Clinical and angiographic characteristics of asymptomatic restenosis after PCI

Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.

Clinical Signifi cance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma

Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.

Assessment of Coronary Flow Velocity Reserve by Noninvasive Transthoracic Doppler Echocardiography in Patients with Angiographically Normal Coronary Arteries

Summary： The measurement of coronary flow velocity reserve （CFVR） by transthoracic Doppler echocardiography （TTDE） with invasive intracoronary Doppler flow wire technique （ICD） was validated and the pathological factors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery （LAD） in 37 of 40 patients with angiographically normal coronary arteries （men 22, women 15, age 20-75 years, mean age 54±12 years）. Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 110 μg/ kg per min within 48 h after ICD technique. Average peak velocity at baseline （APVb）, average peak velocity during hyperemia （APVh） and CFVR determined from TTDE were correlated closely with those from ICD measurements （APVb： y= 0. 64x＋ 5. 04, r=0. 86, P〈0. 001; APVh： y=0. 63x＋14. 36, r=0.82, P〈0.001; CFVR： y=0.65xq-0.92, r=0.88, P〈0.001）. For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension （P〈0.05）. Intravascular ultrasound （IVUS） was performed in 34 patients. Plaque formation was found in LAD by IVUS in 17 （50%） patients. No significant difference in CFVR was found between the patients without plaque formation （3. 11±0. 49） and those with plaque formation （2. 76±0.53, P=0. 056）. It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal I.AD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.

Angiographic “misery collaterals”-grave findings!

Object With the broad application of endovascular aneurysm coiling on grade IV and V patients, the specific angiographic findings of grave prognosis could be detected. This unique finding will be considered as an indicator which would be the urgent treatment option between aggressive ICP control including EVD/decompressive craniectomy and continuing coiling. Methods Very interesting angiographic finding could be found in 7 cases of grave IV & V SAH patients and 3 cases of procedural rupture cases. Especially in the procedural rupture cases, these abnormal collaterals could be disappeared easily with the aggressive medical ICP control as early this finding was detected as possible. Conclusions The author names it “misery collaterals” and it has been defined as whole intracranial large vessels are seen on one vessel angiography.It has been caused by severe brain edema and pressurized contrast injection which has changed the flow hemodynamics through A-com & P-com aretries. When we faced this finding during the aneurysm coiling, urgent ICP control with or without surgical method should be initiated. Regardless of massive ICP control, there is no hemodynamic recover and still this finding remains, almost all patients will show grave course.

Renal arterial embolization:Indications,angiographic findings,and outcomes in a series of 170 patients

Background:The lack of overall experience and reporting on angiographic findings in previously published studies of renal arterial embolization(RAE)compelled us to report our overall experience on a series of patients.Materials and methods:A retrospective study was performed analyzing data of patients enrolled for RAE between 2010 and 2019.History,physical examination,and laboratory data were reviewed for all patients.Abdominal ultrasound was the initial imaging study,and all patients underwent subsequent computed tomography or magnetic resonance imaging.The outcome of RAE was determined based on radiographic and clinical findings.Results:Data from 202 patients were analyzed,with a mean age of 45±15 years,and 71.3%of patients were male.Iatrogenic injury was the most common indication for RAE(54%),followed by renal tumors,trauma,and spontaneous,in 27.7%,10.4%,and 8.4%of patients,respectively.Renal angiography revealing pseudoaneurysm alone or with other pathology in the lower pole of the kidney was the most common finding(40.6%),whereas no lesions were identified on angiography in 32 patients(15.8%),after which RAE was subsequently aborted.Renal arterial embolization was successful in 158 of 170 patients(92.9%)after 1 or more trials(maximum of 4).Microcoil alone or with other embolic materials was the most commonly used material for embolization(85%).Conclusions:latrogenic injury was the most common indication for RAE.Pseudoaneurysm alone or with other lesions was the most common lesion on renal angiography;however,angiography showed a negative result in 16%of patients,even those with symptoms.When lesions are present on angiography,the overall success of repeated trials of RAE reached 92.9%.

