Flexible tantalum stents for the treatment of renovascular hypertension: a 10-year experience

The aim of this study was to determine long-term success of flexible tantalum stents for the treatment of ostial and truncal renal artery stenosis. Since 1989, flexible tantalum stents (type Strecker) were implanted in 34 patients (36 arteries, 25 ostial lesions, 11 truncal lesions) with uncontrollable renovascular hypertension, 9 of them in association with renal insufficiency. Stents were placed unilaterally in 32 patients, and bilaterally in 2 patients for the treatment of renal artery stenosis. Thirty-five of 36 lesions were atherosclerotic, including 5 recurrencies after previous percutaneous transluminal renal angioplasty (PTRA). One patient had Takayasu arteritis. Stents were implanted after unsuccessful PTRA of 11 truncal and 23 ostial lesions, and as a primary procedure in 2 ostial lesions. Follow-up examinations included blood pressure measurement, determination of serum creatinine level, color duplex sonography, or angiography. The technical success rate was 92 %. Technical failure included incorrect stent placement (1 of 36 lesions, 2.8 %), and stent dislocation (2 of 36 lesions, 5.6 %), and two stents were retrieved percutaneously. In one case of Takayasu arteritis, residual stenosis of 40 % was observed. After technically successful stent placement, 77 % of patients became normotensive with or without medication. In the remaining patients there was partial improvement with blood pressure between 140 and 180 mmHg. Renal function improved in 76 % of patients (completely in 3 of 8, 38 %; and partially in 3 of 8, 38 %). Primary patency rate including all stented lesions and initial technical failures was 82.4 % ± 6.8 (1 year) and 82.4 % ± 9.2 (3 years). After technically successful stent placement, patency rates were 89.9 ± 5.6 % (1 year), and 89.9 ± 7.6 % (3 years). For ostial lesions, primary patency rate was 87.9 ± 6.7 % (1 year) and 87.9 ± 9.2 % (3 years). Placement of flexible tantalum stents in renal arteries is technically demanding, especially in ostial lesions. Once placed successfully, stent patency rate is excellent. Received: 8 December 1999; Accepted: 23 February 2000     

冠状动脉造影及冠脉内介入治疗的初步体会

目的　总结 4 1例冠状动脉造影 (CAG)及冠脉内介入治疗 (PCI)的初步体会。方法　回顾性分析4 1例 CAG的造影结果、操作体会及评价 10例 PCI的疗效。结果　 4 1例 CAG均获成功 ,且有 10例冠心病患者接受PCI治疗 ,对 13处病变血管实施经皮腔内冠状动脉成形术 (PTCA) ,共植入支架 16个 ,其中 11个为磷酸胆碱药物涂层支架 (PC支架 ) Biodiv Ysio TMOC,支架置入时最大球囊充盈压力为 12± 2大气压。支架置入后未见残余狭窄 ,总成功率 10 0 % ,术后 3～ 6个月随访未发生再狭窄。结论　 CAG是诊断冠心病的准确方法 ,进一步的 PCI治疗是治疗冠心病的安全有效方法。     

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

Abstract Background : Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation. Methods : The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed. Results : More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1?2 weeks after angioplasty, regardless of the type of intervention. Conclusions : The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.     

球瓣比和球囊长度与儿童经皮球囊肺动脉瓣成形术疗效的关系

目的通过分析不同的球瓣比和球囊长度对儿童经皮球囊肺动脉瓣成形术(PBPV)近期及中远期疗效的影响，探讨最适宜的球瓣比和球囊长度。 方法1987~2005年山东省立医院儿科诊治119例肺动脉瓣狭窄患儿，使用不同球瓣比和长度的扩张球囊行PBPV术，扩张前后测量右室与肺动脉间的峰值压力阶差，并行左侧位右室造影，测量瓣环大小并观察有无右室流出道激惹。术前、术后定期行经胸超声心动图检查，估测最大跨肺动脉瓣压力阶差，并观察肺动脉瓣形态及其反流情况。 结果超大球囊法行PBPV术后，患儿的近期及中远期跨肺动脉瓣压差持续下降，且压差下降率不随球瓣比的增加而增大；术后未发现有肺动脉瓣再狭窄者，所有患儿均有不同程度的肺动脉瓣反流，且反流的程度随时间的延长而加重，并与球瓣比成正相关。对于年龄较小(≤6岁)的儿童，球瓣比大且长度≥40mm的球囊较易引起右室流出道痉挛及三尖瓣反流。中远期三尖瓣反流的发生可能间接继发于肺动脉瓣反流所引起的右室容量负荷过重。 结论PBPV治疗肺动脉瓣狭窄，最佳的球瓣比为1.0~1.2，疗效满意且并发症少；6岁以下儿童宜使用长度<40mm的球囊，可减少右室流出道痉挛及近期三尖瓣反流的发生。     

