Effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following cardiac stent implantation

BACKGROUND Coronary stent implantation is usually used to treat unstable angina to alleviate stenosis or occlusion,promoting blood flow restoration and alleviating symptoms such as myocardial ischemia.And postoperative cardiac rehabilitation is essential for enhancing recovery and prognosis.Nevertheless,conventional rehabilitation lacks specificity,particularly for elderly patients with multiple comorbidities and poor compliance,rendering it less effective.AIM To investigate the effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following coronary stenting intervention.METHODS A retrospective enrollment was conducted comprising fifty-four elderly patients with unstable angina pectoris who underwent systematic cardiac rehabilitation training after receiving coronary intervention as the rehabilitation group,while fifty-three elderly patients who received basic nursing and rehabilitation guidance measures after coronary intervention were assigned to the control group.Differences in Seattle Angina Questionnaire scores,survival quality(SF-36)scores,cardiopulmonary exercise function assessment index,echocardiographic cardiac function index,and adverse cardiovascular events were compared between the two groups.RESULTS After intervention,the rehabilitation group observed greater VO2 Max,maximum metabolic equivalent,eft ventricular ejection fraction,left ventricular end-diastolic diameter and smaller left ventricular end-systolic diameter.And the rehabilitation group observed greater scores of physical activity limitation,stable angina pectoris,treatment satisfaction,and SF-36 score.The incidence of adverse cardiovascular events in the two groups,showed no significant difference.CONCLUSION Systematic cardiac rehabilitation following coronary stenting in elderly patients with unstable angina pectoris can enhance cardiac function recovery,consequently enhancing both quality of life and cardiopulmonary exercise tolerance.

Effects of Continuous Precision Nursing Model on Knowledge, Attitudes, and Practices (KAP) Behavior and Cardiac Function in Patients after Percutaneous Coronary Angiography and Stent Implantation

Objective:To explore the impact of a continuous precision nursing model on patients’Knowledge,Attitudes,and Practices(KAP)and cardiac function during the nursing process of patients undergoing percutaneous coronary angiography and stent implantation.Methods:Ninety patients who underwent percutaneous coronary angiography and stent implantation in our hospital from April 2022 to April 2023 were selected and randomly divided into the control group(45 cases),in which routine nursing support was carried out during the treatment process,and the observation group(45 cases),in which continuous precision nursing model was carried out during the treatment process.Comparisons were made between the two groups of patients on their KAP,cardiac function,and quality of life during recovery.Results:There was no difference in the left ventricular ejection fraction(LVEF),cardiac output(CO),and cardiac index(CI)levels before intervention.After the intervention,the levels of cardiac function in the observation group were higher than those of the control group(P<0.05).There was no difference in the Exercise of Self-Care Agency(ESCA)self-care ability scale scores before the intervention.After the intervention,the observation group had higher ESCA scores than the control group(P<0.05).Conclusion:Implementation of a continuous precision nursing model in the care of patients undergoing percutaneous coronary angiography and stent implantation improved the patient’s cardiac function,and KAP,and promoted recovery.

Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome:five-year results from a large cohort study

BACKGROUND:To investigate the most appropriate dual antiplatelet therapy(DAPT)duration for patients with acute coronary syndrome(ACS)after drug-eluting stent(DES)implantation in the largest cardiovascular center of China.METHODS:We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013.Patients were divided into four groups based on DAPT duration:standard DAPT group(11-13 months,n=1,568)and prolonged DAPT groups(13-18 months[n=308],18-24 months[n=2,125],and>24 months[n=1,186]).Baseline characteristics and 5-year clinical outcomes were recorded.RESULTS:Baseline characteristics were similar across the four groups.Among the four groups,those with prolonged DAPT(18-24 months)had the lowest incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)(14.1%vs.11.7%vs.9.6%vs.24.2%,P<0.001),all-cause death(4.8%vs.3.9%vs.2.1%vs.2.6%,P<0.001),cardiac death(3.1%vs.2.6%vs.1.4%vs.1.9%,P=0.004),and myocardial infarction(MI)(3.8%vs.4.2%vs.2.5%vs.5.8%,P<0.001).The incidence of bleeding was not different among the four groups(9.9%vs.9.4%vs.11.0%vs.9.4%,P=0.449).Cox multivariable analysis showed that prolonged DAPT(18-24 months)was an independent protective factor for MACCEs(hazard ratio[HR]0.802,95%confidence interval[CI]0.729-0.882,P<0.001),all-cause death(HR 0.660,95%CI 0.547-0.795,P<0.001),cardiac death(HR 0.663,95%CI 0.526-0.835,P<0.001),MI(HR 0.796,95%CI 0.662-0.957,P=0.015),and target vessel revascularization(HR 0.867,95%CI 0.755-0.996,P=0.044).Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.CONCLUSION:For patients with ACS after DES,appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.

