Chinese expert consensus on the clinical application of drugcoated balloon(2^(nd) Edition)

Percutaneous coronary interventions have progressed through the era of plain balloon dilation, bare-metal stent insertion to drug-eluting stent treatment, which has significantly reduced the acute occlusion and restenosis rates of target vessels and improved patient prognosis, making drug-eluting stents the mainstream interventional treatment for coronary artery disease. In recent years, drug-coated balloons(DCBs) have become a new treatment strategy for coronary artery disease, and the drugs used in the coating and the coating technology have progressed in the past years. Without permanent implant, a DCB delivers antiproliferative drugs rapidly and uniformly into the vessel wall via the excipient during a single balloon dilation. Many evidence suggests that DCB angioplasty is an effective measure for dealing with in-stent restenosis and de novo lesions in small coronary vessels.As more clinical studies are published, new evidence is emerging for the use of DCB angioplasty in a wide range of coronary diseases, and the indications are expanding internationally. Based on the latest research from China and elsewhere, the Expert Writing Committee of the Chinese Expert Consensus on Clinical Applications of Drug-Coated Balloon has updated the previous DCB consensus after evidence-based discussions and meetings in terms of adequate preparation of in-stent restenosis lesions, expansion of the indications for coronary de novo lesions, and precise guidance of DCB treatment by intravascular imaging and functional evaluation.

Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.

Chinese expert consensus on the non-invasive imaging examination pathways of stable coronary artery disease

1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.

Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation

BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty(BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valveimplantation (TAVI).METHODS: This was a retrospective analysis using data from our local TAVI database. SmallBAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as aballoon size >18 mm. The primary endpoint was the incidence of new PPMI.RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existingpermanent pacemaker. Patients in the small BAV group (n=57) had a signifi cantly lower PPMI ratecompared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aorticvalve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3%vs. 8.1%, P=0.480);likewise, the mean aortic gradient post-procedure did not differ significantly(11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Devicesuccess rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV(P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradientby echo in the basement (P=0.021) were independent predictors of PPMI.CONCLUSIONS: The small BAV strategy is associated with a low rate of permanentpacemaker implantation after transcatheter self-expanding valve implantation in this single-centerobservational study.

Nonhypertensive male with multiple paragangliomas of the heart and neck:A case report

BACKGROUND Paraganglioma is a rare disease that can be lethal if undiagnosed.Thus,quick recognition is very important.Cardiac paragangliomas are found in patients who have hypertension.The classic symptoms are the triad of headaches,palpitations,and profuse sweating.We describe a very rare case of multiple paragangliomas of the heart and bilateral carotid artery without hypertension and outline the management strategies for this disease.CASE SUMMARY A 46-year-old man presented with the chief complaint of recently recurrent chest pain with a history of hemangioma of the bilateral carotid artery that had been surgically removed.He was found to have an intracardiac mass in the right atrioventricular groove and underwent successful excision.The final pathology demonstrated that the intracardiac mass was a cardiac paraganglioma,and the patient had an increased level of normetanephrine in the blood.The pathology and immunohistochemistry results showed that the bilateral carotid masses were also paragangliomas.During the 3 mo follow-up period,the patient did not experience recurrence of chest pain.CONCLUSION To our knowledge,this is the first case of multiple paragangliomas of the heart and neck without hypertension.This rare disease can be lethal if left undiagnosed.Thus,quick recognition is very important.The key to the diagnosis of cardiac paraganglioma is the presence of typical symptoms,including headaches,palpitations,profuse sweating,hypertension,and chest pain.Radiology can demonstrate the intracardiac mass.It is important to determine the levels of normetanephrine in the blood.The detection of genetic mutations is also recommended.Surgical resection is necessary to treat the disease and obtain pathological evidence.

A new sequential two-stent strategy for treating true distal left main trifurcation lesion

The incidence of significant left main(LM)coronary artery stenosis identified by coronary angiography was 5%−17.5%in various clinical presentations;about 80%of stenosis involved the LM bifurcation(LMB).[1]Although per-cutaneous coronary intervention(PCI)is an appro-priate alternative to coronary artery bypass graft in LM disease with low-to-intermediate anatomical complexity,[2]PCI for LMB lesions remains the most technically challenging for interventional cardiolo-gists with higher rates of acute periprocedural com-plications and higher risk of long-term major ad-verse cardiac events in the era of drug-eluting stent(DES).

