CRP水平与冠脉药物支架植入术后再狭窄关系的Meta分析

目的探讨术前高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与冠脉药物支架(DES)植入术后再狭窄(ISR)的关系。方法检索维普中文期刊全文数据库、中国生物医学文献数据库、中国知网、PubMed数据库,收集相关原始研究;采用文献质量评价结合Meta分析的方法分析。结果 ISR组患者术前hs-CRP水平显著高于非ISR组的hs-CRP水平,中国人群和随访时间为6个月的亚组分析表明,ISR组患者术前hs-CRP水平显著高于非ISR组的hs-CRP水平。异质性分析显示纳入文献存在显著异质性。偏倚分析表明发表的文章不存在偏倚。结论术前hs-CRP水平与DES植入术后ISR的发生存在显著相关性。     

The ACSIS Registry and primary angioplasty following coronary bypass surgery

The current evidence‐base pertaining to PCI in coronary bifurcation lesions is not adequate to inform decision making in all patients, hence a gap still exists between the evidence‐base and patient‐centered decision‐making. Although meta‐analyses of the existing RCTs improve the statistical power of the data they do not remedy the problem of trial design. The reason for the gap between “evidence” and patient‐centered decision‐making is that the research methodology used in the RCTs does not simulate the questions asked in practice. The purpose of this review is to make the case for a counter perspective to the narrative that provisional stenting (PS) [stenting the main vessel (MV), with additional stenting of the side branch (SB) only in the case of an unsatisfactory result] is better than elective double stenting (EDS) of both branches in all patients. Namely, that neither approach should be the default strategy in all patients with bifurcation lesions and a decision as to which technique to use should be based on the patient's bifurcation anatomy. The majority of patients with bifurcation lesions will have anatomy that can be safely treated with PS; however, some patients have “at risk” bifurcation anatomy where PS may be associated with high risk of side branch occlusion. © 2011 Wiley‐Liss, Inc.     

Performance of dual source versus 256-slice multi-slice CT in the evaluation of 16 coronary artery stents

Introduction

Invasive coronary angiography is the reference method for identification of in-stent restenosis (ISR) bearing the disadvantages of high costs and invasiveness. New approaches like dual-source CT (DSCT) and 256-multi-slice CT (256-MSCT) may potentially be the future methods of choice to reliably exclude ISR in patients with low or intermediate risk of restenosis.We sought to compare the performance of DSCT and 256-MSCT for the in vitro assessment of stent lumen diameter and basic scan parameters in stents of various diameters and designs.

Materials and Methods

In 16 coronary artery stents we evaluated relative in-stent lumen diameter, attenuation, noise, attenuation-/signal-to-noise ratio (ANR/SNR) and radiation dose (CTDI_vol) in an acknowledged coronary vessel in vitro phantom (iodine-filled plastic tubes) with DSCT (Siemens, SOMATOM Definition, collimation = 2 × 64 × 0.6 mm, pitch = 0.26, current = 400 mAs/rot, voltage = 120 kV, tube-rotation-time = 330 ms) and 256-MSCT (Philips Brilliance, iCT, tube collimation = 2 × 128 × 0.625 mm, pitch = 0.18, current = 800 mAs_eff, voltage = 120 kV, tube-rotation-time = 270 ms). Diameter analysis was conducted with the observer-independent full-width-at-half-maximum (FWHM) technique.

Results

DSCT and 256-MSCT revealed similar stent lumen diameters (50.7 ± 7.2% vs. 50.8 ± 7.4%, p = 0.98). Attenuation (−19 ± 25 HU vs. 54 ± 29 HU), ANR (−0.9 ± 1.2 vs. 2.9 ± 1.8) and SNR (12.1 ± 2.4 vs. 17.4 ± 1.9) were better in the DSCT (all p < 0.001) at the expense of significantly higher radiation doses (CTDI_vol = 87 vs. 51 mGy, p < 0.01). Noise was comparable (21 ± 2 HU vs. 20 ± 2 HU, p = n.s.). Only stents with a diameter >3 mm allowed sufficient stent lumen assessment in both scanners and showed a relative lumen diameter of 60–66%.

Conclusions

The measured stent lumen diameter and image noise were similar in both scanners. Yet the DSCT offered a more truthful stent lumen visualization at the cost of higher radiation dose.Applying the FWHM approach only stents with a diameter >3 mm offered sufficient stent lumen assessment.     

