Response of blood pressure after percutaneous transluminal renal artery angioplasty and stenting

AIM: To evaluate the short and intermediate term out-come of percutaneous transluminal renal artery angioplasty (PTRA) and stenting particularly on blood pressure (BP) control and renal function and to evaluate predictors of poor BP response after successful PTRA and stenting. METHODS: We conducted a prospective analysis of all patients who underwent PTRA and stenting in our institute between August 2010 to September 2012. A total number of 86 patients were underwent PTRA and renal stenting. Selective angiography was done to confirm at least 70% angiographic stenosis. The predilatation done except few cases with critical stenosis, direct stenting was done in the rest of cases. All patients received aspirin 325 mg orally, and clopidogrel 300 mg orally within 24 h before the procedure. Heparin was used as the procedural anticoagulant agent. Optimal results with TIMI-Ⅲ flow obtained in all cases. Following stent placement, aspirin 150 mg orally once daily was continued for a minimum of 12 mo and clopidogrel 75 mg orally once daily for at least 4 wk. The clinical, radiological, electrocardiography, echocardiography and treatment data of all patients were recorded. The BP measurement, serum creatinine and glomerular filtration rate (GFR) were recorded before the procedure and 1 and 6 mo after PTRA. RESULTS: A total of 86 patients were included in the study. The mean age of study population was 55.87±11.85 years old and 67 (77.9%) of patients were male. There was a significant reduction in both systolic and diastolic BP at 1 mo after the procedure: 170.15±20.10 mmHg vs 146.60±17.32 mmHg and 98.38±10.55 mmHg vs 89.88±9.22 mmHg respectively (P=0.0000). The reduction in BP was constant throughout the follow-up period and was evident 6 mo after the procedure: 144.23±18.19 and 88.26±9.79 mmHg respectively (P=0.0000). However, no improvement in renal function was observed at any time during the follow-up period. After multivariate analysis, we found male sex, low GFR (<60 mL/min) and higher baseline mean BP as a poor predictors of successful outcome on BP response after PTRA and stenting. CONCLUSION: The PTRA and stenting can be considered as an effective therapeutic intervention for improving BP control with minimal effect on renal function. The male sex, higher baseline BP and low GFR are associated with poor BP response after successful PTRA and stenting.

Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty

Objective To explore how older patients self-manage their coronary heart disease （CHD） aider undergoing elective percutaneous transluminal coronary angioplasty （PTCA）. Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients （n = 93） approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings in- formed the purposive samplhag for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualita- tive data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants （n = 47） classified as 65 years of age or older. Results 78.7% （n = 37） of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% （n = 16） thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% （n = 19） would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less （P = 0.02） and smoked less （P = 0.01） than their younger counterparts in the study. Age did not seem to affect PTCA patients＇ likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption （P = 0.237）. Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants＇ likelihood to alter lifestyle factors.

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.

CLINICAL APPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutoneous transiuminal coronary anginplesty(PTCA)was performed in33 patients of coronary heart diseases(male 30 cases,female 3 cases, meanage 54.2) with Gruentzig’s method.Of all the 33 patients,there were 26narrow parts in 20 cases of the single branch lesions,27 narrow parts in 11cases of the double branch lesions and 11 narrow parts in 2 cases of thethree branch lesions.In 48 branches with lesion vessels,there were 27branches of the left anterior descending coronary arteries (LAD),7 branchesof the left cicumflex coronary arteries(LCX)and 13 branches of the rightcoronaw arteries.The narrow degrees varied from 75% to 100%. The resultswere that,of 33 patients,48 branches of lesion vessels and 64 narrow parts,the successful rates of dilation were 96.9%,87.5%,85.9%,respectively.Ventricular fibrillation occurred in one case during the procedure,whichsoon recovered sinus rhythm through cardioversion.Symptoms of thesuccessful 32 patients were lmproved obviously or diappeared after PATC.Combining with the documents,we think that the successful rates are higherin type A lesion undergoing PTCA.When PTCA for the multiple branchlesions are performed,we ought to master the principle of dilating the mainlessinos in advence.The long-tube lesions were dilated by the long balloonfitting for these lesions.The causes of failure of PTCA in the severe narrowlesions are mainly the the guilding wires or the balloon catheters cann’t passthrough the lesion parts,in addition,the complication problems in PTCA arealso discussed.

Amiodarone-induced bronchiolitis obliterans organizing pneumonia in patient following percutaneous transluminal coronary angioplasty

Background: Many patients are affected by idiopathicbronchiolitis obliterans organizing pneumonia (BOOP). There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. Numerous agents including cytotoxic and noncytotoxic drugs have the potential to cause pulmonary toxicity. Descriptions of amiodarone-related BOOP continue to be reported throughout the world. Case Report: We reported a patient with original clinical presentation who developed recurrent sustained ventricular tachycardia (SVT) despite the presence of implantable cardioverter-defibrillator (ICD), hypoxaemia and interstitial pneumonitis in both lung bases. After percutaneous transluminal coronary angioplasty, he developed bronchiolitis obliterans organizing pneumonia (BOOP). Conclusions: To our knowledge, such complications after percutaneous coronary procedure in patients with amiodarone therapy for arrhythmia prophylaxis, are not very frequent in literature.

