Stent fracture after transjugular intrahepatic portosystemic shunt placement using the bare metal stent/stent-graft combination technique

BACKGROUND A transjugular intrahepatic portosystemic shunt(TIPS)is widely placed to treat portal hypertension.Because the Viatorr®stent(W.L.Gore and Associates,Flagstaff,AZ,United States)is not available in all hospitals in China,the bare metal stent(BMS)/stent-graft combination technique is still popular for TIPS construction.Stent fracture is a complication after TIPS placement using this technique,with limited available literature focusing on it.AIM To assess the incidence of stent fracture after TIPS placement using the BMS/stent-graft combination technique and to identify the risk factors for stent fracture.We proposed technique modifications to improve the clinical results of TIPS placement with the BMS/stent-graft combination technique.METHODS We retrospectively analyzed the computed tomography(CT)data of all patients with portal hypertension who underwent the TIPS procedure between June 2011 and December 2021 in a single center.Patients implanted with the BMS/stent graft and had follow-up imaging data available were included.We identified patients with stent fracture and analyzed their characteristics.Multivariable logistic regression was applied to identify the potential predictors of stent fracture.RESULTS Of the 68 included patients,stent fracture occurred in seven(10.3%)patients.Based on CT images,the stent fractures were categorized into three types.Our study consisted of four(57.1%)type I fractures,one(14.3%)type II fracture,one(14.3%)type IIIa fracture,and one(14.3%)type IIIb fracture.After adjusting for covariates,multivariable logistic regression revealed that the risk factors for stent fracture were the implantation of a greater number of stents[adjusted odds ratio(aOR)=22.2,95%confidence interval(CI):1.2-415.4,P=0.038]and a larger proximal sagittal stent bending angle(aOR=1.1,95%CI:1.0-1.3,P=0.020).CONCLUSION Stent fracture occurred in approximately 10%of patients with portal hypertension who underwent TIPS with the BMS/stent-graft combination technique.The number of implanted stents and stent bending angle at the inferior vena cava end were predictors of stent fracture,which suggests that the incidence of stent fracture could potentially be reduced by procedural modifications.

Twelve Months Clinical Outcomes after Percutaneous Coronary Intervention with Bare Metal Stents in Unselected Real-Life Patients with Coronary Artery Disease: Results from FLEXUS Study

Background: Though drug-eluting stent is widely used during coronary angioplasty, still there are conditions in which bare metal stents possess a priority role. Objectives: The aim of FLEXUS study is to investigate the safety and efficacy of Flexinnium stent in unselected real-life patients. Methods: The FLEXUS is a single-centric, observational, non-randomized, retrospective study performed from January to August 2014 in 216 patients who received Flexinnium stent. The end-point of study included device-oriented and patient-oriented clinical outcomes as per Academic Research Consortium consensus. These end-points were observed at in-hospital stay and 12-month follow-up. Results: Of 216 patients, 174 (80.6%) patients were male;there were 76 (35.2%) and 84 (38.9%) patients of diabetes and hypertension, respectively. Type B2 and C lesions accounted for 27 (11.3%) and 122 (50.8%), respectively. A total of 241 Flexinnium stents were implanted with an average diameter and length of 2.7 ± 0.2 mm and 21.6 ± 8.0 mm, respectively. The cumulative device-oriented composite at 12-month follow-up included 2.31% cardiac death, 1.39% myocardial infarction (MI) attributed to the target vessel, and 3.70% target lesion revascularization (TLR). Conclusion: FLEXUS study gives an idea about favorable safety and efficacy of the Flexinnium in unselected real-life patients with both simple and complex coronary lesions.