骨髓间充质干细胞移植后颈动脉损伤球囊核转录因子κBp65和增殖细胞核抗原的表达

BACKGROUND: Inflammatory reaction plays an important role in the incidence of restenosis after percutaneous transluminal coronary intervention. Recent studies found that bone marrow mesenchymal stem cells (BMSCs) have strongly characteristics of immunological regulation. However, BMSCs on the inflammatory reaction in vascular injury is rarely reported. OBJECTIVE: To investigate effects of BMSCs transplantation on expression of nuclear factor κBp65 (NF-κBp65) and proliferating cell nuclear antigen (PCNA) after carotid artery balloon injury of rabbits, and to analyze its correlation with intimal proliferation. METHODS: Thirty-six rabbits were prepared for carotid artery atherosclerotic stenosis models and were randomly divided into the control group and BMSCs transplantation group. BMSCs pre-labled by DAPI was infused into rabbits by the ear vein in the BMSCs transplantation group, and the same amount of PBS solution was infused in the control group. The plasma tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were detected by ELIAS in prior to model preparation and at 7, 14, 28 days after transplantation. The NF-κBp65 and PCNA expressions in vessels tissues were detected by immunohistochemical analysis at 14 days after transplantation, and vascular morphological changes were determined by hematoxylin-eosin staining at 28 days after transplantation. RESULTS AND CONCLUSION: The expression of NF-κBp65 and PCNA in the BMSCs transplantation group decreased significantly compared with control group at 14 days after transplantation (P < 0.05). At 7, 14, and 28 days after transplantation, the plasma TNF-α and IL-6 levels in the BMSCs transplantation group were significantly lower than those in the control group (P < 0.05). The intimal area, the ratio of the intima/media area and the luminal stenosis ratio were significantly decreased in the BMSCs transplantation group than control group at 28 days after transplantation (P < 0.05). BMSCs is capable to decrease the inflammatory reaction of injured vessels and down-regulate PCNA expression by inhibiting NF-κBp65 in injured vessels, and BMSCs may be good for inhibition of injured vessels intimal proliferation.     

In‐Stent Restenosis

The introduction of coronary stents marked a major turning point in the practice of interventional cardiology. Whereas the efficacy of balloon angioplasty was challenged both by immediate mechanical complications and by a high incidence of restenosis, coronary stents offered cardiologists a means by which to not only augment immediate procedural success, but also to reduce the incidence of restenosis following coronary intervention. However, despite technological advances and an improved understanding of the restenotic process, the overall rate of in‐stent restenosis following bare metal stent implantation remains high. Although the introduction of drug‐eluting stents has further reduced the incidence of restenosis, the “real‐world” application of drug‐eluting stents in increasingly complex lesion and patient subsets has given way to the even greater clinical challenge of managing drug‐eluting stent restenosis. Although the standard treatment of bare metal stent restenosis typically involves placement of a drug‐eluting stent, the optimal therapeutic approach to drug‐eluting stent restenosis remains less defined. The issue of in‐stent restenosis (especially following implantation of a drug‐eluting stent) remains a clinical challenge, and investigation into therapeutic options remains ongoing. As technology evolves, such investigation will likely incorporate novel approaches including drug‐coated balloons novel stent designs.     

瓜蒌皮颗粒剂治疗PCI术后再狭窄软斑块的疗效观察

目的评价瓜蒌皮颗粒剂治疗经皮冠状动脉介入治疗(PCI)术后再狭窄软斑块的疗效。方法选择2013年5月—2015年5月于辽宁中医药大学附属医院行PCI手术确诊为软斑块的稳定型冠心病病人84例,根据随机数字表法分为试验组与对照组,各42例。对照组采用常规西药治疗,试验组在对照组基础上应用瓜蒌皮颗粒剂;比较两组PCI术后再狭窄情况、血脂及中医证候疗效。结果治疗后,试验组PCI术后再狭窄率低于对照组(P <0.05),中医证候总有效率高于对照组(P <0.01);血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平低于对照组(P <0.05),高密度脂蛋白胆固醇(HDL-C)水平高于对照组(P <0.05)。结论瓜蒌皮颗粒剂能减小PCI术后病人冠状动脉再狭窄发生率。     

Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a pilot studyand 9-month outcomes in a pilot study

Background  The optimal stenting strategy for the treatment of coronary bifurcation lesions (CBLs) remains uncertain. The present study observed technical feasibility and reliability, 9-month clinical and angiographic outcomes of the modified culotte stenting (MCS) in the treatment of CBLs with drug-eluting stents.

Methods  A total of 34 consecutive patients with CBLs that required stenting the parent vessel (PV), the main branch (MB) and the side branch (SB) were included. All patients were first assigned to receive MCS for CBL interventions (per MCS), and might be switched to receive the double-kissing-crush stenting (DKS) in case of temporally acute branch occlusion (per protocol).

Results  The immediate angiographic or procedural success was achieved in 33/34 (97%) lesions (patients) per MCS, 34/34 (100%) lesions (patients) per protocol with 100% successful final balloon kissing. The long-term clinical success at 9 months was 94% per MCS and 94% per protocol, only 2 patients had reoccurrence of angina but none of them needed target lesion revascularization. There were no procedure-related biomarker elevation, no in-stent thrombosis peri-procedurally and at 9-month follow-up. Quantitative coronary angiography data at 9 months showed that in-stent (6%) or in-segment (6%) binary stenosis was infrequent, and minimal lumen diameter was significantly reduced but late lumen loss was acceptable with only (0.10±0.14) mm for PV, (0.21±0.23) mm for MB and (0.27±0.32) mm for SB.

Conclusions  MCS for treatment of CBLs that required dual-stent implantation was technically easier and safer, readily to complete final balloon kissing, and was associated with high immediate success and optimal 9-month outcomes.