PCI中采用药物涂层球囊的拘禁球囊技术对冠状动脉分叉病变边支的保护效果

目的评价采用药物涂层球囊(DCB)的拘禁球囊技术(JBT)在冠状动脉分叉病变PCI中保护边支的安全性、即刻疗效和远期疗效。方法将60例冠状动脉分叉病变患者分为DCB组(29例)与普通球囊(CB)组(31例)。DCB组采用DCB在JBT条件下处理边支,CB组采用CB在JBT条件下处理边支。对比2组手术的安全性、即刻疗效和远期疗效。结果 2组患者基线资料比较差异无统计学意义(P均> 0.05)。术后9个月,DCB组边支的血管最小管径大于CB组[(1.987±0.206) cm vs.(1.840±0.186)cm,P <0.05],DCB组边支的晚期管腔丢失小于CB组[(0.003±0.074)cm vs.(0.062±0.064)cm,P <0.05],DCB组LVEF恢复情况优于CB组[(56.07±4.527)%vs.(52.61±3.65)%,P <0.05]。结论与CB比较,DCB在JBT条件下对处理冠状动脉分叉病变中边支介入治疗安全有效,能保护边支血管,提高患者心脏收缩功能,远期疗效更优。     

拘禁球囊技术在冠状动脉分叉病变介入治疗中有效性的Meta分析

目的 探讨拘禁球囊技术(JBT)在冠状动脉分叉病变介入治疗中的有效性。方法 通过PubMed、EMbase、Cochrane Library、中国知网、万方等数据库收集使用JBT治疗冠状动脉分叉病变的相关研究文献。应用meta分析对所收集的文献进行综合定量评价,以使用JBT作为JBT组,并取传统边支保护技术（拘禁导丝或边支球囊对吻）的作为对照组,运用REVMAN5.3进行统计学处理。结果 共纳入文献9篇,累计病例JBT组380例,对照组366例。Meta分析结果显示:与对照组比较,JBT组缩短了经皮冠状动脉介入术（percutaneous coronary intervention,PCI）手术时间(WMD=-20.41, 95%CI=-24.00~-16.82, P<0.05); JBT组减少了边支闭塞、夹层或慢血流等并发症的发生率(RR=0.40, 95%CI=0.24~0.66,P<0.05),未能降低再发心肌梗死、靶血管重建,严重心力衰竭等心血管不良事件发生率(RR=0.58, 95%CI=0.31~1.07,P=0.08)。结论 与传统边支保护技术比较,JBT可缩短手术时间,减少术中边支闭塞、夹层或慢血流等并发症的发生率,未减少主要心血管不良事件发生率。     

分支拘禁球囊术保护并单支架骑跨技术治疗冠状动脉分叉病变的临床研究

目的评价血管内超声(IVUS)指导下分支拘禁球囊术保护联合单支架跨越技术治疗冠状动脉分叉病变的临床疗效及随访结果。方法选取2016年9月～2018年2月在我院心内科住院行冠状动脉造影显示非左主干真性分叉病变患者30例,在IVUS指导下行分支拘禁球囊术保护及主支单支架横跨支架置入术,12月内完成随访,观察主要心血管事件(MACE),并完成IVUS复查。结果术后一年内,2例发作心绞痛,加强药物治疗后症状缓解。1例急性心肌梗死患者为非靶血管病变,并完成血运重建。2例因心力衰竭发作需住院治疗。IVUS复查主支和边支两组血管管腔丢失比较,差异无统计学意义(P0.05)。结论分支拘禁球囊术保护联合主支单支架越跨技术治疗冠状动脉分叉病变是安全有效的,值得临床推广运用。     

血管内超声指导下拘禁球囊联合Szabo技术治疗冠脉分叉病变(Medina分型0∶1∶1)1例报告

正冠状动脉分叉病变介入治疗的难点在于处理一支血管会影响分叉的另一支血管,造成或加重狭窄,甚至导致闭塞。Aminian等~([1])报道,分叉病变介入治疗中采用拘禁球囊可保护重要的分支血管。Szabo技术是近年来发展起来的一种处理开口及分叉病变(Medina分型0∶1∶0或0∶0∶1)的支架定位技术,由1根穿过冠脉开口病变的导丝和另一根进入边支或主动脉(病变在主动脉开口时)的导丝组成。支架在体外预先给予2～4个大气压(1atm=101.325kPa)。     