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions

sTo 与大冠的 vessels.MethodsFrom 2004年4月为病人与赤裸金属的 stents ( BMS )相比评估 drug-eluting stents ( DES )的长期的安全和有效性到2006年10月， 2407 个连续病人经历 de novo 损害有比大或等于在在中国北京的 Fu Wai 医院的 3.5 公里的参考容器直径的经皮的冠的干预，有希望地被注册进这研究。我们包括死亡，心肌的梗塞(MI ) ，血栓，目标损害 revascularization (TLR ) ，目标容器 revascularization (TVR ) ，和主要不利心脏的事件获得了 9 年的临床的结果(向，死亡， MI，和 TVR 合成) 。我们执行了艇长比例危险的模型在倾向 match.ResultsAfter 倾向得分以后估计所有结果措施的相对风险， 514 个对待 DES 的病人被匹配到 514 个对待 BMS 的病人。与 BMS 对待的病人与 TLR 的更高的风险被联系(HR：2.55， 95%CI：1.520-4.277， P = 0.0004 ) 并且 TVR (HR：1.889， 95%CI：1.185-3.011， P = 0.0075 ) ，但是 death/MI 和向的率不是统计上不同的。所有学术研究协会定义 stent 血栓在 9 年在二 groups.ConclusionsDuring 是可比较的整个九年的长期的后续，在有大冠的动脉的病人的 DES 的使用仍然在 TLR 和 TVR 的风险与重要减小被联系。

Which Offers the Best? Stent Graft or Bare Metal Stent for Endovascular Treatment of Aortoiliac Disease

Background: In the present study, it was aimed to compare the stent grafts and bare-metal stents in terms of post-procedural patency, clinical recovery and complications in the subjects with symptomatic aorto-iliac arterial disease. Methods: A total of 79 subjects with symptomatic aorto-iliac arterial disease treated with endovascular methods were included in the present study. Forty three subjects received self-expendable bare metal stent (ev3 Protégé stent system, Endovascular Inc., Plymouth, Minnesota, USA) and 36 subjects received PTFE-covered stent graft (Fluency Plus Stent Graft, Bard Peripheral Vascular, Tempe, Arizona). The subjects were compared after and at Months 1, 6, and 12 following the procedure in terms of Rutherford’s classification, ankle-arm index (AAI), patency rates, and complications. Results: The subjects receiving bare metal stent and stent graft for aorto-iliac arterial disease were followed for averagely 15 months. For the subjects receiving bare metal stent, primary patency rates at months 1, 6, and 12 were 98%, 81%, and 70%, respectively, while secondary patency rate at month 12 was found to be 84%. For the group of stent graft, primary patency rates were found as 97%, 97%, and 92%, respectively and secondary patency rate at month 12 was found to be 94%. Stent grafts were applied at the same time in 2 patients who had metal bare metal because the rupture occurred during the procedure. In the comparison between two groups, the group of stent graft was found to be statistically superior to the other in terms of patency, clinical and post-procedural complications. Conclusion: In conclusion, it was found that the stent grafts were superior to the bare metal stents in terms of patency and complication rates in the subjects with symptomatic aortoiliac disease.

Comparison of drug eluting stents with bare metal stents in daily practice for bifurcation lesions in Chinese patients

