无预扩张直接冠状动脉内支架置入术

目的　探讨无预扩张直接冠状动脉内支架置入术的可行性及临床效果。方法　参照国外直接冠状动脉内支架置入术标准 ,对 2 7例冠心病患者进行无预扩张直接冠状动脉内支架置入术。结果　 2 7例患者共 2 8处病变 ,置入 2 8个支架 ,其中 A型病变 14例 ,B1 型病变 10例 ,B2 型病变 4例。置入支架前管腔狭窄程度为 78.2 %± 5 .6% ,支架置入后血管残存狭窄程度为 0 .9%± 1.4% ,支架置入成功率为 10 0 % ,无并发症发生。术后随访 1年 ,2例患者出现心绞痛 ,冠状动脉造影证实 1例患者出现支架内再狭窄。结论　正确选择适应证的情况下 ,无预扩张直接冠状动脉内支架置入术是一种安全有效的治疗方法 ,可获得较好的近、远期临床效果     

直接冠状动脉内置入支架的应用

目的　探讨直接冠状动脉内置入支架的可行性、安全性和近期疗效。方法　回顾性分析 3 4例冠心病患者行直接冠状动脉内置入支架的临床资料和支架植入的影像学资料 ,并且进行随访。结果　 3 4例冠心病患者共检出病变部位 44处 ,置入支架 3 8个 ,其中 3 4处病变直接置入支架 ,残余狭窄 <15 % ,无急性并发症。置入成功率 10 0 %。随访 6～ 12个月 ,心绞痛明显减轻 ,无 AMI、需CABG手术或 PTCA术、死亡等严重心脏事件的发生。结论　直接冠状动脉内置入支架在部分冠心病患者中的应用是可行和安全的 ,近期疗效令人满意     

无预扩张直接冠状动脉内支架置入术20例临床观察

目的：探讨无预扩张直接冠状动脉内支架置入术的可行性、临床效果及其优越性。方法：将46例冠心病病人随机分为无预扩张直接冠状动脉内支架置入术组(观察组)20例，与传统的经球囊预扩张后冠状动脉内支架置入术组(对照组)26例进行对比分析。结果：两组病人手术操作成功率相似，均能获得满意的支架置入后冠状动脉造影结果；缓解心绞痛的效果两组无差异：随访期间两组均未发生死亡、急性心肌梗死等心脏急性事件；但观察组可缩短手术时间34．87％，减少X线曝光时间26．76％，减少造影剂用量35．80％，降低治疗费用27．62％。结论：无预扩张直接冠状动脉内支架置入术是一种安全有效的治疗方法，在某些方面优于传统的经球囊预扩张后冠状动脉内支架置入术。     

低压力球囊预扩张及高压力冠状动脉内支架置入临床疗效观察

目的 :评估低压力球囊预扩张、高压力冠状动脉 (冠脉 )内支架置入的可行性和效果。方法 :10 6例选择性支架置入的冠心病患者 ,低压力 (40 5 .3～ 6 0 7.9kPa)球囊预扩张后 ,冠脉内置入支架 ,高压力 12 15 .9～ 16 2 1.2kPa)释放。结果 :共 12 7处病变置入支架 135只 ,球囊预扩张平均压力为 4 86 .4kPa ,平均支架释放压力为 136 7.9kPa ,即刻支架置入和释放的成功率为 10 0 %。低压力预扩张冠脉内膜撕裂发生率为 3.9%(5 / 12 7处 )。结论 :选择性冠脉内支架置入 ,低压力球囊预扩张、高压力支架置入是一种安全、有效和可行的方法 ,可能减少冠脉内膜撕裂的发生率。     

