重症头臂型大动脉炎的血管腔内治疗

目的 探讨腔内治疗重症头臂型大动脉炎的临床疗效及其应用价值.方法 32例重症头臂型大动脉炎患者,女28例(87.5％),男4例;平均年龄(30±8)岁.32例(共35条血管)通过腔内方法治疗,其中15条血管完全闭塞,狭窄程度70％～100％,平均90％±11％;病变长度2.7～5.3 cm,平均(3.1±1.5) cm;其中10例血沉增高(25～37 mm/h).术后6个月及每年进行症状体征随访并应用彩超、CT血管成像、血管造影评估管腔通畅情况.结果 15条完全闭塞血管中开通成功率80％( 12/15),3条未能开通.1例支架置入术中发生栓塞并继发急性血栓形成导致严重卒中事件,技术成功率(残余狭窄＜50％)为88.6％(31/35).31例术后短暂性脑缺血发作症状消失.技术成功的31例中,26例获得随访,随访率83.9％ (26/31).随访时间13 ～40个月,平均(19±10)个月,1例13个月后发生严重再狭窄并导致枕叶脑梗死,2例18个月后发生症状性再狭窄,管腔通畅率为88.5％ (23/26).结论 腔内治疗重症头臂型大动脉炎是一种安全有效方法,严格把握适应证和准确选择靶血管是治疗成功的关键.     

药物洗脱球囊治疗颈动脉支架植入后支架内再狭窄进展

颈动脉狭窄患者接受颈动脉支架（CAS）植入术后可发生支架内再狭窄（ISR）,发生率约5%~20%;药物洗脱球囊（DEB）技术用于治疗CAS植入后再狭窄已取得显著成效。本文对DEB治疗CAS植入术后ISR研究进展进行综述。     

药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效

目的探讨药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效。方法收集2015年6月至2021年6月青岛大学附属医院收治的230例椎动脉开口动脉粥样硬化狭窄患者的临床资料,按照椎动脉植入支架的不同将其分为药物洗脱支架组(n=121)和金属裸支架组(n=109)。比较两组患者术前狭窄程度、术后即刻血管残余狭窄程度、术后6个月改良Rankin量表(mRS)评分、术后6个月美国国立卫生研究院卒中量表(NIHSS)评分、围手术期并发症、术后至出院前时间、出院时卒中或死亡发生情况。观察两组患者术后支架内再狭窄情况、卒中或短暂性脑缺血发作(TIA)发生情况。结果术后即刻,两组患者血管残余狭窄程度均低于本组术前,差异均有统计学意义(P﹤0.05)。术后6个月,两组患者NIHSS评分、mRS评分均低于本组术前,差异有统计学意义(P﹤0.05)。两组患者均未发生围手术期并发症,术后至出院前时间、出院时卒中或死亡发生率比较,差异均无统计学意义(P﹥0.05)。术后1、6个月,两组患者卒中或TIA发生率比较,差异均无统计学意义(P﹥0.05)。术后12个月,药物洗脱支架组患者再狭窄率为7.55%(8/106),低于金属裸支架组患者的23.53%(24/102),差异有统计学意义(P﹤0.05)。结论药物洗脱支架与金属裸支架治疗椎动脉开口狭窄均安全、有效,可有效改善患者神经功能与日常生活能力,且药物洗脱支架效果更好,可有效降低术后远期支架内再狭窄率、卒中或病死率。     

重症头臂型大动脉炎的诊治经验

目的:探讨重症头臂型大动脉炎治疗方案的选择。方法:28例重症头臂型大动脉炎病人中17例行人工血管旁路术,5例行球囊导管扩张术,6例行保守治疗。结果:手术、扩张、保守3种治疗方法均明显地改善了病人的脑缺血症状。术后5至91个月随访,病人均无明显脑缺血症状,并能正常地工作、生活。结论:重症头臂型大动脉炎的病人如果处于活动期应尽量以保守治疗为主,保守治疗可以缓解脑缺血的症状;处于非活动期时可根据情况选择介入或手术治疗。一侧颈总动脉狭窄可行颈总动脉球囊导管扩张术;双侧颈总动脉均完全闭塞,则主张选择升主动脉鄄单侧颈内动脉人工血管旁路的手术方式,不仅疗效肯定,而且能够避免或减轻术中、术后脑水肿的发生。术中及术后应控制血压,并同时应用甘露醇和皮质激素,预防脑水肿的发生。     