Background Recently, numerous randomized and controlled trials have demonstrated great advantages of drug eluting stents （DES） with respect to significant reduction of restenosis and recurrence of symptoms and improvement of clinical outcomes after percutaneous coronary intervention （PCI）. Little is known about the comparative effects between DES and bare metal stents （BMS） for bifurcation angioplasty in the Chinese population. We compared the inpatient and 7-month follow-up outcomes between DES and BMS for the treatment of bifurcation lesions. Methods From April 2004 to October 2005, 291 Chinese patients [85.9% male, mean age （57.8± 10.4） years] underwent DES （387 lesions） and/or BMS （297 lesions） implantation for bifurcation lesions. Clinical and angiographic follow-up was performed at 7 months. Results Compared with BMS group, patients in DES group had significantly lower rates of restenosis at main branch （9.5% vs 28.7%, P 〈 0.001） or side branch （14.5% vs 37.0%, P 〈 0.001） and major adverse cardiac events （MACE） （14.0% vs 26.3%, P = 0.000）. The occurrence rate of late in-stent thrombosis did not differ between the two groups in both main （0.8% vs 0, P = 0.224） and side branches （1.4% vs 0, P =0.198）. Target lesion revascularization （TLR） was less frequent in DES group for main branch （8.3% vs 21.3%, P 〈 0.001） and for side branch （7.6% vs 23.5%, P 〈 0.001）. Multivariate regression analysis revealed that total stent length （OR = 1.029, P = 0.01）, postprocedural in-stent minimum lumen diameter （OR = 0.476, P = 0.03） and stent type （OR = 3.988, P = 0.0001） were independent predictors of TLR for main branch. Prior history of coronary intervention （OR = 2.424, P =0.041）, angulated lesion （OR = 2.337, P = 0.033）, postdilation （OR = 0.267, P = 0.035） and stent type （DES vs BMS, OR = 5.459, P = 0.000） were independent predictors of TLR for side branch. Conclusion The implantation of DES may be associated with greater reduction of restenosis and TLR than BMS in bifurcations angioplasty.

Long-term effects of drug-eluting stents versus bare metal stents on patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention： outcomes of 3-year clinical follow-up

Background The long-term safety and efficacy of drug-eluting stents （DES） versus bare metal stents （BMS） are unclear and controversial issues in patients with acute ST-elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. The purpose of this study was to compare the long-term outcome of STEMI patients undergoing primary PCI with DES versus BMS implantation. Methods A total of 191 patients with acute STEMI undergoing PCI from Jan. 2005 to Dec. 2007 were enrolled. Patients received DES （n=83） or BMS （n=108） implantation in the infarction related artery according to physician＇s discretion. The primary outcome was the occurrence of major adverse cardiac events （MACE）, which was defined as a composite of death, myocardial infarction （MI）, target vessel revascularization （TVR） and stent thrombosis. The difference of MACE was observed between DES and BMS groups. Results The clinical follow-up duration was 3 years （（41.7±16.1） months）. MACE occurred in 20 patients during three years follow-up. Logistic regression analysis showed that the left ventricular ejection fraction （LVEF） was an independent predictor for MACE in the follow-up period （P=0.0301）. There was no significant difference in all-cause mortality （3.61% vs. 7.41%, P=0.2647）, the incidence of myocardial infarction （0 vs. 0.93%, P=-0.379） and stent thrombosis （1.20% vs. 1.85%, P=0.727） between the DES group and BMS group. The incidence of MACE was significantly lower in the DES group compared to the BMS group （4.82% vs. 14.81%, P=0.0253）. The rate of TVR was also lower in the DES group （0 vs. 5.56%, P=0.029）. In the DES group, there was no significant difference in the incidence of MACE between sirolimus eluting stents （SES, n=73） and paclitaxel-eluting stents （PES, n=10） subgroups （2.74% vs. 20.00%, P 〉0.05）. Conclusions This finding suggested that drug-eluting stents significantly reduced the need for revascularization in patients with acute STEMI, without increasing the incidence of death or myocardial infarction. Use of DES significantly decreased the incidence of MACE compared with BMS during the 3-year follow-up.

Two-year clinical outcome after successful implantation of drug-eluting and bare metal stents in diabetic patients： results from a real-world single center registry

Background Drug-eluting stents （DES） have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus （DM） are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention （PCI）. Available information on the efficacy and safety of DES and bare metal stent （BMS） in diabetic patients remains scarce. Methods From April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data： death, myocardial infarction （MI）, thrombus, target lesion revascularization （TLR）, and target vessel revascularization （TVR） at 30 days and 12 and 24 months, as defined by the Academic Research Consortium （ARC）. We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox＇s proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months. Results At 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group （0.08% vs 0.81%, P=0.016）. Patients treated with DES showed a significant lower risk of TLR （3.88% vs 10.89%; hazard ratio （HR） 0.159 （95% CI： 0.151-0.444）, P 〈0.001）, TVR （5.48%vs 11.69%; HR 0.383 （95% CI： 0.232-0.633）, P 〈0.001）, and any revascularization （12.47% vs 18.55%; HR 0.555 （95% CI： 0.370-0.831）, P=0.0004） at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI. Conclusions In contemporary society＇s large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization. There is no significant difference in all-cause mortality, MI, and thrombosis between DES and BMS in the patients with diabetes at 24-month follow-up.

