冠状动脉分叉病变单支架术及双支架术临床疗效对比

目的探讨分叉病变单支架术和双支架术的临床疗效。方法分析冠状动脉分叉病变102例的临床资料,其中52例行单支架术（单支架植入组）、50例行双支架术（双支架植入组）。单支架植入组仅主支植人支架,边支不植入支架;双支架植入组运用mini-crushing技术行双支架植入术。观察两组分叉病变的手术即刻及术后6个月临床疗效及主要心血管事件的发生情况。结果术后即刻冠状动脉造影结果显示两组主支血管心肌梗死溶栓试验（thrombolysisinmyocardialinfarction．TIMI）血流3级、分支血管TIMI血流3级、主支血管残余狭窄〉30％、分支血管残余狭窄〉50％四个指标比较,均差异无统计学意义（P〉0．05）。随访6个月后对两组进行冠状动脉造影后发现,分支血管残余狭窄〉50％在单支架植入组发生率高于双支架植入组,差异有统计学意义[25．0％（13／52）vs．12．0％（6／50）,P〈0．05];其余几项两组比较,差异无统计学意义（P〉0．05）。住院期间单支架植入组1例（1．92％）发生主要心血管事件,双支架植入组2例（4．00％）发生主要心血管事件。6个月后．单支架植入组8例（15．38％）发生主要心血管事件,双支架植入组7例（14．00％）发生主要心血管事件。结论单支架术与双支架术治疗分叉病变短期观察临床疗效基本无差异,其长期疗效还需进一步研究。     

冠心病患者分支病变支架植入术治疗效果及安全性评估

目的评价冠心病患者冠状动脉分叉病变支架植入后的治疗效果及其安全性。方法74例冠心病患者冠状动脉分叉病变行支架植入术，其中24例主支和分支内均植入支架，50例仅在主支内植入支架。结果（1）两组患者病变支数及病变累及部位构成比间差别无显著性意义；（2）两组患者再狭窄发现率间差别无显著性意义；（3）两组患者间主要心血管病事件差别无显著性意义。结论冠状动脉分叉病变的冠心病患者仅在主支内植入支架和主、分支内均植入支架两组间治疗效果相近，主要心血管病事件无显著性差别。     

老年2型糖尿病合并冠心病患者冠状动脉造影及临床特点分析

目的了解老年2型糖尿病合并冠心病患者的临床及冠状动脉病变的造影特点。方法对185例经冠状动脉造影诊断的老年冠心病患者分为两组:有糖尿病组(DM)和无糖尿病组(NDM),分析比较了两组的临床表现及冠状动脉病变的造影特点。结果(1)两组间年龄、吸烟、高血压及心肌梗死率的差异均无显著性意义。甘油三酯(TG)水平DM组较NDM组高(P<0.05)。(2)两组病变血管数量及侧支循环形成情况比较差异无显著性,两组的病变血管分布状况相似。(3)两组冠脉狭窄支数、狭窄程度比较差异均无显著性,DM组的冠脉狭窄范围较NDM组广泛(3.17vs2.44,P<0.05),DM组冠状动脉狭窄<50%的血管片段数高于NDM组。结论老年糖尿病合并冠心病患者的冠状动脉更倾向于弥漫性病变,高TG可加重DM的冠状动脉病变。     

冠心病并发Ⅱ型糖尿病患者临床及冠状动脉造影的特点

目的探讨冠心病并发Ⅱ型糖尿病患者临床及冠状动脉造影特点。方法选择经冠状动脉造影确诊为冠心病的患者共150例,分为冠心病并发糖尿病组54例,冠心病非糖尿病组96例。对比分析两组患者的临床和冠状动脉造影资料。结果冠心病并发糖尿病组3支冠状动脉病变的发生率高于非糖尿病组（54% vs 28%,P<0.01）;糖尿病组病变血管比例高于非糖尿病组（59% vs 46%,P<0.01）;糖尿病组弥漫性病变血管的比例高于非糖尿病组（41% vs 15%,P<0.01）。结论冠心病并发Ⅱ型糖尿病患者中并发高血压病和有心血管病家族史的比例高;多支血管病变和弥漫性病变构成比例、冠状动脉狭窄程度高于未并发Ⅱ型糖尿病患者。     