冠心病PCI术后支架内再狭窄的风险因素及与vWF、RDW、sICAM-1的关系

目的探究冠心病(CHD)患者经皮冠状动脉介入术(PCI)术后发生支架内再狭窄的风险因素及与血管性血友病因子(vWF)、红细胞分布宽度(RDW)、可溶性细胞间黏附因子(sICAM-1)的关系。方法选取唐山弘慈医院2020年6月到2022年6月收治的102例择期行PCI术的冠心病患者作为研究对象,电话或门诊随访1年,根据支架内再狭窄发生情况分为狭窄组31例和非狭窄组71例,采用多因素二元Logistic回归分析PCI术后发生支架内再狭窄的危险因素,绘制受试者工作特征(ROC)曲线评估v WF、RDW、sICAM-1对PCI术后支架内再狭窄的预测价值。结果狭窄组糖尿病患病率、Gensini评分及vWF、RDW、sICAM-1水平均高于未狭窄组,差异有统计学意义(P<0.05);CHD患者vWF、RDW、sICAM-1水平与Gensini评分均呈正相关(r=0.479、0.325、0.450,P<0.05);经多元logistics回归分析显示:合并糖尿病及高水平的vWF、RDW、sICAM-1是CHD患者PCI术后发生支架内再狭窄的独立危险因素(P<0.05);外周血vWF、RDW及sICAM-1预测CHD患者PCI术后支架内再狭窄的曲线下面积(AUC)分别为0.814、0.760、0.771(P<0.05)。结论合并糖尿病及高水平的vWF、RDW、sICAM-1是CHD患者PCI术后发生支架内再狭窄的风险因素,临床可通过监测上述水平指导PCI术后的进一步治疗,以改善患者长期预后。

Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage:A Case Report

Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.

Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM:To report the outcome of Baerveldt glaucoma implant(BGI)with Supramid©ripcord use in neovascular glaucoma(NVG).METHODS:We retrospectively evaluated the surgical outcome of the BGI with Supramid©3/0 ripcord stent in patients with NVG.No tube ligation or venting slits were performed.Supramid was removed after 3mo if the target intraocular pressure(IOP)was not achieved.Surgical success was defined as IOP≤21 mm Hg with(qualified success)or without IOP-lowering medications(complete success).RESULTS:Twenty-six eyes from 24 patients were included in the study.The median duration of follow-up was 4[interquartile range(IQR)=1-5]y,ranging from 0.5 to 5y.IOP decreased by a mean of 24.2 mm Hg(59.7%);from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg,P≤0.001.The number of glaucoma medications reduced from a median of 5(IQR=5-6)to 1(IQR=0-2,P≤0.001)at the final follow-up.Overall success rates were 88.0%at 1y,34.8%at 3y,66.7%at 4y,and 50%at 5y.Hypertensive phase(HP)in the first 3mo occurred in 15/26 eyes(57.7%)with a mean IOP of 31.1 mm Hg.CONCLUSION:BGI with Supramid©ripcord stent gives close to 90%of the overall survival rate at the final follow-up without significant early hypotony.However,early HP is still a challenge.

