支架术治疗颈动脉狭窄的临床研究

目的　观察支架术治疗颈动脉狭窄的近期疗效 ,探讨临床应用中的相关问题。方法　将临床经颈部B超、脑血管造影确诊的颈动脉狭窄患者 10 8例 ,实施颈动脉支架术 ,15例行预扩张 ,12例后扩张成形 ,9例使用滤器装置 ,围手术期给予抗血小板聚集等治疗。结果　 2例手术失败 ;术后 2例发生脑出血 ,1例脑栓塞 ,1例支架内血栓形成 ,除 1例脑出血死亡外 ,3例治疗后恢复 ;1～ 6个月的随访中 ,10 5例患者无复发。手术并发症发生率低 ,近期疗效满意。结论　颈动脉狭窄段支架术治疗颈动脉狭窄具有可行性 ,近期疗效肯定 ,是临床上有推广潜力的治疗颈动脉狭窄的方法 ,但远期疗效尚需进一步观察。     

Multiphoton microscopy for pre-clinical evaluation of flow-diverter stents for treating aneurysms

BackgroundConventional histological analyses are the gold standard for the study of aneurysms and vascular pathologies in pre-clinical research. Over the past decade, in vivo and ex vivo imaging using multiphoton microscopy have emerged as powerful pre-clinical tools for detailed tissue analyses that can assess morphology, the extracellular matrix (ECM), cell density and vascularisation. Multiphoton microscopy allows for deeper tissue penetration with minor phototoxicity.ObjectiveThe present study aimed to demonstrate the current status of multimodality imaging, including multiphoton microscopy, for detailed analyses of neo-endothelialisation and ECM evolution after flow-diverter stent (FDS) treatment in an experimental rabbit model of aneurysms.MethodsMultiphoton microscopy tools for assessing autofluorescence and second harmonic generation (SHG) signals from biological tissues were used to evaluate the endovascular treatment of intracranial aneurysms in an animal model of aneurysms (pig, rabbit). Results from multiphoton microscopy were compared to those from standard histology, electronic and bright field microscopy.ConclusionsThe present study describes novel evaluation modes based on multiphoton microscopy for visualising tissue morphology (e.g., collagen, elastin, and cells) to qualify and quantify the extent of neo-intimal formation of covered arteries and device integration into the arterial wall using a rabbit model of intracranial aneurysms treated with FDS.     

CO-ADMINISTRATION OF FUROSEMIDE AUGMENTS TACROLIMUS-INDUCED IMPAIRMENT IN KIDNEY FUNCTION IN RATS

Sodium-depletion in rats reproduces functional and morphological tacrolimus nephrotoxicity observed in man. Potent diuretics induce sodium-depletion. Our objective was to determine the effect of a loop diuretic furosemide on tacrolimus-mediated functional and pathological impairment of the kidney in rats. Sprague-Dawley rats were divided into four groups; group 1, rats received vehicle (saline) only; group 2, rats were treated with tacrolimus (1mg/kg body weight) and furosemide (5mg/kg body weight); group 3, rats were treated with tacrolimus alone; and group 4, rats were treated with furosemide (5mg/kg body weight) alone. On day 28, tail blood pressure was measured and the rats were placed in metabolic cages for urine collection. After 24 hr the rats were sacrificed. Tacrolimus alone tended to cause growth retardation, hypotension, hypomagnesemia and a rise in blood urea nitrogen. Furosemide co-administration enhanced the effects of tacrolimus on hypotension, hypomagnesemia and a rise in blood urea nitrogen. The renal histology characterized by cytoplasmic vacuolization of the proximal tubules was not different between the rats treated with both tacrolimus and furosemide and the rats treated with tacrolimus alone. A strong immunostaining for FKBP-12, a tacrolimus-binding protein, was observed in the medulla of the kidneys of rats treated with tacrolimus either with or without furosemide.These results indicate that furosemide further augments tacrolimus induced impairment in kidney function, and that furosemide should be used with discretion in patients on tacrolimus therapy.     

