冠状动脉血管内放射治疗预防介入治疗后再狭窄临床试验

介入性心脏病学在近 2 0年内飞速发展 ,已成为心血管疾病诊断和治疗的新的有效手段 ,但是介入治疗后的再狭窄问题远没有解决 ,尚未证实任何一种药物能有效地防止再狭窄 ,血管内支架的应用虽可以部分降低再狭窄率 ,但支架内再狭窄的发生率仍可高达15 %～ 30 % ,且支架内再狭窄的治疗更为棘手。因此 ,寻求一种有效且临床实用的防止再狭窄的方法 ,已成为介入性心脏病学发展的当务之急。经过大量的基础研究和初步临床试验 ,血管内近距离放射治疗(brachytherapy)可以减少再狭窄率 ,是一项有前途的技术。本文对冠状动脉血管内近距离放射治疗预防再…     

中药干预经皮冠状动脉介入治疗后支架内再狭窄

支架内再狭窄（ISR）是影响经皮冠状动脉介入治疗（PCI）远期疗效与预后的重要影响因素。中药因其多效性和安全性,可降低ISR发生率。该文介绍中药干预ISR的基础实验和临床前应用情况。     

冠心病介入治疗术后再狭窄基因治疗的研究现状

冠心病介入治疗术后再狭窄基因治疗的研究现状贺峰，汪家瑞经皮穿刺冠状动脉腔内成形术（ＰＴＣＡ）用于治疗冠状动脉粥洋硬化性心脏病已有２０多年的历史，据统计２５％～５０％的手术成功者于术后几周至几个月发生再狭窄。早期再狭窄（术后几小时至几日）主要是由于血栓...     

血管内放射治疗预防血管成形术后再狭窄

血管内放射治疗预防血管成形术后再狭窄是老技术新用途。ＲＳ形成主要是血管损伤后，管壁组织细胞增殖修复过度所致，血管内放射治疗通过抑制细胞增殖来达到预防ＲＳ，在实验室中效果良好，并已迅速进入临床应用研究。     

放射治疗预防介入治疗后血管再狭窄的地位

介入治疗后再狭窄已成为当今心血管病治疗面临的重要问题,尽管多种方法可用于再狭窄的防治,如药物涂层支架、覆膜支架、血管内放射治疗以及再次行介入治疗或冠状动脉搭桥术,但迄今为止,任何方法都不能完全预防再狭窄的发生。近年,随着血     

血管内近距离照射预防血管成形术后再狭窄

在防治经皮冠状动脉介入治疗（PCI）后再狭窄的方法中，血管腔内近距离照射逐渐成为一种极有前途的新方法。近年来，在血管内照射的机制、放射源种类、剂量、动物和临床实验及安全性等方面取得了重大进展。目前看来，该方法有效且安全可行。     

氧化低密度脂蛋白和血管内超声预测介入术后支架内再狭窄

目的探讨氧化低密度脂蛋白(oxidized-low density lipoprotein,ox-LDL)和血管内超声在预测经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后支架内再狭窄的价值。方法2006～2008年,佛山市第一人民医院实施PCI180例,随访患者经冠状动脉造影(coronary angiography,CAG)证实支架内再狭窄28例。PCI术前及随访时以酶联免疫法测定ox-LDL,用血管内超声检测病变血管的外弹力膜面积、斑块面积、最小管腔面积和内膜面积。结果无支架内再狭窄患者PCI前后ox-LDL差异无统计学意义;支架内再狭窄患者ox-LDL在PCI术后升高[(70±18)μg/L比(78±19)μg/L,P<0.05)];支架内再狭窄组与支架内无狭窄组比较,两组外弹力膜面积差异无统计学意义、两组斑块面积分别为(6.8±2.4)mm2和(5.1±1.6)mm2,P<0.05;最小管腔面积分别为(4.7±1.9)mm2和(6.2±2.1)mm2,P<0.05;最小管腔的支架面积分别为(1.95±0.33)mm2和(1.49±0.21)mm2,...     