Sneddon综合征1例并文献复习

Sneddon综合征是一种罕见的神经皮肤综合征,主要累及中小动脉,典型临床表现为广泛的皮肤网状青斑,伴随反复发作的缺血性卒中。本病例是一位青年女性,在近10年多次经历小卒中事件,并伴有脊髓蛛网膜下腔出血和多发颅内动脉瘤。基因检测提示腺苷脱氨酶2(adenosine deaminase 2,ADA2)基因杂合突变(c.1240G>A)。患者曾接受氯吡格雷抗血小板聚集治疗,后停止该治疗。对于卒中反复发作的青年患者,医师应密切观察并详细询问皮肤病变情况,同时建议进行脑血管造影和基因检测,以便更全面地评估和管理这类病例。

Angiographic prevalence of myocardial bridging in a defined very large number of Chinese patients with chest pain

Background Muscle fibers overlying the intramyocardial segment of an epicardial coronary artery are termed myocardial bridging （MB）. Variable prevalence of MB has been described at autopsy and angiographic series with small and large sample size studies. In addition, no similar study was reported in Chinese population. The aim of this study was to investigate the angiographic prevalence of MB in consecutive 37 106 Chinese patients with chest pain from our center. Methods We conducted an observational study to evaluate the consecutive cases with MB among patients undergone selective coronary angiography, and analyzed the angiograhic prevalence and clinical features of MB in this study of very large sample size. Results Among 37 105 patients with chest pain we found 1002 cases with 1011 MBs in a retrospective manner, and the overall prevalence was 2.70%. Although more than 99% （991/1002） of patients had single bridge, 8 cases were found to have more than two MBs （seven with two, and one with three）. Altogether 54.39% of cases （545/1002） had MB without atherosclerotic lesions, and 96.24% （973/1011） of bridging located in the left anterior descending coronary artery （LAD）, mainly in the middle of LAD （792/1011,78.33%）. According to Nobel classification, of the single bridge （n=-991）, 〈50% of obstruction was predominant （471/991,47.52%）. Totally 50%-69% accounted for 34.81% （345/991）, 〉70% of obstruction was 17.65% （175/991）. Conclusions These data showed that the prevalence of angiographically detectable MB in Chinese patients with chest pain was similar to those of the previous studies, with 2.7% prevalence in this very large sample size.

Comparison of the 1-year Outcomes of Conbercept Therapy between Two Different Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

Background：Polypoidal choroidal vasculopathy （PCV） is characterized by the presence of polyps with or without a branching vascular network and more prevalent among Asians.The aim of this study was to compare the outcomes of conbercept therapy between two different angiographic subtypes of PCV.Methods：Fifty-eight patients of PCV were classified into two phenotypes according to indocyanine green angiography （ICGA）.In Type 1,both feeder and draining vessels are visible on ICGA and network vessels are numerous.In Type 2,neither feeder nor draining vessels are detectable,and the number of network vessels is small.The patients were treated with intravitreal conbercept （IVC） for 3 months.Additional 1VC was given at subsequent monthly visits,if needed.The patients were followed up for 12 months,and changes in mean best-corrected visual acuity （BCVA）,central retinal thickness （CRT）,subretinal fluid （SRF） thickness,pigmented epithelial detachment （PED）,hemorrhage,and number of polypoidal lesions were evaluated.Results：The mean BCVA in Type 2 PCV （15.92 ± 9.76 letters） achieved a significantly greater improvement than that in the Type 1 （14.10± 9.07 letters） at month 12 （t=2.37,P〈 0.01）.Moreover,the mean CRTdecrease was numerically greater in Type 2 （120.44± 73.81μm） compared with Type 1 （106.48 ± 72.33 μm） at month 6 （t =4.31,P 〈 0.01）,and greater in Type 2 （130.21 ± 76.28 μm） compared with Type 1 （111.67 ± 79.57μm） at month 9 （t =1.87,P 〈 0.0l）.There was no significant difference between the two types for the decrease in SRF thickness,PED height,and regression of polyps from month 3 to 12 （t =2.97,P〉 0.05）.Conclusion：Classification systems for PCV will show differences in presentation,natural history,or response to anti-vascular endothelial growth factor treatment and might,therefore,provide a new key to the choice of treatment for the disease.