PCI术后患者运动恐惧潜在剖面分析及与体力活动的关系

目的调查PCI术后患者运动恐惧现况,探讨运动恐惧潜在类别及其与体力活动水平的关系。方法采用便利抽样法选取328例PCI术后患者,采用一般资料调查表、心脏病运动恐惧量表、国际体力活动问卷进行调查。通过潜在剖面分析明确患者的运动恐惧类别,有序logistic回归分析体力活动水平的影响因素。结果PCI术后患者运动恐惧得分为(40.74±5.40)分,运动恐惧可分为低恐惧-适应型(15.2%)、中恐惧-边缘型(50.6%)和高恐惧-回避型(34.2%)。职业状态、心功能分级、患病前运动锻炼情况、运动恐惧类别是体力活动分级的影响因素(均P<0.05)。结论PCI术后患者运动恐惧具有异质性,运动恐惧类别是体力活动的影响因素,医护人员可针对运动恐惧类别采取针对性干预措施,提高患者体力活动水平。

麝香通心滴丸联合尼可地尔片治疗PCI术后心肌缺血再灌注损伤的临床观察

目的观察麝香通心滴丸联合尼可地尔片治疗PCI术后心肌缺血再灌注损伤的临床效果。方法选择2020年4月—2022年4月山东中医药大学附属医院心血管病二科诊治PCI术后心肌缺血再灌注损伤患者86例,根据随机数字表法分为对照组与观察组各43例。对照组患者在常规治疗基础上给予尼可地尔片治疗,观察组在对照组基础上给予麝香通心滴丸治疗,观察2组的临床疗效,治疗前后中医证候评分(胸痛胸闷、心悸汗出、气短乏力、食欲下降),血管内皮功能[血清活性氧簇(ROS)、内皮素⁃1(ET⁃1)、一氧化氮(NO)],心脏超声指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)],心肌缺血再灌注指标[TIMI分级3级、TIMI帧数计数(CTFC)、心肌显影密度分级(MBG)3级情况],记录主要心血管不良事件(MACE)。结果治疗1个月后观察组总有效率显著高于对照组(93.02%vs.74.42%,χ^(2)/P=7.196/0.027);2组中医证候评分均较治疗前降低,且观察组低于对照组(t/P=2.612/0.011、2.906/0.005、2.522/0.014、7.425/<0.001);2组ROS、ET⁃1水平均较治疗前降低,NO水平较治疗前升高,且观察组降低/升高幅度大于对照组(t/P=3.811/0.002、2.936/0.004、2.356/0.021);2组LVEF值均较治疗前升高,LVESD、LVEDD值均较治疗前降低,且观察组升高/降低幅度大于对照组(t/P=5.023/<0.001、2.738/0.008、5.879/<0.001)。治疗1月后,TIMI分级3级及MBG3级数量均较PCI治疗前升高,且观察组高于对照组(χ^(2)/P=3.957/0.047、4.497/0.034);2组CTFC帧数均较PCI治疗前降低,且观察组低于对照组(t/P=3.386/<0.001);观察组MACE不良事件发生率(全因死亡、急性致死性心肌梗死、急性心力衰竭发生率)均低于对照组(χ^(2)/P=4.074/0.044、4.195/0.041、4.914/0.027)。结论麝香通心滴丸联合尼可地尔片治疗PCI术后心肌缺血再灌注损伤临床疗效显著,可改善血管内皮功能,提高心功能,改善心肌缺血再灌注指标,降低MACE事件发生。

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent implantation are still unknown. A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included： 1） pre-operative ones： age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate （eGFR）, hyperuricemia, proteinuria, emergency operation, hydration, medications （ACEI/ARBs, statins）; 2） intraoperative ones： dose of contrast media, operative time, hypotension; and 3） postoperative one： hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. Of the 325 patients, 51（15.7%） developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters （left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration）, emergency operation, intraoperative parameters （operative time, hypotension） and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age （OR=0.253, 95%CI=0.088-0.727）, pre-operative proteinuria （OR=5.351, 95%CI=2.128-13.459）, pre-operative left ventricular insufficiency （OR=8.704, 95%CI=3.170-23.898）, eGFR〈60 ml/min/1.73 m2 （OR=6.677, 95%CI=1.167-38.193）, prolonged operative time, intraoperative hypotension （OR=25.245, 95%CI=1.001-1.034） were independent risk factors ofAKl. AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors ofAKl.

