Failure of cutting balloon angioplasty to prevent restenosis in childhood pulmonary venous stenosis.

We describe bilateral pulmonary vein stenosis in a 5-year-old boy. He initially presented with haemoptysis secondary to left upper lobe pulmonary vein atresia and left lower lobe stenosis and subsequently he underwent left-sided pneumonectomy. He underwent repeat cardiac catheterizations with repeated balloon angioplasty of the right-sided venous stenoses using a cutting balloon. Despite satisfactory initial results the pulmonary venous stenosis reoccurred as early as 2 months following balloon angioplasty. Although cutting balloon angioplasty has demonstrated effective immediate alleviation of pulmonary venous stenosis its utility in providing sustained improvement in pulmonary vein stenosis is limited.     

30例PCI后支架内再狭窄临床分析

目的分析经皮冠状动脉介入治疗术(PCI)后支架内再狭窄(ISR)的临床情况,探索其规律。方法统计我院近3年确诊的30例ISR患者第一次PCI前病因、冠状动脉血管病变情况及支架种类。结果金属支架、多支病变和急性心肌梗死(AMI)支架内再狭窄所占比例最高,30例ISR患者中,共有13例为AMI时行冠脉内支架置入术。结论除金属支架、多支病变等因素外,AMI可能由于其本身的病变特征,易致PCI后ISR。     

QT离散度对PCI术后冠状动脉再狭窄的临床评估及应用价值研究

目的对经皮冠状动脉介入（PCI）术前、术后有及无再狭窄病人行QT离散度（QTd）分析,评估QTd对PCI术后冠状动脉再狭窄的临床应用价值.方法选择PCI术后冠状动脉再狭窄病人36例,随机选择40例PCI术后无再狭窄病人对照比较研究,于PCI术前及术后3个月分别行12导联心电图测量QTd和计算较正QTd（QTcd）,同时行冠状动脉造影检查,观察QTd及QTcd对PCI术前、术后有无再狭窄的影响变化.结果 36例再狭窄组病人PCI术前、术后QTd及QTcd无明显差异,40例无再狭窄组病人PCI术后比术前QTd及QTcd有明显缩短（P〈0.05）.再狭窄组的血管病变程度PCI术前、术后QTd及QTcd无明显变化,无再狭窄组的PCI术后比术前单支血管病变QTd及QTcd缩短（P〈0.05）,双支及3支血管病变QTd及QTcd明显缩短（P〈0.01）.PCI术后再狭窄组的多支病变数较无再狭窄组的多支病变数的发生率明显增多.结论 QTd及QTcd对评估PCI术后再狭窄有明显的临床应用价值.     

放射性PDGFR-β反义寡核苷酸对血管平滑肌细胞增殖和凋亡的影响

目的研究32P标记血小板衍化生长因子β受体（PDGFR-β）的反义寡核苷酸（AON）对血管平滑肌细胞（VSMC）增殖的影响,为抑制血管术后再狭窄的形成提供可能的干预。方法体外进行大鼠VSMC的培养,以510代细胞为实验对象,人工合成PDGFR-βAON,并进行32P标记,按实验目的分组。MTT法分析细胞增殖活力,以流式细胞仪测定细胞周期,用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）检测细胞凋亡。结果32P标记PDGFR-βAON作用后,VSMC的增殖强度明显弱于空白对照组（P<0.01）,而处于DNA合成前期（G0/G1）细胞百分比高于空白对照组（P<0.01）;32P标记AON组细胞凋亡率明显高于空白组（P<0.01）。结论32P-PDGFR-βAON可以诱导VSMC凋亡,抑制其增殖。     

Optimizing dosimetry with high-dose intracoronary gamma radiation (21 Gy) for patients with diffuse in-stent restenosis

