Long Term Clinical and Angiographic Outcome Following Percutaneous Transluminal Angioplasty and Stent Placement for Iliac and Femoral Artery Stenosis

Objective This study reportsthe initial and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac and femoral arteries. Methods and Results From December 1994 to March 1997, we performed iliac and femoral artery angioplasty and primary intravascular stent placement in 37 vessel of 33 patients (19 men and 14 women; mean age, 70. 5 years). A total of 43 self - expanding Wallstents (Boston, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Clinical follow - up was available for all patients at a mean of 26±14months. All patient clinical is-chemic category (claudication or rest pain) was improved. Angiographic follow - up was completed for 17 of 23 patients at a mean follow-up of 10±5 months, The iliac artery restenosis rate was 0(0/8). The femoral artery restenosis rate was 33 % (3/9), All 3 patients underwent repeat balloon angioplasty successfully. Conclusion The iliac and femoral arteries can be performed and reasonable early and late patency rates.

Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS

Effect of Carvedilol on the Coronary Vascular Endothelial Function after Percutaneous Transluminal Coronary Angioplasty

Objectives To understand the effect of carvedilol on the coronary vascular endothelial function of the patients with coronary heart disease after percutaneous transluminal coronary angioplasty (PTCA). Methods 51cases, having one or more than two branches narrow ( ≥ 70% ) , were diagnosed by coronary angiography. These patients were divided randomly into carvedilol group (n = 28) and control group ( n = 23) who did not take carvedilol. Endothelin (ET) and nitro dioxide (NO) levels of peripheral blood were measured before and after PTCA, before and after two weeks by taking earvedilol. Results Compared with the ET and NO levels before PTCA, ET were markedly increased and NO were decreased after PTCA (p <0. 05) ; compared with the ET and NO levels before taking carvedilol, ET were decreased and NO were increased after two week (p <0.05 ) , but the ET and NO levels of the control group did not change in the period of two weeks observation (p > 0.05). Conclusions Carvedilol may improve the coronary vascular endothelial function after PTCA.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

Endovascular Stents in Arterial Injury after Radiotherapy

We evaluated preliminary success and patency of stenting for the treatment of radiation - induced arterial diseases. Thirteen stents were placed in 8 patients to treat occlusion (n = 3), aneurysm (n = 1), residual stenosis (n = 2), multiple stenoses (n = l), and delayed restenosis after previous balloon angioplas-ty (n=l). Interventional procedure was successfully performed in 8 patients for their arterial lesions after radiotherapy. Six patients underwent interventional procedure once or twice. Two patients underwent PTA 4 times. Five of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow-up of 2 years (range: 8 - 60 months). Clinical improvement was noted in the other patients. Our results suggest that stent placement by single or multiple techniques may have immediate effect on arterial lesions caused by radiation and can be considered as a therapeutic option of choice in these cases.

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report

BACKGROUND Aberrant right subclavian artery(ARSA)is the most common congenital anomaly of the aortic arch.When patients having such anomalies receive transradial intervention(TRI),aortic dissection(AD)may occur.Herein,we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient,that was later salvaged by percutaneous angioplasty.CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain.Coronary computed tomography(CT)angiography revealed significant stenosis in the left anterior descending artery.Diagnostic coronary angiography was performed via the right radial artery without difficulty.However,we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention,while the guidewire tended to go down the descending aorta.The patient suddenly complained of chest and back pain.Emergent CT aortography revealed type B AD propagating to the left renal artery(RA)with preserved renal perfusion.However,after 2 d,the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable.Follow-up CT indicated further progression of dissection to the right external iliac artery(EIA)and left RA with limited flow.We performed percutaneous angioplasty of the right EIA and left RA without complications.Follow-up CT aortography at 8 mo showed optimal results.CONCLUSION A caution is required during right TRI in ARSA to avoid AD.Percutaneous angioplasty can be a treatment option.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ITS SUCCESS RATE AND AFFECTING FACTORS

From December 1987 to October 1983, percutaneous transluminal coronary angioplasty (PTCA) was performed in 302 patients with 392 diseased vessels and 440 lesions. The success rate was 93.71% in 302 patients, 94.90% in 392 diseased vessels and 95.00% in 440 lesions. The success rate was 98.92% in Type A lesion, 95.71% in Type B lesion, and 86.57% in Type C lesion (A vs B P=NS, A vs C P<0.01). There were 55 lesions with total or subtotal occlusion, the success rate was 89.09% (93.10% in Type B lesion and 84.62% in Type C lesion). As to the diseased vessels, the success rate was 95.65% in LAD, 94.38% in LCX and 93.75% in RCA. The results showed no significant difference. In this series, acute ischemic complications were found in 6.59% (29 / 440). Of these 29 lesions, 23 were treated successfully, 5 developed Q wave myocardial infarction and 1 died.