Successful coronary angiography with adequate image acquisition using a combination of gadolinium and a power injector in a patient with severe iodine contrast allergy

A history of severe allergic reaction to iodine contrast leading to anaphylactic shock presents a dilemma in patients requiring cardiac catheterization. As an alternative, gadolinium has been an interesting and potentially useful agent. However, gadolinium produces poor image quality and has been associated with significant arrhythmias in small case series. Furthermore, there is no consensus about the maximal allowable dose that can be administered to a patient. In the present report, a successful combination of gadolinium contrast with a power injector that produced adequate image quality in a patient with severe allergy to iodine contrast is described. The case was complicated by the occurrence of ventricular fibrillation when damping occurred during injection of contrast into the right coronary artery. This complication has been reported previously with intracoronary gadolinium injection. The report is followed by a brief literature review.     

Transcatheter ductus arteriosus stenting in paediatric cardiology: Indications,results and perspectives

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多种形式集体宣教在药物涂层冠脉支架手术患者中的应用效果

目的:评估多种形式集体宣教在药物洗脱支架手术患者中的应用效果。方法:选取2013年3月~2013年8月入院的107名患者为实验组,自2013年9月~2014年2月入院的106患者为对照组,术前和术后采取问卷调查的形式,分别对实验组多种形式的医疗知识宣教与对照组传统的单一模式宣教进行比较。结果:经过比较发现进行多种形式宣教后的患者对教育内容的掌握程度(84.1%)高于传统的单一模式宣教(68.9%)(P<0.05),并且焦虑程度较低,宣教满意率也较高。结论:多种形式集体宣教方法多,人力资源消耗相对较少,更加促进了医患之间的相互信任与合作。     

老年冠心病患者冠状动脉内支架术的疗效研究

目的：探讨老年冠心病患冠状动脉内支架术的近期疗效和对远期预后的影响。方法：2000年6月-2002年6月连续240例冠心病患行选择性冠状动脉内支架术，其中86例年龄＞65岁(A组)，154例＜65岁(B组)，比较两组支架术成功率及远期随访结果。结果：A组中84例支架术成功(97．7％)，并发症率9．30％。B组中150例支架术成功(97．4％)，并发症率4．55％，两组差异均无显性(P＞0．05)。随访12．5土6．5个月，随访率95．7％。A、B两组的心功能改善(54．7％和51．9％)、心绞痛复发(30．2％和36．4％)、再入院(18．6％和20．1％)、总心脏事件发生率(18．6％和22．7％)及无心脏事件存活率(86．0％和85．1％)均无显性差异(P＞0．05)。结论：老年患冠状动脉内支架术安全、成功率高，且远期预后良好。     

AVE Micro Ⅱ型冠状动脉内支架的临床应用

目的：为评价AVEMicroⅡ型冠状动脉内支架在冠心病（CHD）患者治疗中的安全性和有效性。方法：自1996年7月至1997年4月，82例CHD患者使用了AVEMicroⅡ型冠脉支架，在100个病变中，49个为B型病变，51个为C型。结果：本组共用125个支架，成功置人117个（93．6％）。AVEMicroⅡ型冠脉支架血管造影成功率为93／98（94.9％）。5个支架（6．1％）置入失败。其中1例出现支架从球囊上脱落但无并发症。并发症为1例出现亚急性闭塞，和1例非致命性AMI。无死亡和急诊冠状动脉搭桥术（CABG）。在对74／75（987％）成功病例进行的平均6．6±2.5月的随访表明，58例（78．4％）病例为加拿大心血管学会（CCS）心绞痛分级0至1级，16例2至3级病人15例为多支血管病变。6例（81％）有再狭窄，其中4柳成功行经皮经腔冠脉球囊成形术（PTCA），2例行CABG。结论：本组资料显示，AVEMicroⅡ型冠脉支架适合于复杂病变的支架置入术，且成功率高，并发症和再狭窄率低。