Sustainable Antirestenosis Effect With a Low-Dose Drug-Coated Balloon: The ILLUMENATE European Randomized Clinical Trial 2-Year Results

Objectives

The aim of this study was to assess the safety and effectiveness of a next-generation low-dose drug-coated balloon (DCB) designed to optimize the amount of drug transferred into the vessel wall and to maximize the amount of time the drug resides in the vessel wall.

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.     

Myocardial viability assessment and utility in contemporary management of ischemic cardiomyopathy

BackgroundIn clinical practice, we encounter ischemic cardiomyopathy (ICM) with underlying viable, dysfunctional myocardium on a regular basis. Evidence from the Surgical Treatment for Ischemic Heart failure (STICH) and its Extension Study is supportive of improved outcomes with coronary revascularization, irrespective of myocardial viable status. However, Dobutamine stress echocardiography (DSE) and single‐photon emission computed tomography (SPECT), used in STICH to assess myocardial viability may fail to distinguish hibernating myocardium from scar due to suboptimal image resolution and poor tissue characterization.HypothesisCardiac magnetic resonance (CMR) and positron emission tomography (PET) can precisely quantify myocardial scar and identify metabolically active, viable myocardium respectively. Unlike DSE and SPECT, CMR and PET allow examining myocardial status as a contiguous spectrum from viable to partially viable myocardium with varying degrees of subendocardial scar and nonviable myocardium with predominantly transmural scar, the therapeutic and prognostic determinants of ICM.MethodsUnder the guidance of CMR and PET imaging, myocardium can be distinguished viable from partially viable with subendocardial scar and predominantly transmural scar. In ICM, optimal medical therapy and coronary revascularization of viable/partially viable myocardium but not transmural scar may improve outcomes in patients with acceptable procedural risk.ResultsCoronary revascularization of partially viable and viable myocardial territory may improve clinical outcomes by preventing future ischemic, infarct events and further worsening of left ventricular remodeling and function.ConclusionsWhen deciding if coronary revascularization is appropriate in a patient with ICM, it is essential to take a patient‐tailored, comprehensive approach incorporating myocardial viability, ischemia, and scar data with others such as procedural risk, and patient''s comorbidities.     

2型糖尿病合并急性冠状动脉综合征患者血运重建预后的评价

目的探讨2型糖尿病合并急性冠状动脉综合征(acute coronary syndrome,ACS)患者经血运重建治疗对远期预后的影响。方法选择ACS患者424例,根据是否合并糖尿病分为糖尿病组(120例)和无糖尿病组(304例)。分析两组患者冠状动脉造影、冠状动脉支架置入术的临床资料以及两组患者术后2年的随访资料。结果糖尿病组患者冠状动脉3支、多支、闭塞性病变比率明显高于无糖尿病组(P<0.05):糖尿病组患者不完全血运重建的比率高于无糖尿病组,完全血运重建的比率低于无糖尿病组(P<0.05):糖尿病组惠青生活质量改善率低于无糖尿病组,重大心血管事件的发生率高于无糖尿病组(P<0.05)。结论糖尿病合并ACS患者冠状动脉以3支、多支、重度、闭塞病变为主的特点,且其远期预后较差。     

益气养阴活血中药对急性心肌梗死患者血运重建后心室壁运动的影响

目的 观察益气养阴活血中药对急性心肌梗死（AMI）患者血运重建后心室壁运动和收缩功能的影响。     

蛛网膜对儿童缺血型烟雾病间接颅内外血管重建术疗效的影响

目的探讨儿童缺血型烟雾病行间接颅内外血管重建术时打开蛛网膜对术后血管重建疗效的影响。方法回顾性分析2010年8月至2015年11月21例(28侧)行间接颅内外血管重建术的儿童缺血型烟雾病患者临床资料,术中打开蛛网膜组12例(18侧),术中未打开蛛网膜组9例(10侧);术后12个月时复查MRI和DSA以及结合临床症状来评价打开蛛网膜与未打开蛛网膜组颅内外血管重建术后疗效。结果两组术后均有不同程度侧支循环形成及PWI改善,术中打开组术后12月时DSA侧支循环的良好及一般率达94.44%明显优于未打开组的60%,且构成的差异有统计学意义(P0.05);两组术后临床症状改善差异无统计学意义,而术中打开蛛网膜组的优秀及良好率达88.89%,高于未打开组的60%;两组并发症差异无统计学意义。结论术中打开蛛网膜较未打开者可能更有利于改善儿童缺血型烟雾病间接颅内外血管重建术的疗效。     