冠心病合并2型糖尿病病人冠状动脉造影分析

目的观察冠心病合并2型糖尿病病人的冠状动脉病变特征.方法对155例冠心病病人进行回顾性分析,对合并糖尿病者及无糖尿病者的冠状动脉病变进行比较.结果冠心病合并2型糖尿病组与非糖尿病组相比,病变血管支数比率高(76.5%vs 55.5%,P<0.01),多支血管病变(85.1%vs 45.7%,P<0.01)、弥漫性病变(11.3%vs 3.8%,P<0.05)及左主干病变(22.2%vs 7.0%,P<0.05)发生率高;相关性分析显示冠状动脉血管病变支数与糖尿病的病程呈正相关.结论冠心病合并2型糖尿病病人多支病变、弥漫性病变、左主干病变比例高,血管受累支数多.     

冠状动脉多支病变支架术的临床应用

目的旨在分析冠状动脉多支病变支架术的效果。方法168例冠状动脉造影异常者按单支和多支病变分两组,单支组56例,多支组112例,支架置入率分别为58.9%和52.7%,血管狭窄70%以上置入支架。结果两组年龄和支架长度有显著性差异,性别、吸烟、高血压、糖尿病、高血脂、冠状动脉并发症、支架术失败率以及随访心脏事件和再狭窄率均无差异。结论冠状动脉多支病变支架置入术安全有效。     

冠状动脉分叉病变置入支架后分支狭窄率的变化

目的研究冠状动脉分叉病变的主支经支架治疗后分支闭塞的影响因素。方法回顾性分析2005年9月至2006年1月在我院接受经皮冠状动脉介入治疗(PCI)的92例患者共121处分叉病变,术后进行定量血管造影分析,探讨分支闭塞的相关因素。结果分叉病变主支置入支架后,分支狭窄程度与分支自身的斑块负荷、分支参考直径、分叉角度、主支斑块负荷相关。其中,分支狭窄程度与分支和主支自身的斑块负荷呈正相关,与分叉角度、分支直径呈负相关。逐步回归分析显示:Y=0.48A-11.4B-0.23C 0.22D(Y:主支支架术后分支面积狭窄率,单位:%;A:分支狭窄率;B:分支参考直径;C:分叉角度;D:主支狭窄率)。结论分叉病变置入支架后分支狭窄程度与分支自身的斑块负荷、分支参考直径、分叉角度以及主支斑块负荷相关。分支自身的病变越重、分支越小、分叉角度越小及主支的病变越重,介入治疗后分支闭塞的可能性越大。     

冠状动脉分叉病变边支行血流储备分数测定的临床意义分析

目的探索冠状动脉分叉病变边支行血流储备分数测定的临床意义。方法选取2014年4月~2015年4月我院收治的冠状动脉支架治疗的冠状动脉分叉临界病变患者100例作为研究对象,动态随机分为对照组和观察组,各50例。对照组采用常规介入,观察组采用血流储备分数检查。结果两组患者术后边支血流TI-MI(3级)率、主支架术后边支狭窄(70%)率比较,差异无统计学意义(P0.05),观察组患者双球囊对吻实施率(24.00%)、边支支架的植入实施率(4.00%)、术后边支残余狭窄率(30.00%)优于对照组,差异有统计学意义(P0.05)。结论血流储备分数检查在冠状动脉分叉病变患者中效果显著,可降低心血管不良事件。     

