Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

Clinical Outcomes in Patients Undergoing Triple-Vessel Angioplasty for Symptomatic Coronary Artery Disease

Current treatment strategies for multi-vessel coronary artery disease include either coronary artery bypass surgery or percutaneous coronary intervention with stenting. The present study evaluates the morbidity and mortality among coronary artery disease patients undergoing triple-vessel angioplasty. This prospective record based descriptive study was carried out in Medical College, Pariyaram, Kannur, Kerala;a tertiary care cardiac centre in South India. Fifty consecutive patients who underwent angioplasty of one or more lesions in each of the three major coronary arteries from May 2010 to July 2012 were included in the study. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Event-free survival rate was 94% at a mean follow-up of 20 months. Overall 98% continued success was obtained with triple-vessel angioplasty. Triple-vessel angioplasty is a safe and effective therapy as an alternative to surgical revascularization in selected patients with triple-vessel coronary artery disease.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR COMPLICATED CORONARY ARTERY LESIONS

Objective To research the effect of percutaneous transluminalcoronary angioplasty (PTCA) on treating complicated artery lesions.Methods Type B or type C of complicated coronary artery lesionswere confirmed by selective coronary angingraphy in 16 cases with coronaryheart disease.Gruentzig’s method was used in carring out PTCA.Results Fifteen of sixteen and thirty-two of thirty-five parts ofcoronary artery lesions were dilated successfully,the success rate was 93.7%and 88.5%,respectively.In failed four parts of PTCA,three parts werebecause of the guilding wire or the balloon failed to pass the narrow arterythrough,the other one was unable to be performed for the occurrencedsevere arrthymia during the procedure.Four stents were implantend foracute accident.Symptoms of the successful cases were improved ordisappeared after PTCA.Conclusion PTCA is also fit in treating complicated coronary arterylesions and has a better therapeutic effect,but it has more complications andrun more risks relatively.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Left main coronary stenosis as a late complication of percutaneous angioplasty:an old problem,but still a problem

Objective Accelerated left main coronary stenosis (LMCS) is a known potential late complication of coronary artery catheter procedures. The aim of this study was to assess the current occurrence of LMCS as a delayed complication of percutaneous angioplasty (PTCA) of the left coronary branches in our institution. Methods The medical records of patients referred for coronary artery by-pass surgery from the same Cardiology Unit in the January 2003 to December 2006 period and presenting a significant (> 50%) LMCS as a new finding following a PTCA of the left coronary artery branches, were reviewed. Patients with retrospective evidence of any LMCS at previous coronary angiographies preceding the percutaneous procedure were excluded. Results Thirty-seven patients (5 females, mean age 71.1±8.6 years) out of 944 (4%) having undergone a PTCA, fulfilled the inclusion criteria, 19 (51%) after a procedure also involving the LAD coronary artery. Extraback-up guiding catheters were used in most cases. Use of multiple wires or balloons was observed in 3 cases (8%). Rotablator and proximal occlusion device were used in one case respectively (3%). Twenty patients (54%) have had more than one percutaneous coronary intervention on the left coronary branches. The mean time elapsed from the first angioplasty and surgical intervention was 18.1±7.8 months. Conclusions The potential occurrence of LMCS following a percutaneous intervention procedure, especially when complicated and repeated, should not be underestimated in the current era. This evidence may offer the rationale to schedule non-invasive imaging tests to monitor left main coronary patency after the procedure as well as to fuel further research to develop less traumatic materials.