急性冠脉综合征患者左主干分叉病变的危险因素研究

目的 分析急性冠脉综合征（acute coronary syndrome,ACS）患者左主干分叉病变的危险因素。方法 回顾性选取2020年1月至2021年10月广西百色市人民医院收治的合并左主干分叉病变的ACS患者125例为左主干分叉病变组,另选取同期收治的未合并左主干分叉病变的ACS患者105例为非左主干分叉病变组。使用单因素及多因素logistic回归分析ACS患者发生左主干分叉病变的独立危险因素。结果 左主干分叉病变组糖尿病占比高于非左主干分叉病变组,血尿酸、红细胞分布宽度变异系数（red cellvolumedistributionwidth-coefficientofvariation,RDW-CV）、脑钠肽（brainnatriureticpeptide,BNP）、超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）高于非左主干分叉病变组（P<0.05）。多因素logistic回归分析显示,糖尿病、血尿酸、RDW-CV、BNP、hs-CRP是ACS患者发生左主干分叉病变的独立危险因素（OR分别为2.385、1.005、2....     

冠脉血流储备分数在治疗血管临界病变中的临床效果研究

选取2012年3月~2014年6月已使用造影确定冠脉狭窄高于40%的患者166例,随机分为对照组和观察组各83例,其中对照组采用血管内超声指导治疗,观察组采用冠脉血流储备分数指导治疗,治疗后对所有患者进行为期1年的随访,主要调查两组患者的治疗后恢复情况和不良反应情况。结果观察组患者的总体治疗有效率明显高于对照组(P<0.05),不良反应发生率明显低于对照组(P<0.05)。冠脉血流储备分数能够有效的指导冠心病支架术后心绞痛的临床介入治疗,有效提高治疗效果,减少患者不良反应的发生情况,提高患者治疗体验,值得在临床上进行推广。     

分支为小血管的冠脉真性分叉病变中行支架+药物球囊PCI术式的临床研究

目的 探讨支架+药物球囊术式在冠脉真性分叉病变中的即刻治疗效果和远期治疗效果。方法 选取2021年1月—2022年12月茂名市电白区人民医院收治的60例冠状动脉分叉病变患者,按照抽签法分为两组,每组30例。对照组接受支架+普通球囊术治疗,研究组接受支架+药物球囊术治疗。对比两组在术后即刻和远期的主支及边支TIMI血流分级,主支及边支病变,边支闭塞、严重狭窄加重发生情况以及血清炎症因子指标。结果 两组远期边支TIMI血流3级情况比较,差异有统计学意义（P<0.05）。研究组边支闭塞、狭窄加重的发生率分别为0和3.3%,低于对照组的13.3%和20.0%,但差异无统计学意义（P>0.05）。两组患者术后6个月心脏超声射血分数、胸痛发生率比较,差异有统计学意义（P<0.05）。术后,研究组hs-CRP、Lp-PLA2低于对照组,hs-cTnl高于对照组,差异有统计学意义（P<0.05）。结论 在真性冠脉分叉病变患者中,支架+药物球囊术式治疗的治疗效果较支架+普通球囊术更为显著,能够有效地改善患者主支及边支TIMI血流分级,改善炎症水平。     

分支球囊保护技术在分叉病变PCI术中的应用

目的探讨分支球囊保护技术在分叉病变PCI术中的应用效果。方法 100例被明确诊断为分叉病变无重要器官病变可耐受手术患者,随机分为观察组(50例)和对照组(50例)。观察组在PCI术中采用分支球囊保护技术,对照组在PCI术中不采用分支球囊保护技术。观察手术一般情况、术中并发症、住院及随访期间心血管不良事件。结果观察组PCI成功率明显高于对照组(P<0.05);观察组手术时间、放射线量、手术靶血管支架植入数量明显少于对照组(P<0.05);术中分支受累情况及随访期间心血管不良事件发生率低于对照组(P<0.05)。结论分支球囊保护技术是一种操作简单、方便,能提高分叉病变PCI成功率的冠状动脉介入治疗操作技术,在冠状动脉分叉病变尤其是真性分叉病变治疗中可以合理采用。     

冠心病患者冠脉CTA斑块特征定量参数与血流储备分数相关性分析

目的：探讨冠心病患者冠脉CT血管成像（CTA）技术斑块特征定量参数与血流储备分数（FFR）的相关性。方法：选取2021年1月—2023年8月南京市六合区人民医院收治的冠心病患者128例（166支血管）为研究对象,均行冠脉CTA检查及FFR检测,根据FFR检测结果为诊断心肌缺血的标准,分为FFR> 0.80组（78例,83支血管）和FFR≤0.80组（50例,93支血管）,比较两组冠脉CTA斑块特征定量参数,并采用Pearson相关系数分析上述指标与FFR相关性。结果：两组冠脉病变支数比较差异有统计学意义（P <0.05）;两组性别比例、年龄、合并高血压、合并糖尿病、冠心病家族史、体质量指数比较,差异均无统计学意义（P> 0.05）。FFR≤0.80组斑块长度、斑块负荷、斑块总体积均小于FFR> 0.80组（P <0.05）;两组钙化斑块体积、脂质斑块体积、纤维斑块体积、最小管腔面积、最小管腔直径、重塑指数、偏心指数比较,差异均无统计学意义（P> 0.05）。FFR≤0.80组低密度斑块占比高于FFR> 0.80组（P <0.05）;两组正...     