老年冠心病合并糖尿病患者冠状动脉造影术病变差异探讨

目的：讨论老年冠心病合并糖尿病患者与无糖尿病患者冠状动脉的病变程度差异。方法回顾性分析该院2009年1月-2013年1月经过冠状动脉造影术所确诊的200例老年冠心病患者,其中合并糖尿病者112例,无糖尿病者88例,比较两组得出的冠状动脉造影术的结果。结果并糖尿病组的冠状动脉狭窄长度、狭窄程度、狭窄支数明显高于无糖尿病组,完全闭塞及弥漫性病变分别为10例（8.9%）,14例（12.5%）;明显高于无糖尿病组4例（4.5%）,6例（6.8%）。结论年冠心病合并糖尿病患者,冠状动脉病变程度更重,完全闭塞以及弥漫性病变较无糖尿病患者更为常见。     

老年冠心病合并糖尿病患者冠状动脉造影术病变差异探讨

目的讨论老年冠心病合并糖尿病患者与无糖尿病患者冠状动脉的病变程度差异。方法回顾性分析该院2009年1月—2013年1月经过冠状动脉造影术所确诊的200例老年冠心病患者,其中合并糖尿病者112例,无糖尿病者88例,比较两组得出的冠状动脉造影术的结果。结果并糖尿病组的冠状动脉狭窄长度、狭窄程度、狭窄支数明显高于无糖尿病组,完全闭塞及弥漫性病变分别为10例(8.9%),14例(12.5%);明显高于无糖尿病组4例(4.5%),6例(6.8%)。结论年冠心病合并糖尿病患者,冠状动脉病变程度更重,完全闭塞以及弥漫性病变较无糖尿病患者更为常见。     

Treatment of coronary bifurcation lesions by stent implantation only in parent vessel and angioplasty in sidebranch: immediate and long-term outcome

The aim of this study was to evaluate the immediate and long-term outcome of intracoronary stent implantation for the treatment of bifurcation lesions. We treated 30 patients with bifurcation stenosis with the Bx Velocity stent implanted only in the parent vessel and with balloon angioplasty of the sidebranch. Angiographic success was 86.7% (n = 26 patients) in both branches and 100% in the main branch. Clinical success was achieved in 29 patients (96.7%). One patient (3.3%) suffered from a small non-Q wave myocardial infarction. All 30 patients underwent control coronary angiography at 6 months unless performed earlier due to symptoms. After the 6-month follow-up, a total of 27 patients (90%) were asymptomatic; angiographic restenosis (> 50%) was found in four cases (13.3%). There was no sidebranch restenosis. During the follow-up, one patient (3.3%) had unstable angina and angiography revealed severe diffuse restenosis within the whole stent; this patient was referred for coronary artery bypass surgery. Two patients had mild angina (Canadian Cardiovascular Society Class II) and 1 patient had silent ischemia during exercise stress test. These patients underwent repeat coronary angioplasty. The rate of major adverse cardiac events was 16.6% and target vessel revascularization rate was 13.3%. We concluded that stent implantation only in the parent vessel with angioplasty of the sidebranch in bifurcation lesions is safe and has a high clinical success rate and low rate of target lesion revascularization.     

Clinical and angiographic predictors of luminal changes beyond 6 months after implantation of thicker strut coronary stents.

BACKGROUND: Late luminal changes beyond 6 months after thicker strut stent implantation have not been fully elucidated. The purpose of this study was to clarify the clinical and angiographic predictors of late changes in minimal lumen diameter (MLD) after 6-month follow-up of stenting. METHODS AND RESULTS: Fifty-one lesions from 44 patients who underwent successfully S670/660 stent (Medtronic Vascular, Santa Rosa, CA, USA) implantations without target lesion revascularization were studied at 6-month follow-up and coronary angiography was repeated after the follow-up. Late luminal loss beyond 6 months after stenting significantly correlated with late loss (r=-0.42, p=0.0025) and MLD (r=0.28, p=0.047) at 6-month follow-up. On multivariate analysis, age (p=0.005), diabetes mellitus (p=0.002), hyperlipidemia (p=0.023), smoking (p=0.015), bifurcation lesion (p=0.018), small stent diameter (p=0.001) and MLD at 6-month follow-up (p<0.001) were identified as independent predictors of late luminal loss. CONCLUSIONS: This study demonstrated that older age, diabetes mellitus, hyperlipidemia, smoking and small stent diameter (<3.0 mm) were associated with late luminal loss beyond 6 months after stenting, and that a bifurcation lesion and small lumen diameter at 6 months were associated with late luminal recovery.     