Clinical Study on The rapeutic Mechanism of Sini Decoction (四逆汤) in Treating Post-Percutane ous Transluminal Coronary Angioplasty Ische mia-Reperfusion In jury in Terms of Syndrome Typing of TCM

Objective: To study the mechanism of Sini Decoction (SND) in prevention and treatment of post-percutaneous transluminal coronary angioplasty (PTCA) ischemia-reperfusion injury with different Syndrome typing of TCM.Methods: Forty patients who received PTCA were randomly divided equally into the SND group and the control group, there were 10 of Excess Syndrome (ES) and 10 of Deficiency Syndrome (DS)in each group.25 ml SND was gi ven daily to the SND group from 3 days before operation to the third day after operation. The blood superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) content of patients were determined before PTCA, and 1 hr, 12 hrs, 24 hrs, 48 hrs and 72 hrs after PTCA. Results: Before PTCA, the cases with DS were characterized by low SOD activity and high MDA content, as compared with the patients with ES, P<0.05. SND could relieve the post-PTCA deprivation of SOD activity and NO content and the elevation of MDA level in both ES and DS patients, the amplitude of elevation of SOD activity in DS patients was higher than that in ES patients (P<0.05). Conclusion: SND has antagonizing effect on post-PTCA ischemia-reperfusion injury, which is more effective in treating patients with DS.

Study on Influence of Sini Decoction (四逆汤) on Quality of Life of Patients after Percutane ous Transluminal Coronary Angioplasty

Objective: To determine the influence of Sini Decoction (SND) on quality of life(QOL) of patients after percutaneous transluminal coronary angioplasty (PTCA). Methods: Randomized case-control clinical trial was conducted to evaluate QOL of 40 post-PTCA patients before and after SND treatment by scoring. Results: The scores in physical symptoms, sense of well-being, degree of depression, index of satisfaction of life and work capacity of the patients after PTCA were improved significantly as compared with before PTCA, P<0.01. Scores of patients who received SND treatment were higher than those untreated with SND in the first three criteria, P<0.05, particularly in relieving palpitation and dyspnea. Conclusion: SND is helpful in improving QOL of patients after PTCA.

PERCUTANEOUS TRANSLUMINAL EXCIMER LASER CORONARY ANGIOPLASTY CLINICAL REPORT OF SIX CASES

Six patients with 95% to 100% occluded atheroseleroticlesions underwent percutaneous transluminal excimer lasercoronary angioplasty (PTELCA). Among them, 5 were maleand ! was female; their age ranged from 28 to 66 years. Fourpatients had LAD stenosis and 2 LCX lesions.Acuteangiographic and clinical success was achieved in all patientsbut one, with a success rate Of 83.3%. It was demonstratedthat PTELCA is a safe and effective therapy for selected pa-tients with coronary artery disease.

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.

Plaque increase may be an important contributor to late restenosis after percutaneous transluminal coronary balloon angioplasty

There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.

Potassium in Prevention of Restenosis after PTCA

Objectives To investigate safety and effectivity of potassium inprevention of restenosis after PTCA. Methods Eighty patients with PTCA were randomized into two groups: Control group ( Group Ⅱ n= 40) with conventional therapy; Treatment group (Group Ⅰ n = 40) with conventional therapy plus oral potassium (Slow - K 1.2 g, q8h, given 3 days before PTCA and continued to the end ofsub - study). Observation indeces of two groups were compared in follow - up. Results Seventy - seven patients were followed -up(39 in group Ⅰ, 38 in group Ⅱ) All blood indices (including fat, sugar, uric acid, cretonne, Na+, Cl-, Ca2+, Mg2+ ) except blood potassium in both groups were similar. Oral potassium could increase blood potassium level about 0. 3 mmol/L in group Ⅰ without causing any side effects. Suspicious angina pectoris and evidence of myocardial ischemia by ETT were developed in group Ⅱ had 14 patients (28. 9 % ) and Group I had 7 patients (17. 9 % ); 6 of 17 patients(35. 3 % ) in groupⅠ and 11 of 21 patients in group Ⅱ (52. 3 % ) appeared restenosis confirmed by coronary arteriography. 10. 2 % in group Ⅰ (4/39) and 23.7 % in group Ⅱ (9/38) needed revascular-izations(PTCA or CABG) . Conclusions Therapy with potassium after PTCA showed that recurrence of myocardial ischemia, restenosis rate by follow - up coronary arteriography and revascularization rate tended to be lower in group Ⅰ than in group Ⅱ.

