血管内超声以及冠状动脉造影引导下支架植入术效果比较的meta分析

目的血管内超声(IVUS)引导植入支架的效果目前仍存在争议,该研究旨在探讨血管内超声以及传统造影(Angiography)引导下支架植入效果在临床上的优劣比较。方法全面检索2000年1月—2014年6月国内外研究文献,筛选出符合评价标准的文献,采用Rev Man5.0软件进行分析。以支架植入术后死亡、心肌梗死、靶血管血运重建、支架内血栓形成以及主要心血管不良事件为主要临床终点,分析血管内超声与血管造影植入支架效果之间的差异。结果血管内超声引导下支架植入术后心肌梗死(RR=0.67,95%CI:0.56~0.81;Z=4.08,P<0.0001)、靶血管血运重建(RR=0.76,95%CI:0.66~0.87;Z=3.87,P=0.0001)、支架内血栓形成(RR=0.62,95%CI:0.47~0.82;Z=3.35,P=0.0008)以及主要不良事件(RR=0.82,95%CI:0.73~0.91;Z=3.62,P=0.0003)的发生率均低于传统造影下支架植入术,差别有统计学意义。结论说明血管内超声支架植入术能显著降低术后心梗、靶血管血运重建、支架内血栓及主要不良时间的发生,相比传统冠脉造影更能让患者获益。     

Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary Intervention

Objectives

The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.

Coronary angiogram classification of spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is under‐diagnosed and the true prevalence is underestimated. Unfortunately, SCAD is frequently missed on coronary angiogram since the arterial wall is not imaged with this test. Optical coherence tomography or intravascular ultrasound should be the true gold‐standard to diagnose SCAD. Given the elusive angiographic diagnosis of SCAD and the lack of familiarity with angiographic variants of SCAD, a diagnostic algorithm and angiographic classification for SCAD is proposed in this article. © 2013 Wiley Periodicals, Inc.     

Assessing Bioresorbable Coronary Devices: Methods and Parameters

Bioresorbable vascular scaffolds (BRS) represent a novel approach to provide transient vessel support to drug-delivery capability without the long-term limitations of metallic drug-eluting stents (DES). The technology has the potential to overcome many of the safety concerns associated with metallic DES and possibly even convey further clinical benefit. In particular, the BRS are designed to provide short-term lumen support, and after being completely bioresorbed, eliminate the permanent caging typical of metallic DES. However, this technology has required new imaging modalities and methodologies for its assessment because the design, degradation rate, loss of mechanical property, and drug deliverability may affect its safety and efficacy. We provide an overview of all existing methods for assessing bioresorbable devices, from noninvasive to invasive, from light to sound based, and from morphological to functional parameters.     

冠状动脉钙化病变识别与评估进展

冠状动脉钙化（CAC）在很多复杂性冠状动脉病变中都有所涉及,使得经皮冠状动脉介入治疗（PCI）难度大大增加,给心脏介入临床带来了很大的挑战。而预先准确评估冠状动脉的钙化病变对于后续治疗有着至关重要的影响。近年来,随着医学领域对冠状动脉钙化病变研究的不断深入,在临床中可以通过许多其他针对冠脉的检查,来帮助完成对钙化病变的预先评估,从而规避了介入治疗的风险,改善了介入治疗的预后。本文分别从冠状动脉计算机断层扫描（computed tomography angiography,CTA）、冠状动脉造影（coronary angiography,CAG）、冠状动脉血管内超声（intravascular ultrasound,IVUS）及光学相干成像（optical coherence tomography,OCT）4种临床常用辅助检查的角度,详细分析各种技术手段所存在优势与不足,并强调在实际临床工作中,我们需要将无创手段与冠状动脉造影相结合完善冠状动脉钙化病变介入治疗。