西罗莫司洗脱支架置入术后血栓发生率及相关因素分析

目的观察西罗莫司洗脱支架冠状动脉内置人术后,支架血栓发生率及临床相关因素。方法2006年4月至2007年8月间,156例患者于首都医科大学大兴医院置入西罗莫司洗脱支架（Cypher select和Firebird支架）,84例患者随防1年,72例患者随访半年,明确支架血栓发生情况;分析支架血栓的相关因素及转归。结果早期支架血栓3例（1．92％）,晚期支架血栓1例（0．64％）。4例支架血栓患者多支病变（〉2支）2例,分叉病变2例,弥漫长病变2例。共置入支架6枚,平均1．5枚／人,平均支架直径（2．88±0．38）mm,平均长度（25．5±6．12）mm,支架释放压力（13．33±1．03）atm,一枚支架置入后行后扩张,术后TIMI血流均为3级。1例术后3d出现介入血管急性ST段抬高心肌梗死,爱通立溶栓后再通并出现休克,置入主动脉气囊反搏治疗5d,现病情平稳;2例分别于术后6d及15d猝死;1例于术后81d猝死。结论156例西罗莫司洗脱支架置入后,早期支架血栓3例,晚期支架血栓1例;表现为急性心肌梗死或猝死;多数患者为急性冠状动脉综合征,多支病变、分叉病变、弥漫长病变,因无血管内超声指导可能遗留残余夹层或支架贴壁不全;发生支架血栓患者预后差,死亡率高。     

Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking

We compared the risk factors for coronary spasm with those for coronary atherosclerosis in 183 patients with coronary spasm, 132 patients with coronary organic stenosis, and 224 control subjects with chest pain syndrome. Our findings confirmed that, when compared with controls, age, gender, total cholesterol, LDL-cholesterol, hypertension, diabetes mellitus, and cigarette smoking are all significant risk factors for coronary organic stenosis. On the other hand, only cigarette smoking proved to be a significant risk factor for coronary spasm. Also, when compared between coronary spasm group and coronary organic stenosis group, the incidence of cigarette smoking in males was significantly higher in the coronary spasm group than in the coronary organic stenosis group. We conclude that cigarette smoking is a crucial risk factor for coronary spasm. On the other hand, serum lipid levels and the incidence of hypertension and diabetes mellitus were within the normal ranges in the coronary spasm patients and were thus poorly associated with coronary spasm. These results showed that the risk factors for coronary spasm differ significantly from those for atherosclerosis-based coronary stenosis in the Japanese. Among the risk factors for coronary atherosclerosis (organic stenosis) smoking alone was a significant preventable risk factor for coronary artery spasm.     

Isolated post-challenge hyperglycemia in patients with normal fasting glucose concentration exaggerates neointimal hyperplasia after coronary stent implantation.