Comparison of drug-eluting stents with bare metal stents implantation for the treatment of acute ST-elevation myocardial infarction： 2-year clinical outcomes from single-center registry

Background Some larger scale, randomized studies have demonstrated the superiority of drug-eluting stents （DES） over bare metal stents （BMS） for the treatment of acute myocardial infarction （AMI）. This study aimed to investigate the impact of DES, in comparison with BMS, on the 2-year clinical outcomes in patients with ST-elevation myocardial infarction （STEMI）.Methods From January 2002 to December 2008, a total of 1301 consecutive STEMI patients treated with coronary stenting in Shenyang Northern Hospital were prospectively registered. Patients received BMS （n=868） or DES （n=435） implantation in the infarction related artery according to physician＇s discretion. A propensity score analysis was performed and two well matched subgroups were selected （BMS, n=288; DES, n=288） to evaluate the 2-year clinical outcomes. The primary outcome was the occurrence of major adverse cardiac events （MACE）, which was defined as a composite of all-cause death, myocardial infarction （MI）, or target vessel revascularization （TVR）.Results Survival salvage analysis showed that 2-year cumulative hazards were not significantly different between the two groups with respect to TVR （2.8% vs. 3.1%, log-rank P=0.780）, stent thrombosis （1.7% vs. 4.2%, log-rank P=0.079） and MACE （8% vs. 10.8%, log-rank P=0.236）. Multivariate analysis showed that DES was an independent protective factor of MI （HR： 0.211, 95% CI： 0.049 to 0.908） and stent thrombosis （HR： 0.327, 95% CI： 0.107 to 0.994）.Conclusion DES was associated with similar 2-year clinical outcomes to those of BMS for the treatment of STEMI in daily practice.

Clinical outcomes and cost-utility after sirolimus-eluting versus bare metal stent implantation

Background Randomized studies have shown beneficial effects of drug-eluting stent （DES） in reducing the risk of repeated revascularization. Other studies have shown higher proportion of death, myocardial infarction （MI） and increased cost concerning DES. However the long term safety and effectiveness of DES have been questioned recently.Methods To compare long term clinical outcomes, health-related quality of life （HRQOL） and cost-utility after sirolimus-eluting stent （SES） and bare metal stent （BMS） implantation in angina patients in China, 1241 patients undergoing percutaneous coronary revascularization （PCl） with either SES （n=632） or BMS （n=609） were enrolled continuously in this prospective, nonrandomized, multi-center registry study.Results Totally 1570 stents were implanted for 1334 lesions. Follow-up was completed in 1205 （97.1%） patients at 12 months. Rates of MI, all causes of death were similar between the two groups. Significant differences were found at rate of cardiovascular re-hospitalization （136 （22.4%） in BMS group vs. 68 （10.8%） in SES group, P=0.001） and recurrent angina （149 （24.5%） vs. 71 （11.3%）, P=0.001）. Dramatic difference was observed when compared the baseline and 9-month HRQOL scores intra-group （P 〈0.001）. However no significant difference was found inter-group either in baseline or follow-up HRQOL. Compared with SES, the total cost in BMS was significantly lower on discharge （62 546.0 vs. 78 245.0 Yuan, P=0.001）. And follow-up expenditure was remarkably higher in the BMS group than that in the SES group （13 412.0 vs. 8 812.0 Yuan, P=0.0001）.Conclusions There were no significant differences on death, in-stent thrombosis, MI irrespective of stent type. SES was superior to BMS on improvement of life quality. SES was with higher cost-utility compared to BMS.

