When and How Should We Revascularize Patients With Atherosclerotic Renal Artery Stenosis?

Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension and may lead to resistant (refractory) hypertension, progressive decline in renal function, and cardiac destabilization syndromes (pulmonary edema, recurrent heart failure, or acute coronary syndromes) despite guideline-directed medical therapy. Although randomized controlled trials comparing medical therapy with medical therapy and renal artery stenting have failed to show a benefit for renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials may not have enrolled patients with the most severe atherosclerotic renal artery stenosis, who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is critical that the hemodynamic severity of moderately severe (50% to 70%) atherosclerotic renal artery stenosis lesions be confirmed on hemodynamic measurement. The authors review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. The authors also review the current American College of Cardiology and American Heart Association guidelines and the Society for Cardiovascular Angiography and Interventions appropriate use criteria as they relate to renal stenting.     

Coronary in-stent restenosis

Coronary stent implantation was considered as a way of coronary revascularization. It has been widely used in the treatment of coronary heart disease, but restenosis has become the main bottleneck to the development of stent technique. Despite drug-eluting stents used widely, restenosis rate is still about 10%. The incidence of restenosis was associated with intervention injury, patient factors, genetic types, nerve endocrine factors and so on. Overview above aspects is expected to provide some ideas for restenosis prevention and treatment.     

高压氧对冠状动脉支架术后患者C反应蛋白的影响

目的了解高压氧治疗对冠状动脉(冠脉)支架术后患者C反应蛋白(CRP)的影响.方法将64例首次接受冠脉内支架治疗的冠心病患者随机分为高压氧治疗组和对照组,比较治疗前后CRP的测定结果.结果高压氧组在治疗后CRP含量显著低于治疗前(P＜0.05),治疗后两组CRP差异有显著意义(P＜0.05);而治疗前两组的CRP差异无显著性(P＞0.05);对照组治疗前后CRP的差异也无显著性(P＞0.05).结论高压氧治疗可显著降低冠脉支架术后患者CRP的含量.     

血管内照射对兔血管平滑肌细胞增殖和凋亡的影响

目的:探讨188铼(188Re)血管内照射对血管平滑肌细胞增殖和凋亡的影响.方法:40只新西兰白兔随机分为对照组(n=20只)和照射组(n=20只),均行腹主动脉球囊内皮拉伤术.照射组内皮拉伤后行188Re血管内照射治疗,管腔下0.5 mm处累计吸收剂量为15 Gy;对照组则不行血管内照射.分别于术后1、3周处死动物,取病理组织学标本进行增殖细胞核抗原(PCNA)和凋亡细胞分析.结果:照射组第1、3周PCNA细胞阳性率分别为(27.69±7.04)%与(20.88±4.55)%,明显低于对照组(42.71±6.11)%、(29.48±10.13)%(P均＜0.05);照射组第3周平滑肌细胞凋亡细胞百分比为(40.16±7.93)%,明显高于对照组(28.50±9.39)%(P=0.018).结论:188Re血管内照射能抑制血管平滑肌细胞增殖,促进血管平滑肌细胞凋亡,从而抑制新生内膜增生,减少PTCA术后再狭窄的发生.     

Therapeutic potential of colchicine in cardiovascular medicine: a pharmacological review

Colchicine is an ancient herbal drug derived from Colchicum autumnale. It was first used to treat familial Mediterranean fever and gout. Based on its unique efficacy as an anti-inflammatory agent, colchicine has been used in the therapy of cardiovascular diseases including coronary artery disease, atherosclerosis, recurrent pericarditis, vascular restenosis, heart failure, and myocardial infarction. More recently, colchicine has also shown therapeutic efficacy in alleviating cardiovascular complications of COVID-19. COLCOT and LoDoCo2 are two milestone clinical trials that confirm the curative effect of long-term administration of colchicine in reducing the incidence of cardiovascular events in patients with coronary artery disease. There is growing interest in studying the anti-inflammatory mechanisms of colchicine. The anti-inflammatory action of colchicine is mediated mainly through inhibiting the assembly of microtubules. At the cellular level, colchicine inhibits the following: (1) endothelial cell dysfunction and inflammation; (2) smooth muscle cell proliferation and migration; (3) macrophage chemotaxis, migration, and adhesion; (4) platelet activation. At the molecular level, colchicine reduces proinflammatory cytokine release and inhibits NF-κB signaling and NLRP3 inflammasome activation. In this review, we summarize the current clinical trials with proven curative effect of colchicine in treating cardiovascular diseases. We also systematically discuss the mechanisms of colchicine action in cardiovascular therapeutics. Altogether, colchicine, a bioactive constituent from an ancient medicinal herb, exerts unique anti-inflammatory effects and prominent cardiovascular actions, and will charter a new page in cardiovascular medicine.     