Percutaneous treatment of left main and non-left main bifurcation coronary lesions using drug-eluting stents

Current evidence and guidelines support the use of the single-stent technique as the default treatment strategy for the treatment of coronary bifurcations. For the single-stent technique, routine final kissing balloon inflation is not recommended, unless side branch ostial stenosis is assumed to be functionally significant. The double-stent technique is still a viable option for bifurcations with large and severely diseased side branches. Due to the unique features of bifurcation anatomy and bifurcation stenting techniques, all deployed stents should be optimized by postdilation, kissing balloon inflation and/or the proximal optimization technique, regardless of the stenting technique used. Intravascular ultrasound can guide preimplantation decision-making and postimplantation optimization by providing information on reference diameter, plaque burden and distribution, and stent underexpansion and malapposition.     

Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future?

ABSTRACT

Introduction: The assessment of coronary lesions severity has always been a relevant topic in the management of the patient undergoing coronary angiography. Fractional flow reserve (FFR) has been introduced as an objective index to determine the significance of a coronary stenosis with a positive impact on clinical outcomes has been demonstrated for FFR-guided coronary interventions. However, several technical drawbacks have been pointed out in clinical practice limiting the diffusion of FFR worldwide. To exceed these limits, other indices and the quantitative flow ratio (QFR) have been recently developed and tested in clinical studies.

Areas covered: This review aims to provide a brief overview of functional assessment of coronary stenosis and a particular attention to the QFR, to its validation and application studies for its potential applicability in clinical practice. QFR through a computational fluid dynamic analysis, proved to be useful in discriminating functionally significant stenosis, with an excellent correlation with FFR values, and considerable advantages in terms of acquisition time and costs.

Expert opinion/commentary: QFR is an innovative angiographic-based technique that uses modern software for three-dimensional vessel reconstruction, and flow models calculation. The significant technical benefits reported in the management of patients with intermediate coronary stenosis, make it a modern, effective and usable tool.     

冠状动脉旋磨术在真性分叉病变PCI中的应用

目的将冠状动脉旋磨术应用于真性分叉病变经皮冠状动脉内支架置入(PCI)术中,探讨其在分叉病变中的应用效果。方法收集2013年7¹0月行冠状动脉造影证实为非左主干、真性冠状动脉分叉病变并行支架置入术的患者50例。其中应用旋磨术预处理者30例作为旋磨组,余未应用者20例为对照组,比较两组术中、术后情况。结果旋磨组靶血管支架置入数量、术中发症(边支受严重影响、冠状动脉夹层及支架膨胀不全)发生率均低于对照组,二者比较差异均有统计学意义(P<0.05);旋磨组院外随访心血管事件总发生率及晚期管腔丢失或再狭窄发生率均明显低于对照组,二者比较差异均有统计学意义(P<0.05)。结论冠状动脉旋磨术可改善真性分叉病变患者PCI术即刻临床效果和预后。     

定量血流分数指导下经皮腔内冠状动脉介入治疗伴多支血管病变超高龄急性冠状动脉综合征患者的临床效果

目的  探究定量血流分数（QFR）指导下经皮腔内冠状动脉介入（PCI）治疗伴多支血管病变超高龄急性冠状动脉综合征（ACS）患者的临床效果。方法  选取2019年3月~2020年4月在我院接受治疗并符合纳入标准拟行急性冠状动脉综合征超高龄患者（90~110岁）80例为研究对象,根据患者意愿分为研究组及对照组,40例/组。对照组采用单纯冠状动脉造影诊断PCI手术治疗;研究组采用QFR指导PCI。检测术前及术后1月患者血浆脑利钠肽、氨基末端B型利钠肽前体、心肌肌钙蛋白I水平,心脏功能指标（左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、射血分数）、纽约心脏病协会分级变化及不良事件发生情况。结果  研究组冠状动脉造影血管直径狭窄程度≥50%共83支,其中QFR≤0.8阳性43支（51.81%）,阴性40支（48.19%）,其中阳性41支、阴性7支行PCI联合冠状动脉旁路移植术治疗,与QFR分析结果相符率分别为95.35%、82.50%;对照组冠状动脉造影血管直径狭窄程度≥50%共79支,其中70支病变血管行PCI联合冠状动脉旁路移植术治疗。术后1月研究组血浆脑利钠肽、氨基末端B型利钠肽前体水平、左心室收缩末期内径、左心室舒张末期内径均低于对照组,射血分数值高于对照组（P < 0.05）;研究组术后1月内不良事件发生率低于对照组（27.50% vs 50.00%,P < 0.05）。结论  QFR指导外科PCI手术治疗超高龄多支血管病变的急性冠状动脉综合征安全可行,可降低术后不良事件发生率,但其有效性仍需进一步扩大样本和进行前瞻性临床研究验证。     