CLINICAL APPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutoneous transiuminal coronary anginplesty(PTCA)was performed in33 patients of coronary heart diseases(male 30 cases,female 3 cases, meanage 54.2) with Gruentzig’s method.Of all the 33 patients,there were 26narrow parts in 20 cases of the single branch lesions,27 narrow parts in 11cases of the double branch lesions and 11 narrow parts in 2 cases of thethree branch lesions.In 48 branches with lesion vessels,there were 27branches of the left anterior descending coronary arteries (LAD),7 branchesof the left cicumflex coronary arteries(LCX)and 13 branches of the rightcoronaw arteries.The narrow degrees varied from 75% to 100%. The resultswere that,of 33 patients,48 branches of lesion vessels and 64 narrow parts,the successful rates of dilation were 96.9%,87.5%,85.9%,respectively.Ventricular fibrillation occurred in one case during the procedure,whichsoon recovered sinus rhythm through cardioversion.Symptoms of thesuccessful 32 patients were lmproved obviously or diappeared after PATC.Combining with the documents,we think that the successful rates are higherin type A lesion undergoing PTCA.When PTCA for the multiple branchlesions are performed,we ought to master the principle of dilating the mainlessinos in advence.The long-tube lesions were dilated by the long balloonfitting for these lesions.The causes of failure of PTCA in the severe narrowlesions are mainly the the guilding wires or the balloon catheters cann’t passthrough the lesion parts,in addition,the complication problems in PTCA arealso discussed.

COMPLEX PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutancous transluminal coronary angioplasty was pcrfonned in 70patients with high risk characteristics from Jan.1998 toDcc.1997 These factors include age】70(10patients),unstableangina(35patients),ejection fraction【40%(7 patients),multivesseldisease(50patients).There were 96 lesions(79 vessels)dilated,amongthem type Alesion 15,type B lesion 52,type C lesion 29.Autoperfusion balloon was used in 7 patients, coronary stcnl wasimplantcd in 50 paticnts.One patient undcrgoing directional coronaryathrectomy(DCA).The clinical success rate was 91.5% and lesionsuccess rate was 89.6%.Average predilation stenosis was 89.5+8.2%and average postdilation stenosis was 16.9+6.2%.Two patients diedfrom abrupt vessel closureno acule myocardial infarction andemergency coronary bypass operation.The considerations in selectionand management of these high risk patients were discussed. The resultsshowed that PTCA can be performed safely in the complex cases.

Conservative strategy for treatment of stable coronary artery disease

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.

Long-term effect of stenting in unprotected left main coronary artery disease in the elderly

Objective To evaluate the feasibility,safety and efficacy of percutaneous stent implantation for treating left main coronary artery(LMCA)stenosis.Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention(PCI)at 6 medical centers in China were enrolled.Procedural data and clinical outcomes were obtained from all patients.Results From January 2001 to December 2004,138 patients(79 males and 59 females;mean age:69.7±5.8 years)underwent PCI for LMCA stenosis.Bare metal stents(BMS)were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003(BMS group);.Drug eluting stents(DES)were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004(DES group).Procedural success rate of the 138 cases was 98%(135/138).One patient(0.7%)with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure.During a mean follow up period of 21.3±5.6 months,one patient died from renal failure,one from sudden cardiac death,4 underwent target lesion revascularization(TLR)in the BMS group,which all occurred in patients with bifurcational lesions;whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR.Conclusions(1)PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals.(2)BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA.(3)DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.

Drug eluting balloons for the treatment of coronary artery disease: What can we expect?

Drug-eluting balloons (DEBs) represent an enhancement of the therapeutic repertoire for the interventional cardiologist. The therapeutic concept of DEBs is promising, notably on the basis of initial studies in patients with diffuse in-stent restenosis (ISR). At present, however, a number of questions regarding long-term efficacy and safety remain, specifically in indications other than diffuse ISR. The results of the evaluation of different substances, balloon systems and clinical indications will determine the long-term success of DEBs.

Safety and efficacy of dalteparin in percutaneous coronary intervention in Chinese patients with non-ST-elevation acute coronary artery syndromes： comparison with unfractionated heparin

Objective To prospectively evaluate the safety and therapeutic efficacy ofdalteparin in patients with high risk non-ST- elevation acute coronary syndromes （ACS） during percutaneous coronary intervention （PCI）. Methods A total of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin （UFH） group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/ kg intravenous bolus ofdalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mg just before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminal coronary angioplasty （PTCA）. Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in daltepafin group were measured. The average anti-Xa activity was （0. 83± 0.26） U/ml at 15 minutes after intravenous injection of dalteparin and anti-Xa〉0.SU/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group （2.3% vs 9.2%, P 〈 0.05）; none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection ofdalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus ofdalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI.

