Le Rotablator : un outil d’angioplastie indispensable

Rotational atherectomy is the treatment of choice for calcified coronary lesions. It should not be used routinely but only in some appropriate cases, especially when the successful deployment of a stent may be uncertain. Complications are rare but serious. Several cases of “off label” use, however, have been reported in the literature without additional complications.     

Stent for Life in Portugal: This initiative is here to stay

AimsPortugal has one of the lowest rates of primary percutaneous coronary intervention (p-PCI) in Western Europe. This study assessed the progress of Portuguese p-PCI performance indicators one year after Portugal joined the Stent for Life (SFL) initiative.Methods and ResultsTwo national surveys were carried out, each covering a period of one month: the first when Portugal joined the SFL in 2011 (Moment Zero), and the second one year later (Moment One). A total of 397 consecutive patients with probable ST-segment elevation myocardial infarction were enrolled (201 at Moment Zero and 196 at Moment One) from 15 centers. During this period, the number of patients who arrived at a local hospital without p-PCI decreased (62–47%; p=0.004) and transportation to a p-PCI hospital by the National Institute for Medical Emergencies (INEM) increased significantly (13–37%; p<0.001). Shorter times to revascularization were observed, due to shorter patient delay (118–102 min; p=0.008). Door-to-balloon delay and system delay remained unchanged.ConclusionsImprovements in performance indicators for p-PCI demonstrate the success of the first year of the local SFL plan, which was mainly focused on raising public awareness of the need to use the INEM emergency services, which has reduced patient delay, and on improving secondary transportation.     

药物支架时代冠状动脉旋磨术治疗严重钙化病变63例分析

目的探讨在药物支架时代冠状动脉旋磨术治疗冠状动脉钙化病变的安全性及有效性。方法连续收集自2008年3月1日至2011年12月31日的本院单中心63例行冠状动脉旋磨术的患者资料,并回顾分析临床资料,手术成功率及临床效果和主要心血管事件(心源性死亡、心肌梗死和靶病变重建)的发生率。结果 63例患者共有66处钙化病变,63例患者中5例为急性心肌梗死(7.9%);58例为不稳定型心绞痛(92.1%)。17例(27%)合并糖尿病,52例(82.5%)合并高血压。66处病变中60处(90.9%)旋磨联合球囊扩张及DES支架植入,4处(6.1%)旋磨加球囊扩张未植入支架,2处(3.0%)仅旋磨,未植入DES支架是由于血管直径<2.25 mm。手术成功率为96.8%。1例残余狭窄大于50%,另1例左主干患者术后12小时心源性死亡,考虑为可能性支架血栓形成。所有患者随访8～12个月。有2例再发心绞痛,无主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)发生。结论在药物支架时代,冠状动脉旋磨术联合球囊扩张和支架植入术治疗冠状动脉钙化病变是治疗钙化病变安全、有效的方法,可取得很高的手术成功率。     

Acute branch occlusion after Pipeline embolization of intracranial aneurysms

Flow-diverters are used in the treatment of large and complex intracranial aneurysms. One major concern with this concept is the potential for compromise of side branches and perforators covered by the device. We describe three patients treated with the Pipeline embolization device (PED; ev3 Endovascular, Plymouth, MN, USA) who developed immediate compromise of flow into an eloquent side branch covered by the device. Three patients, two with giant posterior circulation aneurysms and one with recurrence of a previously clipped and subsequently coiled middle cerebral artery aneurysm, were each treated by placement of a single PED. Shortly after placement of the devices, despite adequate antiplatelet and anticoagulation regimens, partial or complete occlusion of a major side branch occurred. In all three patients, the occlusion was promptly reversed with intra-arterial administration of abciximab with no clinical sequelae. These cases are concerning because branch occlusion occurred even in the setting of patients appropriately premedicated with dual antiplatelet therapy and in whom genetic testing suggested clopidogrel responsiveness. Close monitoring of patients treated with these devices is critical to establish the frequency of this and other unanticipated complications.     