Impact of the gut microbiome on atherosclerosis

Atherosclerosis is a chronic inflammatory metabolic disease with a complex pathogenesis.However,the exact details of its pathogenesis are still unclear,which limits effective clinical treatment of atherosclerosis.Recently,multiple studies have demonstrated that the gut microbiota plays a pivotal role in the onset and progression of atherosclerosis.This review discusses possible treatments for atherosclerosis using the gut microbiome as an intervention target and summarizes the role of the gut microbiome and its metabolites in the development of atherosclerosis.New strategies for the treatment of atherosclerosis are needed.This review provides clues for further research on the mechanisms of the relationship between the gut microbiota and atherosclerosis.

Contemporary characteristics,management,and outcomes of patients hospitalized for atrial fibrillation in China:results from the real-world study of Chinese atrial fibrillation registry

Atrial fibrillation(AF)is a growing public health problem in the context of the epidemiologic transition from communicable to non-communicable diseases,and a high prevalence of AF was found in Chinese patients who died in hospital.[1]Indeed,most understanding of AF is based on findings from clinical trials and observational studies performed in North America and Western Europe,[2]and some studies have described the characteristics of patients with AF in other regions.These data have highlighted the important differences in the clinical characteristics and treatment of patients with AF in these regions.[3,4]However,few studies have investigated the characteristics of patients with AF in China.Hence,the aim of this study was to investigate the clinical demographics,management,and outcomes of patients hospitalized for AF using data from a recently registered AF-specific nationwide cohort study in China,the real-world study of Chinese atrial fibrillation(RWS-CAF)registry.The RWS-CAF registry(registration number:ChiCTR1900021250)comprises a multicenter,observational,prospective cohort that includes consecutive patients requiring hospitalization with a diagnosis of AF made according to the Chinese AF guidelines,spanning from November 1,2017,to October 31,2018.All of the enrolled hospitals are grade A class three hospitals.Individual patients hospitalized with AF who were aged 18 years or older were recruited.

Trends in the prevalence of heart diseases over a ten-year period from single-center observations based on a large echocardiographic database

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 （P〈0.01）. Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 （P〈0.001）. The prevalence of hy- pertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases （CHDs） decreased by about 10% from July 2003 to Dec. 2008 （all P〈0.001）. The prevalence of moderate pulmonary arterial hypertension （PAH） or left ventricular systolic dysfunction （LVSD） decreased during the 10-year period （P〈0.001）, but there was no change in the prevalence of severe PAH or LVSD （P〉0.05）. The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.

Deficiency of mitochondrial aldehyde dehydrogenase increases type 2 diabetes risk in males via autophagy dysregulation

Metrics To the editor:The diabetes epidemic has increasingly become a major public health concern worldwide.In 2014,there were 102.9 million diabetic adults in China,representing 24.4%of the world's diabetic population,even though China only comprised 18.7%of the global population at the time.[1]Furthermore,the estimated overall prevalence of diabetes and prediabetes was 10.9%and 35.7%,respectively,indicating China as one of the countries with the highest prevalence of diabetes in the world.[2]Although factors,including sedentary lifestyles and energy-dense diets,drive the diabetes epidemic,genetic architecture may also contribute to the susceptibility of an individual's response to environmental challenges.Aldehyde dehydrogenase(ALDH)2 is a key enzyme that eliminates toxic aldehydes by catalyzing their oxidation to non-reactive acids.Emerging evidence has suggested that individuals with ALDH2 deficiency have an increased risk of cardiovascular and metabolic diseases,in addition to alcohol intolerance,nitroglycerin tolerance,and carcinoma.[3]Notably,a unique ALDH2 loss-of-function allele,ALDH2∗2,is found in approximately 50%of the East Asian and 8%of the global populations.It has been reported that this ALDH2 mutation is associated with a higher prevalence of diabetes in coronary artery disease(CAD)patients,accompanied with increased C-reactive protein(CRP)levels.[4]ALDH2 mutation is also related to various diabetes risk factors,but the direct correlation remains elusive.Herein,we have explored the potential pathogenicity and mechanisms of ALDH2 deficiency in the development of type 2 diabetes in both laboratory and clinical settings.