药物洗脱支架与药物涂层球囊治疗股腘动脉病变进展

外周动脉疾病(PAD)可累及全身动脉,以下肢动脉较多见。血管内治疗(EVT)是治疗下肢PAD的常用技术之一,主要包括药物洗脱支架(DES)及药物涂层球囊(DCB)。与传统技术相比,DES及DCB治疗PAD后血管通畅率更高、再狭窄率更低,但目前相关研究尚少,且缺乏长期随访结果,二者间如何选择仍需探讨。本文对DES、DCB治疗股腘动脉病变应用进展进行综述。     

裸支架与药物洗脱支架腔内置入术治疗膝下动脉缺血性疾病疗效的Meta分析

目的采用Meta分析的方法评价药物洗脱支架（drug clutingstent,DES）和金属裸支架（bare metal stent,BMs）腔内置人术治疗膝下动脉缺血性疾病的疗效及安全性。方法计算机检索国内外数据库中关于DES和BMS腔内置人术治疗膝下动脉缺血性疾病的相关随机对照试验（RCT）,按照纳入标准和排除标准进行文献筛选和质量评价后,采用RevMan5．2软件进行Meta分析。比较2组患者的术后1年再狭窄率、术后1年支架通畅率、术后保肢率、术后死亡率及术后靶血管血运重建率。结果共纳入了6个研究,包括572例膝下动脉缺血性疾病患者,其中DES组302例,BMS组270例。Meta分析结果显示：2组患者的术后1年支架通畅率比较差异有统计学意义（OR=I．64,95％CI：1．35～1．98,P〈0．0001）,DES组较高;术后1年再狭窄率（OR=0．19,95％CI：0．12～0．30,P〈0．0001）和靶血管血运重建率（OR=0．09,95％CI：0．02～0．32,P=-0．0002）比较差异均有统计学意义,DES组均较低;而2组患者的术后死亡率（OR=0．98,95％CI：0．58～1．65,P=0．9400）与保肢率（OR=I．29,95％CI：0．58～2．86,P=0．5300）比较差异均无统计学意义。结论与BMS腔内置入术治疗膝下动脉缺血性疾病相比较,DES腔内置人术可显著提高术后1年支架通畅率,明显降低术后1年再狭窄率和降低靶血管血运重建率。     

大动脉炎的介入及外科治疗

目的 探讨介入技术和外科手术在大动脉炎治疗中的应用.方法 2006年1月至2009年12月共收治大动脉炎26例,男女比例为1:4.2,平均年龄(27±15)岁;Lupi-Herre法分型,Ⅰ型16例,Ⅱ型7例,Ⅲ型3例.16例患者实施介入治疗,9例行开放手术,1例患者保守治疗.结果 16例患者实施介入治疗23次,其中1...     

不稳定型心绞痛合并2型糖尿病患者药物洗脱支架治疗的临床分析

目的:探讨不稳定型心绞痛合并2型糖尿病患者药物洗脱支架治疗近远期效果。方法:将不稳定型心绞痛130例根据是否有糖尿病为两组-无糖尿病组(A组,n=70)和糖尿病组(B组,n=60),两组都采用药物洗脱支架治疗。结果:两组患者共置入Fi r ebi r d支架141枚,手术成功率100%。随访6个月,两组超声的LVEF、E值、A值对比无明显差异(P>0.05)。随访12个月,两组无死亡病例,均无急性心力衰竭或心源性休克,但是A组的再发心肌梗死、心绞痛等主要心脏不良事件明显少于B组(P<0.05)。结论:药物洗脱支架治疗能有效改善不稳定型心绞痛近期预后,但是糖尿病对于远期再发心肌梗死和心绞痛有一定影响。     

重症头臂型大动脉炎手术并发症的防治

目的探讨预防重症头臂型大动脉炎治疗过程中相关并发症的方法。方法回顾性分析33例重症头臂型大动脉炎的临床资料。结果33例均有严重的脑缺血症状,其中药物治疗6例;介入治疗6例;手术治疗21例(22人次)。所有患者的脑缺血症状得到明显改善,无1例死亡。1例术前药物治疗过程中出现脑梗塞,经保守治疗后好转出院,手术治疗组随访9~97个月,无脑缺血或脑水肿等严重并发症出现。结论正确选择手术适应证,规范手术操作,术前给予有效的药物治疗缓解脑缺血的症状,非活动期病变根据情况选择适当的介入或手术治疗方法等有助于减少手术合并症的发生。     

