Fractional flow reserve measured via left internal mammary artery after coronary artery bypass grafting:Two case reports

BACKGROUND The fractional flow reserve(FFR)has made the treatment of coronary heart disease more precise.However,there are few reports on the measurement of FFR via the left internal mammary artery(LIMA).Herein,we described the determination of further treatments by measuring FFR via the LIMA in 2 cases after coronary artery bypass grafting(CABG).CASE SUMMARY Case 1 was a 66-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 7 years prior due to coronary heart disease.Coronary artery angiography showed complete occlusion of the left anterior descending artery(LAD),and subtotal occlusion of the third segment of the right coronary artery.On arterial angiography,there was 85%stenosis at the distal end of the anastomosis of the LIMA-LAD graft.FFR via LIMA was determined at 0.75.Thus,balloon dilation was performed in Case 1.FFR after balloon dilation was 0.94.Case 2 was a 60-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 6 years prior due to coronary heart disease.There was 60%segmental stenosis in the middle segment of LAD and 75%anastomotic stenosis.FFR measured via LIMA was 0.83(negative);thus the intervention was not performed.Case 2 was given drug treatments.At the 3-mo follow-up,there was no recurrence of chest tightness or shortness of breath in both cases.They are currently under continual follow-up.CONCLUSION We provided evidence that FFR measurement via grafted blood vessels,especially LIMA,after CABG is a good method to determine the intervention course.

PET tracers and techniques for measuring myocardial blood flow in patients with coronary artery disease

Assessment of the relative distribution of myocardial flow with myocardial perfusion imaging （MPI） is meth- odologically limited to predict the presence or absence of flow-limited coronary artery disease （CAD）. This limi- tation may often occur, when obstructive lesions involve multiple epicardial coronary arteries or disease-related disturbances of the coronary circulation coexist at the microvascular level. Non-invasive assessment of myocar- dial blood flow in absolute units with position emission tomography （PET） has been positioned as the solution to improve CAD diagnosis and prediction of patient outcomes associated with risks for cardiac events. This article reviews technical and clinical aspects of myocardial blood flow quantitation with PET and discusses the practical consideration of this approach toward worldwide clinical utilization.

Comparison of Fractional Flow Reserve-Guided Revascularization Strategies in Isolated Proximal Left Anterior Descending Coronary Artery Disease

The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%;p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%);p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Previous studies demonstrated that coronary revascularization,especially percutaneous coronary intervention(PCI),does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease.Many studies using myocardial perfusion imaging(MPI) showed that,for patients with moderate to severe ischemia,revascularization is the preferred therapy for survival benefit,whereas for patients with no to mild ischemia,medical therapy is the main choice,and revascularization is associated with increased mortality.There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia,which is associated with increased mortality.Studies using fractional flow reserve(FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI,and the presence of ischemia is the key to decisionmaking for PCI.Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations.Recent studies of appropriateness criteria showed that,although PCI in the acute setting and coronary bypass surgery are properly performed in most patients,PCI in the non-acute set-ting is often inappropriate,and stress testing to identify myocardial ischemia is performed in less than half of patients.Also,some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis.Taken together,the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease,and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.

Optimizing woven coronary artery management by optical coherence tomography: three cases report

Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.

Relationship between red blood cell distribution width and intermediate-term mortality in elderly patients after percutaneous coronary intervention

关于在红血房间分发宽度(RDW ) 和在有冠的动脉疾病(CAD ) 的老病人的中间术语的预后之间的关系的 BackgroundLarge 规模临床的研究正在缺乏。因此，这研究在经历了选任的经皮的冠的干预(一种总线标准) 的老病人的中间术语的死亡上调查了 RDW 的效果从 1891 病人 &#x02265 的 .MethodsData；65 岁从 2009 年 7 月经历了选任的一种总线标准到 2011 年 9 月被收集。基于外科手术前的中部的 RDW (12.3%) ，病人被划分成二个组。低 RDW 组(RDW &#x0003c； &#x000a0； 12.3%) 有 899 个案例；高 RDW 组(RDW &#x02265； &#x000a0； 12.3%) 有 992 个案例。二个组的所有原因死亡率是在高 RDW 组的 compared.ResultsPatients 是更可能的与糖尿病女性、伴随，有的更低的血红素水平。吝啬的后续时期是 527 &#x000a0；天。在后续期间， 61 个病人死了(3.2%) 。高 RDW 组的手术后的死亡比低 RDW&#x000a0 的显著地高；组(4.3% 对 2.0% ， P&#x000a0； =&#x000a0； 0.004 ) 。在调整另外的因素以后， multivariate 考克斯回归分析表明外科手术前的高 RDW 显著地与手术后的所有原因死亡被联系(危险比率：2.301， 95% 信心间隔：1.106-4.785， P&#x000a0； =&#x000a0； 0.026 ).ConclusionsIncreased RDW 是在在选任的一种总线标准以后的老 CAD 病人的增加的中间术语的所有原因死亡的一个独立预言者。

