应用冠脉血管内超声评价药物涂层支架置放后再狭窄及血管内膜增生

目的应用冠脉内超声测量支架置入6个月后内膜增生厚度,准确比较不同支架再狭窄率。方法选择57例药物洗脱支架(DES)置入术后4～8(6±2)个月同意复查冠脉造影及冠脉血管内超声的冠心病(CHD)住院患者,分为Cypher支架组(25例)和Firebird支架组(32例),及同期491例植入金属裸支架(BMS)CHD患者,测量支架置入后6个月时的内膜增生并进行比较。结果冠脉造影显示DES发生再狭窄Cypher组11例,Firebird组10例,裸支架组25例。再狭窄率分别为8.4%,8.9%和10.0%。DES两组差异无统计学意义,裸支架组与Cypher组及Firebird组相比较差异有显著性。冠脉内超声检查结果显示DES组中Cypher支架新生内膜面积为(1.11±0.89)mm2,支架再狭窄率(9.0±0.1)%;Firebird组为(1.13±0.08)mm2,支架再狭窄率(10.0±0.2)%。DES两组间比较差异无统计学意义。裸支架组支架新生内膜面积为(1.44±0.04)mm2,再狭窄率为(21.0±0.1)%,与DES两组比较,有显著的统计学差异(P<0.05)。支架两端的节段狭窄率DES组中近端的节段狭窄Cypher组(0.43±0.25)%与Firebird组(0.40±0.15)%都显著高于裸金属支架组(0.29±0.13)%(P<0.05)。远端的节段狭窄率,三组比较差异无统计学意义。结论应用冠脉内超声评价支架内再狭窄准确度优于冠脉造影。DES降低支架内再狭窄率明显优于裸金属支架,防止支架节段狭窄,裸金属支架可能有优势。     

比较CypherTM和TaxusTM支架在冠心病合并糖尿病患者中应用的安全性和有效性

背景与裸支架相比,药物洗脱支架可以显著降低冠心病合并糖尿病患者PCI术后再狭窄率和靶病变重建率.但目前尚未见关于直接比较雷帕霉素洗脱支架(CypherTM)和紫杉醇洗脱支架(TaxusTM)在治疗冠心病合并糖尿病患者中安全性和有效性的研究.目的观察和比较两种药物洗脱支架在冠心病合并糖尿病患者中应用的安全性和有效性.方法自2002年6月～2004年2月新加坡国立大学医院心脏中心所有置入Cypher或Taxus支架冠心病合并糖尿病患者,观察术后6个月的主要不良心脏事件(包括死亡、心肌梗死、靶病变重建).结果共计122例患者(Cypher组为31例,Taxus组为91例).B2和C型病变75%.两组患者基本特征无显著差异.与Taxus组相比Cypher组有更小参照血管直径(2.4±0.6 mm和2.6±0.7 mm,P＜0.01),Cypher组和Taxus组术后急性和亚急性支架内血栓发生率(0%和1.1%)、6个月靶病变重建率(3.2%和3.3%)和主要不良心脏事件(6.4%和5.5%)都没有差异.结论两种药物洗脱支架在冠心病合并糖尿病患者中的临床应用安全、有效的,在降低6个月临床再狭窄率、靶病变重建率和主要不良心脏事件上无明显差异.     

Firebird2~(TM)雷帕霉素洗脱支架治疗复杂冠脉病变临床观察

目的评估Firebird2~(TM)雷帕霉素洗脱钴基合金支架治疗复杂冠脉病变的有效性与安全性。方法选取110例符合行经皮冠状动脉介入治疗指征患者,体内植入支架均为Firebird2~(TM)药物支架。通过电话或门诊随访,观察患者术后30 d及6、12、24、36、48、60个月心绞痛发生情况及主要不良心脏事件发生时间及发生率、出院后发生的任何介入治疗。结果 Firebird2~(TM)雷帕霉素洗脱钴基合金支架植入手术成功率100%,5年累计主要不良心血管事件(MACE)发生率6.3%,与支架相关MACE发生率2.7%,血栓发生率0.9%。结论 Firebird2~(TM)雷帕霉素洗脱钴基合金支架治疗复杂冠脉病变的心脏不良事件发生率低,疗效可靠、安全。     