Percutaneous endovascular management of atherosclerotic axillary artery stenosis:Report of 2 cases and review of literature

With recent advancement in percutaneous endovascular management,most atherosclerotic peripheral arterial diseases are amenable for intervention.However,there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management.We report two cases of atherosclerotic axillary artery stenosis,which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting.The long term follow-up revealed patent axillary stents in both cases.

Comparison of pre-dilation with a non-compliant balloon versus a dual wire scoring balloon for coronary stenting

Purpose: The aim of this study was to determine the influence of lesion preparation using the dual wire scoring balloon on stent expansion and long-term outcomes. Methods: Forty-six consecutive de novo lesions treated with a single >2.5 mm drug-eluting stent under intravascular ultrasound guidance, using two implantation strategies, were randomly assigned to: 1) pre-dilation with a non-compliant balloon (NC group;n = 23) or 2) pre-dilation with a dual wire scoring balloon (DS group;n = 23). Results: Although the balloon size and the maximal dilation pressure for pre-dilatation was larger (3.33 ± 0.28 vs 3.09 ± 0.33 mm, p = 0.01) and higher (11.6 ± 3.2 vs 8.6 ± 2.7 atm,

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report

BACKGROUND Aberrant right subclavian artery(ARSA)is the most common congenital anomaly of the aortic arch.When patients having such anomalies receive transradial intervention(TRI),aortic dissection(AD)may occur.Herein,we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient,that was later salvaged by percutaneous angioplasty.CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain.Coronary computed tomography(CT)angiography revealed significant stenosis in the left anterior descending artery.Diagnostic coronary angiography was performed via the right radial artery without difficulty.However,we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention,while the guidewire tended to go down the descending aorta.The patient suddenly complained of chest and back pain.Emergent CT aortography revealed type B AD propagating to the left renal artery(RA)with preserved renal perfusion.However,after 2 d,the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable.Follow-up CT indicated further progression of dissection to the right external iliac artery(EIA)and left RA with limited flow.We performed percutaneous angioplasty of the right EIA and left RA without complications.Follow-up CT aortography at 8 mo showed optimal results.CONCLUSION A caution is required during right TRI in ARSA to avoid AD.Percutaneous angioplasty can be a treatment option.

Multivariate Analysis of Clinical Factors in Restenosis after Coronary Stenting

Ojbective To find the independent predictors for restenosis after coronary stenting. Methods Quantitative angiography was performed on 60 cases (67 successfully dilated lesions) after angio-plasty over 6-months follow-up, and both univariate and multivariate logistic regression analysis were done to i-dentify the correlations of restenosis with clinical factors. Results The total restenosis rate was 31. 3% (21 of 67 lesions), and according to univariate analysis the patients who underwent coronary stenting≥ 3. 5mm had a lower rate of restenosis ( P < 0. 01). Collateral circulation to the obstruction site, high maximal inflation pressure, smoking and the less minimal lumen diameter after PTCA made the rate of restenosis higherower ( P < 0. 05) . Multivariate logistic regression analysis showed that coronary stenting ≥3. 5mm had a low rate of restenosis, but high maximal inflation pressure and smoking made the restenosis rate higher. Conclusion Coronary stent size, maximal inflation pressure and. smoking were independent predictors for restenosis.

经皮冠状动脉腔内冲击波球囊导管成形术治疗冠状动脉钙化病变的研究进展

冠状动脉钙化通常导致动脉血管顺应性下降,诱发术后支架膨胀不全、支架内再狭窄等并发症,最终造成介入治疗失败。传统的钙化病变处理策略受限于钙化斑块的性质和病变特征等,且操作较为复杂,手术并发症多,术后不良心血管事件发生风险增高。经皮冠状动脉腔内冲击波球囊导管成形术,又称为血管内碎石术,基于球囊的导管系统,能够安全有效地修饰浅表与深层钙化、同心或偏心钙化,从而明显改善血管顺应性,有利于后续介入治疗。目前血管内碎石术成为治疗冠状动脉钙化病变越来越重要的方法。本文主要对血管内碎石术的作用机制及治疗冠状动脉钙化病变的研究进行综述。