Predictive Study of Velocimetry in the Coronary Artery after Iodinated Contrast Agent Injection

This study aims to determine the retention time of iodinated contrast agents (ICA) in the coronary artery. The mechanical aspect of ICA displacement was studied in order to better understand the effect of these products on the inner wall of the artery of patients with coronary artery stenosis, undergoing repeated imaging examinations with iodinated contrast agents. ICA flow, ICA and blood flow in the artery were modelled. The fluid was regarded to be viscous, incompressible and Newtonian. Blood flow was presumed to be unidirectional, laminar and unstationary. Iodine flow velocity and retention time were calculated using the Runge-Kutta 4th order method programmed in C++ and MatLab R2013a language. The results showed that for coronary artery CT-scans, ICA retention time is 1 minute 40 seconds and for coronary arteriography it is between 2.41 and 3.61 seconds. The values calculated were compared to theoretical values and to clinical observations. The results enabled us to validate our model.

Fractional Flow Reserve-guided Percutaneous Coronary Intervention:Standing the Test of Time

Percutaneous coronary intervention(PCI)improves symptoms and prognosis in ischemia-inducing,functionally signifi cant,coronary lesions.Use of fractional flow reserve allows physicians to investigate the ischemia-inducing potential of a specifi c lesion and can be used to guide coronary revascularization,especially in multivessel coronary artery disease.Fractional flow reserve-guided PCI has been extensively investigated.Results show that deferral of stenting in non-signifi cant lesions is safe,whereas deferral of stenting in functionally signifi cant lesions worsens outcome.FFR-guided PCI improves outcome in multivessel disease over angiography-guided PCI.Until recently,there was little known about the long-term outcome of FFR-guided revascularization and its validity in acute coronary syndromes.This review aims to address the new evidence regarding long-term appropriateness of FFR-guided PCI,the need for hyperemia to evaluate functional severity,and the use of FFR in acute coronary syndromes.

Sodium nitroprusside injection immediately before balloon inflation during percutaneous coronary intervention

BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.

Interventional treatment of the left subclavian in 2 patients with coronary steal syndrome

In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) using internal mammary artery grafts,great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery(LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.

Coronary artery disease and heart failure:Late-breaking trials presented at American Heart Association scientific session 2023

The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coronary artery disease and heart failure(HF).The dapagliflozin in patient with acute myocardial infarction(DAPA-MI)trial showed that dapagliflozin use among patients with acute MI without a history of diabetes mellitus or chronic HF has better cardiometabolic outcomes compared with placebo,with no difference in cardiovascular outcomes.The MINT trial showed that in patients with acute MI and anemia(Hgb<10 g/dL),a liberal transfusion goal(Hgb≥10 g/dL)was not superior to a restrictive strategy(Hgb 7-8 g/dL)with respect to 30-day all-cause death and recurrent MI.The ORBITA-2 trial showed that among patients with stable angina and coronary stenoses causing ischemia on little or no antianginal therapy,percutaneous coronary intervention results in greater improvements in anginal frequency and exercise times compared with a sham procedure.The ARIES-HM3 trial showed that in patients with advanced HF who received a HeartMate 3 levitated left ventricular assist device and were anticoagulated with a vitamin K antagonist,placebo was noninferior to daily aspirin with respect to the composite endpoint of bleeding and thrombotic events at 1 year.The TEAMMATE trial showed that everolimus with low-dose tacrolimus is safe in children and young adults when given≥6 months after cardiac transplantation.Providing patients being treated for HF with reduced ejection fraction(HFrEF)with specific out-of-pocket(OOP)costs for multiple medication options at the time of the clinical encounter may reduce‘contingency planning’and increase the extent to which patients are taking the medications decided upon.The primary outcome,which was cost-informed decisionmaking,defined as the clinician or patient mentioning costs of HFrEF medication,occurred in 49%of encounters with the checklist only control group compared with 68%of encounters in the OOP cost group.