EXPERIMENTAL WORK AND RESEARCH The Experimental Study of Xue Guan Tong（血管通）on PreventingRestenosis after Percutaneous Transluminal A

The effect of Xue Guen Tong (XGT) granule in preveriting restenosis of atherosclerotic iliacartery after percutaneous transluminal angioplasty (PTA) in rabbits was studied. Forty-two purebred NewZealand rabbits with their endothelium of iliac arteries denuded and fed with high cholesterol diet for sixweeks to form the model of atheresclerotic stenosis. After PTA, the high cholesterol diet was stopped imme-diately and they were divided into 3 groups randomly. the XGT group, the lovastatin group and the controlgroup. Arterial angiogreph and pathological observation were carried out 4 weeks after PTA. The resultesbewed that ( 1 ) The luminal diameter of artery was 1 . 82 0. 46mm in the XGT group, 0 . 96 0. 71mm in thelovastetin grcxjp and 0. 71 0 . 53mm in the control group. The former one was larger than the latter two sig-nificantly ( P< 0. 01 ) . (2) Thickness of intima of artery was 0 . 27 0 . 40mm in the XGT group, it was thinnerthan those in the other two groups (O. 43 0. 04mm in the lovastatin group arid 0. 48 0. 10mm in the controlgroup) . (3) In XGT group, the smooth muscle cells ( SMCs) contained fewer organelles. more muscular fibersand were well differentiated than in the other two groups. The conclusion was XGT has the preventive effecton past-PTA arterial restenosis in rabbits.

Experimental Study of Hirudo and salvia miltiorrhiza on Smooth Muscle Cell Hyperplasia following Balloon Angioplasty

Objective: To find the prevention of restenosis after transluminal angioplasty (TA).Methods: Sixty rabbit iliac arteries of 30 rabbits were randomly divided into three groups: group A, B and C, 20 in each. After experimental atherosclerotic stenosis and TA performing, ordinary forage plus 2 g of Hirudo (Hirudo nipponica whitmania) powder was fed to group A every day, to the group B, 2 gSalvia miltiorrhiza (red sage root) powder was added and to the group C, ordinary forage only. Angiography and pathomorphological examination were carried out 30 days later.Results: (1) Hirudo significantly reduced the thickness of iliac intima as compared with the other two groups (P < 0.05), the thickness in the group A, B and C was 40.1 ± 9.8 μm, 48.2 ± 8. 2 μm and 69. 3 ± 9. 2 μm respectively. (2) The incidence of restenosis after TA in both group A (31.4%) and group B (48.4%)were significantly lower than that in the group C (62.8%,P < 0.05). The difference was also found between the group A and B(P < 0.05). (3) Ultrastructure examined by transmission electron microscopy showed that less rough endoplasmic reticulum and more myofilaments in well differentiated smooth muscle cell (SMC) of the arterial intima in the group A and B, while in the group C, more rough endoplasmic reticulum, more synthetic cells were seen in SMC.Conclusions: Hirudo andSalvia miltiorrhiza could effectively inhibit the hyperplasia of SMC in arterial intima and reduce intima thickness and the incidence of restenosis after TA significantly, thus it might play a role in the prevention of restenosis after TA. The effect of Hirudo is more potent than that ofSalvia miltiorrhiza.

The influence of admission glucose on epicardial and microvascular flow after primary angioplasty

Background Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited. Methods Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level： group 1, 〈7.8 mmol/L; group 2, （7.8 - 11.0） mmol/L; and group 3, ≥ 11.0 mmol/L. Results Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides （TG） in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction （TIMI） 3 flow after percutaneous coronary intervention （PCI） （89.7%, 86.0% and 86.3%, P=NS）. However, corrected TIMI frame count （CTFC） in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade （TMPG） 0-1 grade among patients with hyperglycemia after PCI were more frequent （30.9% and 29.0% vs 17.3%, P〈0.05）. There was less frequent complete ST-segment resolution （STR） and early T wave inversion among patients with hyperglycemia after PCI. Conclusion Elevated admission glucose levels in ST-segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.

Treatment of in stent coronary restenosis with excimer laser angioplasty

OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P

Successful recanalization of chronic total occlusion of the superior mesenteric artery by transradial approach

It is a challenge to confirm chronic mesenteric ischemia(CMI) as a cause of gastrointestinal(GI) symptoms such as postprandial epigastric bloating,anorexia,and debilitating weight loss.Endovascular intervention for CMI has been gaining popularity because of the high morbidity associated with surgical revascularization.However,in EVI for superior mesenteric artery(SMA) occlusion,the transfemoral approach is limited by difficulty in coaxial alignment of the guiding catheter,which leads to insufficient back-up support.Herein,we report on a 58-year-old male patient with chronic total occlusion of the SMA,which was successfully revascularized by endovascular intervention via the left radial artery.Transradial endovascular therapy may be another treatment option for the treatment of CMI.

Percutaneous coronary intervention for chronic total occlusion in 1263 patients:a single-center report

Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.