国产可降解涂层雷帕霉素洗脱支架在冠心病介入中的应用评价

目的探讨国产可降解涂层雷帕霉素药物洗脱支架介入治疗冠心病的临床效果。方法将90例ST段抬高型心肌梗死(STEMI)患者按入院次序分为观察组与对照组,每组45例,观察组给予国产可降解涂层雷帕霉素药物洗脱支架(EXCEL)介入治疗,对照组给予国产不可降解涂层雷帕霉素药物洗脱支架(Cypher Select)介入治疗,比较两组患者疗效。结果两组患者在PCI成功率、置入支架数目、长度、术后支架内管腔丢失、节段内管腔丢失、支架内再狭窄发生率、节段内再狭窄发生率、MACE发生率均无统计学差异(P>0.05)。结论国产EXCEL与Cypher Select相比,两者对于冠心病患者的治疗均具有良好效果,但EXCEL并未降低术后患者再狭窄及血栓形成发生率。     

重叠药物洗脱支架术治疗冠状动脉长病变的临床疗效

目的评估重叠药物洗脱支架治疗冠状动脉长病变的疗效。方法47例患者53处长病变(≥30 mm)接受重叠冠脉药物洗脱支架术治疗(DES组),47例51处病变接受重叠金属裸支架患者作为对照组(BMS组)。比较两组临床情况、造影及介入治疗特征、临床和造影随访结果。结果两组介入治疗前临床情况和冠脉造影结果无显著差异。DES组植入支架较多,病变长度、支架覆盖总长度大于对照组,且血管内径小于BMS组。DES组复发胸痛者显著少于对照组(6%和38%,P<0.01),DES术后支架内晚期管腔丢失显著低于对照组[(0.1±0.03)mm和(1.1±0.41)mm,P<0.01],支架内再狭窄和靶血管再次血运重建率显著低于对照组(4.3%和34.0%;6.4%和44.7%,P<0.01),严重心脏不良事件发生率显著降低(6%和45%,P<0.01)。结论与金属裸支架相比,重叠药物洗脱支架术治疗冠状动脉超长病变能显著降低支架内再狭窄率、靶血管再次血运重建率及严重心脏不良事件发生率。DES治疗冠脉超长病变安全有效。     

药物洗脱支架治疗2型糖尿病合并冠心病多支血管病变的中期疗效

目的对比分析裸金属支架（BMS）与药物洗脱支架（DES）在2型糖尿病（T2DM）合并多支冠脉病变经皮冠状动脉介入治疗（PCI）应用中的安全性和中期疗效,为DES治疗此类患者提供依据。方法连续人选2002年11月-2005年6月首次接受PCI治疗的443例T2DM合并多支冠脉血管病变患者,其中BMS组226例,雷帕霉素（Cypher）支架组91例,紫杉醇（TAXUS）支架组126例,分析患者住院期间及随访6个月的临床情况。结果三组患者临床特征、手术成功率及住院期间主要不良心脏事件（MACE）发生率等指标均无明显差异。Cypher支架组中病变长度和分叉病变的比例及TAXUS支架组中3支血管和分叉病变的比例均明显高于BMS组（P〈0．05或0．01）。两DES组的造影随访再狭窄率明显低于BMS组（Cypher组3．2％、TAXUS组4．5％协BMS组37．3％,P〈0．05）,临床随访6个月MACE发生率亦明显低于BMS组（Cypher组5．7％、TAXUS组5．8％wBMS组18．5％,P〈0．01）。结论与BMS相比,T2DM合并多支冠脉血管病变患者植入Cypher支架和TAXUS支架安全性高,6个月中期疗效较理想。     

国产可生物降解涂层支架治疗冠心病的临床研究

目的 研究EXCEL支架临床应用的安全性和有效性.方法 2008年1-10月,选择100例冠心病行PCI术并同意术后冠脉造影复查的患者,分为EXCEL组58例,Cypher组42例.观察介入治疗手术即刻成功率和住院期不良事件发生率,术后随访以及冠脉造影复查结果.结果 两组患者基本情况以及冠状动脉病变支数、类型、置入支架平均长度方面差异无统计学意义,随访结果两组主要心脏不良事件(MACE)、支架内再狭窄和血栓发生率差异无统计学意义.结论 与Cypher支架相比EXCEL支架MACE和支架内再狭窄率相似,均较低.     