Impact of primary percutaneous coronary intervention on blood perfusion in nonculprit artery in patients with anterior ST elevation myocardial infarction

Background Recent studies have demonstrated that epicardial flow in nonculprit arteries, which has been assumed to be normal, was slowed in the setting of ST-elevation myocardial infarction （STEMI）. However, the impact of primary percutaneous coronary intervention （PCI） on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified. The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors. Methods A total of 117 patients with anterior wall STEMI, the culprit artery being the left anterior descending artery （LAD）, undergoing primary PCI （the study group） and 100 patients with normal coronary angiography （the control group） were enrolled. To observe the differences of corrected TIMI frame count （cTFC） and myocardial blush grade （MBG） before and after primary PCI in both culprit and nonculprit arteries, the left circumflex coronary artery （LCX）, cTFC and MBG in the LAD and LCX were measured in the study group and control group. The study group was divided into three groups; refiow in the culprit artery group （the R group）, no reflow in culprit artery group （the NR group）, and no reflow in both the culprit artery and nonculprit artery group （the NRB group） according to MBG grade. The level of serum C-reactive protein （CRP）, catecholamine, and fibroblast growth factor-21 （FGF21）were assayed. The clinical and angiographic characteristics were also analyzed. Results cTFC （28.1±24.3 vs. 20.3±19.3, P 〈0.05） and MBG in the LCX were different in the study group compared to the control group before primary PCI. cTFC （25.2±22.3 vs. 28.1±24.3, P 〈0.05） and the MBG level in the LCX were improved after successful primary PCI, but were not recovered to the normal level. Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery （78% vs. 19%, P 〈0.0001）, and the levels of CRP （（3.29±1.31） mg/dl vs. （2.51±1.14） mg/dl vs. （2.93±1.07） mg/dl, P 〈0.05, respectively）, catecholamine （（epinephrine （693.48±89.78） pg/ml vs. （398.12±93.28） pg/ml vs. （562.54±96.22） pg/ml, P 〈0.0001, respectively）, and norepinephrine （（7012.43±932.47） pg/ml vs. （4012.34±814.16） pg/ml vs. （5549.03＋912.65） pg/ml, P 〈0.0001, respectively））in the NRB group were higher than those in the R group and NR group. The level of FGF21 （（0.299±0.093） ng/ml vs. （0.612±0.071） ng/ml vs. （0.428±0.074） ng/ml, P 〈0.0001 respectively） in the NRB group was lower than that in the R group and NR group. Conclusions The blood perfusion in the nonculprit artery may be impaired in patients with STEMI. Although nonculprit artery perfusion may be improved after successful primary PCI, it is still lower than that in the control group, and may be involved in inflammation and spasms.

A Case of Local Groin Abscess Caused by Transfemoral Coronary Procedures

Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reasons for this symptom are still unclear. We report a case of local groin abscess two weeks after the latest procedure. The reasons responsible for the groin abscess in this case might be diabetes mellitus without being properly controlled, left ventricular (LV) systolic dysfunction, multiple operations in the same site, the usage of vascular closure device (VCD), and long time pressure after the procedure. We should pay enough attention to these risk factors in the future clinical practice to avoid this serious complication.

Non-invasive Angiographic-based Fractional Flow Reserve:Technical Development,Clinical Implications,and Future Perspectives

New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.

Evaluation of the effect of myocardial perfusion after percutaneous coronary intervention in coronary artery disease by using intracoronary myocardial contrast echocardiography and two other angiographic techniques

Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography(ICMCE),corrected thrombolysis in myocardial infarction frame count(CTFC),and coronary blood flow velocity(BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A(normal coronary artery),group B(75%–95%coronary artery stenosis),group C(coronary artery stenosis>95%)and group D(acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A(P<0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A(P<0.05),and there were significant differences in the three MCE parameters between group D and group A(P<0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments(P<0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly.Thus,the IC-MCE method is of great value to coronary artery disease(CAD)patients undergoing PCI,especially for those with acute myocardial infarction(AMI).