支架内再狭窄的介入治疗

目的介绍支架内再狭窄的处理经验.方法回顾分析156例支架内再狭窄患者经PTCA或支架植入术治疗的即刻和术后随访结果.支架内再狭窄治疗前后行冠脉造影,并于术后5.7±3.8个月复查冠脉造影.结果 156例支架内再狭窄患者PTCA或支架术治疗均获成功,其中134例(144支血管)行PTCA治疗,占86.7%;22例(22支血管)行再次支架置入术,占13.3%.156例经再次PTCA或支架术治疗后随访平均6个月的再狭窄率为24.3%.40处弥漫性支架内再狭窄经PTCA处理后18处(45%)再次再狭窄,而96处局限性支架内再狭窄中有17处再次再狭窄(18%),弥漫性支架内再狭窄经PTCA治疗后,再次再狭窄率明显高于局限性支架内再狭窄(P<0.01).支架内狭窄严重程度(>75%)也是影响PTCA疗效的主要因素.结论对于大多数支架内再狭窄(70%)采用PTCA治疗安全有效,术后再狭窄率与首次支架置入术相似.     

冠脉介入术后血管再狭窄的危险因素

冠心病是目前导致死亡的主要病因之一,随着世界范围内经皮冠状动脉介入术（PCI）广泛应用于治疗冠心病,冠心病的死亡率大大下降,支架术的应用使再狭窄率从30%～50%下降到10%～20%,但是PCI术后血管再狭窄（RS）的问题仍然困扰着我们。虽然PCI术后发生RS的发病机制目前尚不清楚,但是近年来对RS的认识有了显著的进展。本文对冠状动脉介入术后RS的危险因素作一综述。     

Diltiazem Reduces Restenosis After Percutaneous Transluminal Coronary Angioplasty

In a prospective, randomized, and double-blinded protocol, the effect of oral diltiazem (180 mg) over placebo on the restenosis rate was assessed in 189 consecutive patients (150 males. 39 females, 57.6 ± 8.4 years) eligible for follow-up angiography after 3.6 ± 0.6 months (diltiazem 90.4%, placebo 89.6%). Pre-PTCA stenoses were similar in both groups (diltiazem 83.9%; placebo 84.4%). Immediately after PTCA, the remaining stenoses were identical in both groups (22.6% vs 22.8%). At follow-up angiography there was a highly significant difference (P < 0.01) in favor of diltiazem (minimal lumen diameter 38.6% vs 50.3%). Restenosis rate (> 50% stenosis or loss of > 50% of the initial gain) was significantly (P < 0.03) reduced by diltiazem (18 [21.4%] of 84 patients) compared to placebo (33 [38.4%] of 86 patients). Diltiazem was superior to placebo in all vessels: (1) left anterior descending coronary artery: 21.6% vs. 32.7%, (2) right coronary artery: 25% vs 46.7%; and (3) left circumflex. 16.7% vs 36%. The benefit of diltiazem was most pronounced in calcified plaques (33.3% vs 47.1%), in diabetics (15% vs 46.2%), in hypercholesterolemia (20.4% vs 44.2%, P < 0.05), in the age range of 41–50 years (21.4% vs 44.4%), and in patients with CCS Class 2 (11.1% vs 64%, P < 0.01). In stratified analysis, the effect was apparent in both sexes, independent from concomitant therapy, regardless of whether or not coronary artery disease had progressed in segments other than the dilated ones. Thus, in this limited series of patients, diltiazem significantly reduced the number and extent of restenosis. Confirmation in a larger cohort is necessary .     

血管内照射对经皮冠脉球囊成形术后再狭窄的影响

经皮冠脉球囊成形术后再狭窄机制复杂,血管平滑肌细胞增殖是导致再狭窄的主要机制之一。β、γ放射源血管内照射治疗均能抑制新生内膜增生,促进血管平滑肌细胞凋亡,能有效降低再狭窄,为预防临床经皮冠脉球囊成形术后再狭窄提供了有效手段。     