Postprandial hyperglycemia has been shown to increase the risk of cardiovascular disease as much as overt diabetes mellitus does. The aim of this study was to determine whether isolated post-challenge hyperglycemia during an oral glucose tolerance test (OGTT) is related to exaggerated neointimal proliferation after coronary stent implantation. Forty seven coronary lesions treated with stents in 40 patients who had normal fasting glucose levels (<110 mg/dl) were categorized into the following 2 groups according to the results of a 75-g OGTT: 29 lesions in 24 patients with normal glucose tolerance (NGT group) and 18 lesions in 16 patients with abnormal glucose tolerance (AGT group). Although there were no differences in angiographic characteristics before and immediately after stenting between the 2 groups, the minimal lumen diameter was significantly smaller (p=0.04) and the degree of stenosis and late loss were also significantly greater (p=0.01 and p=0.047) in the AGT group than in the NGT group at 6-month follow-up. Multiple regression analysis including the insulin concentrations during an OGTT revealed that the 120-min plasma glucose concentration after glucose load significantly correlated with late loss (p=0.0018) and the degree of stenosis (p=0.0100) at follow-up. It is concluded that isolated post-challenge hyperglycemia exaggerates neointimal hyperplasia after coronary stent implantation.     

冠脉支架植入术后支架内再狭窄的危险因素研究

目的对冠脉支架植入术后的支架内再狭窄危险因素进行研究。方法在2011年7月-2013年7月期间,我院收治冠脉支架植入术患者120例,对该120例患者术后支架内的再狭窄危险因素进行研究,并采取Logistic多因素分析再狭窄的危险因素。结果通过术后患者危险因素研究可知,与患者的胆固醇、术前狭窄、是否吸烟、有糖尿病及高血压等因素有关,与支架有无药物涂层也有关,表现为负相关,危险度是0.01。结论对糖尿病及高血压患者来说,实施支架植入术之后,出现再狭窄症状的几率增加。同时,冠脉支架患者对危险因素应采取预防措施,如戒烟,避免再狭窄情况出现,提高患者的生存质量。     

Initial clinical experience with the new EBI (BARD-XT) flexible coronary stent: Acute results and follow-up

The EBI (BARD-XT, C.R. Bard, Murray Hill, NJ) stent is a new radiopaque balloon expandable coronary stent with high resistance to external radial forces. It does not shorten significantly with expansion and allows stent implantation in bifurcation lesions. A total of 28 EBI stents were implanted in 23 lesions in 21 patients. Indications for stent implantation were acute closure in 1, threatened closure in 15, and electively in 7 lesions. In 2 cases, the lesion involved a bifurcation where a stent was implanted in both vessels. All patients received aspirin and ticlopidine. No anticoagulant therapy was given. The stenting procedure was successful in 22 of 23 lesions. No complications occurred with the exception of 1 patient with a thrombotic reocclusion within 1 hr after stent implantation and 1 patient with a temporary occlusion of a side branch. The mean minimal luminal diameter (MLD) increased from 0.74 ± 0.46 mm before balloon dilatation to 1.27 ± 0.62 mm before stent implantation and 2.32 ± 0.57 mm after stent implantation. Percent stenosis decreased from 71 ± 19% before angioplasty to 46 ± 25% after angioplasty to 5 ± 8% after stent implantation. MLD at the time of follow-up angiography after 4 months was 1.98 ± 0.77 mm and percent stenosis was 26 ± 21%. Restenosis of more than 50% occurred in 2 lesions. In these lesions, a second percutaneous transluminal coronary angioplasty was performed. Advantages of this stent are its flexibility together with an acceptable radial strength as well as enabling radiopacity without obscuring the arterial lumen. Stenting of bifurcation lesions is possible. Cathet. Cardiovasc. Diagn. 43:159–162, 1998. © 1998 Wiley-Liss, Inc.     