冠状动脉CT血管成像血流储备分数应用于冠状动脉疾病的研究进展

冠状动脉血流储备分数(fractional flow reserve,FFR)是评价冠状动脉血管生理功能的金标准。基于冠状动脉CT血管成像的无创血流储备分数(CT-FFR)是研究冠状动脉疾病的新技术,它将计算机流体力学应用于解剖数据为临床医生提供了进一步的功能评估,以指导治疗决策。目前,CT-FFR的潜力已被认识到。在这篇综述中,介绍了CT-FFR的基本原理,CT-FFR对于冠状动脉疾病的诊断效能及影响因素,限制与不足及未来发展方向。

腺苷负荷与ATP负荷评估冠状动脉微血管疾病中的不良反应分析

背景 冠状动脉微血管疾病(CMVD)的诊疗一直是非冠状动脉阻塞性缺血性心脏病的重点。腺苷注射液和ATP注射液是目前测定冠状动脉血流储备(CFR)评估CMVD的临床常用负荷药物,两者有所关联,但具有显著区别。ATP是腺苷的前体,其价格低廉且血管扩张机制与腺苷类似,临床上常代替腺苷,但忽视了其潜在的不良反应。目的 比较腺苷负荷与ATP负荷在评估CMVD过程中的不良反应发生率。方法 选取2019年6月—2020年7月因典型心绞痛就诊于陕西省人民医院心内科行冠状动脉造影术/冠状动脉CT血管造影术(CTA)明确各支冠状动脉残余狭窄直径<50%的患者170例,依据随机数字表法分为腺苷组和ATP组,腺苷组88例,ATP组82例。腺苷组给予腺苷注射液负荷测定CFR,ATP组采用ATP负荷测定CFR,检测过程中记录患者的血压、心率、扫描时间及不良反应发生情况。结果 与腺苷组相比,ATP组患者胸闷[61.0%(50/82)和20.4%(18/88)]、头晕[72.0%(59/82)和31.8%(28/88)]、头痛[68.3%(56/82)和11.4%(10/88)]、胃肠道不适[13.4%(11/82)和4.5%(4/88)]、心悸[69.5%(57/82)和5.7%(5/88)]、气促[40.2%(33/82)和2.3%(2/88)]、大汗[28.0%(23/82)和3.4%(3/88)]、潮热[19.5%(16/82)和2.3%(2/88)]、颜面潮红[13.4%(11/82)和4.5%(4/88)]的发生率均较高(P<0.05);两组患者神经过敏、耳鸣、咽干、颈部不适的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 与ATP负荷相比,腺苷负荷测定CFR的不良反应发生率更低。

替罗非班冠状动脉给药对冠心病合并SAS患者PCI术后慢血流现象及不良心血管事件发生的影响

目的:探讨替罗非班冠状动脉给药对冠心病合并睡眠呼吸暂停综合征(SAS)患者经皮冠状动脉介入治疗(PCI)术后慢血流现象及不良心血管事件(MACE)发生的影响。方法:按照治疗方式不同将120例冠心病合并SAS患者分为对照组(n=60)和观察组(n=60),两组患者均进行PCI治疗,对照组、观察组分别予以替罗非班静脉与冠状动脉给药。对比两组患者TIMI分级、血清心肌功能指标[乳酸脱氢酶(LDH)、谷草转氨酶(AST)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]水平、PCI术后慢血流现象、血小板微粒(PMPs)水平、出血情况及MACE发生情况。结果:观察组术后即刻心肌梗死溶栓治疗(TIMI)分级优于对照组(P<0.05)。给药后,观察组cTFC低于对照组(P<0.05)。术后3 d,观察组PMPs水平低于对照组(P<0.05);血清LDH、AST、CK-MB、cTnI水平均低于对照组(P<0.05);两组出血情况无统计学差异(P>0.05)。观察组术后MACE总发生率低于对照组(P<0.05)。结论:替罗非班冠状动脉给药可以更好地预防冠心病合并SAS患者PCI术后慢血流现象发生,降低MACE发生率。