高龄冠心病患者药物洗脱支架术的临床疗效

目的　评估高龄冠心病患者冠脉内植入药物洗脱支架的临床安全性和远期预后。方法　连续 2 39例接受冠脉内药物洗脱支架术治疗的冠心病患者中 ,≥ 70岁 88例 (高龄组 ) ,<70岁 15 1例 (对照组 )。记录并比较两组一般临床情况、手术成功率、心绞痛复发和远期心脏事件总发生率。结果　两组支架术的手术成功率与并发症相似。随访期间 ,高龄组和对照组心绞痛复发率为 2 3.9%和 7.3% (P <0 .0 0 1) ,心脏事件总发生率为 5 .7%和 2 .7% (P <0 .0 0 1)。冠脉造影随访两组的再狭窄发生率无显著差异。结论　 70岁以上高龄冠心病患者冠脉内植入药物洗脱支架安全、成功率高 ,但其缓解临床心绞痛症状较年轻患者差     

多枚药物洗脱支架治疗冠心病远期疗效

目的回顾性分析经皮冠状动脉介入治疗(PCI)患者植入单枚与多枚(≥3枚)药物洗脱支架远期预后差异。方法466例接受PCI治疗并植入药物洗脱支架患者,分为单个药物洗脱支架组(373例)和多枚药物洗脱支架组(93例)。比较两组的基础临床情况和12个月主要心脏不良事件(死亡、心肌梗死、靶血管血运重建)。结果与单枚药物洗脱支架组相比,多枚药物洗脱支架组有更多患者伴有高血压、糖尿病和心功能不良,随访17个月主要心脏不良事件发生率(17.2%)较单个药物洗脱支架组(8.6%)明显增加(P＜0.05)。结论与植入单个药物洗脱支架患者比较,植入多个药物洗脱支架患者远期预后不佳。     

雷帕霉素洗脱支架在冠心病合并2型糖尿病中的疗效

目的　评估冠心病合并 2型糖尿病患者冠状动脉 (冠脉 )内植入雷帕霉素洗脱支架的临床疗效。方法　 10 1例 2型糖尿病患者接受冠脉内支架术 ,其中 6 7例植入雷帕霉素洗脱支架 (SES组 ) ,34例接受普通金属支架 (BMS组 )。比较两组的一般临床情况、冠脉造影和支架术 ,以及远期心脏不良事件发生率。结果　两组即刻手术成功率均为 10 0 % ,且无严重并发症发生。平均随访 1年中 ,SES组远期心脏不良事件发生率显著低于BMS组 (7.5 %比 32 .4 % ,P =0 .0 0 1)。结论　冠心病合并 2型糖尿病患者中植入雷帕霉素洗脱支架安全有效 ;与普通支架相比 ,药物洗脱支架能显著降低心脏不良事件发生率     

冠脉支架ZetaTM和DriverR的临床应用观察

 目的观察冠脉支架Multi-Llink RX ZetaTM和DriveR的特点、临床应用的安全性及其短期随访结果.方法分析经选择性冠状动脉造影(Coronary angiography,CAG)证实为管腔狭窄面积＞75%的冠心病(Coronary heart disease,CHD)患者87例,46例冠状动脉内置入Multi-Llink RX ZetaTM支架,共置入支架47只;41例冠状动脉内置入DriverR支架,共置入支架41只,观察支架术后疗效和6个月内临床心脏事件(Major adverse cardiac events,MACE)发生率以及再狭窄率.结果两组手术成功率均为100%.Multi-Llink RX ZetaTM支架组,血管扭曲病变及长病变占89.5%,6个月MACE发生率为2.2%,再狭窄率为12.6%;DriverR支架组,扭曲病变及长病变占87.8%,分叉病变占46.7%,其中,直接置入支架4个,6个月MACE发生率为2.4%,再狭窄率为12.2%.结论两组手术成功率高,治疗扭曲病变及长病变疗效好,MACE发生率和6个月再狭窄率均较低;Multi-Llink RX ZetaTM支架具有良好的跟踪性和高穿过性,DriverR支架具有可弯曲性好、支撑力好、侧孔大、易到位等优点,直接置入成功率高,对边支血管影响小,适用于分叉病变.     