Efficacy and safety of Shexiang Baoxin pill(MUSKARDIA)in patients with stable coronary artery disease:a multicenter,double-blind,placebo-controlled phase IV randomized clinical trial

Background:The Shexiang Baoxin Pill(MUSKARDIA)has been used for treating coronary artery disease(CAD)and angina for more than 30 years in China.Nevertheless,methodologically sound trials on the use of MUSKARDIA in CAD patients are scarce.The aim of the study is to determine the effects of MUSKARDIA as an add-on to optimal medical therapy(OMT)in patients with stable CAD.Methods:A total of 2674 participants with stable CAD from 97 hospitals in China were randomized 1:1 to a MUSKARDIA or placebo group for 24 months.Both groups received OMT according to local tertiary hospital protocols.The primary outcome was the occurrence of a major adverse cardiovascular event(MACE),defined as a composite of cardiovascular death,non-fatal myocardial infarction(MI),or non-fatal stroke.Secondary outcomes included all-cause mortality,non-fatal MI,non-fatal stroke,hospitalization for unstable angina or heart failure,peripheral revascularization,angina stability and angina frequency.Results:In all,99.7%of the patients were treated with aspirin and 93.0%with statin.After 2 years of treatment,the occurrence of MACEs was reduced by 26.9%in the MUSKARDIA group(MUSKARDIA:1.9%vs.placebo:2.6%;odds ratio=0.80;95%confidence interval:0.45-1.07;P=0.2869).Angina frequency was significantly reduced in the MUSKARDIA group at 18 months(P=0.0362).Other secondary endpoints were similar between the two groups.The rates of adverse events were also similar between the two groups(MUSKARDIA:17.7%vs.placebo:17.4%,P=0.8785).Conclusions:As an add-on to OMT,MUSKARDIA is safe and significantly reduces angina frequency in patients with stable CAD.Moreover,the use of MUSKARDIA is associated with a trend toward reduced MACEs in patients with stable CAD.The results suggest that MUSKARDIA can be used to manage patients with CAD.Trial registration:chictr.org.cn,No.ChiCTR-TRC-12003513.

Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure： Three-Month Primary End-point Results of PARACHUTE China Study

Background： The primary cause of ischemic heart failure （HF） is myocardial infarction （MI） resulting in left ventricle （LV） wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device （CardioKinetix, lnc., CA, USA） in ischemic HF patients as a result of LV remodeling after anterior wall M1. Methods： Thirty-one patients with New York Heart Association （NYHA） Class I1, I11 ischemic HF, ejection traction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin tbr at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index （LVESVI） against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-SD and visual analog scale （VAS）. For quantitative data comparison, paired t-test （normality data） and signed-rank test （abnormality data） were used： application of signed-rank test was tbr the ranked data comparison. Results： A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ~ 20.0 ml/m-＇ to 53,1 ~ 17.0 ml/m-＂ （P 〈 0.0001 ）, The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than halfa class at 3 months （P 〈 0.001 ）. Quality of life assessed by the VAS value increased 11.5 points （P 〈 0.01 ）, demonstrating improvement at 3 months.Conclusion： The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients. Trial Registration： ClinicalTrials.gov, NCT02240940; https：// clinicaltrials.gov/ct2/show/NCT02240940.