头臂型大动脉炎外科治疗的中长期效果分析

目的探讨手术治疗头臂型大动脉炎的中长期效果。方法本研究为回顾性病例系列研究。回顾性分析2012年7月至2022年11月就诊于郑州大学第一附属医院的244例头臂型大动脉炎患者中接受手术治疗的39例患者的临床资料。男性5例, 女性34例;年龄(37.9±14.0)岁(范围:13～71岁)。患者因药物治疗后症状未缓解或缺血症状严重行手术治疗。其中20例患者接受腔内手术(腔内治疗组), 11例接受开放手术(开放手术组), 8例患者接受复合手术(复合手术组)。记录并分析患者手术情况、术后并发症及再干预情况。患者术后1、3、6个月于门诊随访, 之后每年随访1次, 随访截至2022年11月, 记录患者术后临床症状并评估血管通畅情况。使用Kaplan-Meier法绘制生存曲线, 分析患者术后血管通畅率。结果患者手术均获成功, 无术中死亡病例, 未发生严重手术并发症。随访时间(48.8±38.2)(范围:1～123个月), 33例患者在术后症状得到缓解, 6例患者接受二次手术。随访1、3、5、10年时, 腔内治疗组的通畅率分别为95.0%、75.2%、60.2%、60.2%, 开放手术组均为90.9%,...     

Nationwide trends in drug-coated balloon and drug-eluting stent utilization in the femoropopliteal arteries

ObjectiveDrug-coated balloons (DCB) and drug-eluting stents (DES) have significantly altered treatment paradigms for femoropopliteal lesions. We aimed to describe changes in practice patterns as a result of the infusion of these technologies into the treatment of peripheral arterial disease.MethodsWe queried the Vascular Quality Initiative registry from 2010 to 2017 for all peripheral vascular interventions involving the superficial femoral artery and/or the popliteal artery. Cases were divided into a PRE and a POST era with a cutoff of September 2016, when specific device identity was first recorded in Vascular Quality Initiative. For each artery, a primary treatment was identified as either plain balloon angioplasty, atherectomy, DCB, bare-metal stent, or DES. The relative distribution of primary treatments between the PRE and POST eras was evaluated, as were lesion characteristics associated with DCB and DES use and regional variability in the adoption of these new technologies.ResultsOf 210,666 arteries in the dataset, 91,864 femoropopliteal arteries (across 74,842 procedures in 55,437 patients) were included. Each artery received 1.5 ± 0.6 treatments. Primary treatment use changed from 40% balloon angioplasty, 45% stenting, and 15% atherectomy in the PRE era to 22% plain balloon angioplasty, 26% bare-metal stent, 8% atherectomy, 37% DCB, and 8% DES in the POST era (P < .001). Forty-three percent of arteries received a drug-containing device as a primary or adjunctive therapy and 1.3% received both a DCB and DES in the POST era. DCB use as the primary treatment was highest in lesions with length 10.0 to 19.9 cm (42%), TransAtlantic InterSociety A, B, or C lesions (38%), and lesions with mild to no calcification (38%). DES use was highest in lesions with a length of 20 cm or more (12%), TransAtlantic InterSociety D lesions (13%), and lesions with moderate to severe calcification (9%). The range of use across 18 regions was 125 to 40% for DCB and 1% to 14% for DES. Regional variability was greater for DES (SD 4% vs mean 8%) than for DCB (SD 7% vs mean 29%).ConclusionsThere has been a rapid dissemination of DCB and DES technology in the femoropopliteal vessels, with nearly one-half of arteries receiving a drug-containing therapy in modern practice. DCBs are most used in medium length, minimally calcified lesions and DESs are most used in longer, more heavily calcified lesions. There is significant regional variability in adoption, especially with DES.     

Outcome of drug-eluting balloon angioplasty versus endarterectomy in common femoral artery occlusive disease

Objective

Common femoral artery (CFA) occlusive disease remains a debatable site for endovascular therapy, and the outcome of drug-eluting balloon (DEB) angioplasty in treating CFA occlusive disease is largely unknown. This study compared the efficacy, safety, and short-term patency rate of DEB angioplasty and femoral endarterectomy for treatment of CFA occlusive disease.