不同类型支架治疗椎动脉开口狭窄的对照研究

【摘要】　目的?比较不同类型支架治疗椎动脉开口狭窄的有效性和安全性。方法?2018年1月至2018年12月73例椎动脉开口狭窄患者共86条病变血管接受支架成形术治疗,分别应用肾动脉支架23枚,Apollo支架26枚,冠状动脉裸支架19枚,药物洗脱支架（DES）18枚。回顾性分析患者临床资料,对比不同类型支架植入术疗效和支架内再狭窄发生率。结果?不同类型椎动脉开口支架成形术均获成功。术前影像显示椎动脉开口平均狭窄率为90.9%,术后即刻影像显示平均残余狭窄率为10.3%。围术期手术相关并发症发生率为1.2%（1/86）。术后平均随访（6.2±3.1）个月,患者临床症状得到改善。肾动脉枚架失访1枚,再发狭窄4枚（17%）;Apollo枚架失访2枚,再发狭窄8枚（31%）,1例患者术后第2日并发大面积后循环脑梗死;冠状动脉裸枚架无失访,再狭窄7枚（37%）,1例患者6个月时枚架断裂;DES组失访1枚,再狭窄2枚（11%）,与其他组再发狭窄差异有统计学意义（P＜0.05）。结论?不同类型枚架治疗椎动脉狭窄安全有效。DES在降低枚架内再狭窄发生方面最优,肾动脉枚架次之,Apollo枚架和冠状动脉裸枚架再狭窄率较高。     

Preliminary study of the use of drug-eluting stents in atherosclerotic renal artery stenoses 4 mm in diameter or smaller

PURPOSE: To describe restenosis and clinical outcomes with drug-eluting stents (DESs) and compare them to those of bare metal stents (BMSs) in the treatment of symptomatic atherosclerotic renal artery stenosis (RAS) in the same patients. METHODS AND MATERIALS: A retrospective study was performed of all patients with RAS treated with a DES (Taxus Express 2 or Cypher). DESs were used for RASs with luminal vessel diameters of 4 mm or smaller and BMSs were used for those larger than 4 mm. RESULTS: Sixteen patients (eight women; mean age, 72 years +/- 8) underwent treatment of 27 RASs for worsening renal function (n = 10) and uncontrolled hypertension (n = 6). Eighteen RASs were treated with 23 DESs (Cypher, n = 12; Taxus, n = 11) and nine were treated with BMSs. The average follow-up was 22 months +/- 10. After the procedure, the mean systolic blood pressure decreased significantly (P < .05), with no change in the mean diastolic pressure, serum creatinine, or number of antihypertensive medications. By Kaplan-Meier estimates, the 1- and 2-year patency rates for DESs were 78% and 68%, respectively; and for BMSs, the respective rates were 58% and 47% (P = NS). The average diameters of RASs were 3.4 mm +/- 0.6 in the DES group and 5.3 mm +/- 0.6 in the BMS group (P < .05). There were two technical failures (7.7%) in the DES group. There was one minor complication and a non-flow-limiting dissection. CONCLUSIONS: DESs were used to treat RASs with good technical results and low restenosis rates compared with BMSs despite the smaller artery diameters in the DES group.     