经皮氧分压联合血清ox-LDL预测下肢动脉硬化闭塞症介入治疗后再狭窄的临床价值

目的]探究经皮氧分压(TcPO₂)联合血清氧化型低密度脂蛋白(ox-LDL)预测下肢动脉硬化闭塞症(LASO)介入治疗后再狭窄的临床价值。 [方法]选取2020年1月—2021年6月在上海中医药大学附属岳阳中西医结合医院行介入治疗的113例LASO患者为观察对象,根据介入治疗后1年再狭窄发生情况将其分为未狭窄组(n＝79)和再狭窄组(n＝34),采用ELISA及相应试剂盒检测血清ox-LDL水平,运用激光多普勒血流仪测量TcPO₂,比较两组资料及TcPO₂、ox-LDL值,多因素Logistic回归模型研究LASO介入治疗后再狭窄的影响因素,采用Spearman检验进行相关性分析,ROC曲线评估TcPO₂、ox-LDL值预测LASO介入治疗后再狭窄的效能。 [结果]两组年龄、体质指数(BMI)、性别、饮酒、脑血管疾病史、冠心病史、病变血管支数、空腹血糖、同型半胱氨酸水平比较差异无统计学意义(P＞0.05)。与未狭窄组比较,再狭窄组吸烟、术后不规律用药、植入支架数量、ox-LDL和血尿酸水平明显增高(P＜0.05),TcPO₂明显降低(P＜0.05)。Logistic回归模型分析显示,吸烟、术后不规律用药、植入支架数量多、TcPO₂降低、ox-LDL和血尿酸增高为LASO介入治疗后再狭窄的危险因素(P＜0.05)。Spearman检验显示,ox-LDL与LASO介入治疗后再狭窄呈正相关(r＝0.513,P＜0.001),TcPO₂与其呈负相关(r＝－0.524,P＜0.001)。ROC曲线分析显示,TcPO₂＋ox-LDL预测LASO介入治疗后再狭窄时的效能(AUC＝0.802)高于各指标单独应用时,其预测的灵敏度和特异度为67.60%、94.90%,临界点为37.23 mmHg、5.31 mmol/L。 [结论]LASO介入治疗后再狭窄患者TcPO₂降低、ox-LDL增高,二者对LASO介入治疗后再狭窄有一定预测价值,TcPO₂与ox-LDL结合能更全面反映介入治疗后再狭窄情况。     

Vascular endoscopic and macroscopic observations after crush stenting of coronary artery bifurcations in pigs.

The crush stent technique has recently been proposed to limit the development of restenosis between drug-eluting stents implanted at coronary artery bifurcations. We studied the stent expansion, apposition to the vessel, and aspect of the overlapping stents after in vivo crush stent implantation. Crush stent implantation was performed at coronary bifurcations in anesthetized swines. The treated sites were examined using intravascular ultrasound and a vascular endoscope. The stents removed from the vessel were analyzed macroscopically. After final kissing balloon inflation, an adequate apposition of the stent to the vessel wall was confirmed by vascular endoscopy and visual inspection. However, the side-branch stent was narrowed at the site of stent overlap, and the overlapping stents in the main branch created a metal mass, which could promote the development of thrombosis. The technique of crush stent implantation with additional kissing balloon inflation is feasible and promising. However, it may be limited by thrombosis and restenosis at the carina because of stent overlapping and potential incomplete apposition. Additional studies are needed to confirm the safety and long-term clinical results of this technique.     