Effect of self-expanding bare metal stents of different diameters on the trachea of dogs

Objective To study the effect of self-expanding bare metal stents on the trachea of dogs,and therefore to provide useful information for choice of airway stents by interventional physicians.Methods In this experiment,8beagles were randomly divided into 4 groups.Four selfexpanding metal stents of different diameters(16,18。

Clinical outcomes of serolimus-eluting stents versus bare metal stents in ST-segment elevation myocardial infarction patients： a meta-analysis

Background The benefits and safety of sirolimus-eluting stent （SES） have not been systematically quantified in different trials in ST-segment elevation myocardial infarction （STEMI） patients with primary or rescue percutaneous coronary intervention （PCI）. A meta-analysis of randomised trials comparing SES and bare-metal stent （BMS） was performed. Methods A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the rate of major adverse cardiac events （MACEs）. The secondary outcomes included death, recurrent myocardial infarction, recurrent revascularization, and stent thrombosis.Results Totally, 1973 STEMI patients were enrolled in seven eligible randomized trials comparing SES with BMS. The pooled rate of major adverse cardiac events was significantly lower in the SES group than in the BMS group （9.7% vs 20.3%, OR 2.45, 95% Cl 1.88-3.19, P 〈 0.00001）. No significant difference in all causes of death was found between the SES and BMS groups, as well as in the pooled recurrent myocardial infarction rates. The pooled recurrent revascularization rate was significantly lower in the SES group than in the BMS group （5.1% vs 14.8%, OR 3.30, 95%CI 2.37-4.60, P 〈 0.00001）. No significant difference was found between the pooled rates of stent thrombosis （1.2% in the SES group and 2.0% in the BMS group, OR 1.61, 95%CI 0.79-3.26, P = 0.19）.Conclusions SES is associated with a decreased risk of major adverse cardiac events compared with BMS by the greater reduction in repeat revascularization in STEMI patients. Larger trials with longer follow up are warranted to better define the role of SES in STEMI.

A Novel High Nitrogen Nickel-free Coronary Stents System: Evaluation in a Porcine Model

Objective To study the safety of the novel high nitrogen nickel-free austenitic stainless steel bare metal stents （BMS） in a recognized porcine coronary model and to select a better grid structure of it. Methods Three types of stents were randomly implanted in different coronary arteries of the same pig： 316L stainless steel BMS （316L-BMS） （n=12）, novel high nitrogen nickel-free stents Grid A （NF-A-BMS） （n=12） and novel high nitrogen nickel-free stents Grid B （NF-B-BMS） （n=12）. In total, eighteen animals underwent successful random placement of 36 oversized stents in the coronary arteries. Coronary angiography was performed after 36 d of stents implantation. Nine animals were respectively sacrificed after 14 d and 36 d for histomorphologic analysis. 〈br〉 Results Quantitative coronary angiography （QCA） showed similar luminal loss （LL） in the three groups：（0.21±0.17） mm for 316L-BMS, （0.16±0.12） mm for NF-A-BMS, （0.24±0.15） mm for NF-B-BMS （P=0.05）. Histomorphomeric analysis after 15 d and 36 d revealed that there was also no significant difference among the three groups in neointimal area （NA） with similar injury scores respectively. High magnification histomorphologic examination showed similar inflammation scores in the three groups, but NF-A-BMS group had poorer endothelialization scores compared with NF-B-BMS group, 2.00±0.63 vs. 2.83±0.41 （P=0.015） at 15 d, which also could be proved by the scanning electron microscope. However, the difference could not been observed at 36 d. Conclusion The novel NF-BMS showed similar safety as 316L-BMS during the short-term study. NF-B-BMS had better endothelialization than NF-A-BMS and this may owe to the specific strut units.