Intracoronary β-brachytherapy using a rhenium-188 filled balloon catheter in restenotic lesions of native coronary arteries and venous bypass grafts

Purpose We have previously demonstrated the efficacy of intracoronary β-brachytherapy using a liquid ¹⁸⁸Re-filled balloon in a randomised trial including de novo lesions. Percutaneous coronary interventions in restenotic lesions and in stenoses of venous bypass grafts are characterised by a high recurrence rate for restenosis and re-interventions. Against this background, we wanted to assess the impact of intracoronary β-brachytherapy using a liquid ¹⁸⁸Re-filled balloon in restenotic lesions in native coronary arteries and venous bypass grafts.Methods In 243 patients, β-brachytherapy with 22.5 Gy was applied at a tissue depth of 0.5 mm. Patients were followed up angiographically after 6 months and clinically for 12 months. The primary clinical endpoint was the incidence of MACE (death, myocardial infarction, target vessel revascularisation). Secondary angiographic endpoints were late loss and binary restenosis rate in the total segment.Results All irradiation procedures were successfully performed. A total of 222 lesions were in native coronary arteries; 21 were bypass lesions. Mean irradiation length was 41.6±17.3 mm (range 20–150 mm) in native coronary arteries and 48.1±33.9 mm (range 30–180 mm) in bypass lesions; the reference diameter was 2.57±0.52 mm and 2.83±0.76 mm, respectively. There was no vessel thrombosis during antiplatelet therapy. Angiographic/clinical follow-up rate was 84%/100%. MACE rate was 17.6% in the native coronary artery group and 38.1% in the CABG group (p<0.03). Binary restenosis rate was 22.5% and 55.6% (p<0.01), and late loss was 0.38±0.72 mm and 1.33±1.11 mm (p<0.001), respectively.Conclusions We conclude that intracoronary β-brachytherapy with a liquid ¹⁸⁸Re-filled balloon using 22.5 Gy at a tissue depth of 0.5 mm in restenotic lesions is safe. It is associated with a low binary restenosis rate, resulting in a low occurrence rate of MACE within 12 months in restenotic lesions in native coronary arteries but not in vein grafts.     

药物洗脱支架治疗多支慢性完全闭塞冠脉病变的中期疗效观察

目的探讨药物洗脱支架（DES）对多支慢性完全闭塞病变（CTO）冠心病患者的中期疗效和临床意义。方法选取2002年11月-2005年6月成功完成的多支CTO经皮冠状动脉介入治疗（PCI）置入DES的89例冠心病患者作为DES组,对照组为2000年11月-2003年6月成功置人裸金属支架（BMS）的多支CTO冠心病患者70例。分析比较两组临床资料、病变特征、PCI结果和住院期间主要不良心脏事件（MACE）,并记录出院后6个月临床随访时的MACE发生率。结果两组患者基础临床特征无统计学差异,仅DES组心肌梗死患者比例低于BMS组（29．2％vs45．7％）;两组患者CTO靶血管分布和PCI治疗情况无统计学差异;与BMs组比较,DES组CTO特征中≥15mm的靶病变数、平均支架数及平均支架长度均较高,而平均支架直径较低。两组患者住院期间均未发生MACE事件;6个月后随访DES组靶病变再血管化、靶血管再血管化、累积MACE率和总再狭窄率均低于BMS组,差异有统计学意义。结论DES在多支CTO患者PCI治疗中有较好的应用前景。     

Restenosis after carotid stent placement in patients with previous neck irradiation or endarterectomy

PURPOSE: Placement of a carotid artery stent (CAS) is an appealing treatment option for patients who have undergone neck irradiation or endarterectomy. Early outcomes and restenosis rates in these patients were analyzed and compared with those in de novo lesions. MATERIALS AND METHODS: Single-center, retrospective review of 269 CAS procedures that used cerebral embolic protection and nitinol stents was conducted from May 2001 through July 2006. In this cohort, 66 procedures were performed in patients with a history of external-beam neck irradiation (n=26) or carotid endarterectomy (CEA; n=40), designated as the "hostile neck" group. Mean follow-up was 16 months. RESULTS: The 30-day event rate for the entire group included major ipsilateral stroke (1.1%), minor posterior stroke (1.1%), and myocardial death (0.4%); none occurred in the hostile neck group. The rate of restenosis or occlusion for all 269 arteries was 2.6%. There was no significant difference in restenosis or occlusion rates between de novo lesions (2.0%, four of 203) and the hostile neck group (4.5%, three of 66; P=.17). Repeat angioplasty with or without stent implantation was employed for all patients with restenosis and resulted in no periprocedural stroke, death, or subsequent restenosis. CONCLUSIONS: Periprocedural outcomes of CAS procedures are similar in de novo lesions as in patients with a history of neck irradiation or CEA. Importantly, restenosis requiring repeat intervention remains uncommon, and its incidence is comparable between groups.     

