抗血小板药物在冠状动脉内支架植入术前的应用

由冠脉阻塞所致的缺血型心脏病在临床上较为常见,经皮冠状动脉腔内成型术(PTCA)是冠心病的主要治疗手段之一,冠状动脉内支架植入术是在PTCA基础上发展起来的一个介入技术,其应用在很大程度上提高了介入技术对于血管病变的临床价值,但无论是PTCA还是冠状动脉内支架植入术均面临着急性血管闭塞和再狭窄难题,特别是冠状动脉腔内治疗术能显著激活血小板而增加了急性期或亚急性期血栓形成的风险,目前主要预防措施是应用抗血小板和抗凝药物治疗,以减少血栓形成。本文主要针对抗血小板药物在药理学预防血栓形成的疗效以及副作用的研究现状做一综述。

Cell Area and Strut Distribution Changes of Bent Coronary Stents:A Finite Element Analysis

Coronary stents are metal coils or mesh tubes delivered to blocked vessels through catheters, whic Recently, special drugs h are expanded by balloons to reopen and scaffold target vessels. are carried by stents （drug-eluting stents） to further reduce instent restenosis rate after stenting procedure. However, continual study on biomechanical characteristics of stents is necessary provide a more suitable drug loading for better interactions between stents and tissue, or to platform for drug-eluting stents. The purpose of this paper is to show how finite element methods can be used to study cell area and strut distribution changes of bent coronary stents. A same bending deformation was applied to two commercial coronary stent models by a rigid curved vessel. Results show that the stent design influenced the changes of cell area and strut distribution under bending situation. The stent with links had more cell area changes at outer curvature, and the stent with peak-peak （ 〉 〈 ） strut design could have strut contact and overlapping at inner curvature. In conclusion, this finite element method can be used to study and compare cell area and strut distribution changes of bent stents, and to provide a convenient tool for designers in testing and improving biomechanical characteristics of new stents.

Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

Objective To observe the immediate angiographic and intravascular ultrasound (IVUS) results and their effects on one month clinical outcomes in forty one patients who submitted to coronary stent deployment with IVUS guidance Methods All patients were allocated to coronary stent implantation with high inflation pressure After good angiographic results (<20% residual stenosis), all patients underwent IVUS and higher pressure dilatation would be necessary if criteria for optimal coronary stent implantation were not met The optimal criterion of IVUS for stent implantation was the ratio of intrastent lumen cross sectional area to the average of the proximal and distal reference lumen cross sectional areas ≥80% All patients had aspirin and ticlopidine therapy on the day of angioplasty and during the one month follow up period Results Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty five patients but intrastent higher pressure dilatation was performed in fourteen patients whose ultrasound results did not reach the criteria In these patients, we increased the minimal intrastent lumen area 25 7% ( P <0 05) Thirty five patients (90%) had good minimal intrastent lumen area of IVUS There were no deaths, myocardial infarction, acute stent thrombosis or need for revascularization during the study and the one month follow up Conclusions Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical outcomes after one month follow up

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

In the present study,we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α(HIF-1α)proteins before and after the coronary stent implantation.A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching(PSM)method.Of the 134 patients,67 patients taking spironolactone were used as a test group,and the other 67 patients without taking spironolactone were used as a control group.In all patients,the levels of serum GATA4,HIF-1α,and troponin I proteins were determined before as well as 24 h and 6 months after the coronary stent implantation.Left ventricular ejection fraction(LVEF)and left ventricular systolic global longitudinal strain(GLS)were determined before and 6 months after the coronary stent implantation.There were no significant differences in the HIF-1αlevel between the two groups before and 6 months after the operation,while the HIF-1αlevel was significantly lower in the test group compared with the control group at 24 h after the operation(P<0.01).There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation,while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation(P<0.01).There was no significant difference in LVEF between the two groups before and 6 months after the operation.GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups,while GLS was significantly better in the test group compared with the control group at 6 months after the operation(P<0.01).Collectively,spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.