Nine-month Angiographic and Two-year Clinical Follow-up of Novel Biodegradable-polymer Arsenic Trioxide-eluting Stent Versus Durable-polymer Sirolimus-eluting Stent For Coronary Artery Disease

Background:Despite great reduction of in-stent restenosis,first-generation drug-eluting stents (DESs) have increased the risk of late stent thrombosis due to delayed endothelialization.Arsenic trioxide,a natural substance that could inhibit cell proliferation and induce cell apoptosis,seems to be a promising surrogate of sirolimus to improve DES performance.This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES),compared with traditional sirolimus-eluting stent (SES).Methods:Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group.The primary endpoint was target vessel failure (TVF),and the second endpoint includes rates of all-cause death,cardiac death or myocardial infarction,target lesion revascularization (TLR) by telephone visit and late luminal loss (LLL) at 9-month by angiographic follow-up.Results:From July 2007 to 2009,212 patients were enrolled and randomized 1 ∶1 to receive either AES or SES.At 2 years of follow-up,TVF rate was similar between AES and SES group (6.67％ vs.5.83％,P =0.980).Frequency of all-cause death was significantly lower in AES group (0 vs.4.85％,P =0.028).There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis,but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs.0.1 0 ± 0.25 mm,P =0.008).Conclusions:After 2 years of follow-up,AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.

Current status of percutaneous coronary intervention of chronic total occlusion

This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%-20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient's angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.

Short-term Safety and Efficiency of Cryoablation for Rena Sympathetic Denervation in a Swine Model

Background:Renal sympathetic nerves are involved in the reflective activation of the sympathetic nervous system in circulatory control.Catheter-based renal denervation (RDN) ameliorated treatment-resistant hypertension safely,but 10％-20％ of treated patients are nonresponders to radiofrequency denervation.The purpose of this study was to investigate the safety and efficiency of cryoablation for sympathetic denervation in a swine model and to explore a new way of RDN.Methods:Seven swines randomly assigned to two groups:Renal cryoablation (CR) group and control group.The control group underwent renal angiogram only.The CR group underwent renal angiogram plus bilateral renal cryoablation.Renal angiograms via femoral were performed before denervation,after denervation and prior to the sacrifice to access the diameter of renal arterial and the pressure of aorta abdominalis.Euthanasia of the swine was performed on 28-day to access norepinephrine (NE) changes of the renal cortex and the changes of renal nerves.Results:Cryoablation did not induce severe complications at any time point.There was no significant change in diameter of renal artery.CR reduced systolic blood pressure (BP) from 145.50 ± 9.95 mmHg at baseline to 119.00 ± 14.09 mmHg.There was a slight but insignificant decrease in diastolic BP.The main nerve changes at 28-day consisted of necrosis with perineurial fibrosis at the site of CR exposure in conjunction with the nerve vacuolation.Compared with the control group,renal tissue NE of CR group decreased by 89.85％.Conclusions:Percutaneous catheter-based cryoablation of the renal artery is safe.CR could effectively reduce NE storing in the renal cortex,and the efficiency could be maintained 28-day at least.

Factors underlying the association of body mass index with serum ALT in Chinese hypertensive adults without known hepatic diseases

Objective： High body mass index （BMI） is considered as the most important risk factor for elevated serum alanine aminotransferase （ALT） concentration. This study examined an array of factors, including waist circumference （WC） and folate deficiency, which may mediate the association of BMI with serum ALT concentration in Chinese hypertensive adults without known hepatic diseases. Methods： A multicenter, cross-sectional study was carried out. A total of 378 patients with mild or moderate hypertension and without known hepatic diseases were recruited from five hospitals in Harbin, Shanghai, Beijing, Xi＇an, and Nanjing. Results： Of the 360 hypertensive patients with complete data in our final analysis, 13.6% had high ALT concentrations （〉40 IU/L）. Factors including BMI, WC, triglycedde level, and folate concentration were associated with ALT concentration in univariate analysis. Consistently higher preva- lence rates of elevated ALT were observed in subjects with lower folate concentrations （≥12 vs. 〈12 nmol/L, 9.9% vs. 17.8%, P=-0.03）, with higher BMI （≥28 vs. 〈28 kg/m2, 21.5% vs. 11.4%, P=-0.02） or higher WC （≥90 vs. 〈90 cm, 18.5% vs. 10.0%, P=-0.02）. However, in multivariate analysis, the association between BMI and ALT concentration disap- peared （P=-0.802 in males and 0.369 in females）, while WC in females （P〈0.001） and folate concentration （P=-0.036 in males and 0.044 in females） remained as significant predictors for ALT concentration. Conclusions： This multicenter study demonstrated that WC and low folate concentration were important factors underlying the association between BMI and ALT concentrations in Chinese hypertensive adults without known hepatic diseases.