经皮冠状动脉腔内成形术后再狭窄与介入前病变形态学的关系

目的：探讨国人冠心病经皮冠状动脉腔内成形术（ＰＴＣＡ）后再狭窄与冠状动脉（冠脉）病变类型、部位和病变血管数的关系。　　方法：冠心病介入治疗３５２ 例,选择其中６５ 例（８６个病变）术后３～１６个月造影随访者,按随访结果分为再狭窄组（ｎ＝ ３８）,非再狭窄组（ｎ＝ ２７）,分析再狭窄与病变形态学的关系。　　结果：再狭窄与多个易患因子、多支病变、病变类型和前降支病变呈正相关,与支架置入呈负相关。再狭窄组Ｃ型、钙化病变多见,前降支病变内径丢失比回旋支、右冠脉病变大（Ｐ＜ ０．０５）,半年内一支血管病变再狭窄率（１０．２７％ ）低于二支（４１．１０％ ）和三支（４８．５０％ ）血管病变再狭窄率（Ｐ＜ ０．０００１）。　　结论：再狭窄与冠脉病变类型、部位和血管支数相关,Ｃ型及钙化、多支和前降支病变再狭窄率高     

PCI术后再狭窄的病理生理及其危险因素

经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是一种成熟的冠心病治疗方法,可以很好的实现血运重建,显著的改善患者的生活质量,降低病残率以及死亡率.然而,PCI使患者受益的同时,也会造成血管再狭窄,虽然术后强效抗血小板药物以及药物洗脱支架的引入一定程度上降低了支架植入术后的再狭窄率,但其所致的晚期支架内血栓形成和再狭窄仍然不能忽视.因此,深入了解PCI术后再狭窄及相关影响因素将为PCI术后并发症的治疗提供新的思路和策略.     

去纤酶对冠状动脉成形术后再狭窄和心脏负荷能力的影响

本研究旨在评价去纤酶对冠状动脉成形术 (PTCA)后再狭窄及心脏负荷能力的影响。方法 :142例PTCA术后患者随机进入去纤酶组 (n =70 )和肝素组 (n =72 ) ,术后分别用去纤酶及肝素治疗 ,分别于PTCA前、PTCA后 7～ 14天、3～ 6个月和 10～ 12个月进行心电图运动试验及核素心肌灌注显像负荷试验 ,可疑再狭窄者行冠状动脉造影。PTCA后 2组患者最大运动时间、心率指数、ST段缺血指数及心肌血流灌注均较PTCA前明显改善 ,但去纤酶组的改善程度较肝素组更显著 (P均 <0 .0 5)。去纤酶组及肝素组的再狭窄率分别为 11%和 2 1% (P >0 .0 5)。去纤酶能显著改善PTCA术后心肌血流灌注和心脏负荷能力 ,并具有降低再狭窄率的趋势     

Can Aggressive Lipid Lowering Using Low-Density Lipoprotein Apheresis Prevent Restenosis After Percutaneous Transluminal Coronary Angioplasty in Patients with Normocholesterolemia?

Abstract: We examined whether aggressive lipid lowering using low-density lipoprotein (LDL) apheresis could prevent restenosis after percutaneous transluminal coronary angioplasty (PTCA). Fifteen patients with 17 lesions underwent LDL apheresis once within a week before and after PTCA and thereafter every 2 or 3 weeks (apheresis group) for about 4 months. The control group consisted of 17 patients with 17 lesions. No patients received additional lipid lowering drugs after PTCA. In the apheresis group, the time interval means of the total and LDL cholesterol levels were significantly lower than those in the control group whereas no significant differences were found between the 2 groups regarding the mean percent diameter stenosis or minimal lumen diameter before and after PTCA and at follow-up. The restenosis rate was 29.4% in the apheresis group and 47.1% in the control group. The restenosis rate tended to be slightly lower in the apheresis group. The overall results, however, indicated that aggressive lipid lowering does not prevent restenosis.     

Detection of Restenosis After Percutaneous Transluminal Coronary Angioplasty by an Angiographic Score