CHANGES AND SIGNIFICATION OF SERUM CPK BEFORE AND AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN PATIENTS WITH CORONARY HEART DISEASES

To study the damage effect of percutaneous transfuminalcoronary angioplasty(PTCA)on myocardium,wedetermined the serum CPK and CPK-MB level in 35 casesof patients with coronary henrt disease(CHD)beforePTCA and at 6th,12th,24th hour,2nd,3rd day afterPTCA.The results showed that after PTCA,the serumCPK and CPK-MB in 21 of 35 case of patients wised at12th hour.2nd day reached the peak level.But comparedwith others,it has no significant different(P】0.05).TheCPK and CPK-MB decreased to normal level at 3rd day.Itis suggested that PTCA has no significant damage effect onmyocardium.

RELATION BETWEEN ECG CHANGES DURING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AND IMPROVEMENT OF MYOCARDIAL VIABILITY

The purpose of this study was to demonstrate the relation between the transientchanges of electrocardiogram(ECG)on body surface during balloon dilating inpercutaneous transluminal coronary angioplasty(PTCA) and improvement of theresidual myocardial viability after PTCA,Eighteen patients with twenty-threecoronary arteries narrowing above 70% were underwent PTCA and myocardialviability was examined with 99mTc-MIB1 Singlephoton Emission ComputedTomography(SPECT)before and after the procedure.During the balloon dilating30-60s,the ECG with leads Ⅱ,Ⅲ.avF.V4 weve recorded.There were 15 caseswith ECG changes of T wave.ST-Seg-ment and QRS axis(65.2%,47 8% and26.1%.respectively),3 case without ECG chanse.More than 50% change of Twave altitude was scored as 1.ST segment shift(elevation≥lmm or depression≥0.5mm.10mm=lmv)as 2.QRS axis deviation≥15 as 3.Myocardial viabiliiy.was evaluated by SPECT with four-point of nine segments of the left ventricularwall.The integral value of ECG change dung PTCA was closely correlated withthe change value of SPECT(SPECT△)(r=0.74,p【0.01).The sensitivity of themethod was 80%;specificity 100%;the positive predictive value 100%;the negativepredictive value 50%;the accuracy 83.3%.This method was simple,useful and.excellent in evaluating myocardial viability.The rest myocardial viability afterPTCA was higher than it was before PTCA(21.2±3.8 vs 17.6±3.6point,P【0.01).The hibernating myocardial viability was improved post PTCA.

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

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.

COMPLEX PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutancous transluminal coronary angioplasty was pcrfonned in 70patients with high risk characteristics from Jan.1998 toDcc.1997 These factors include age】70(10patients),unstableangina(35patients),ejection fraction【40%(7 patients),multivesseldisease(50patients).There were 96 lesions(79 vessels)dilated,amongthem type Alesion 15,type B lesion 52,type C lesion 29.Autoperfusion balloon was used in 7 patients, coronary stcnl wasimplantcd in 50 paticnts.One patient undcrgoing directional coronaryathrectomy(DCA).The clinical success rate was 91.5% and lesionsuccess rate was 89.6%.Average predilation stenosis was 89.5+8.2%and average postdilation stenosis was 16.9+6.2%.Two patients diedfrom abrupt vessel closureno acule myocardial infarction andemergency coronary bypass operation.The considerations in selectionand management of these high risk patients were discussed. The resultsshowed that PTCA can be performed safely in the complex cases.

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.

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.

Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective To examine long term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this hospital were followed by direct interview or letter The rate of follow up was 84 2% and the period of follow up was 0 9-12 7 (3 5±2 4) years Results During follow up, 4 (0 5%) patients died, 22 (2 8%) had nonfatal acute myocardial infarction, 10 (1 3%) had coronary artery bypass surgery, and 98 (12 4%) had repeat PTCA The rate of recurrent angina pectoris was 31 1% The cardiac event free survival rate calculated by the Kaplan Meier method was 88 2% at 1 year and 80 6% at 12 7 years Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events Compared to the PTCA group, patients with PTCA+stent had significantly lower rates of total cardiac events Conclusion The long term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treatment for revascularization in patients with coronary heart disease

EXPERIMENTAL WORK AND RESEAROHThe Experimental Study of Xue Guan Tong (血管通)on Preventing Restenosis after Percutaneous Transluminal Angioplasty

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.

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.

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.

EXCIMER LASER CORONARY ANGIOPLASTY ──A PRELIMINARY REPORT OF 11 CASES

We reported 11 cases of excimer laser coronary angioplasty (ELCA). All were males, the average age being 59.7 years. Five patients had sustained previous myocardial infarctions with post-infarction angina in 2 cases and 6 presented angina only. Coronary angiograms showed stenosis in LAD (N9), LCX(N6) and RCA (N6). According to the ACC/AHA classification, 6 were categorized as type B, and 5 type C. ELCA with adjunctive PTCA were performed in all 8 patients, 1. 3 mm (energy density 14. 5 mJ) and 1.6 mm (energy density 21.0 mJ) laser catheters with 20Hz pulse frequency were used There was one failure and in another ELCA was successful but death followed the procedure. The overall result was laser success 10 out of the 11 cases and procedure success 9.