球囊预扩张对冠状动脉支架置入操作的影响

目的观察球囊预扩张效果对支架置入操作的影响.方法将内径≥3.0 mm的前降支开口以远病变(长度≤20mm、狭窄80%～99%、中度以下钙化、TIMI Ⅱ～Ⅲ级、近端弯曲≤45°)随机分为2.0 mm、2.5 mm和3.0 mm球囊预扩张组,采用同一品牌的指引导管、导丝和球囊导管进行预扩张,观察球囊充盈程度、球囊通过病变率、TIMI血流率和夹层发生率.对达到支架样扩张效果者结束操作,其他病变均置入相同品牌的预装混合支架并观察支架到位率、球囊充盈程度、近端血管直径与球囊直径、残余狭窄程度、TIMI改善率.结果共入选病人50例(男36、女14),年龄67.8±15.3(42～87)岁.前降支病变特点长度16.4±8.3(5～24)mm,狭窄程度94.1±5.2(80～99)%,TIMI 1.6±0.7(1～2).三组病人年龄、病变长度、狭窄程度和TIMI等参数具有可比性(P<0.05).预扩张后,3.0 mm球囊组2例达到支架样扩张效果,退出观察.各组预扩张压力和时间无显著差异(P>0.05).与2.5 mm以上球囊组相比,2.0 mm球囊组预扩张后TIMI改善率低、支架不能通过病变率高(P>0.05).与2.5 mm以下球囊组相比,3.0 mm球囊组的TIMI改善率、支架通过率虽然较高,但血管夹层的发生率亦明显增加(P<0.05).三组综合分析,对直径3.0 mm的病变血管采用2.5 mm球囊预扩张夹层发生率低、支架通过率高、TIMI改善率适中.结论如果不考虑可能达到的支架样扩张效果,预扩张操作最好选用比病变血管内径小10%～20%的球囊.这样一方面能达到较好的预扩张效果、便于支架到位,另一方面又不至于明显加重血管损伤或造成新的需要处理的血管夹层.     

直接冠状动脉内支架置入术治疗急性心肌梗死

目的观察急性心肌梗死(AMI)时行无球囊预扩张直接置入冠状动脉内支架治疗的临床效果.方法对22例AMI患者在发病12小时内,未经球囊预扩张而直接置入冠状动脉内支架.梗死相关血管(IRA)(共22支血管),左前降支12例(54.5%),左回旋支5例(22.7%),右冠状动脉5例(22.7%).心肌梗死溶栓试验(TIMI)血流1级5例(22.7%),2级13例(59.1%),3级4例(18.2%).结果 22例患者共置入22个支架,支架置入后 TIMI血流3级21例(95.5%),2级1例(4.5%),残余狭窄为3.2±2.9%,支架置入成功率100%.住院期间无一例死亡、再次心肌梗死及再次靶病变需重复再通治疗.结论急性心血肌梗死(AMI)时行无球囊预扩张直接置入冠状动脉内支架治疗,成功率高、并发症少,TIMI血流3级达到率高.     

预扩张球囊导管的选择对冠状动脉支架置入操作的影响

目的 :探讨预扩张球囊导管的选择对支架置入操作的影响。方法 :将内径≥ 3.0mm的前降支开口以远病变 (长度≤ 2 0mm、狭窄 80 %～ 99%、中度以下钙化、TIMIⅡ～Ⅲ级、近端弯曲≤ 4 5°)的患者 5 0例随机分为 2 .0mm、2 .5mm和 3.0mm球囊预扩张组 ,采用同一品牌的指引导管、导丝和球囊导管进行预扩张 ,观察球囊充盈程度、球囊通过病变率、TIMI血流率和夹层发生率。对达到支架样扩张效果者结束操作 ,其他病变均置入相同品牌的预装混合支架并观察 :支架到位率、球囊充盈程度、近端血管直径与球囊直径、残余狭窄程度、TIMI改善率。结果 :各组预扩张压力和时间差异无显著性意义 (P >0 .0 5 )。与 2 .5mm球囊组相比 ,2 .0mm球囊组预扩张后TIMI改善率低、支架不能通过病变率高 (均P <0 .0 5 ) ;与 2 .5mm球囊组相比 ,3.0mm球囊组的TIMI改善率、支架通过率虽然较高 ,但血管夹层的发生率亦明显增加 (P <0 .0 5 ) ;对直径 3.0mm的病变血管采用 2 .5mm球囊预扩张夹层发生率低、支架通过率高、TIMI改善率适中。结论 :预扩张操作最好选用比病变血管内径小10 %～ 2 0 %的球囊 ,如此可达到较好的预扩张效果、便于支架到位 ,同时又不至于明显加重血管损伤或造成新的需要处理的血管夹层。     