冠状动脉血管成形术后再狭窄的研究现状

经皮冠状动脉腔内成形术是目前冠心痛的重要治疗手段，而术后再狭窄的发生严重影响病人的远期疗效与生活质量。本文介绍了再狭窄的发生机制，并从药物、机械、涂层支架、放射及基因方面对再狭窄的防治研究现状进行了综述分析。     

布-加综合征腔内成型术治疗体会

目的 :评价单球囊导管扩张 +内支架置放腔内成型治疗膜性及局限性布 加综合征 ,以探讨此术式的优缺点及适应证。方法 :采用下腔静脉单球囊导管扩张及内支架置放的手术方法对 8例膜性及局限性布 加综合征进行治疗。随访时间 10个月～ 2a。结果 :8例患者均一次性穿刺、扩张成功。阻塞段被扩张至 12mm～ 2 0mm ,行内支架置放腔内成型术后 ,阻塞下方下腔静脉压力从平均 (32± 4 .7)cmH2 O下降至 (19± 3.4 )cmH2 O。随访期内全部患者无复发。结论 :经腔内成型术对于短段闭塞型及重度下腔静脉狭窄型有良好疗效。     

急性心肌梗死患者PTCA术后并发症预防和护理

目的观察急性梗死患者PTCA术后并发症的发生情况及护理重点。方法:对88例急性梗死患者PTCA术后并发症分析,并实施相应护理。结果:88例急性梗死患者PTCA术后,严重心律失常7例,穿刺部位血肿2例,迷走社经反射3例。结论:急性梗死患者PTCA术后并发症发生率较高;术后严密监护及有效护理措施,可以减少和预防并发症发生。     

双球囊导管用于瘢痕子宫足月引产的临床观察

目的 探讨瘢痕子宫使用双球囊导管促宫颈成熟及引产后阴道分娩的安全性和有效性.方法 以2016年1月—2018年7月本院收治有阴道分娩条件和意愿的59例宫颈未成熟的足月瘢痕子宫作为研究组,以同期分娩的67例足月非瘢痕子宫宫颈未成熟的为对照组,两组均使用双球囊导管促宫颈成熟及引产,比较两组的母婴结局.结果 研究组孕产妇的年...     

赤芍对内膜增殖机制中丝裂素活化蛋白激酶信号通路的影响探讨

目的:观察赤芍对家兔颈动脉血管成形术后内膜增殖及丝裂素活化蛋白激酶磷酸酶-1(MKP-1)mRNA表达的影响。方法:新西兰白兔随机分为对照及赤芍组,各组均饲喂高脂饲料(普通饲料 2%胆固醇 5%猪油)。赤芍组按剂量给予赤芍提取物:高剂量组(相当于生药3g.kg-1.d-1)、中剂量组(相当于生药2g.kg-1.d-1)、低剂量组(相当于生药1g.kg-1.d-1)。血管成形术后,取材血管行RT-PCR检测MKP-1mRNA表达、形态学测定、免疫组化染色。结果:与对照组比较,增生内膜面积、增生内膜面积/中膜面积显著减少(P<0.05或P<0.01);MKP-1mRNA表达显著增高(P<0.05或P<0.01)。结论:赤芍增加高脂喂养兔颈动脉球囊损伤后MKP-1mRNA表达,减轻内膜增殖程度。表明内膜增殖程度的减低与赤芍阻断MAPK信号通路有关。     

EST小切开联合EPBD治疗乳头旁憩室合并胆总管结石的疗效分析

目的探讨内镜下乳头括约肌小切开联合气囊扩张术治疗乳头旁憩室合并胆总管结石的效果和安全性。方法回顾175例十二指肠乳头旁憩室合并胆总管结石的治疗,85例采用乳头括约肌小切开联合气囊扩张术取石,作为观察组,90例行常规内镜下乳头括约肌切开取石作为对照组,观察取石成功率、术中碎石率和术后并发症。结果观察组取石成功率为96.5%,对照组93.3%,两组比较差异无统计学意义(P>0.05)。而碎石率分别为14.1%和31.1%,观察组明显少于对照组。观察组无出血,明显少于对照组的6.7%。术后胰腺炎、高淀粉酶血症和胆管炎两组相当,差异无统计学意义(P>0.05)。结论内镜下乳头括约肌小切开联合气囊扩张术治疗乳头旁憩室合并胆总管结石可以减少术中碎石率和出血率,是一种安全、有效的治疗方法。