The effects of comprehensive nursing interventions on sexual functions in young and middle-aged patients with coronary stent implantation

Objective: To study the effects of comprehensive nursing interventions on sexual functions in young and middle-aged patients with coronary stent implantation. Methods: 96 cases of coronary stent implantation were randomly divided into control group and intervention group (experimental group) with each group of 48 cases. The control group received the routine nursing measures after the coronary stent implantation and the experimental group was treated by the comprehensive nursing interventions such as psychological nursing, education of sexual knowledge, playing the full enthusiasm of spouse and appropriate exercise therapy on basis of the routine nursing measures. The two groups were given the questionnaire of brief male sexual function questionnaire (BSFI), Chinese patients with premature ejaculation sexual function score (C-ISFPE) and the international index of erectile function (IIEF-5). The scores of BSFI, C-ISFPE and IIEF-5 were compared between the two groups. Results: There were 29 cases who were satisfied with sexual life on the whole (≤1), 26 cases with different degrees of premature ejaculation symptoms and 21 cases with erectile dysfunctions, which were respectively 27.08%, 30.2% and 21.87% of the total number. The scores of BSFI, C-ISFPE and IIEF-5 inthe experimental group were significantly increased after the interventions (P P IIEF-5 scores in the two groups were significantly different

加味温胆汤联合黛力新治疗冠心病PCI术后焦虑抑郁患者的临床疗效及对Lp-PLA2的影响研究

【目的】观察加味温胆汤治疗冠心病冠状动脉支架植入术(PCI)后并发焦虑抑郁患者的临床疗效及其对血清脂蛋白磷脂酶A2(Lp-PLA2)的影响。【方法】将60例冠心病PCI术后伴有焦虑抑郁状态,中医证型为痰浊闭阻证的患者随机分为对照组和观察组,每组各30例。所有患者均给予冠心病PCI术后常规西药治疗,对照组同时给予黛力新(氟派噻吨美利曲辛片)口服及心理干预治疗(包括健康教育、语言安慰及运动疗法等),治疗组在对照组的基础上联合加味温胆汤治疗,2周为1个疗程,共治疗4个疗程。观察2组患者治疗前后汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、中医证候积分及血清Lp-PLA2水平的变化情况,并评价2组患者的中医证候疗效和焦虑抑郁症状改善疗效。【结果】(1)中医证候疗效方面,治疗后,观察组的总有效率为93.33%(28/30),对照组为76.67%(23/30),组间比较,观察组的中医证候疗效明显优于对照组(P<0.05)。(2)焦虑抑郁症状改善疗效方面,治疗后,观察组焦虑、抑郁症状改善疗效的总有效率分别为93.33%(28/30)、96.67%(29/30),对照组均为76.67%(23/30),组间比较,观察组的焦虑、抑郁症状改善疗效均优于对照组(P<0.05)。(3)量表评分方面,治疗后,2组患者的HAMA评分、HAMD评分和中医证候积分均较治疗前明显下降(P<0.01),且观察组的下降幅度均明显优于对照组(P<0.05或P<0.01)。(4)血清Lp-PLA2水平方面,治疗后,2组患者的血清Lp-PLA2水平均较治疗前明显下降(P<0.01),且观察组的下降幅度明显优于对照组(P<0.01)。【结论】加味温胆汤有助于缓解冠心病PCI术后患者焦虑抑郁状态,减轻中医临床症状,改善患者预后,提高患者生活质量,其机制可能与降低血清Lp-PLA2水平,减轻炎性细胞浸润有关。

Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation

Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.

A combination strategy of functionalized polymer coating with Ta ion implantation for multifunctional and biodegradable vascular stents

Biodegradable stents made of magnesium(Mg)and its alloys have been developed to minimize persistent inflammation or in-stent restenosis,which are the main problems for permanent stents.However,their rapid corrosion behavior under physiological conditions leads to poor vascular compatibility and premature structural failure,which remains an important unsolved clinical problem.Herein,we demonstrate a new strategy for solving this problem by combining poly(ether imide)(PEI)coating and subsequent tantalum(Ta)ion implantation.The PEI coating covers the whole surface of the Mg stent uniformly via a spray coating technique and provides Mg with superior corrosion resistance and stable sirolimus-carrying ability.Ta ion implantation is conducted by a sputtering-based plasma immersion ion implantation technique only onto the luminal surface of the PEI-coated Mg stent.Its extremely short processing time(<30 s)permits preservation of the PEI coating’s corrosion protection ability and sirolimus loading characteristics.In addition,a Ta-implanted skin layer that forms on the topmost surface of the PEI coating plays an effective role in not only preventing a rapid release of sirolimus from the surface but also improving the PEI coating’s surface hydrophilicity.Based on in vitro cellular response and blood compatibility tests,Ta ion implantation leads to the improvement of endothelial cell adhesion/proliferation and suppression of platelet adhesion/activation regardless of sirolimus loading.These results indicate that the combination of PEI coating and Ta ion implantation has significant innovative potential to provide excellent vascular compatibility and prevent in-stent restenosis and thrombosis.