急性心肌梗死患者左心室重构与冠状动脉微循环及预后的相关性

目的在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)且行直接经皮冠状动脉介入(primary percutaneous coronary intervention,pPCI)治疗患者中研究以左心室质量指数(left ventricular mass index,LVMI)为代表的左心室重构与以冠状动脉(冠脉)造影微循环阻力指数(angio-IMR,AMR)为代表的微循环障碍及预后的关系。方法本研究是回顾性病例对照研究,纳入2018年3月至2020年12月于广东省人民医院、广东省人民医院珠海分院和2021年11月至2022年1月于博罗县人民医院确诊STEMI且行pPCI治疗的患者,在术后及3个月后分别行超声心动图检查,计算患者LVMI变化百分比,根据LVMI变化量是否>20%分为高左心室重构组(n=62)、低左心室重构组(n=99)。通过对比两组的一般情况、冠脉微循环指标及预后情况,评价其之间的相关性及结局变量。结果(1)高左心室重构组比低左心室重构组AMR更高(287±89 vs.247±56,P=0.006),冠脉血流速度(coronary flow velocity,CFV)更慢(14.6±5.8 vs.16.6±5.3,P<0.05),预后更差(33.8%vs.13.1%,P=0.003)。LVMI绝对变化量与AMR呈正相关、线性关系(r=0.169,P=0.032)。无复流仅存在于高左心室重构组[3(4.8%)vs.0,P=0.027]。(2)Logistic回归分析表明AMR是LVMI变化量大于20%的危险因素(OR=1.008,P=0.001)。AMR是左心室重构的独立预测因子。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析AMR切点为268.5。结论STEMI患者行pPCI治疗以LVMI为代表的左心室重构与以AMR为代表的冠脉微循环有明确关系,左心室重构变化越大,AMR越大,预后更差。

Inter-and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion(CatLet©)angiographic scoring system in patients with acute myocardial infarction

Background:Previously,we developed a novel Coronary Artery Tree description and Lesion EvaluaTion(CatLet©)angiographic scoring system,which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction(AMI).Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.However,the reproducibility of the CatLet score in both inter-and intra-observer remains to be evaluated.Methods:A total of 30 consecutive AMI patients,admitted in September of 2015,were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score.Another set of 49 consecutive AMI patients,admitted between September and October in 2014,were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score.The weighted kappa was used to express the degree of agreement.Results:The weighted kappa values(95%confidence interval)for the intra-and inter-observer reproducibility of the CatLet Score were 0.82(0.59-1.00,Z=7.23,P<0.001)and 0.86(0.54-1.00,Z=5.20,P<0.001),respectively,according to the tertile analysis(≤14,15-22,>22).Regarding the adverse characteristics pertinent to lesions and dominance parameters,the kappa values for the inter-observer variability were 0.80(0.56-1.00,Z=6.47,P<0.001)for total number of lesions,0.57(0.28-0.85,Z=3.03,P<0.001)for bifurcation,0.69(0.43-0.96,Z=5.06,P<0.001)for heavy calcification,1.00(0.72-1.00,Z=6.93,P<0.001)for tortuosity,0.54(0.26-0.82,Z=3.78,P<0.001)for thrombus,0.69(0.48-0.91,Z=6.29,P<0.001)for right coronary artery dominance,0.69(0.41-0.96,Z=4.91,P<0.001)for left anterior descending artery length,and 0.22(0.06-0.51,Z=1.56,P=0.06)for diagonal size.Equivalent values for the intra-observer variability were moderate to almost perfect(range 0.54-1.00).Conclusions:The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent.The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.