颌内动脉搭桥治疗颅内巨大动脉瘤

目的 探讨颌内动脉与颅内动脉搭桥治疗复杂性动脉瘤的方法.方法 22例颅内巨大动脉瘤患者,颈内海绵窦段8例,大脑中动脉6例,眼动脉段4例,床突上段1例,椎-基底动脉交接处2例,基底动脉下段1例.瘤体有重要穿通动脉发出9例.3例经弹簧圈治疗后,动脉瘤复发.取7 cm桡动脉做移植血管,先行颌内动脉与桡动脉端-端吻合.颈内动脉瘤做桡动脉与中动脉M2起始部端-侧吻合,椎基底动脉瘤做大脑后动脉P2段近端行端-侧吻合.动脉搭桥后,16例海绵窦段和床突上段动脉瘤做孤立术,6例动脉瘤有穿动脉发出,仅作动脉瘤近端阻断远端开放,使搭桥血流逆流入动脉瘤体内,保持穿通动脉血流.结果 20例术后恢复良好,移植搭桥血管畅通,动脉瘤消失.2例吻合血管未通,但无缺血性神经功能缺失表现.22例患者经3个月-3.3年随访,21例恢复正常生活,1例因患其他疾病需要照顾.结论 用桡动脉移植,颌内动脉作为供血动脉与颅内动脉搭桥,可得到较高的搭桥通畅率和较小的损伤效果.     

全动脉化非体外循环冠状动脉搭桥术的临床应用

目的探讨全动脉化非体外循环冠状动脉旁路移植术(冠脉搭桥术)的手术技术、安全性和近中期手术效果。方法 2004年3月～2012年4月接受全动脉化非体外循环冠脉搭桥术(包括微创冠脉搭桥)患者35例,人均搭桥2.7支(1～4支)。其中常规开胸非体外循环冠脉搭桥30例,胸腔镜辅助下微创冠脉搭桥5例。同期行体外循环下全动脉化冠脉搭桥8例,同期行一根乳内动脉和静脉做常规非体外循环冠脉搭桥248例,比较不同手术方式的死亡率、并发症、桥血管数目和近中期疗效等。结果全动脉化非体外循环冠脉搭桥术后仅1例患者因胸骨感染死亡,34例症状明显改善顺利出院,随访效果均良好,无心绞痛发作,心功能明显改善。结论全动脉化非体外循环冠状动脉旁路移植术临床效果较好,并发症及死亡率较体外循环下搭桥少,总的风险更低,但因患者病变、病情及各种因素,本术仍不能完全取代冠状动旁路移植术。     

3-D多孔结构的小肠黏膜下组织在兔膀胱再生中的应用

目的 探讨3-D多孔结构的小肠黏膜下组织(small intestine submucosa,SIS)在新西兰大白兔膀胱再生中的应用.方法 用物理及化学方法制备具有3-D多孔结构的SIS.将24只雄性新西兰大白兔随机分为3组(n=8),分别行膀胱半切术建立膀胱缺损模型,使用3种不同处理的SIS进行膀胱重建.A组:未经过氧乙酸(peroxyacetic acid,PAA)处理的SIS组;B组:PAA处理的SIS组;C组:PAA处理后100％胎牛血清浸润的SIS组.3组在术前及术后4周测定膀胱容量,并于术后4周取材,行大体观察及组织学检测,评估膀胱再生情况.结果 应用SIS行兔膀胱重建术后4周,3组再生膀胱组织与周围组织粘连依次降低,结石率分别为33.3％、28.6％、14.31％.与术前自身比较,术后4周3组膀胱最大容量均缩小且依次增加,组间比较差异有统计学意义(P＜0.05).术后组织学检测示3组膀胱上皮细胞均有再生,与A组比较,B、C组的上皮再生更好,边缘区和中心区无明显差异.3组膀胱平滑肌的再生均不理想,但边缘区平滑肌再生较中心区多;在边缘区和中心区,组间比较差异有统计学意义(P＜0.05).3组在边缘区和中心区的再生血管面积依次增加,3组间比较差异有统计学意义(P＜0.05).结论 经PPA及胎牛血清处理后3-D多孔结构的SIS,具有良好的促进膀胱组织再生能力,是一种比较理想的修复支架材料.     

Multivessel coronary revascularization with bilateral internal thoracic artery grafts

Sixteen patients underwent coronary revascularization with bilateral internal thoracic artery (ITA) grafts between 1988 and 1989 at the Okayama University Hospital. A total 39 coronary grafts were performed, being an average of 2.4 grafts per patient. Each patient received bilateral ITA grafts, and in 5 patients an additional 7 grafts were constructed with 5 autologous veins and 2 gastroepiloic arteries. The right ITA was grafted as a free graft in 4 patients. The ITA graft patency rate was 96.8 per cent (31/32) at the time of hospital discharge. The postoperative morbidity included one reoperation for bleeding and one myocardial infarction. Coronary artery bypass grafting with bilateral ITA grafts can be safely performed and its application facilitates complete revascularization with arterial grafts.