Two case of preoperative bridging therapy for patients undergoing non- cardiac surgery after coronary stent implantation

It has been reported that up to 12% of patients underwent non-cardiac surgery or invasive procedures within the first year after the coronary stent implantation. Premature dis- continuation of antiplatelet therapy is associated with a sig- nificant increase in mortality and major adverse cardiac events, in particular, stent thrombosis. Thus, postpone- ment of elective surgery is advocated during the first year after the coronary stent implantation.

A CLINICAL ANALYSIS OF 24 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PTCA AND INTRACORONARY STENT IMPLANTATION

The data of 24 cases(18men,6women) with AMI treated with directPTCA and intracoronary stant implantation were analyzed.The infart-related vessels were 13 LADs,4LCXs,7KCAs:The successful rate washigh(95.8%).The mean stenoses before and after performation were 95.6±5.4%,8.3±0.2%.18 stems were implanted in 16 cases.Lesscomplication happened during the procedure.There was a higher TIMI Ⅲflow patency rate in PTCA and intracoronary stent implantation than indrug thrombolysis (92% vs 40%).Stent implantation had a significanteffect on myocardial reperfution by enhancing the successful rate ofPTCA and reducing the stenosis significantly.

Clinicsl research of Palmaz-Schatz stent implantation

Objective To evaluate the clinical efficacy of Palmaz-Sctatz(P-S)stent,and sum up the experience of P-S stent implantation.Methods The P-S stent were implanted in 79 patients with 85 coronarylesions.According abscences of in hospital death.emergency coronary arterybypass grafting(CABG),Q wave myocardial infarctina(MI)or repeatintervention,measured the primary successfui rate of stent implantation atpostoperatively and the bail out rate of acute coronary closure afterpercutaneous transluminal coronary angioplasty(PTCA).Clinical follow upin 74 of 82 lesions of successful stent implantation was obteined at 3-6month after operation,the restnotic rate was measured by quantitativecoronary angiography.The restenosis was defined as】50% diameterstenosis at follow up.Results In 79 patients with 85 coronary lesion.82 were successfulimplanted.the successful rate was 96%.The Q wave MI 2 patients andemergency CABG 1 patient in 3 patients of unsuccessful stent implantation,and that have not death and repeat interveation.The 28 patients weredelivered in 31 patients with acute coronary closure after PTCA.The bailout rate was 90%.12 have restenosis in 82 lesions of follow up at 3-6month after stent implantation,the restenotic rate was 16%.Conclusion The successful rate of P-S stent implantation was high.andthe occur rete of major adverse events was lower than other stents.Thebail out rate was high in acute coronnry closure after PTCA.The restenotierate at 3-6 month after stunt implantation has lower than other stents.Butthe P-S stent yes not suitable for medium winding blood vessel and was

Angiographic Iongterm follow-up after coronary stent implantation in acute myocardial infarction

Stent implantation in acute myocardial infarction(AMI)has been shown to improvethe acute angiographic outcomes.So far few data on long-term angiographic follow-up are avallble.Methods:We studied 130 consecutive patients(mean age 58±11,24 women)betweenOctober 1993 and October 1997,in whom coronary stonts were implanted afterunsuccessful percutaneous transluminal coronary angioplasty (PTCA)in AMI.Quantitative coronary angiography(QCA)was performed and residual stenosis wasmesuremesured for all patients immediately and for 74 patients at a mean of 6 months afterthat procedure.Results:The infarct related artery was the left anterior dascending in 60(46%)pts,the circumflex in 15(12%)and the right coronary artery in 55(42%).At baseline,72(55%)pts had a totally occluded artery(TLMI0)and 11(8%)TIMI 1 flow. Eight(6%) pte were given aboiximab(ReoPro) or thrombolyais to deal with acute slantthrombosis during the intervention.Immedately after stent implantation,angiographicsuccess(TLMI 3)was obtained in 113(87%)pts,TLMI2 in 14 (11%)and TLMI 1 intwo (2%). Only three pts had residual stonosis(≥50% stenosis)immediately aftertreatment.Except the patients who had coronary artery bypass grafting(CABG)ordied coronary angiographic follow-up was performed in 74(70%)pts at a mean of 6months following the intervention(Table).Conclusion:Rescue stent implantation after failed PTCA in AMI may improve initialangiographic results,but we found a higher restenosis-rate and reintervention-rate inthe long-term run as compared with selectiv stent implantation.