INTRAVASCULAR ULTRASOUND IMAGING OF ANGIOGRAPHICALLY "SILENT" LEFT MAIN CORONARY ARTERY ATHEROSCLEROSIS

Patients with left main coronary artery (LMCA) atherosclerosis have a poor prognosis compared with lesions in the other coronaries. Because of the methodological problems. LMCA atherosclerotic lesions are not frequently detected by coronary angiography. The purpose of the study was to reveal the existence of LMCA disease in patients with normal coronary arteries by using intravascular ultrasound imaging. Ninety-seven patients with angiographically normal coronary arteries were examined with a 3.5 F or 4.8 F. 20 MHz intravascular ultrasound catheter. The vessel, lumen and plaque areas were determined and percent area and diameter stenosis were calculated. Plaque formation with or without calcific deposits identified by ultrasound accoustic shadowing were regarded as signs of atherosclerosis.

Assessment of angiographic coronary slow flow phenomenon with intracoronary ultrasound and doppler flow mapping

In order to study the mechanism of angiographic coronary slow flow phenomenon (SF), intracoronary ultrasound (ICUS) and Doppler (ICD) were performed in 14 patients with angiographic SF phenomenon but with normal angiograms and in 16 patients with normal angiographic coronary flow (NF). A 3.5 F, 20 MHz ultrasound catheter (Boston Scientific) was used for ICUS and a 0.014 inch FloWire (Cardiometrics) was used for ICD. Coronary flow velocity including average peak velocity (APV), maximal peak velocity (MPV) at rest and at hyperemia as well as coronary flow reserve (CFR) were compared in both groups in comparison to the presence or absence of plaque formation based on ICUS. CFR in the SF group (4.2±1.1) was even higher than that of the NF group (3.1±0.6, P<0.001). Department of Cardiology, University GHS Essen, Germany (Ge JB, Simon H, Jeremias A, Liu FQ, Grge G, Haude M, Baumgart D and Erbel R) Significant differences were also found concerning the APV and MPV among both groups (both P <0.001). Plaque formation was found in 7/13 patients with a lumen reduction of 21%±24% in SF group and in 7/16 of the NF group with a lumen reduction of 19%±17%. Comparison of APV, MPV and CFR in SF and NF grups. Comparison of APV, MPV and CFR in SF and NF groups[BHDFG1*2,WK8ZQ1,WK11DW,WK11DWW] SF group NF groupAPV (cm/s) Rest 7.7±2.0 21.1±5.0 * Peak31.7±14.961.3±14.2 *MPV (cm/s) Rest17.4±4.637.0±11.4 * Peak56.8±14.981.8±17.7 *CFR4.2±1.13.1±0.6 # * P<0.001, #P=0.002. Coronary slow flow phenomenon in angiography indicates reduced resting flow velocity without reduction of coronary flow reserve.

Angiographic differentiation of systolic narrowing of the left anterior descending coronary artery in hypertrophic cardiomyopathy from myocardial bridges

To the Editor： I read with great interest the case report of multiple myocardial bridges affecting both coronary arteries in a patient with hypertrophic cardiomyopathy. However, I differ with the authors in their interpretation of the coronary arteriograms.

Angiographic Observation of Immediate Effect of Electric Pulse Stimulation at Zhiyang Point on Coronary Artery