Tracheobronchial Amyloidosis Treated by Endobronchial Laser Resection and Self Expanding Y Stent

Amyloid deposition in tracheobronchial tree is a rare presentation and counts about 1% of benign tumors in this area. Herein, we describe a case of primary tracheobronchial amyloidosis which obstructed almost completely the distal trachea and the main left bronchus.The mass was successfully resected by mechanical resection and Nd-YAG laser coagulation during rigid bronchoscopy. Afterwards, a self-expanding Y-stent of new generation was inserted to restore airway patency. Five months later, radiological and bronchoscopic findings showed the stent in site, with normal patency of the tracheo-bronchial tree.     

冠状动脉内支架置入术在冠心病治疗中的价值

目的 评价冠状动脉内支架置入术在冠心病治疗中的临床应用价值。方法 对157例206支冠状动脉病变内置入203只支架，其中置入左前降支103只，右冠状动脉57只，左回旋支42只，左主干1只。结果 157例全部置入成功。置入后经冠状动脉造影证实狭窄消失，效果良好。其中5例急性心肌梗死患者由于急诊置入支架后，病情迅速缓解。择期冠状动脉支架置入术全部置入成功，无一例发生严重并发症。结论 冠状动脉内支架置入术是治疗冠心病的一种安全可靠、效果良好的介入性治疗方法、有良好的应用价值。     

经皮冠状动脉介入治疗后肌钙蛋白I阳性患者血清基质金属蛋白酶水平升高的临床意义

目的 :探讨血清基质金属蛋白酶 (MMP)在稳定型心绞痛患者中介入治疗后的表达。方法 :16例冠状动脉造影正常的患者 (对照组 )及 5 1例行冠状动脉介入治疗的稳定型心绞痛患者 (患者组 )入选 ;术后常规查肌钙蛋白I(cTnI) ,分别采取术前 ,术后第 1、第 3及第 5天的外周血 ,Elisa试剂盒测定MMP 2、MMP 9的水平。结果 :5 1例患者中共有 2 1例患者cTnI增高 ,平均 (0 .6 8± 0 .2 3) μg/L ;术前两组的MMP水平无明显差异 ;cTnI阳性者的MMP 9在术后第 1天明显高于阴性者及对照组〔(198± 5 8.5 )∶(14 4± 4 8.3)、(132± 4 6 .7) μg/L ,均 P <0 .0 5〕 ,并在术后第 3天、第 5天保持较高水平 ;MMP 2仅在术后第 1天增高 ,第 3天、第 5天恢复正常。结论 :冠状动脉介入治疗后心肌微损伤的发生率较高 ,这种心肌微损伤对患者的预后有一定的影响 ;血清MMP水平的增高 ,可能是此类患者临床预后较差的原因之一。     

血管内超声以及冠状动脉造影引导下支架植入术效果比较的meta分析

目的血管内超声(IVUS)引导植入支架的效果目前仍存在争议,该研究旨在探讨血管内超声以及传统造影(Angiography)引导下支架植入效果在临床上的优劣比较。方法全面检索2000年1月—2014年6月国内外研究文献,筛选出符合评价标准的文献,采用Rev Man5.0软件进行分析。以支架植入术后死亡、心肌梗死、靶血管血运重建、支架内血栓形成以及主要心血管不良事件为主要临床终点,分析血管内超声与血管造影植入支架效果之间的差异。结果血管内超声引导下支架植入术后心肌梗死(RR=0.67,95%CI:0.56~0.81;Z=4.08,P<0.0001)、靶血管血运重建(RR=0.76,95%CI:0.66~0.87;Z=3.87,P=0.0001)、支架内血栓形成(RR=0.62,95%CI:0.47~0.82;Z=3.35,P=0.0008)以及主要不良事件(RR=0.82,95%CI:0.73~0.91;Z=3.62,P=0.0003)的发生率均低于传统造影下支架植入术,差别有统计学意义。结论说明血管内超声支架植入术能显著降低术后心梗、靶血管血运重建、支架内血栓及主要不良时间的发生,相比传统冠脉造影更能让患者获益。