右冠分叉病变三维重建最佳投照角度与介入投照角度的对照研究

目的:研究medis3D系统快速生成的用于右冠状动脉分叉病变介入治疗的最佳投照角度的准确性。方法:随机抽取我院2009年5-11月期间接受右冠状动脉介入治疗的20位患者进行回顾性研究。通过患者右冠脉病变的两个视图的投照影像进行三维靶血管重建,快速生成最少短缩率或延长率的最佳投照角度,选取两名10年以上介入经验的术者对其优越性进行评估,量化为-2至2五个等级。并对短缩率和所需投照次数进行比较评估。结果:本研究20例右冠状动脉的三维重建率为100%。生成的最佳投射角度量化评分1.38±0.72,明显优于实际介入时的角度,P<0.01。最佳投照角度下右冠状动脉主支三维长度与实际介入角度下二维测量无明显差异(32.54±5.68mmvs29.43±5.47mm,P=0.72),侧支明显长于实际测量值(26.58±3.59mmvs18.03±5.12mm。P<0.05),而主、侧支短缩率均明显小于实际介入时的投照角度的短缩率(1.48±1.88vs10.54±4.89,P<0.01;3.6±2.35vs22.13±8.08,P<0.01),并能显著减少投照次数(2.10±0.31vs2.55±0.61)。结论:medis3D系统快速生成的用于冠状动脉介入治疗的最佳投照角度优于传统介入使用的投照角度,具有较少的短缩率,并能减少所需的X线投照次数。     

Effect of intraaortic balloon counterpulsation (IABP) on myocardial infarct size and collateral flow in an experimental dog model

To determine the influence of IABP on infarct size and collateral blood flow in each of 12 openchest anaesthetised mongrel dogs two small branches of the left coronary artery were occluded consecutively. The perfusion areas of both branches were comparable in size. IABP was started immediately before ligation of the first branch for a 90-min period followed by a reperfusion period of 90 min. Subsequently the second vessel was also occluded for 90 min as a control without IABP while myocardial oxygen consumption remained constant and was then reperfused. Infarct size was expressed as a percentage of the perfusion area. A difference in infarct size with and without IABP (18±17, 18±10% respectively) could not be observed. However a significant increase of collateral blood flow due to IABP in the subendocardial layer from 8.9±4.8 to 14.9±4.6 ml/100 g/min (p<0.05) was prevalent. In the subepicardial layer the augmentation from 23.7±19.9 to 26.9±15.2 was not significant. Thus, in spite of a small increase of collateral blood flow in the subendocardial layer of the ischemic myocardium the infarct size was not reduced by IABP in our dog model.     

急性冠脉综合征患者血尿酸水平与冠脉病变程度的相关性及其对经皮冠状动脉介入术预后的影响

目的探讨血清尿酸（SUA）水平与急性冠脉综合征（ACS）患者冠脉病变程度的相关性及其对经皮冠状动脉介入术（PCI）预后的影响。方法对253例诊断为 ACS 且接受冠状动脉造影和 PCI 术的患者,测定血清尿酸水平。根据尿酸是否正常分成高尿酸组和正常尿酸组,比较两组间冠状动脉狭窄程度以及 PCI术中的冠脉血流情况,并随访 PCI 术后心功能变化以及一个月和半年的主要心血管不良事件（MACE）的发生率。结果高尿酸组 Gensini 积分明显高于正常尿酸组（P ＜0．01）。血清尿酸水平与 Gensini 积分呈正相关（r ＝0．301,P ＜0．05）。高尿酸组 PCI 术中慢血流的发生率为28．3％,明显高于正常尿酸组（10．5％）,差异有统计学意义（P ＜0．01）。且血尿酸是 PCI 术中出现慢血流的独立预测因素（OR ＝5．579,95％CI 2．163～14．389,P ＜0．01）。术后心功能及随访期间 MACE 事件的发生率高尿酸和正常尿酸组之间并无明显差异（P ＞0．05）。结论ACS 患者血尿酸水平越高,冠脉狭窄程度越重;合并高尿酸血症的 ACS 患者接受 PCI 治疗时,发生冠脉慢血流的风险增加。     

Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation

ABSTRACT: INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO. METHODS: In 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined. RESULTS: CaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%). CONCLUSIONS: In a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.