Morphological Evidence of Telocytes in Mice Aorta

Background： Telocytes （TCs） are a novel type of interstitial cells, which have been recently described in a large variety of cavitary and noncavitary organs. TCs have small cell bodies, and remarkably thin, long, and moniliform prolongations called telopodes （Tps）. Until now, TCs have been found in various loose connective tissues surrounding the arterioles, venules, and capillaries, but as a histological cellular component, whether TCs exist in large arteries remains unexplored. Methods： TCs were identified by transmission electron microscope in the aortic arch of male C57BL/6 mice. Results： TCs in aortic arch had small cell bodies （length： 6.06-13.02 μm： width： 1.05-4.25 μm） with characteristics of specific long （7.74-39.05 μm）, thin, and moniliform Tps; TCs distributed in the whole connective tissue layer of tunica adventitia： TCs in the innermost layer of tunica adventitia, located at the juncture between media and adventitia, with their long axes oriented parallel to the outer elastic membrane： and TCs in outer layers oftunica adventitia, were embedded among transverse and longitudinal oriented collagen fibers,forming a highly complex three-dimensional meshwork. Moreover, desmosomes were observed, serving as pathways connecting neighboring Tps. In addition, vesicles shed from the surface of TCs into the extracellular matrix, participating in some biological processes. Conclusions： TCs in aorta arch are a newly recognized complement distinct from other interstitial cells in large arteries, such as fibroblasts. And further biologically functional correlations need to be elucidated.

Balloon-expanding stent and delivery system for transcatheter aortic valve implantation:An animal study

Objective: To evaluate the feasibility and satefy of transcatheter aortic valve implantation in animals by using a new balloon-expanding valved stent. Methods: The balloon-expandable stent is made from cobalt-based alloy material and designed with a tubular, slotted structure. Fresh bovine pericardium was treated, sutured and fixed on the balloon-expandable stent. Ten healthy sheep (five males and five females), weighing an average of (25.16 ± 1.83) kg, were selected to undergo transcatheter implantation of the valve stents. The function of the valve stent was evaluated by angiography, echocardiography, and histology six months after the procedure. Results: Of the ten experimental sheep, two sheep died during the operation because the higher position of the artificial valve affected the opening of the coronary artery. We successfully implanted the aortic valve stent in other eight sheep;however, one sheep died of heart failure two weeks after the operation due to the lower position of the valve stent. The valve stents were implanted in the desired position in seven sheep. Ascending aortic angiographic and autoptic findings immediately after the operation confirmed the satisfactory location and function of the valved stent. Echocardiography, angiography, and histology at six post-operative months confirmed the satisfactory location and function of the valve stent. Conclusion: We successfully implanted our new valve stent as a replacement of native aortic valve via the transcatheter route with satisfactory outcome. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

First-in-man Implantation of the XINSORB Bioresorbable Sirolimus-eluting Scaffold in China

To the Editor：A 35-year-old man who smoked for 15 years suffered from chest pain 12 days ago before admission.He was diagnosed as myocardial infarction.Thrombolytic therapy was given consequently.The electrocardiogram showed sub-acute inferior wall myocardial infarction.Echocardiogram showed attenuated constriction of the inferior wall with an ejection fraction of 59％.On September 5,2013,he was treated with a XINSORB scaffold in right coronary artery （RCA）.

Current status of percutaneous coronary intervention of chronic total occlusion

This paper describes the current status of percutaneous coronary intervention (PCI) for totally occluded coronary arteries. Chronic total occlusion is associated with 10%-20% of all PCI procedures. Results show that opening an occluded vessel, especially one supplying a considerable area of myocardium, may be beneficial for a patient's angina relief and heart function. We describe the devices used currently in re-canalization such as new wires, microcatheters (including Tonus and Cosair) and intravascular ultrasound guidance. Different techniques to improve the success rate and reduce complications are discussed in detail.