Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.

Distribution of C - myc Antisense Oligonucleotides in Rabbits after Local Delivery by Implanted Gelatin Coated Platinium - Iridium Stent

Objectives To assess thefeasibility, efficiency and tissue distribution of local delivered c - myc antisense oligonucleotides (ASODN) by implanted gelatin coated Platinium - Iridium (Pt -Ir) stent. Methods Gelatin coated Pt - Ir stent which absorbed carboxyfluorescein - 5 - succimidyl ester (FAM) labeled c - myc ASODN were implanted in the right carotid arteries of 6 rabbits under vision. Blood samples were collected at the indicated times. The target artery, left carotid artery, heart , liver and kidney obtained at 45 minutes , 2 hours and 6 hours. The concentration of c - myc ASODN in plasma and tissues were determined by Thin Layer Fluorome-try. Tissue distribution of c - myc ASODN were assessed by fluorescence microscopy. Results At 45 min, 2 h, 6 h, the concentration of FAM labeled c -myc ASODN in target artery was 244. 39, 194. 44, 126. 94(μg/g tissues) respectively, and the delivery efficiency were 44. 4% , 35. 4% and 23. 1% respectively. At the same indicated time point, the plasma concentration was 8. 41, 5. 83, 14. 75 (μg/ml) respectively. Therefore c - myc ASODN concentrations in the target vessel were 29, 33 and 9 -fold higher than that in the plasma. There was circumferential distribution of labeled c - myc in the area of highest fluorescein coinciding with the site of medial dissecting from stent-ing, and the label was most intense in target vessel media harvested at 45 min time point and then dispersed to adventitia. Conclusions Gelatin coated Pt - Ir stent mediated local delivery of c - myc ASODN is feasible and efficient. The localization of ASODN is mainly in target vessel wall.

Local Delivery of C-myc Antisense Oligodeoxynucleotide by Gelatin Coated Platinium-Iridium Stent to Prevent Restenosis in a Normal Rabbit Carotid Artery

Objectives To investigate the feasibility and effect of local deliveryof c-myc antisense oligodeoxynucleotide (ASODN) by gelatin coated Platinium-Iridium stent to prevent restenosis in a normal rabbit carotid artery. Methods Gelatin coated Platinium-Iridium stent were implanted in the right carotid arteries of 32 rabbits under vision. Animals were randomized to the control group and the treated group receiving c-myc ASODN (n=16 respectively).7, 14, 30,90 days following the stenting procedure, morphometry for caculation of neointimal area and mean neointimal thickness were performed.The expression of c-myc protein was detected by immunohistochemical methods. Results 32 stents were successfully implanted into the right carotid arteries in 32 animals.Morphometric analysis showed that neointimal area and mean neointimal thickness siginificantly increased continuously up to 12 weeks after stent implantation,and at each time point , neointimal area and mean neointimal thickness were siginificantly smaller in the treated group than control group. (P<0.001,respectively).c-myc protein expression was weak positive or negative in treated group and positive in control group. Conclusions Gelatin coated Platinium-Iridium stent mediated local delivery of c- myc ASODN is feasibility , and it can inhibit neointimal hyperplasia to prevent restenosis in a normal rabbit carotid artery.

Safety and efficacy of stent placement for treatment of intracranial aneurysms： a systematic review

Objective To evaluate the safety and efficacy of stent placement for the treatment of complex intracranial aneurysms. Data sources We searched six databases, including Pubmed, Embase, SCI-expanded, the Cochrane Library, ISI Proceedings and ProQuest Dissertations ＆ Theses for the relevant studies using multiple key words from December, 1997 to February, 2009. Study selection Thirty-three studies about stent placement for intracranial aneurysms were identified, which reported data from a total of 1069 patients with 1121 intracranial aneurysms. Data extraction We prepared a standardized data extraction form （DEF）, which was used by two independent researchers to extract data from the included 33 studies. Results The overall initial complete occlusion rate was 52.5% （456/869, 95% CI： 49.2%-55.8%）. The overall complication rate was 14.3% （162/1130, 95% CI： 12.3%-16.4%）, of which 3.6% （38/1044, 95% CI： 2.5%-4.8%） were permanent. Clinical follow-up showed a dependence rate of 8.4% （39/465, 95% CI： 5.9%-10.9%）. Angiographic follow-up showed an improvement rate of 24.3% （117/481, 95% CI： 20.5%-28.2%） and a recurrence rate of 12.9% （62/481, 95% CI： 9.9%-15.9%）. Chi-squared tests were performed to compare the following subgroups： self-expandable vs. balloon-expandable stents, unruptured vs. acutely ruptured aneurysms, and with vs. without pre-medication. Statistical significance was reached in eight tests. Conclusions Intracranial stent is a safe and effective tool for embolizing complex intracranial aneurysms. Self-expandable stents are significantly easier and safer than balloon-expandable stents with respect to navigation and deployment through the tortuous cerebral vasculature. Patients with acutely ruptured aneurysms are more likely to be dependent, but not more likelv to suffer more orocedure-related comolications.

Recurrence of resistant hypertension after renal artery stent implantation: A case report

Takayasu＇s Arteritis is a chronic non-specific inflammatory vascular disease involving the aorta and its major branches. Takayasu＇s arteritis is one of important reason for renal artery stenosis（RAS） which may result in severe hypertension. Angioplasty, preferably with stenting, is recommended in RAS secondary to atherosclerosis. However, the safety and efficacy of stent implantation is still unclear in RAS caused by Takayasu＇s arteritis. In order to raise the awareness for the importance of Takayasu＇s arteritis in renal artery disease and further to discuss the endovascular revascularization strategies, we are going to present a case report regarding RAS resulted by Takayasu＇s arteritis and provide a timely summary and update on current understanding.