Coronary stenting:A matter of revascularization

In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention(PCI) and the use of balloon catheters, bare metal stents(BMSs), and drug-eluting stents(DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion restenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of instent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a renarrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced restenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and antiproliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy(DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.

Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis,a novel technique for malignant obstruction:A case report and review of literature

For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of choice.ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct(CBD).We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma.The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.

Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease

Objectives: The study was designed to evaluate the efficacy and safety of drug eluting stents (DESs) in aorto-ostial (A-O) coronary artery lesions, in terms of early and late restenosis rate;including clinical assessment, non-invasive stress testing and angiographic follow-up. Also, the study was aimed to compare the results of implantation of drug eluting stents (DES) to that of bare metal stents (BMS) in aortoostial lesions done over a previous 5 years in Royal Brompton Hospital. Background: The safety and effectiveness of DESs for the treatment of aortoostial lesions. Methods: We included 161 consecutive patients with symptoms subjective of angina pectoris or objective evidence of myocardial ischemia;who underwent percutaneous coronary interventions (PCI) in coronary ostial lesions using DES. The patients were divided into two groups based on the site of ostial lesion. The control group consisted of 125 consecutive patients who underwent percutaneous coronary intervention for ostial lesions using bare metal stents (BMS) implantation in the period immediately before the introduction of DES. The incidence of major adverse cardiac events (MACE), including death or Q-wave myocardial infarction (MI), need for repeated revascularization procedure CABG or angioplasty, were recorded in-hospital and at twelve months ± 3 months. Follow-up angiography was only performed in case of recurrent symptoms subjective of myocardial ischemia or if there was objective evidence of myocardial ischemia by stress testing. Results: The initial procedure was successful in 149 patients (92.5%) in the DES arm. There were no statistically significant major in-hospital complications in the DES group, compared to BMS group which showed 4 cases of in-hospital deaths (p = 0.017). At Twelve months ± 3 months follow-up, MACE were significantly less frequent in the DES group compared to the BMS group, including death (0.8% vs. 6.4%, p = 0.004) and need for CABG (1.7% vs. 10%, p = 0.012). Conclusions: The main finding of our study is that, compared to the BMS, implantation of the DES in coronary ostial lesions appears safe and effective. It is associated with high procedural success rate, low immediate and in-hospital complication rate, infrequent late adverse events and favourable long-term clinical and angiographic outcomes compared with bare metal stents implantation at 12-month follow-up. Advanced age, previous myocardial infarction and acute coronary syndromes at presentation were all found to be independent positive predictors for clinical events after drug eluting stent implantation in ostial lesions.

药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效

目的探讨药物洗脱支架与金属裸支架治疗椎动脉开口狭窄的疗效。方法收集2015年6月至2021年6月青岛大学附属医院收治的230例椎动脉开口动脉粥样硬化狭窄患者的临床资料,按照椎动脉植入支架的不同将其分为药物洗脱支架组(n=121)和金属裸支架组(n=109)。比较两组患者术前狭窄程度、术后即刻血管残余狭窄程度、术后6个月改良Rankin量表(mRS)评分、术后6个月美国国立卫生研究院卒中量表(NIHSS)评分、围手术期并发症、术后至出院前时间、出院时卒中或死亡发生情况。观察两组患者术后支架内再狭窄情况、卒中或短暂性脑缺血发作(TIA)发生情况。结果术后即刻,两组患者血管残余狭窄程度均低于本组术前,差异均有统计学意义(P﹤0.05)。术后6个月,两组患者NIHSS评分、mRS评分均低于本组术前,差异有统计学意义(P﹤0.05)。两组患者均未发生围手术期并发症,术后至出院前时间、出院时卒中或死亡发生率比较,差异均无统计学意义(P﹥0.05)。术后1、6个月,两组患者卒中或TIA发生率比较,差异均无统计学意义(P﹥0.05)。术后12个月,药物洗脱支架组患者再狭窄率为7.55%(8/106),低于金属裸支架组患者的23.53%(24/102),差异有统计学意义(P﹤0.05)。结论药物洗脱支架与金属裸支架治疗椎动脉开口狭窄均安全、有效,可有效改善患者神经功能与日常生活能力,且药物洗脱支架效果更好,可有效降低术后远期支架内再狭窄率、卒中或病死率。