BACKGROUND: The efficacy of intracoronary gamma radiation (IRT-gamma) in reducing recurrent in-stent restenosis (ISR) is well established using doses of 14-18 Gy. We sought to examine whether an escalation in dose to 21 Gy is safe and confers additional benefit in reducing repeat revascularization and major adverse cardiac events (MACE) in patients with diffuse ISR. METHODS: Forty-seven patients with diffuse ISR (lesion length 20-80 mm) in native coronary arteries (n=25) and saphenous vein grafts (n=22) underwent percutaneous transluminal coronary angioplasty and/or additional stents followed by IRT-gamma using the Checkmate system (Cordis) with a dose of 21 Gy. All patients were discharged with clopidogrel for 12 months and aspirin indefinitely. Six-month angiographic and 12-month clinical outcomes of these patients were compared to 120 patients treated with 18 Gy using the same system. RESULTS: At baseline, patients in the 21-Gy group had more multivessel, vein graft disease and history of prior myocardial infarctions and coronary artery bypass grafts (P<.001). The use of debulking devices and stents was less in this group (P<.001). Procedural and in-hospital complications were similar. Follow-up at 6 months revealed nonsignificant but lower late loss (in-stent, 0.33+/-0.7 mm; in-lesion, 0.41+/-0.6 mm) in the 21-Gy group compared to the 18-Gy group; follow-up at 12 months revealed a trend toward less overall myocardial infarction, although repeat revascularization and MACE rates were similar. CONCLUSIONS: IRT-gamma therapy for diffuse ISR lesions with a 21-Gy dose is clinically safe and feasible with marked reduction in late loss but does not confer additional benefit with regard to repeat revascularization and MACE when compared to a dose of 18 Gy.     

Mortality Following Nonemergent,Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients

Objectives

This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI).

冠状动脉支架内慢性完全闭塞病变介入治疗的长期疗效

目的总结冠状动脉支架内慢性完全闭塞（in—stent chronicto tal occlusion，ISCTO）病变应用经皮冠状动脉介入治疗（percutaneous coronary intervention。PCI）的技术及长期疗效。方法回顾性分析ISCTO135例的临床、介入手术资料及术后长期随访结果，总结PCI治疗技术及经验。结果PCI病变成功率93．2％（136／146），病例成功率94．1％（127／135）。单纯经皮腔内球囊血管成形术（percutaneous transcoronary angioplasty，PTCA）23例（17．0％）。再次置人支架112例（83．0％）。置人的112枚支架中药物洗脱支架94枚（83．9％）。具有支架内闭塞时间超过6个月、绝对性闭塞、闭塞部位呈刀切状、有分支发出、闭塞长度在15mm或以上、病变近端或病变处弯曲在45。或以上特征的ISCTO病变较不具备这些特征的病变PCI成功率降低（88．2％与97．4％，89．7％与98．3％，81．8％与98．0％，82．9％与97．1％，87．8％与98．6％，86．2％与97．7％，P〈0．05）。8例患者10处病变PCI操作失败，其中导丝不能通过ISCTO病变7处，球囊不能跨越病变2处，开通血管后发生无复流1处。术中发生心室颤动1例，急性左心衰竭1例，均处理成功。术后住院期间无主要不良心脏事件发生，心绞痛症状缓解率为89．0％。临床随访4～78个月，造影随访72例（53．3％），发现心绞痛复发23例（17％），靶血管重建16例（11．9％），心脏性猝死4例（3．0％）。结论ISCTO成功PCI因素包括合适的手术时机、适当的手术器械选择及术者的经验及决策。手术难度虽大，但一旦成功，患者将明显受益。     

炎症反应在冠脉支架置入术后再狭窄中的研究进展

炎症反应通过刺激内膜增生在支架置入术后再狭窄的过程中发挥重要作用。支架置入术后局部和系统炎症反应的强度和持续时间直接与患者的预后有关。治疗应该通过抗增生、局部药物释放等方法直接增加局部对促增生炎性刺激的抵抗力和减少机体炎症反应的强度和持续时间。     

Favorable effect of gamma-radiation for in-stent restenosis: effect of diabetes on angiographic and clinical outcomes.

The purpose of this study was to examine the effect of vascular brachytherapy with gamma-radiation (gamma-RT) in patients with diabetes mellitus (DM) with coronary in-stent restenosis (ISR). In the Washington Radiation for In-Stent Restenosis (WRIST) trial, 130 patients with ISR were treated with (192)Ir or placebo. Of the patients enrolled, 44 (34%) had DM (18 of them treated with gamma-RT and 26 with placebo). Gamma-radiation therapy of ISR in diabetics resulted in similar procedural success and in-hospital outcome compared to nondiabetics. At 6-month follow-up, both DM and non-DM patients treated with gamma-RT had significantly lower target lesion revascularization (TLR), target vessel revascularization, and major adverse cardiac event rates compared to placebo. DM remains a powerful predictor of TLR and major adverse cardiac events even after treatment of ISR with gamma-RT.