先天性左冠状动脉缺如1例

患者女,79岁,间断心悸1周,无胸闷、胸痛;高血压病史30年,脑梗死病史10年,糖尿病病史9年,未经规律治疗。查体:心率91次/分,房颤律,各瓣膜听诊区未闻及明显病理性杂音;双下肢轻度凹陷性水肿。实验室检查:N-末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)1551.00 pg/ml,糖化血红蛋白8.10%,脂蛋白相关磷脂酶A2203.83 ng/ml,甘油三酯3.04 mmol/L。心电图:心房颤动,ST-T轻度改变。冠状动脉造影:右冠状动脉开口处直径4.0 mm,全程散在斑块;未见左冠状动脉显影;左心室后支远端走行于回旋支分布区,后降支远端走行于前降支分布区。冠状动脉CT血管造影(CT angiography,CTA):单一冠状动脉开口于主动脉右冠状动脉窦并发出分支为正常情况下左冠状动脉供血区供血;冠状动脉管壁多发钙化斑块。临床诊断:先天性RI型单冠状动脉畸形,左冠状动脉缺如,心房颤动。本例报道经医院伦理委员会批准。

^(188)Re-MAG_3的制备及动物体内评价

本工作着重研究了可用于PTCA(Percutaneous transluminal coronary angioplasty)后冠状动脉再狭窄防治的放射性标记化合物188Re-MAG3的制备,并与Na188ReO4的小鼠体内生物分布加以比较。结果表明,在TechneScan MAG3锝药盒中加入酒石酸亚锡,控制标记条件,188Re-MAG3的标记率可大于98％。188Re-MAG3在小鼠体内的血液清除明显快于Na188ReO4,甲状腺和胃肠道吸收明显低于Na188ReO,标记物主要经肾脏通过尿液排出体外。为降低PTCA后冠脉再狭窄的发生率,与Na188ReO4相比,188Re-MAG3更适于临床应用。

运动康复对经皮冠状动脉介入治疗术后冠心病患者心功能的影响

目的:探讨运动康复对经皮冠状动脉介入治疗(PCI)术后冠心病患者心功能的影响。方法:选取2014-01至2015-09期间我院心内科首次行PCI的冠心病不稳定性心绞痛患者130例,按随机分组方法,将其分为常规治疗组和运动康复治疗组,各组65例。两组都给予常规药物治疗及PCI术后常规知识教育,此外,给予运动康复治疗组为期3个月的不同阶段、不同强度的运动康复锻练,再对两组患者心功能[包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、6min步行距离(6MWD)、纽约心脏病协会(NYHA)心功能分级]进行术后1个月、3个月、6个月随访观察和比较。结果:常规治疗组和运动康复治疗组患者入选时的LVEF、LVEDD、6MWD、NYHA心功能分级比较,差异均无统计学意义(P>0.05)。(1)术后1个月时:运动康复治疗组与常规治疗组相比,6MWD差异有统计学意义(P<0.05),LVEF、LVEDD及NYHA心功能分级差异无统计学意义(P>0.05);运动康复组术后1个月与入选时相比,6MWD、NYHA心功能分级差异有统计学意义(P<0.05),而心功能的其余指标差异无统计学意义(P>0.05);常规治疗组术后1个月与入选时比较,6MWD差异有统计学意义(P<0.05),而心功能的其余指标差异无统计学意义(P>0.05)。(2)术后3、6个月时:运动康复治疗组与常规治疗组相比心功能的各项评价指标差异均有统计学意义(P<0.05),运动康复治疗组术后3、6个月较入选时的各项评价心功能指标差异也均有统计学意义(P<0.05);术后3个月时:常规治疗组与入选时相比,LVEDD、6MWD差异有统计学意义(P<0.05);术后6个月时,常规治疗组患者的6MWD与入选时相比差异有统计学意义(P<0.05)。结论:运动康复治疗可以使PCI术后患者的心功能得到改善,从而提高了患者的运动耐力和生活质量。