血管内超声评价冠状动脉远端血管弹性对慢性重度狭窄病变开通后血流的影响

目的研究血管内超声(IVUS)评价冠状动脉远端血管弹性对慢性重度狭窄病变开通后血流的影响。方法以回顾性分析为法,观察对象为2020年12月至2023年9月铜陵市立医院收治的60例慢性重度狭窄病变患者,所有患者均接受经皮冠状动脉介入治疗(PCI)且支架置入成功,并行IVUS检查。参考支架置入后远端血流情况分为研究组(血流减慢,n=12)与对照组(血流正常,n=48),其中研究组患者TIMI血流分级0级或Ⅰ级,对照组患者心肌梗死溶栓治疗试验(TIMI)血流分级≥Ⅱ级;比较两组造影结果、术中操作特点及IVUS相关资料;同时采用Logistic回归分析慢性重度狭窄病变开通后对血流减慢产生的影响因素。结果(1)造影结果。两组狭窄段长度、病变血管迂曲、狭窄段钙化、狭窄处分支、顿头狭窄、狭窄段部位、狭窄靶血管比较,差异均无统计学意义(P>0.05);研究组Rentrop侧支分级1级占比高于对照组,2、3级占比低于对照组,差异均有统计学意义(P<0.05)。(2)术中操作特点。两组患者的冠状动脉穿孔率、远端药物球囊率、支架总长度、支架置入率、正向导丝通过率、逆向开通率比较,差异均无统计学意义(P>0.05);研究组患者TIMI血流分级0级、Ⅰ级占比高于对照组,Ⅱ、Ⅲ级占比低于对照组,差异均有统计学意义(P<0.05)。(3)IVUS相关资料。两组支架边缘夹层、导丝行走于内膜下、中膜血肿、最大钙化弧度、闭塞段钙化率、近端参考管腔面积、远端参考血管外弹力膜(EEM)面积、近端参考血管EEM面积比较,差异均无统计学意义(P>0.05);研究组患者远端血管收缩面积、远端血管收缩期面积、远端血管舒张期面积、最小支架面积、最大支架面积、远端参考管腔面积均小于对照组,远端血管弹性差占比高于对照组,差异均有统计学意义(P<0.05)。(4)相关性分析。于Logistic相关性分析中纳入血管弹性、最小支架面积、参考血管管腔面积,结果显示远端血管弹性变差为慢性重度狭窄病变开通后血流减慢独立影响的预测因素(OR=13.74,95%CI:1.945~97.177,P<0.001),与最小支架面积、血管管腔面积无相关性(OR=0.107,95%CI:0.002~5.932,P=0.276;OR=0.657,95%CI:0.011~35.131,P=0.836)。结论IVUS评价提示CTO病变远端血管弹性是CTO病变开通后血流减慢的独立危险因素。

改良螺旋式桡动脉止血器用于经桡动脉行冠状动脉介入术后患者的效果分析

目的:探讨改良螺旋式桡动脉止血器应用于经桡动脉行冠状动脉介入(TRI)术后患者的效果。方法:将2020年1月—2022年1月收治的80例TRI术后患者按照简单随机化法分为对照组(40例)和观察组(40例)。对照组采用传统螺旋式止血器压迫,观察组采用改良螺旋式止血器压迫。观察两组患者止血情况、各时间点疼痛麻木程度、肿胀程度、止血前后血氧饱和度差异及压力损伤发生情况。结果:两组止血率对比,差异无统计学意义(P>0.05);两组患者术后回病房时的疼痛及麻木评分对比,差异无统计意义(P>0.05);术后2 h、术后4 h、术后6 h及术后8 h两组患者疼痛及麻木评分均较术后回病房时的评分降低,且观察组低于对照组(P<0.05);观察组患者肿胀率低于对照组,差异有统计学意义(P<0.05);两组患者止血前后经皮血氧饱和度(SpO_(2))及压力损伤发生率比较,差异无统计学意义(P>0.05)。结论:改良螺旋式桡动脉止血器应用于TRI术后患者,可有效降低患者手部肿胀、疼痛、麻木程度,且安全性高。