吸烟和高脂血症是冠状动脉痉挛的重要危险因子

目的：探讨临床上具有心绞痛样胸痛发作但无显著冠状动脉狭窄患者胸痛的病因，并甄别与冠状动脉痉挛相关的临床危险因子，方法：对275例临床上具有心绞痛发作但冠状动脉造影无显著冠状动脉狭窄患者进行乙酰胆碱试验，以冠状动脉狭窄程度达到90％以上伴胸痛发作和／或心电图缺血性改变为冠状动脉痉挛的诊断标准。Logistic回归强迫引入法分析冠状动脉痉挛与性别，年龄，高血压，糖尿病，吸烟，血脂代谢紊乱和心电图活动平板试验结果的关系，并根据乙酰胆碱试验结果分组比较左室射血分数和舒张末期压力，结果：271例资料完整的患者中乙酰胆碱试验的阳性率为38％，Logistic回归分析表明，吸烟和高脂血症分别使冠状动脉痉挛的优势比（OR）值增加4．2倍和2．3倍，糖尿病与冠状动脉痉挛呈显著负相关，冠状动脉痉挛对左室功能无明显影响，结论：冠状动脉痉挛是冠状动脉造影正常的心绞痛患者的重要病因之一，吸烟和高脂血症是冠状动脉痉挛的重要危险因子。     

真实临床条件下国产西罗莫司药物支架的临床评价

目的观察国产西罗莫司药物支架的临床和造影随访效果。方法选择北京安贞医院心内科自2006年8月至2007年10月516例应用国产西罗莫司药物支架的患者,于置入支架9个月（±2个月）后进行电话或门诊随访主要心血管事件（MACE,包括心源性死亡、非致死性心肌梗死、靶血管血运重建）的发生率,尽量进行冠状动脉造影随访,观察患者MACE事件总发生率;同时观察糖尿病亚组的治疗效果;初步评价各种类型病变,包括左主干病变、分叉病变、慢性闭塞病变、钙化病变、开口病变、小血管病变、急性闭塞病变、再狭窄病变的治疗效果;评价药物支架对于以上各类病变的疗效。结果516例患者共置入国产西罗莫司药物支架872枚,成功率为99.5%,其中随访到482例,随访率93.4%。随访到的患者中有18例患者发生MACE事件,发生率为3.5%。造影随访共239例患者,占总例数的46.3%,再狭窄率为11.3%。糖尿病亚组再狭窄率为14%。并对左主干病变、分叉病变、弥漫病变、慢性闭塞病变、小血管病变、钙化病变、急性闭塞病变、开口病变、再狭窄病变分别进行了描述。结论大样本研究显示应用国产西罗莫司药物支架可以取得比较好的疗效。糖尿病亚组患者应用国产药物支架效果良好、初步判断国产药物支架对于弥漫、开口、小血管、再狭窄病变有较好的疗效;对于左主干病变、分艾病变的疗效提示有益的结果,需要继续总结观察。     

Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin

Coronary lesions located in major bifurcations constitute a challenge for the use of stents. Although the occlusion of a side branch covered by a stent is infrequent, the maintenance of a patent, stenosis-free bifurcation may result in a complex procedure. Between September 1994 and April 1998, 70 patients were treated by stent implantation for coronary bifurcation stenosis. The side branch always had a diameter >2 mm. The pairs of treated arteries were: left anterior descending (LAD)/diagonal artery in 32 patients, circumflex/obtuse marginal in 26, right coronary/posterior descending artery in 5, and LAD/circumflex in 7. We applied 2 different techniques of stent implantation: (1) deployment of 1 stent in the parent vessel covering the takeoff of the side branch and subsequent angioplasty of the side branch across the metallic structure (group A, n = 47 patients), and (2) implantation of 1 stent at the ostium of the side branch and complete reconstruction of the entire bifurcation with additional implantation of 1 or 2 stents at the parent vessel (group B, n = 23 patients). There were no significant differences between groups at baseline variables. Procedural success was similar in both groups: 42 (89%) in group A versus 21 (91%) in group B. However, major cardiac events at 18 months follow-up were higher in group B (event-free probability 44% vs 75%, p <0.05). Selected patients with coronary stenosis at major bifurcations can be treated with an acceptable rate of primary and late success. Complex techniques providing radical stent reconstruction of the bifurcation seems to provide no advantages over the simpler stent jail followed by ostial side branch balloon dilation.