Objective: To evaluate angiographical diameter and pressure changes of coronary artery and heart rate in patients with coronary heart disease (CHD) or suspected CHD immediately after electric pulse stimulation of Zhiyang point. Methods: Twenty-four patients including 21 males and 3 females with an average age of 48. 7 years were enrolled. Parameters of electric pulse stimulation were as follows: the positive pulse range was 440 V, the negative pulse range 160 V, the cycle 8 ms, frequency 125 Hz, the positive pulse width was 0. 8 ms,the negative 0. 4 ms, and the output voltage 9 V. Coronary arteriography was performed by using Judkins technique, and intracoronary pressure with heart rate and any response of patients to the stimulation were recorded preand post-stimulation for 90 seconds. The relative diameter of left main coronary artery (LMCA ), left anterior descending artery (LAD ), left circumflex coronary artery (LCx), and right coronary artery (RCA) before and after the stimulation was measured in the same magnification and their results with recordings of intracoronary pressure and heart rate was analyzed. Results: A mild dilation effect was observed in all coronary arteries with an average dilation of 8. 3 % (6. 3 % - 15 % ) in LMCA, 7. 7% (5% - 11. 8%) in LAD, 8.5% (6. 7% - 11. 1% ) in LCx, and 9. 1% (6.1 % - 13. 3 % ) in RCA. No significant difference was found in the change of the diameter of LMCA, LAD, LCx and RCA before and after the stimulation. No significant change of intracoronary pressure was shown in three patients, an increase of intracoronary systolic and diastolic pressure by 36 % and 13 % was identified in one, and a decrease by 21 % and 31 % in another patient. Heart rate was decreased by 2. 3 % in those five patients. Conclusion:Electric pulse stimulation of Zhiyang point can immediately produce mild dilation effect on coronary arteries, slight decrease on the heart rate, and different effects was produced in intracoronary pressure.Original article on CJIM(Chin) 1998; 18(6): 330

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

血清白蛋白联合CatLet©冠状动脉评分预测急性心肌梗死患者预后

目的探讨血清白蛋白联合冠状动脉树描述及病变评估(CatLet©)冠状动脉评分(简称复合模型)预测急性心肌梗死患者预后的价值。方法连续纳入2012年1月至2013年7月因急性心肌梗死在苏州大学附属第一医院行急诊经皮冠状动脉介入治疗(PCI)的患者。计算非闭塞状态下CatLet©冠状动脉评分,并收集入院时血清白蛋白水平等基线资料。主要终点为主要不良心脑血管事件(MACCE),次要终点为全因死亡和心原性死亡。通过受试者工作特征曲线下面积(AUC)、净再分类指数(NRI)与整体鉴别指数(IDI)比较CatLet©冠状动脉评分单纯模型(简称单纯模型)及复合模型的区分能力。通过Hosmer-Lemeshow拟合优度检验与一致性曲线图,检测模型的校正度。结果与单纯模型相比,复合模型MACCE、全因死亡以及心原性死亡AUC(95%CI)分别为[0.77(0.71~0.84)比0.71(0.64~0.78),P=0.010]、[0.80(0.73~0.86)比0.72(0.64~0.79),P=0.012]以及[0.82(0.75~0.88)比0.77(0.70~0.84),P=0.096]。进一步NRI和IDI分析表明,与单纯模型相比,复合模型中所有研究终点的NRI和IDI均大于0(均P<0.001),且复合模型较单纯模型有更好的校正度。结论血清白蛋白联合CatLet©冠状动脉评分复合模型可以更好地预测急性心肌梗死患者预后。

机器人辅助系统在脑血管疾病介入治疗中的应用现状

虽然血管内介入术已成为多种心脑血管疾病的主要治疗方式,但该干预策略仍存在一定局限性,如术者具有X线暴露的风险,在操作过程中需穿沉重的铅衣等。伴随人工智能技术取得的突破,临床可实现通过导管室外操作机器人辅助系统进而解决上述传统血管内介入治疗的局限性。尤其近年来,机器人辅助系统的高速发展进一步提升了血管内介入治疗操作的准确性、稳定性和安全性。本文将围绕机器人辅助系统的优势、已应用于临床脑血管病介入治疗的机器人辅助系统及其应用现状展开论述,并对该辅助系统存在的问题进行总结,同时对未来发展方向进行展望。

