-up (9.6 months, IQR 3.9) was complete in 3146 (99.3%) patients with a mean age of 62.1+/-10.7 years. Of them 896 (28.5%) were female, 459 (14.6%) had diabetes and 1459 (46.4%) had multi-vessel disease. Most patients (2105, 66.9%) were treated for stable angina. Of all patients, 819 (26.0%) were treated for multiple lesions, 2340 (74.4%) underwent stenting and 820 (26.1%) received glycoprotein IIb/IIIa inhibitors. All stented patients received life-long aspirin and ticlopidin/clopidogrel during at least 1 month after the procedure. Target vessel revascularisation during follow-up by either coronary artery by-pass grafting (CABG) or PTCA was necessary in 304 patients (9.7%). Thirty-three (1.1%) patients died of cardiac disease and 22 (0.7%) patients suffered from myocardial infarction (MI) attributable to the originally treated vessel. Overall, the need for revascularisation, or the incidence of cardiac death or MI occurred in 346 patients (11.0%), at 9 and 12 months these event-rates were 10.2% and 12.0%, respectively. Diabetes, hypertension, peripheral vessel disease, multi-vessel disease and treatment of type C lesions prevailed as independent risk factors for clinical restenosis. Longer stents and smaller minimal stent diameter were risk factors for in-stent stenosis. CONCLUSION: In this unselected series of consecutive patients treated for stable and unstable angina in everyday clinical practice in the pre-drug-eluting stent era, clinical restenosis after 9 and 12 months follow-up of the patients occurred in 10.2% and 12.0%, respectively. The risk varies from 8.3% to 17.6% depending on the number of risk factors. A proper selection of patients that benefit from new devices warranted, since the vast majority are well-treated with standard techniques and proper assignment of expensive new devices is obviously of importance for overall health care.     

白细胞介素-1及白细胞介素-1受体拮抗剂与经皮腔内血管成形术后再狭窄的关系

炎性反应是经皮腔内血管成形术后再狭窄的主要发病机制之一。炎性反应通过刺激内膜增生在支架置入术后再狭窄的过程中发挥重要作用。支架置入术后局部和系统炎性反应的强度和持续时间直接与患者的预后有关。白细胞介素（IL）-1在其发病过程中发挥了重要作用,而作为IL-1特异性的天然拮抗物IL-1受体拮抗剂（IL-1Ra）也越来越受到广泛的重视。本文就IL-1和IL-1Ra与再狭窄的关系作一综述。     

Calcium channel antagonists reduce restenosis after percutaneous transluminal angioplasty of an arteriovenous fistula in hemodialysis patients

Percutaneous transluminal angioplasty (PTA) for stenosis of hemodialysis fistulas is associated with a high incidence of restenosis, and improvement of the patency rate after PTA is greatly needed. In addition, angiotensin II receptor blockers (ARB), calcium channel antagonists (CCA) and antiplatelet agents (APA) are commonly administered to most hemodialysis patients. This study retrospectively examined the effect of these medications on the incidence of restenosis after angioplasty for hemodialysis fistulae. The subjects were 92 patients--54 with anastomotic stenosis of an arteriovenous fistula (AVF) and 38 with stenosis of the draining veins of an arteriovenous graft (AVG)--who underwent angioplasty between January 2001 and December 2003. The patency period was defined as the interval from the first to the second angioplasty or surgical reconstruction. We excluded patients who received angioplasty two or more times. The effect of each drug on the patency of the AVF or AVG was assessed by the Kaplan-Meier method with the log-rank test and multiple logistic regression analysis. The group receiving CCA therapy showed a higher patency rate for both an AVF and an AVG. Although multiple logistic regression analysis also showed that a CCA reduces restenosis independently in an AVF, there was no significant correlation between a CCA and patency in an AVG. Treatment with an ARB and an APA was not associated with significantly higher patency rates for either an AVF or AVG. A CCA may reduce the incidence of restenosis after percutaneous intervention for stenosis of an AVF.     

右冠状动脉成形术306例临床分析

目的分析评估右冠状动脉成形术(PTCA)和支架置入术的特点。方法总结1995年1月至1999年12月行右冠状动脉PTCA和支架置入术的冠心病患者306例。结果对306例右冠状动脉的338处病变行PTCA和支架置入术;17例失败,手术成功率为94.4%,支架置入成功率98.8%。其中严重夹层撕裂7例(包括2例急性心肌梗死和1例死亡),因开口异常被迫中止手术1例,导丝不能通过闭塞病变9例,心包积血死亡1例,并发急性血栓形成2例,支架远端再撕裂2例。结论右冠状动脉因其开口位置和方向变异相对较大,走向和分支等解剖具有不同的特点,行PTCA和支架置入时必需考虑其特点,尽量减少并发症的发生。     

Late thrombosis following treatment of in-stent restenosis with drug-eluting stents after discontinuation of antiplatelet therapy.

Drug-eluting stent usage has become commonplace for the percutaneous treatment of de novo coronary lesions, but the safety and efficacy profile for their evolving usage in restenotic lesions is largely unknown. We report three cases of angiographically confirmed drug-eluting stent thrombosis following treatment of restenotic lesions that occurred late (193, 237, and 535 days) and shortly after interruption of antiplatelet therapy. All three patients suffered ST elevation myocardial infarction, and there was one death. Further studies are necessary to better define the associated risk and ideal duration of antiplatelet therapy necessary in this cohort of patients with restenotic lesions.