冠状动脉内直接支架置入治疗急性冠状动脉综合征--与传统支架置入方法的随机对比研究

目的 :采用与传统支架置入术 (CS)随机对比研究的方法 ,评价冠状动脉 (冠脉 )内直接支架置入术 (DS)治疗急性冠脉综合征相关病变的可行性和安全性。　　方法 :将 15 0例急性冠脉综合征患者随机分为DS组和CS组 ,两组的基本临床特征和造影特征及术前治疗无显著差异。实验第一终点是影像学的成功 :支架置入后靶病变残余狭窄 <2 0 % ,心肌梗死溶栓治疗临床试验 (TIMI) 3级血流 ,“无再流或慢血流现象”的减少 ;第二终点为严重并发症发生率和手术操作时间及花费的评价。　　结果 :DS组和CS组组间手术成功率无差异 (DS组为 94 7% ,CS组为 96 0 % )。无再流或慢血流现象发生率DS组为 5例 (6 7% ) ,CS组为 4例 (5 3 % ) ,两组间亦无差异 (P =NS)。手术时间、球囊导管及造影剂用量DS组均低于CS组 ,两组比较有极显著差异 (P <0 0 1)。住院期间效果及严重并发症两组间无差异 ;6个月随访结果两组比较亦无显著性差异。　　结论 :本随机研究证实了一些回顾性研究的结果 ,DS治疗急性冠脉综合征的相关病变具有可行性和安全性 ,与CS相比较 ,这一策略的突出优点是显著增加效益费用比 ,而对急性并发症特别是“无再流或慢血流”现象的发生无影响。     

支架影像增强显影技术在冠状动脉置入支架可视性及球囊后扩张必要性评价中的应用

目的 探讨支架影像增强显影技术（SB）在冠状动脉置入支架可视性和球囊后扩张必要性评价中的指导作用.方法 行冠状动脉介入治疗（PCI）术并置入支架的冠心病患者102例.通过标准的冠状动脉造影（CA）和SB对支架可视性进行评价,并进行积分评价（1分为差,2分为可,3分为良,4分为优）.经CA定量分析、SB对球囊后扩张的必要性进行评价（球囊后扩张必要性：0为支架贴壁良好不需要后扩张;1为支架贴壁可,不需要后扩张;2为支架贴壁不良,需要后扩张）.结果 CA显示支架可视性为（2.03 ±0.84）分（其中1分44例,2分71例,3分33例,4分8例）,SB显示支架可视性为（2.79 ±0.84）分（其中1分14例,2分32例,3分82例,4分28例）,两者相比,P＜0.05.根据CA定量分析结果拟行球囊后扩张31例,根据SB评价结果实际行球囊后扩张48例,两者相比,P＜0.01.结论 SB可明显提高冠状动脉置入支架的可视性,有效指导球囊后扩张.     

Direct Stenting without Predilation: a Single-Center Experience with 1,000 Lesions

INTRODUCTION: Direct stenting has been shown to save costs, procedural time, radiation, and contrast use. We analyze the results of direct stenting in daily practice. MATERIAL AND METHODS: We retrospectively analyzed the interventions in the first 1,000 lesions that were treated with direct stenting at our center. Primary success, dissection, need for additional dilation, embolism, stent loss, and side branch occlusion were the variables assessed. RESULTS: Direct stenting was attempted in 1,000 lesions in 784 patients (age 63 11 years, females 21%, diabetes 37%). Primary or rescue angioplasty was performed in 8%. One or more thrombi were found in 16%, bifurcation in 9%, calcification in 5%, angulation in 2.3%, and tortuosity in 3.2%. The reference diameter was 3.0 0.5 mm. The primary success rate was 93.1%. Failure of direct stenting (6.9%) was associated with the circumflex artery in 38%, calcification in 26%, angulation in 22%, and tortuosity in 31%. In 39 lesions, additional dilation with different balloons was required. Additional stenting was required for dissection in 40 lesions and secondary to incomplete coverage of the lesion in 27. Thrombus embolism occurred in 7 lesions, 6 of them with a previously visible thrombus and one in a vein graft. Stent embolisms occurred in 6 cases, 4 of which were retrieved. Four side branches became occluded, but 2 of them were recovered at the end of the procedure. CONCLUSIONS: Direct stenting is a safe technique with low percentage of dissection, need for postdilation, thrombus embolism, and side br     

直接支架术治疗左冠状动脉主干病变(附三例报告)

目的评估直接支架术治疗左冠状动脉主干病变的可行性及其术后即刻与远期疗效。方法选择性对３例左主干病变患者进行不预扩左主干的支架直接置入术,其中２例置入ＭｕｌｔｉＬｉｎｋ支架,一例置入ＢｅＳｔｅｎｔ支架。每例均采用高压（１６至２２个大气压）扩张１至２次,持续时间１０至２０秒。结果３例左主干病变直接支架置入术均获成功,术中未发生并发症,术后临床随访６、７及１２个月均无心绞痛症状复发。结论选择性左主干病变直接置入支架术安全、有效、可行。该方法对左主干病变治疗较其他部位及方法可能更为有利,但此需得到大组病例及随机对比试验证实。     

Direct stenting.