冠状动脉前降支不同造影体位和图像区域测量准确性分析

目的探讨冠状动脉前降支在不同造影体位和图像区域测量的准确性。方法选取201例前降支支架植入术的造影图像共240幅,根据造影体位分为:右肩位(RAO 30°+CRA 30°)、头位(RAO 0°+CRA 30°)和左肩位(LAO 30°+CRA 30°)三组。将图像平均分为九个区域,比较血管内支架在不同造影体位和图像区域测量值与实际值的差异。结果三组样本间的血管特征和支架类型差异无统计学意义。右肩位造影图像上测量值和实际值差异无统计学意义(P>0.05),头位、左肩位图像中上区和中间区的测量值和实际值差异有统计学意义(P<0.05)。造影体位结合图像区域的模式下,右肩位+中上区、右肩位+中间区和头位+中上区的测量值与实际值比较差异无统计学意义(P>0.05)。头位+中上区、左肩位+中间区和左肩位+中上区的测量值和实际值呈正相关(r=0.864,0.835,0.823,P<0.05)。以测量值为自变量(X),实际值为因变量(Y)建立回归方程。头位+中上区:Y=4.664+0.91X(F=138.17,P<0.01);左肩位+中间区:Y=3.988+1.012X(F=50.56,P<0.01);左肩位+中上区:Y=6.955+0.828X(F=113.27,P<0.01)。结论不同造影体位和成像区域影响着图像的测量精确度。造影体位+图像区域的模式下测量值和实际值有很好的相关性,在前降支血管的测量中可以依据成像条件应用测量值或回归方程的计算结果,为介入治疗提供了更精准的手术方案。

CTA在颅内动脉瘤诊断中的应用及与DSA结果的对比分析

目的 探讨计算机体层成像血管造影(computed tomography angiograph,CTA)在颅内动脉瘤诊断及特征判断中的应用价值。方法 选取2018年5月1日至2020年9月30日浙江大学医学院附属杭州市第一人民医院经数字减影血管造影(digital subtraction angiography,DSA)诊断的94例颅内动脉瘤患者作为研究对象,其中50例发生动脉瘤破裂(破裂组),44例患者未发生动脉瘤破裂(未破裂组)。患者于1周内同时接受CTA检查,以DSA作为诊断金标准,计算CTA诊断的颅内动脉瘤的相关指标。结果 CTA诊断颅内动脉瘤与DSA的符合率较高,对大脑后动脉、大脑前动脉、基底动脉、颈动脉段、椎动脉、小脑后下动脉的检测符合率均达到100%,对前交通动脉、后交通动脉、大脑中动脉的动脉瘤检出率均达到90%以上;通过CTA与DSA测量两组动脉瘤的瘤颈、动脉瘤最宽径、动脉瘤最长径测定值,两组比较,差异无统计学意义(P>0.05);两组患者的颈内动脉颅外段Ⅰa型、Ⅰb型、Ⅱ型、Ⅲ型、Ⅳ型占比及颈总动脉迂曲指数、颈内动脉迂曲指数、椎动脉迂曲指数比较,差异均无统计学意义(P>0.05)。结论 CTA作为一种无创检测手段,在诊断颅内动脉瘤方面与DSA具有较高的符合率,对颅内动脉瘤参数特征检测方面与DSA检测结果无差异;但是通过CTA检测颈动脉迂曲及形态学特征评估动脉瘤是否发生破裂方面的价值有限。

术前心理疏导结合疼痛管理对肝癌患者造影灌注栓塞术后疼痛及睡眠质量的影响

目的探讨术前心理疏导结合疼痛管理对肝癌患者造影灌注栓塞术后疼痛及睡眠质量的影响。方法选取2021年1月—2023年4月在本院收治行造影灌注栓塞术治疗肝癌患者50例进行研究,按随机数字表法分为对照组及观察组,每组25例。对照组采用常规护理干预,观察组在对照组基础上施以术前心理疏导结合疼痛管理,比较两组疼痛状况、心理状态、睡眠及生活质量。结果观察组疼痛状况优于对照组(P<0.05);两组护理前HAMA、HAMD评分比较,差异无统计学意义(P>0.05),经护理,两组HAMA、HAMD评分均有降低,观察组低于对照组(P<0.05);两组护理前PSQI、FACT-Hep评分比较,差异无统计学意义(P>0.05),经护理,两组PSQI评分均有下降,FACT-Hep评分则见上升,观察组PSQI评分低于对照组,FACT-Hep评分高于对照组(P<0.05)。结论行造影灌注栓塞术治疗肝癌患者应用术前心理疏导结合疼痛管理,可减轻疼痛状况,改善负性心理状态,并提升睡眠及生活质量。