药物洗脱支架与裸金属支架在老年冠状动脉粥样硬化性心脏病患者中有效性和安全性的Meta分析

目的采用Meta分析比较老年冠状动脉硬化性心脏病(冠心病)患者植入药物洗脱支架(DES)和裸金属支架(BMS)的有效性和安全性。方法检索PubMed、Embase、Cochrane Library、中国知网和万方数据库于2017年10月28日前发表关于老年冠心病患者中DES和BMS有效性和安全性的随机对照研究(RCTs)或队列研究(CS)。结局为全因死亡(ACM)、心肌梗死(MI)、靶血管再次血运重建(TVR)、心源性死亡(CD)、支架内血栓形成(ST)和出血。合并所有研究数据作为整体效应量,按研究设计行组分析。结果共纳入17篇文献,含10 813例患者。DES植入患者整体和CS组ACM[相对危险度(RR)=0.71、0.68,P均0.001]、MI(RR=0.66,P0.001;RR=0.60,P=0.008)、TVR(RR=0.50、0.54,P均0.001)、CD(RR=0.73、0.72,P=0.003、0.020)和ST(RR=0.68、0.59,P=0.02、0.01)风险显著低于BMS植入患者,但出血风险差异无统计学意义(RR=1.00、1.00,P=0.96、0.97)。RCT组中,DES植入患者MI(RR=0.68,P=0.003)和TVR(RR=0.43,P0.001)风险较BMS植入患者显著降低,其余结局差异无统计学意义。结论 DES在老年冠心病患者中有效性和安全性均优于BMS。     

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

Objectives. Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, nonocclusive stent thrombosis with microembolization. In this paper, we illustrate possible mechanisms both with optical coherence tomography (OCT) and histology. Design. We present two cases with ACS from very late stent thrombosis who have been previously treated with first-generation drug-eluting stents (DES). Results. The first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not visible on CAG. These are findings that may explain the ACS. The second patient had subclinical episodes with chest pain after DES implantation. The patient died from stent thrombosis in a DES. Postmortem histological examination of the coronary arteries revealed stent struts with little or no neointimal coverage, persistent peri-strut fibrin deposition, inflammatory cells, malapposition, and small luminal platelet-rich thrombi. Old spotty myocardial infarctions were found in the supplied territory possibly caused by earlier episodes of embolizing thrombus. Conclusions. In patients with previous implanted DES presenting with ACS, OCT may detect abnormalities and thrombus formation not visible on CAG. Such findings may impact the treatment strategy in these patients.     

The results of treatment in renal artery stenosis due to Takayasu disease: comparison between surgery,angioplasty, and stenting. A monocentrique retrospective study

Purpose

To evaluate retrospectively and compare the long-term patency and the antihypertensive effect of open surgery, angioplasty, and stent insertion of the renal artery stenosis due to Takayasu’s arteritis.

Patients and methods

We retrospectively analyzed and compared the effects on blood pressure and permeability of the renal artery over 23 patients (age ranging from 16 to 60 years, mean 33.9 years); with renovascular hypertension caused by Takayasu’s arteritis. those patients underwent surgical treatment (11 arteries) or endovascular (19) including angioplasty (11) and stenting (8) for 30 stenotic renal arteries.

Results

Technical success was 96.7% (29/30) without major complications (but longer period of hospitalization among patients who had surgery). In the last follow-up CT angiography (mean 60 ± 36 months), restenosis was 18.2% (2/11) in the surgery, 9% (1/11) in the angioplasty, and 62.5% (5/8) in the stenting. Rate of the permeability of the surgery was 100%, 90.9%, 81.8%, the permeability of the angioplasty was 100%, 90.9%, 90.9%, primary patency rate stenting was 62.5%, 37.5%, 37.5%, assists permeability was 87.5%, 75%, 50% at 1, 3 and 5 years, respectively.In the clinical follow-up (mean 60 ± 37.8 months, range 48–96 months) beneficial effects on blood pressure were achieved into 91.3% of patients (21/23), and there was no significant difference between patients who have been treated by surgery and angioplasty alone and the patients who received a stent in at least one renal artery.

Conclusion

Angioplasty has shown better long-term patency and a similar clinical benefit of renovascular hypertension in renal artery stenosis caused by Takayasu’s arteritis compared with the surgery and the stenting. We suggest that stenting should be reserved in case of clear failure of the angioplasty. The surgery is our choice for patients who do not meet the indication of endovascular treatment or failure of this treatment.     

妊娠合并大动脉炎的处理（附7例报告）

目的探讨妊娠与大动脉炎的相互影响及孕期处理。方法回顾性分析北京协和医院妊娠合并大动脉炎的7例病例,对大动脉炎的诊治、孕期监测、妊娠并发症及妊娠结局进行分析。结果1例因早孕期病情活动终止妊娠,其余6例严密监测下继续妊娠,发生子痫前期2例、心衰1例、肾功能不全1例、早产3例、小于胎龄儿2例。结论大动脉炎患者孕前需要进行评估,孕期需要多科协作进行病情监测,以获得较好的妊娠结局。     

Anaesthetic management in a parturient with Takayasu arteritis

We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 μg fentanyl at lumbar 4–5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.