Elective placement of covered stents in native coronary arteries

PURPOSE: To study the feasibility of placing a polytetrafluoroethylene (PTFE)-covered stent graft into native coronary arteries and assess the complications and the restenosis rate. MATERIAL AND METHODS: Fifty consecutive patients with stable angina pectoris were included and the stent graft was placed into native coronary arteries. Clinical and angiographic follow-up were performed after 6 months. RESULTS: The stent grafts were successfully placed in all patients. The mean reference diameter was 3.3 +/- 0.6 mm. During follow-up the stent grafts occluded in patients after 1, 2 and 2.5 months and one more was occluded at 6 months. Three patients experienced myocardial infarction, 2 Q wave and one non-Q wave. After 6 months 42 (84%) patients had angina NYHA class 0 or 1. Target vessel revascularization was done in 11 cases for restenosis in the graft (n = 4), outside the graft (n = 3) and both (n = 4), giving a restenosis rate of 24%. The total major adverse coronary events at 6 months was 24%. CONCLUSION: The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, this study showed that subacute occlusion may occur more frequently and we therefore recommend that ticlopidine or clopidogrel treatment should be prolonged to at least 3 months.     

ACS MULTI-LINK PENTA冠状动脉内支架临床应用

目的　评估ACSMULTI LINKPENTA(PENTA)冠状动脉 (冠脉 )内支架术的即刻和近期临床效果。方法　分析 30例PENTA冠脉支架临床应用情况。结果　 2 8例患者中高血压 (6 1% )、不稳定性心绞痛患者 (5 3% )较多 ,多数为左前降支血管 (5 7% )病变和复杂病变 (B2 C ,占 6 7% )。 77%支架植入前以球囊作预扩张 ,2例支架植入后分支血管受累 ,支架术成功率达 93%。平均随访 (74± 35 )d ,2例复发胸痛 (7% ) ,但无严重不良心脏事件发生。结论　PENTA冠脉支架术治疗冠心病安全、有效 ,即刻和近期临床疗效较好 ,且对于复杂冠脉病变同样有效。     

金属裸支架与药物洗脱支架在治疗症状性椎-基底动脉狭窄与急性闭塞中的应用

目的评价金属裸支架(bare metal stent,BMS)与药物洗脱支架(drug eluting stent,DES)治疗症状性椎-基底动脉狭窄与急性闭塞的安全性、有效性和中短期疗效并作初步比较。方法对2005年3月至2008年1月收治的25例症状性椎-基底动脉狭窄与急性闭塞患者行血管内球囊支架成形治疗。结果25例患者成功植入28枚球囊支架,其中BMS15枚,DES13枚。植入椎动脉支架25枚,基底动脉支架3枚(其中2枚为基底动脉急性闭塞经溶栓后植入)。血管平均狭窄程度从治疗前的平均81.4%(50%～95%)降低到6.3%(0%～15%)。22例经2～36个月临床随访,平均随访23个月,3例失访。1例患者植入1枚BMS后9个月症状复发,DSA复查发现支架再狭窄达50%,患者拒绝继续治疗;1例患者植入1枚DES后35d出现急性血栓闭塞,经急诊再植入1枚DES后血管开通良好。余20例超声复查支架通畅,未见明确狭窄,未见卒中及脑缺血发作。随访22例中19例(86.4%)症状明显缓解或消失,3例(13.6%)部分缓解。结论BMS与DES治疗症状性椎-基底动脉狭窄安全、有效,中短期效果令人满意。DES降低手术后支架内再狭窄发生率具有一定的预防作用,优于BMS金属裸支架。