Stents have ameliorated the outcome of percutaneous coronary interventions. Improved design, profile and flexibility of the currently available stents now permit to deliver the stent without pre-dilatation. In western European countries, stent implantation now occurs in up to 80% of all percutaneous revascularization procedures. In selected cases the safety and feasibility of direct stenting over conventional balloon-predilatation stenting has been demonstrated, in association with slightly superior outcome. This likely results from reduced vessel wall damage-dissections are sealed at the moment they are created-and distal embolization is reduced. In addition, a significant reduction in terms of costs and duration of procedures was demonstrated, while restenosis rate is not reduced with direct stenting.     

Aortic Pseudo Aneurysm Complicating Coarctation Stenting Successfully Treated with a PTFE Balloon Expandable Covered Stent

Percutaneous stenting of both native and recurrent coarctation of the aorta has become an acceptable alternative to surgical repair in most centers throughout the world. Severe complications such as aortic rupture, dissection, and late pseudo aneurysm formation are rare but worrisome complications. In many countries, commercially available balloon expandable covered stents designed for intravascular use are used either for primary stenting, or in treating complications once identified. These endovascular stents, however, are not available in the United States. We report the use of a commercially available covered stent, which has been approved by the Food and Drug Administration for tracheal use, to exclude an aortic pseudo aneurysm that was identified late after stenting a native coarctation.     

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We report a patient who received a stent following intracoronary 3-irradiation. Despite a good initial angiographic result, the stent appeared to be not fully expanded on intravascular ultrasound imaging at 6-month follow-up. Four months later, sudden thrombotic occlusion occurred shortly after aspirin cessation.     

Comparison of ReoPro® (abciximab) versus intracoronary thrombolysis for early coronary stent thrombosis

AIMS: This study evaluated the treatment of early coronary stent thrombosis with intracoronary urokinase or the platelet glycoprotein IIb/IIIa receptor inhibitor ReoPro (abciximab). METHODS AND RESULTS: Seventy-four patients (126 stents) were treated immediately after identification of early (0-30 days) coronary stent thrombosis. Twenty-nine patients were treated with intracoronary urokinase (UK) (UK alone in 19; UK and additional balloon angioplasty in 10) and another 45 patients were given ReoPro® (abciximab) (0.25 mg/kg as a bolus alone in 26, abciximab with additional balloon angioplasty in 19) within 30 days of stent implantation. TIMI grade 3 flow was obtained in 23 patients (79%) in the UK group and in 38 (84%) in the abciximab group (nonsignificant). Three patients (10%) in the UK group and one (2%) in the abciximab group underwent repeat percutaneous transluminal coronary angioplasty (PTCA) (nonsignificant). Five patients (17%) in the UK group and three (7%) in the abciximab group were referred for urgent coronary artery bypass graft surgery (CABG) because of residual thrombus and refractory ischemia (nonsignificant). Repeat revascularization was necessary in eight patients (28%) in the UK group versus four (9%) in the abciximab group ( p < 0.05). Five patients (17%) in the UK group and eight (18%) in the abciximab group developed myocardial infarction (nonsignificant). Five patients (17%) in the UK group (cardiogenic shock (three), cerebral hemorrhage (one) and pneumonia (one)) and three (6.6%) in the abciximab group (cardiogenic shock (two), heart failure (one)) died within 30 days (nonsignificant). Overall, noncardiac complications (bleeding including surgical repair of groin) were observed in 11 patients (38%) in the UK group and three (7%) in the abciximab group ( p < 0.001). CONCLUSION: Compared to urokinase, abciximab reduced the need for repeat revascularization procedures and the risk of noncardiac events, including bleeding complications in patients with early coronary stent thrombosis. (Int J Cardiovasc Intervent 2000; 3: 173-179)