Non-invasive Assessment of Coronary Flow Velocity Reserve: A New Method Using Transthoracic Doppler Echocardiography

Coronary flow reserve (CFR) has been used toassess coronary microcirculation and epicardial coro-nary stenoses[1— 3 ] . CFR is defined as the ratio ofcoronary flow under maximal coronary vasodilatationto coronary flow under resting conditions[4 ] .Whenthe cross- sectional area of epicardial coronary arteriesis constant,coronary flow velocity (CFV) ratios areequal to volume flow ratios.The most common method used clinically formeasuring CFVR is intracoronary Doppler flow(ICD) analysis re…     

Effect of Shuxinyin (舒心饮) on In-Stent Restenosis after Coronary Artery Stenting

Objective: To evaluate the effect of anti-platelet regimens and it's combination with Shuxinyin (SXY, 舒心饮,) on in-stent restenosis after stent implantation. Methods: Forty-four patients with successful stent implantation in a coronary artery were randomly assigned to the treated group (n=20) and the control group (n=24). The treated group received: SXY and anti-platelet therapy. The control group were treated with anti-platelet regimens only. Platelet activation was assessed before and immediately after the stenting by flow cytometry, the expression of P-selectin (CD62P) and glycoprotein(GP) Ⅱb/Ⅲa receptor. It was reassessed on the 30th day after stenting. Plasma fibrinogen (Fg) and C-reaction protein (CRP) were measured by biuret and laser scattering turbidimetry respectively at the same time. Observation was made on the scoring of the symptoms of Qi deficiency syndrome, Qi-Yin deficiency syndrome and blood stasis syndrome in the two groups. Differences between groups were compared. Results: Compared with the control group, combination with SXY and anti-platelet therapy was remarkable in reducing plasma CRP (P<0.05), and also with the tendency to decrease plasma Fg, GPⅡb/Ⅲa and CD62P. It could also evidently decrease the scoring of Qi-Yin deficiency syndrome, Qi deficiency syndrome and blood stasis syndrome after stenting (P<0.05, 0.01, 0.01) respectively. Follow-up survey found 40% relapse of angina pectoris with 4 cases of in-stent restenosis proved by angiography in the treated group. But the relapse of angina pectoris in the control group was 67% with 2 cases of myocardial infarction (MI), 7 cases of in-stent restenosis proved by angiography and one death. Conclusions: Combination with SXY and anti-platelet regimens can prevent stent thrombosis and in-stent restenosis after stent implantation, and it seems superior to anti-platelet therapy only.     

Long-term Results of Primary Stent Placement to Treat Infrarenal Aortic Stenosis

OBJECTIVE: To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. DESIGN: Retrospective observational study. PATIENTS AND METHODS: From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. RESULTS: Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. CONCLUSION: Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.     

ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.     

肾动脉狭窄支架植入术的临床疗效观察

目的探讨肾动脉狭窄支架植入术的临床疗效.方法1997年1月～2004年12月,我院行支架介入治疗肾动脉狭窄27例.对27例术前、术后及随访期内血压、肾功能以及生活质量进行评估,并与同期单纯药物治疗肾动脉狭窄27例进行比较.结果介入组27例植入支架40枚,手术成功24例(88.9%,24/27),失败3例(11.1%,3/27),手术并发症5例(18.5%,5/27).术后在血压下降(包括收缩压舒张压)肌酐下降,肾小球滤过率增加方面,介入组获益率明显优于药物组,两组比较差异均有显著性,术后随访6个月～8年6个月,中位数为1年9个月,介入组有19例能比较健康的生活和工作,药物组仅12例能维持生活和工作.结论支架介入治疗较单纯药物治疗肾动脉狭窄疗效显著.     

Stenting of coronary bifurcation lesions by using modified crush technique with double kissing balloon inflation (sleeve technique): immediate procedure result and short-term clinical outcomes.

BACKGROUND: Sleeve technique is a modified version of crush technique. It is specifically designed to increase the success rate of final kissing balloon inflation, which used to be a major limitation of the latter. OBJECTIVES: The aim of this study was to examine the feasibility, safety, and early clinical outcomes of sleeve technique in stenting different types (de novo, in-stent restenotic or in-stent bifurcation) of coronary bifurcation lesions at different locations. METHODS: From August 2005 to May 2006, 41 consecutive patients with symptomatic, nonleft-main coronary bifurcation stenoses of diameter narrowing >or=50% were treated with two-stent strategy, using sleeve technique. RESULTS: The mean age was 63.6 +/- 11.6 years with male predominance (70.7%). High prevalence of diabetes mellitus (31.7%), total occlusion (22.0%), and multi-vessel disease (65.9%) was observed in this cohort. Intravenous abciximab was given in 35 (85.4%) patients. Final kissing balloon inflation was successfully performed in all patients. The minimal luminal diameter in main vessel and side branch was increased from 0.97 +/- 0.53 mm and 0.81 +/- 0.45 mm to 2.76 +/- 0.34 mm and 2.22 +/- 0.35 mm, respectively. The mean procedure time was only 66.6 +/- 24.6 min. There was one (2.4%) case of subacute stent thrombosis presented as non-Q-wave myocardial infarction at day 3 postprocedure. The resultant in-hospital and 30-day major adverse cardiac event rate were both 2.4%. CONCLUSIONS: Sleeve technique is a feasible and efficient approach in stenting of coronary bifurcation stenoses.     

经皮冠状动脉腔内切割球囊成形术的临床应用

目的　评价经皮冠状动脉腔内切割球囊成形术 (CBA)治疗初治病变和支架内再狭窄的疗效。　方法　 35例冠心病病人 (初治病人 7例 ,支架内再狭窄病人 2 8例 )施行CBA。左前降支病变 2 5处 ,左回旋支病变 10处 ,右冠病变 7处。初治病变平均狭窄 (85 9± 7 2 ) % ,支架内再狭窄的平均狭窄程度是 (89 6± 8 9) %。CBA后即刻行冠脉造影评价近期手术成功率 ,随后严格的临床随访每个月 2次 ,共 6个月 ,以评价中期疗效。　结果　共使用切割球囊 4 2个 ,直径 (3 2± 0 3)mm(3 0～ 3 75mm) ,长度 10～ 15mm ,扩张压力 (72 7± 6 0 )kPa(6 0 6～ 10 10kPa) ,扩张次数 (5 0± 2 1)次 (4～ 7次 ) ,扩张时间 (2 0 3 6± 90 8)s。CBA近期手术成功率 10 0 % ,无严重冠脉闭塞等并发症。术前病变的狭窄程度为 (89 6± 8 9) % ,术后残余狭窄为 (8 8± 3 7) % (P <0 0 1)。 6个月随访未发现心绞痛复发 ,心电图和超声心动图无心肌缺血加重的证据。　结论　切割球囊不论对初治还是冠状动脉支架内再狭窄的病人 ,都是安全有效的介入治疗方法 ,其近期手术成功率高 ,中期的临床疗效确切。     

NEW METHOD OF STENTING TREATMENT FOR MALIGNANT DUODENAL STENOSIS: USING DOUBLE‐BALLOON ENTEROSCOPY

Recently, a self‐expandable metallic stent has been recognized for treatment of malignant duodenal stenosis. But the complications by stenting are important problems even now. In the present study, we report our new method of duodenal stenting by using of double‐balloon enteroscopy considered safe and effective.