单层或双层裸金属支架治疗冠状动脉瘤的流体力学分析

目的:使用计算流体力学研究单层或双层裸金属支架治疗冠状动脉瘤(冠脉瘤)的新方法。方法:选取5例瘤体直径不同的冠脉瘤患者,分别置入单层或双层裸金属支架治疗,使用计算流体力学方法构建冠脉瘤模型并模拟单、双层裸金属支架置入过程,分析裸金属支架置入后冠脉瘤内血液动力学参数的变化。结果:在模型1(病例1,瘤体直径4 mm)中,相比无支架状态和双层裸金属支架状态,单层裸金属支架状态时血流速度最低。在模型2至模型5(病例2~病例5)中(瘤体直径6.5~16.0 mm),相比无支架状态和单层裸金属支架状态,双层裸金属支架状态的血流速度最低。在模型1和模型2中,随着裸金属支架依次模拟置入,冠脉瘤壁面压力和切应力呈现出下降趋势。模型3、4和5则表现出随着裸金属支架的依次模拟置入,冠脉瘤壁面压力逐渐上升,切应力则呈现出个体化变化。随访发现5例冠脉瘤均成功封闭且无明显支架内再狭窄。结论:瘤体直径<6.5 mm的冠脉瘤可采用单层裸金属支架覆盖瘤颈,瘤体直径在6.5~16.0 mm之间的冠脉瘤建议采用双层裸金属支架覆盖瘤颈。该技术可有效改变冠脉瘤内血流速度及载瘤动脉血流导向,促进瘤体愈合。

裸金属支架与药物洗脱支架在经皮冠状动脉介入术治疗中的研究现状

经皮冠状动脉介入术(PCI)是一种有利于解除冠状动脉狭窄、改善心肌供血的治疗手段。随着介入材料的发展,裸金属支架(BMS)和药物洗脱支架(DES)在临床中已被广泛使用,患者术后的支架内再狭窄(ISR)、靶血管血运重建(TVR)、支架内血栓(IST)以及主要心血管不良事件(MACE)的发生率已成为研究的热点。本文就BMS和DES应用于PCI治疗的研究现状作一综述,以期为临床选择介入材料提供有益的指导。

药物涂层球囊、Viabahn覆膜支架及金属裸支架治疗下肢动脉硬化闭塞症的效果比较

目的 比较药物涂层球囊(DCB)、Viabahn覆膜支架及金属裸支架(BMS)治疗下肢动脉硬化闭塞症(ASO)的效果。方法 选取2017年7月至2019年12月在温岭市第一人民医院治疗的下肢ASO患者104例,按照治疗方法的不同分为DCB组37例、Viabahn组34例和BMS组33例。比较各组通畅率、踝肱指数(ABI)以及不良事件发生情况。结果 术后3、6个月3组患者通畅率比较,差异均有统计学意义(P<0.05),且DCB组(78.38%、86.49%)、Viabahn组(76.47%、85.29%)通畅率明显高于BMS组(51.52%、60.61%)(P<0.05)。术后3、6、9、12个月3组患者ABI均明显升高(P<0.05),3组患者间歇性跛行距离比较,差异均无统计学意义(均P>0.05)。3组患者均未出现肢体截肢、心脑血管事件以及死亡等严重不良事件。结论 与BMS相比,DCB和Viabahn覆膜支架治疗下肢ASO可更明显改善ABI,提高通畅率,且安全性相当。

Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent

Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.