BACKGROUND: Restenosis, or òAchilles heeló of balloon angioplasty, remains in a range near 30% and cannot be predicted with certainty. To find adequate methods for its foresight is a challenge. OBJECTIVES: To determine risk factors and an angiographic score to predict the appearance of restenosis after one-site percutaneous transluminal coronary angioplasty (PTCA). METHODS: We restudied prospectively 315 (239 men, 76 women, age range from 29 to 78, 53.6 +/- 9.5 years) of 360 patients who underwent PTCA to a native coronary artery. The study didn?t include patients with left main disease, total occlusion, side-branch involvement, ostial stenosis, acute phase of myocardial infarction or those who repeat PTCA. Two-hundred twenty-eight patients underwent PTCA of the left anterior descending artery, 56 of the right coronary artery and 31 of the left circumflex artery. RESULTS: Restenosis, defined as a luminal renarrowing > 50% at follow-up, was present in 82 (26%) patients between 1 and 8 months after the procedure. Univariate and multivariate analysis revealed four vascular factors related to restenosis (p < 0.05): a) lesion length and; b) irregularity of the lesion borders before PTCA; c) perivascular and/or endovascular haziness and; d) intensity of residual stenosis after PTCA. To construct the score, a zero was given to a lesion length < 8 mm; to smooth lesion borders; to residual stenosis up to 20%; and to absence of haziness after PTCA. A one was given to a lesion length between 8 and 10 mm; and to a lesion with irregular borders. A two was given to a lesion length > 10 mm. A three was given to a residual stenosis > 20%; and to the presence of haziness after PTCA. The sum of all terms was considered the final score. So, it could oscillate from 0 to 9. Calculated score from 0 to > 5 showed respective restenosis rates of (%): 5.2; 15.1; 24.0; 39.4; 44.8; 60.8; and 84.2. The calculated correlation coefficient (0.98) among the scored values and the correspondent restenosis rates was highly significant (p < 0.001). CONCLUSIONS: It is concluded that restenosis is primarily a multifactorial problem based on vascular factors and may be predicted with a high degree of probability by the proposed score.     

血管紧张素(1-7)对兔腹主动脉球囊损伤后血浆可溶性细胞凋亡相关因子及再狭窄的影响

目的观察血管紧张素(1-7)对兔腹主动脉球囊扩张术后再狭窄及血浆可溶性细胞凋亡相关因子浓度的影响。方法健康新西兰白兔24只,随机分成3组:对照组始终不施予球囊成形术及任何处理;模型组和血管紧张素(1-7)组均施予腹主动脉球囊扩张术,然后分别通过微泵持续静脉给予生理盐水(2.5μL/h)或血管紧张素(1-7)[12μg/(kg.h)]4周,于术前、术后3、7、14及28天采血,用酶联免疫吸附法测定血浆中可溶性细胞凋亡相关因子浓度。术后4周行血管造影,并取腹主动脉做病理切片,行HE及弹力纤维染色,计算血管腔最狭窄处内径、新生内膜面积及内膜、中膜厚度、再狭窄率等。结果术后4周,血管紧张素(1-7)组血管腔的丢失程度较模型组明显减轻(4.11±0.10 mm比2.88±0.08 mm,P<0.05),而血管紧张素(1-7)组与对照组比较无明显差异(4.11±0.10 mm比3.85±0.03 mm,P>0.05)。与模型组相比,血管紧张素(1-7)组可明显减少球囊损伤后新生血管内膜面积(0.266±0.009 mm2比0.408±0.020 mm2,P<0.05)和内膜厚度(207.51±16.70μm比448.08...     

辐射防治血管成形术后再狭窄的机制研究进展

辐射治疗是防治血管成形术后再狭窄的一个新手段。然而尚存在许多问题。究其原因是机制尚未明确，本文主要从相关的细胞及细胞因子着看综述了辐射治疗防治血管成形术后再狭窄机制的研究进展。     

冠状动脉成形术后再狭窄防治研究若干进展

经皮腔内冠状动脉成形术 (PTCA)已成为治疗冠心病的最有效方法之一 ,其成功率可达 95 %以上。但是术后 3～ 6个月有 30 %～ 5 0 %的患者会出现再狭窄 ,从而影响了冠脉介入治疗冠心病的远期疗效。冠状动脉内支架是降低 PTCA术后再狭窄的有效手段 ,但是支架内再狭窄发生率仍高达 2 5 %～ 30 %。对于 Denovo冠脉病变 ,支架内再狭窄率也达 15 %～ 2 0 %左右 ,为此本综述就近几年来国内外有关这方面的一些研究进展总结如下。1　再狭窄的病理生理基础关于再狭窄的发生机制目前还不十分清楚 ,但近年来的研究都普遍认为 :再狭窄是局部血管损伤的…