Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decr...Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era. Methods From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We used Cox＇s proportional-hazard models to assess relative risks of all the outcome measures after propensity match. Results At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR （8.39% vs. 3.28%, HR2.38, 95% Cl. 1.50-3.70）, TVR （11.07% vs. 6.32%,/-/R 1.61, 95% Cl. 1.15-2.27） and MACE （13.75% vs. 8.75%, FIR 1.37, 95% Cl. 1.02-1.85）. No significant difference was apparent in terms of mortality （1.22% vs. 1.70%, HR 0.55, 95% Cl. 0.24-1.25）, MI （1.95% vs. 2.31%, HR0.73, 95% Cl. 0.37-1.42）, or thrombosis （definite＋probable） （0.73% vs. 1.58%, HR0.40, 95% Cl. 0.15-1.05）. Conclusions In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.展开更多
Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal ...Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal carotid artery occlusion(CICAO).In consulting the literature,we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment.We reported the case of a 50-year-old male patient with blurred vision,headache,and weakness in the right upper limb.After the exclusion of other neurological diseases,he was diagnosed with symptomatic CICAO;the occlusion segment was long and the stump was too short.We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting.After 6 months of follow-up,computed tomography angiography(CTA)confirmed that the left internal carotid artery was unobstructed,and the symptoms were relieved.A brief review of the literature is presented in addition to this report.展开更多
Background: The biodegradable polymer-coated sirolimus-eluting coro-nary stent (SES) system for the treatment of coronary artery disease (CAD) has been implanted in a real-world patient population. Aim: The present st...Background: The biodegradable polymer-coated sirolimus-eluting coro-nary stent (SES) system for the treatment of coronary artery disease (CAD) has been implanted in a real-world patient population. Aim: The present study was designed to evaluate the safety and performance of MetaforTM sirolimus- eluting coronary stent (SES) system in consecutive patients with CAD in a real-world patient population. Methods: All the consecutive 251 patients who underwent percutaneous coronary interventions with the use of Metafor sirolimus-eluting stents were included in this study. Patients were clinically/tele- phonically followed-up at one-year from August 2015 to August 2016. We observed and analyzed major adverse cardiac event (MACE) defined as the aggregate of cardiac death, myocardial infarction (MI), and any target lesion revascularization (TLR) at one-year. Also, stent thrombosis (ST) was observed at one-year patients follow-up. Results: We collected and analyzed the data for 251 patients. Out of 251 participants, 191 (76.1%) were males, 95 (37.8%) patients had diabetes, 117 (46.6%) had ST-segment-elevation myocardial infarction (STEMI), and 134 (53.4%) had hypertension. Mean patient age was 56.35 ± 11.23 years. A total of 295 lesions were treated, out of which 13.6% of the lesions were the long lesion of ≥40 mm. At one-year, MACE occurred in 4 (1.6%) of 251 patients, consisting of 2 (0.8%) cardiac deaths, 2 (0.8%) MI, and 0 (0%) TLR. Stent thrombosis was reported in one patient (0.4%). Conclusions: This retrospective data demonstrated excellent safety and performance of Metafor SES in a “real-world” consecutive CAD patient, indicating low rates of MACE and ST at one-year follow-up.展开更多
背景与目的气道内支架广泛应用于气管狭窄和气管瘘的治疗,但使用气道内支架重建复杂气道的临床数据仍不充足。硅酮支架杂交金属支架重建复杂气道的有效性和安全性。方法纳入无法手术的复杂恶性气道狭窄和气道瘘患者。使用Y型硅酮支架联...背景与目的气道内支架广泛应用于气管狭窄和气管瘘的治疗,但使用气道内支架重建复杂气道的临床数据仍不充足。硅酮支架杂交金属支架重建复杂气道的有效性和安全性。方法纳入无法手术的复杂恶性气道狭窄和气道瘘患者。使用Y型硅酮支架联合金属覆膜支架(杂交支架)重建气道。评价置入支架后6个月的疗效和并发症。结果共纳入23例患者,置入23枚Y型硅酮支架和25枚金属覆膜支架。19例患者(19/23,82.6%)置入支架后症状迅速缓解。支架平均置入(153.43±9.14)d。置入支架后改良呼吸困难指数(modified British Medical Research Council,mMRC)、卡氏功能状态(Karnofsky performance status,KPS)评分和功能状态(performance status,PS)评分显著改善。12例患者带支架生存超过6个月。其余患者肿瘤进展导致6个月内死亡。无支架置入相关死亡及严重并发症。结论杂交支架重建恶性复杂气道疗效确切,耐受良好。展开更多
文摘Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era. Methods From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We used Cox＇s proportional-hazard models to assess relative risks of all the outcome measures after propensity match. Results At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR （8.39% vs. 3.28%, HR2.38, 95% Cl. 1.50-3.70）, TVR （11.07% vs. 6.32%,/-/R 1.61, 95% Cl. 1.15-2.27） and MACE （13.75% vs. 8.75%, FIR 1.37, 95% Cl. 1.02-1.85）. No significant difference was apparent in terms of mortality （1.22% vs. 1.70%, HR 0.55, 95% Cl. 0.24-1.25）, MI （1.95% vs. 2.31%, HR0.73, 95% Cl. 0.37-1.42）, or thrombosis （definite＋probable） （0.73% vs. 1.58%, HR0.40, 95% Cl. 0.15-1.05）. Conclusions In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.
