西京医院冠心病介入治疗537例

目的　总结西京医院冠心病介入治疗的成功率及并发症发生率 .方法　回顾性分析 1998- 12前所有冠心病介入治疗病历完整患者的临床资料 .结果　在 5 37例患者中 ,6 9.3%为不稳定性心绞痛 ,2 0 .3%射血分数≤ 40 .0 % ,6 4.6 %为多支病变 .治疗血管 6 71支、病变 76 9处 ,B,C型病变77.9% .介入治疗病例成功率为 89.2 % .病变成功率 89.1% ,严重并发症发生率为 3.4% (死亡 1.9% ,Q波心梗 2 .0 % ,急症冠脉搭桥术 0 .2 % ) .普遍应用支架前后对比 ,病例成功率提高 (91.0 % vs80 .0 % ,P<0 .0 1) ,严重并发症发生率下降 (2 .6 % vs 6 .4% ,P<0 .0 5 ) .结论　我院病例病情严重 ,介入治疗成功率和并发症发生率与国外文献报道相似 .支架提高了介入治疗的安全性     

Self-expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compression

The role of self-expanding metallic stents is well established in the palliation of oesophageal stenosis and dysphagia due to primary oesophageal malignancy. However, their role in palliation of dysphagia due to external compressive mediastinal malignancies is not well established. The purpose of this study was to assess the efficacy of self-expanding metallic stents in the palliation of dysphagia due to extrinsic oesophageal compression by mediastinal malignancy. Between January 1995 and January 1998, 21 patients with oesophageal compression due to malignant mediastinal tumours underwent oesophageal stent placement for palliation of dysphagia. Complete data were available in 17 patients (10 men and 7 women). The mean age was 63.5 years (range 46–89 years). A total of 19 stents were placed successfully. The dysphagia grade prior to and after oesophageal stent placement was assessed and the complications documented. Of the 17 patients, 16 reported an improvement in dysphagia. The mean dysphagia score improved from 3.1 prior to treatment to 1.3 after treatment. In 1 patient the stent slipped during placement and another stent was placed satisfactorily. Early complications (within 48 h) in the form of mild to moderate retrosternal chest pain occurred in 5 patients. This was treated symptomatically. Late complications (after 48 h) in the form of bolus impaction occurred in 2 patients. This was successfully treated with oesophagoscopy and removal of bolus. In 2 patients the stent was overgrown by tumour and in one of these an additional stent was placed. In 1 patient incomplete closure of a tracheo-oesophageal fistula was observed. There was no procedure- or stent-related mortality. The mean survival time of this group was 2.1 months. Self-expanding metallic stents can be safely and effectively used in the palliation of dysphagia due to external mediastinal malignancies. Received: 21 October 1998; Revised: 1 February 1999; Accepted: 4 February 1999     

Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents

The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1–6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6–24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related. Correspondence to: P. Rossi     

Tetralogy of Fallot with Absent Pulmonary Valve and Bronchial Compression: Treatment with Endobronchial Stents

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac lesion. The lesion includes ventricular septal defect, overriding aorta, and absence of the pulmonary valve, with resultant pulmonary incompetence. It has been suggested that the pulmonary incompetence induces intrauterine dilatation of the pulmonary artery, which leads to tracheobronchial compression. One of the presenting features in infants with APVS is severe airway obstruction, which may be difficult to manage. We report an infant who benefited from bilateral endobronchial endoscopic stent placement.     

Percutaneous Placement of Self-expandable Metallic Biliary Stents in Malignant Extrahepatic Strictures: Indications of Transpapillary and Suprapapillary Methods

Objective

To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied.

Materials and Methods

Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared.

Results

Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62).

Conclusion

For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.     

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。     

Outcomes of using Firebird rapamycin eluting stents in routine coronary intervention practice: one-year results from the pilot study of Firebird in China registry

Recent clinical trials with rapamycin-eluting stents have shown very low restenosis rates.1-4 However, the higher penetration of drug eluting stent (DES) in China is being limited by the high costs of these imported devices, especially when considering multiple stenting.     

冠心病合并糖尿病患者应用雷帕霉素洗脱支架和紫杉醇涂层支架的疗效观察

目的:评价雷帕霉索洗脱支架(Cypher~(TM))和紫杉醇涂层支架(Taxus~(TM))治疗冠心病(CAD)合并2型糖尿病(DM)患者短期疗效和安全性。方法:从2002年12月至2006年3月共116例合并CAD和DM的患者入选本研究,共植入药物涂层支架186个(雷帕霉素洗脱支架97个,紫杉醇涂层支架89个)。观察6个月的主要心血管不良事件(MACE)。结果:接受两种支架植入的患者基本临床特征相似。支架植入成功率100%,95%的患者完成了6个月的随访。雷帕霉素洗脱支架组总的MACE事件发生率约为6．78%(4/59),紫杉醇涂层支架组总的MACE事件发生率约为7．02%(4/57),两组相比无统计学差异。结论:雷帕霉素洗脱支架和紫杉醇涂层支架治疗CAD合并2型DM的患者有相似的疗效。     

Meta-Analysis of Short vs. Prolonged Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation and Role of Continuation with either Aspirin or a P2Y12 Inhibitor Thereafter

Aim: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an ongoing debate and novel data has emerged. The aim of this meta-analysis was to assess outcomes of short vs. control DAPT duration. In addition, the role of single antiplatelet therapy (SAPT) after DAPT with either aspirin or P2Y₁₂ inhibitor monotherapy was analyzed. Methods: The authors searched MEDLINE and Cochrane databases and proceedings of international meetings for randomized controlled trials (RCT) comparing ≤ 3 months with ≥ 6 months DAPT after DES implantation. The primary and co-primary outcomes of interest were definite or probable stent thrombosis (ST) and bleeding. In addition, we performed an analysis on studies who continued with either aspirin or P2Y₁₂ monotherapy after DAPT. Results: 9 RCTs comprising 41,864 patients were included and we analyzed a short DAPT duration of median 1.5 months vs. 12.1 months in the control group. The risk for ST was similar with short vs. control DAPT duration (0.5 vs. 0.5%; hazard ratio 1.17[95% CI 0.89-1.54];p=0.26). Bleeding was significantly reduced with short vs. control DAPT duration (1.9 vs. 3.0%; 0.65[0.54-0.77];p＜0.0001). ST was not different between short vs. control DAPT duration in the analysis of the 4 RCTs who continued with aspirin after DAPT and the 5 P2Y₁₂ RCTs, respectively, and no heterogeneity was detected (p=0.861). Bleeding was also reduced with short vs. control DAPT in both the aspirin (1.2 vs. 1.7%; 0.71[0.51-0.99];p=0.04) and P2Y₁₂ inhibitor studies (2.1 vs. 3.4%; 0.62[0.47-0.80];p=0.0003) and no heterogeneity was detected (p=0.515). Conclusions: Our meta-analysis shows that short DAPT ≤ 3 months followed by SAPT reduces bleeding and is not associated with an increase in ST. The results were consistent within the aspirin and P2Y₁₂ SAPT studies.