药物洗脱支架和金属裸支架治疗弥漫病变的比较研究

目的比较冠心病患者弥漫病变采用药物洗脱支架和金属裸支架治疗的近期和远期预后,分析影响这类病变介入治疗预后的危险因素。方法研究对象为我院2004年4月至2005年8月接受置入单个长度>25.0mm支架治疗并且进行冠状动脉造影随访的205例患者,排除支架置入失败及支架置入位置不理想者。分为置入药物洗脱支架(DES)组(n=128)和置入金属裸支架(BMS)组(n=77)。所有的患者术后均接受阿司匹林300mg、氯吡格雷75mg等规范药物治疗。手术成功判定标准为至少用相互垂直的两个投照体位行冠状动脉造影,肉眼判定残余狭窄<20%和前向血流TIMI3级。再狭窄判定标准以复查冠状动脉造影定量分析支架内或支架邻近血管管腔直径狭窄程度≥50%。患者在支架术后6个月左右接受冠状动脉造影随访。结果共205例患者(男性181例,女性24例)227个靶病变置入382枚支架完成造影随访。其中C型病变占总数的93.8%,B2型病变为6.2%。双支或双支以上血管病变的患者比例达到86.8%。平均术前参考血管直径(2.88±0.43)mm。平均每个病变支架长度(40.09±12.94)mm,54.2%的病变接受了重叠置入支架。比较置入DES组和置入BMS组,两组的患者基本条件差异无统计学意义,在病变基本条件方面,DES组术前参考血管直径明显小于BMS组[(2.80±0.37)mm比(3.10±0.48)mm,P=0.005]。6个月随访结果显示再狭窄率DES组(15.4%)小于BMS组(48.4%),P<0.001。晚期支架内腔径丢失BMS组明显大于DES组[(0.94±0.76)mm比(0.39±0.53)mm,P<0.001]。靶病变血管重建率DES要明显好于BMS(11.6%比38.5%,P<0.001)。支架内再狭窄在置入DES组的局限性再狭窄比例大于置入BMS组(33.3%比18.2%,P=0.029)。对影响复杂弥漫病变支架再狭窄因素的多元logistic回归分析发现,采用支架重叠置入(OR=2.82,P=0.017)和支架类型(OR=5.71,P<0.001)是对复杂弥漫病变支架内再狭窄影响最大的危险因素。结论我们的研究发现对于复杂弥漫病变的治疗,药物洗脱支架有着良好的治疗效果,较金属裸支架能明显减低再狭窄率。对于弥漫病变,我们应该使用长支架,尽可能减少支架重叠置入的数量。     

粒细胞集落刺激因子对大鼠颈总动脉损伤后新生内膜增生的影响

目的探讨粒细胞集落刺激因子（G-CSF）对动脉粥样硬化（AS）大鼠颈总动脉球囊损伤后再狭窄的影响。方法Wistar大鼠48只,随机分为3组:普通饮食组（普食组,n=6）,高脂饮食组（高脂组,n=42）。高脂组又分为:G-CSF组（n=21）和生理盐水组（NS组,n=21）。高脂饮食后1个月用HE染色及透射电镜证明AS形成情况。G-CSF组和NS组分别于高脂饮食后1个月给予G-CSF或生理盐水干预6d,然后行左颈总动脉球囊损伤术,术后14、21、90d分别用扫描电镜、HE染色及图像分析观察血管内皮形成及内膜的增生情况。结果高脂组大鼠高脂饮食后1个月可见AS的早期改变,行球囊损伤后可见大鼠颈总动脉内膜逐渐增厚,但是G-CSF组明显小于NS组,G-CSF组损伤血管内皮较快恢复连续性,G-CSF组内膜与中膜面积比值（Ai/Am）远小于NS组（P<0.01）。结论G-CSF可以加速AS大鼠损伤血管的再内皮化、抑制血管损伤后再狭窄的发生。     

血浆总胆红素浓度与经皮冠状动脉介入治疗后支架内再狭窄的研究

目的探讨冠状动脉粥样硬化性心脏病（冠心病）患者血浆总胆红素（total bilirubin,TBIL）浓度与冠状动脉支架内再狭窄的关系。方法选择241例接受经皮冠状动脉介入（percotaneous coronary intervention,PCI）治疗以及术后1年内再次接受冠状动脉造影（CAG）检查的患者,根据影像结果分为再狭窄组和非再狭窄组,分别在PCI治疗前、出院前及复查冠状动脉造影前测定血浆TBIL浓度。比较分析两组相应的TBIL浓度。结果再狭窄组PCI治疗前、出院前及复查冠状动脉造影前的TBIL浓度与非再狭窄组分别进行比较,差异有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示,血浆TBIL浓度是预测再狭窄的独立危险因子（P〈0．05）。结论血浆TBIL浓度与PCI治疗后再狭窄密切相关．是预测PCI治疗后再狭窄的独立预测因子。