文摘Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal carotid artery occlusion(CICAO).In consulting the literature,we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment.We reported the case of a 50-year-old male patient with blurred vision,headache,and weakness in the right upper limb.After the exclusion of other neurological diseases,he was diagnosed with symptomatic CICAO;the occlusion segment was long and the stump was too short.We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting.After 6 months of follow-up,computed tomography angiography(CTA)confirmed that the left internal carotid artery was unobstructed,and the symptoms were relieved.A brief review of the literature is presented in addition to this report.
文摘Background: The biodegradable polymer-coated sirolimus-eluting coro-nary stent (SES) system for the treatment of coronary artery disease (CAD) has been implanted in a real-world patient population. Aim: The present study was designed to evaluate the safety and performance of MetaforTM sirolimus- eluting coronary stent (SES) system in consecutive patients with CAD in a real-world patient population. Methods: All the consecutive 251 patients who underwent percutaneous coronary interventions with the use of Metafor sirolimus-eluting stents were included in this study. Patients were clinically/tele- phonically followed-up at one-year from August 2015 to August 2016. We observed and analyzed major adverse cardiac event (MACE) defined as the aggregate of cardiac death, myocardial infarction (MI), and any target lesion revascularization (TLR) at one-year. Also, stent thrombosis (ST) was observed at one-year patients follow-up. Results: We collected and analyzed the data for 251 patients. Out of 251 participants, 191 (76.1%) were males, 95 (37.8%) patients had diabetes, 117 (46.6%) had ST-segment-elevation myocardial infarction (STEMI), and 134 (53.4%) had hypertension. Mean patient age was 56.35 ± 11.23 years. A total of 295 lesions were treated, out of which 13.6% of the lesions were the long lesion of ≥40 mm. At one-year, MACE occurred in 4 (1.6%) of 251 patients, consisting of 2 (0.8%) cardiac deaths, 2 (0.8%) MI, and 0 (0%) TLR. Stent thrombosis was reported in one patient (0.4%). Conclusions: This retrospective data demonstrated excellent safety and performance of Metafor SES in a “real-world” consecutive CAD patient, indicating low rates of MACE and ST at one-year follow-up.
文摘背景与目的气道内支架广泛应用于气管狭窄和气管瘘的治疗,但使用气道内支架重建复杂气道的临床数据仍不充足。硅酮支架杂交金属支架重建复杂气道的有效性和安全性。方法纳入无法手术的复杂恶性气道狭窄和气道瘘患者。使用Y型硅酮支架联合金属覆膜支架(杂交支架)重建气道。评价置入支架后6个月的疗效和并发症。结果共纳入23例患者,置入23枚Y型硅酮支架和25枚金属覆膜支架。19例患者(19/23,82.6%)置入支架后症状迅速缓解。支架平均置入(153.43±9.14)d。置入支架后改良呼吸困难指数(modified British Medical Research Council,mMRC)、卡氏功能状态(Karnofsky performance status,KPS)评分和功能状态(performance status,PS)评分显著改善。12例患者带支架生存超过6个月。其余患者肿瘤进展导致6个月内死亡。无支架置入相关死亡及严重并发症。结论杂交支架重建恶性复杂气道疗效确切,耐受良好。