ROUTINE HIGH PRESSURE BALLOON INFLATIONS AFTER CORONARY STENT IMPLANTATION WITHOUT ANTICOAGULATION

Wikter-i and multilink Coronary stent has beenimplanted in 38 lesions in 31 patients.Theindications for stent implantation were 21 elective,11 chronic total occlusion.4 threatened closure and2 suboptimal.Vessel distribution was 21 LAD,8 RCA,9LCX,Successful stent implabation was achievied inall of pstients,Lession length was 15.3±8.6mm.Theaverage final balloon size after stent placement was4.5mm(range 3.5-6.0mm) end minimal luminal diameterwithin the stent was 3.75mm(range 3.0-4.0mm).Maximum inflation pressure was 14±2 atmospheres.AWiktor-i stent used in 21 lesions and multilinkstent in 17 lesion.All of patients were treated withonly antiplatelet therapy after successful stentimplantation,There was no stent thrombosis orvascular complication.Mean elapsed time from stentplacement to femoral sheath rsmoval was 5.6 hours(range 4-7hours).Patients were discharged from thehospital within 1 week of stent placement,allreceiving aspirin 300mg per day,end ticlopidine250ms twice a day,In three months of clinic follow-up,no patients experienced stent throebosJs.After astent is deployed,routine high pressure ballooninflation is performed within the stent to ensureuniform circumferential expansion and optimalopposition of the stent to the vessel wall.Whenoptimal stent expansion was achieved,there was nostent thrombosis despite the absence of anti-coagulation in all of patients.

COMPLICATIONS OF IMPROPER ANTITHROMBOTIC THERAPY IN THREE PATIENTS WITH STENT IMPLANTATION

The clinical benefit of coronary-artery steating performed inconjunction with coronary angioplasty is limited by the risk of thromboticocclusion of the stant as well as hemorrhagic and vascular complications ofintensive anticoaguistion.We analysed complications of three patientscaused by improper antithrombotic therapy after coronary artery stanting.Method and Result:Case 1,male,52 years old.The diagnosis is old myocardial infarction(OMI),unstable angina pectoris(UAP).Gianturco-Roubin stent was successfullyimplanted into right coronary artery(RCA).Balloon angioplasty wasperformed in left circumflex artary(LCX).Angiography showed optimal resultafter the procedure.The patient bad acute inferior myocardial infarction onthe same day,and died from ventricular fibrillation on the third day afterthe stenting.Case 2,male,53 years old.The diagnosis is UAP.Two Gianturco-RoubinStents were implanted into left anterior descending artery(LAD)and RCArespectively,angioplasty was done in LCX On the tenth day atfer theprocedure,bloody urine happened.By reducing warfarin dosage be bloodyurine disappeared.Case 3.female.71 years old.the diagnosis is acute anterior myocardialinfarction,UAP.Multilink stent was implanted into LAD,balloon dilatationwas done in RCA.On the day of the stenting,groin regional bleeding andshock happendod.Afterwards.acute anterior,Supralataral MI and acute heartfailure happended.Finally the patient was discharged.DiscussionRecently the success rate of the stent implantation reach at 95%.However,the main complications are stent thrombosis as well as bleeding,vascular access complicalions caused by intensive antithrombotic agent.Inthese three patients,the death of the first case is due to acute stentthrombosis resulted from insufficient antithrombotic therapy.The bloodyurine of second case is caused by too much intensive anticoagulation.Thecomplications of the third case is due to too much intensive antithrombosisat beginning and insufficient antithrombosis at latter.The antithrombosisafter stenting should be monitored by ACT,CT or PTT The antipisteletherapy can largely reduce the stent thrombosis and the incidence of theleeding.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.