Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one ca...Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.展开更多
Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well reco...Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well recognize the role of stenting in dealing with the complications of PTCA.Methods In this study, two hundrad sixty four patients with coronary artery disease were included, who were classified as PTCA group (138 cases)and coronary stented group(126 cases).They all received Exercise Test(ET)、Ultrasound Cardiogram(UCG)and Ambulatory Electrocardiography (AECG)at admission and before discharge, respectively. The coronary artery lesions were categorized into type A.B.C according to the methods reported by ACC/AHA . It was that the data between two groups including clinical information, cronary artery lesion characteristicis, procedural success rate, major complications, Minimum Lumen Diameter (MLD),residual stenosis, collateral circulation scores both before and after procedure had been compared. Following up were performed 6 months to 3 years after procedure. Results The study showed that there were no significant different in two groups including the clinical information, positive rate of ET, EF, results of AECG. But the rate of type B2/C lesions were higher in CS group than that in PTCA group( P <0.05). Both PTCA Group and CS Group had extremely success rate in type A and type B1, but CS had a higher success rate than that in PTCA in type B2 and type C (94.28%VS 89.2%, P <0.05). CS group had a lower rate of complication in procedure than that of PTCA group. There are no signifiance in MLD between the two groups (0.53± 0.22)mm vs (0.42±0.26)mm,( P >0.05) before procedure. But MLD was signifantly higher in CS group than that in PTCA group (2.51±0.66)mm vs (3.08±0.66)mm,( P <0.001) after procedure.The collateral circulation scrores were signifantly decreased after procedure (1.7±0.6) vs (0.8±0.4); (2.1±0.3) vs (0.3±0.4) in both PTCA Group and PTCA Group respectivesly,( P <0.001). Residual stenosis were higher in PTCA group(15±6%)than that in CS group (6±3%, P <0.001). The positive rate of ET, exercise capacity, ST depressions, EF and wall motion were all improved significantly both in PTCA group and CS group, CS group has a higher effect in exercise capacity, MLD, EF and ischemia duration.Seventy nine patients were followed up and the rate of cardiac events in the CS group were lower than in PTCA group.Conclusions 1.Coronary stenting had a high success rate and low complication in treatment of severe and complex coronary artery lesions.2.Coronary stentig reduced residual stenosis, improved blood supply, salvaged the hibernating and /or stunned myocardium, improved the left ventricular function. CS have offered a new, safe and effective metbods for treatment of left main trunk lesions; 3.Coronary stenting has broden the indication for invasive treatment of coronary artery diseases.展开更多
目的：对比观察冠状动脉复杂病变介入治疗术中及术后应用替罗非班的疗效和安全性。方法150例冠状动脉复杂病变患者，随机分为 A组（冠脉造影明确后即静脉应用替罗非班并行PCI治疗）和B组（PCI术后即刻应用替罗非班）。比较两组PCI术后 T...目的：对比观察冠状动脉复杂病变介入治疗术中及术后应用替罗非班的疗效和安全性。方法150例冠状动脉复杂病变患者，随机分为 A组（冠脉造影明确后即静脉应用替罗非班并行PCI治疗）和B组（PCI术后即刻应用替罗非班）。比较两组PCI术后 T IM I3级血流率、术后6～12h超敏肌钙蛋白（hs-T nT ）、术后1周左室射血分数、术后1个月内主要心血管事件及出血和血小板减少事件的发生率。结果 A组 PCI术后即刻 TIMI3级血流率有高于B组倾向72／75 vs 66／75，χ2＝3．26，P＝0．05），A组术后6h、12hhs-TnT浓度显著低于B组（94±12．8vs104±6．2pg／mL，P＜0．001；69±11．4 vs 78±13．2 pg／mL ，P＜0．001），其余观察指标两组间无显著差异（P＞0．05）。结论论复杂冠脉病变介入术中早期应用替罗非班较术后应用可能获得更好的心肌灌注水平，降低介入手术相关心肌损伤，不增加严重出血及血小板减少发生率。展开更多
文摘Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.
文摘Objective To study the clinical value of coronary stenting in treatment of severe complex coronary artery lesions, to evaluate the short and long term outcome of the patients imployed coronary stents, and to well recognize the role of stenting in dealing with the complications of PTCA.Methods In this study, two hundrad sixty four patients with coronary artery disease were included, who were classified as PTCA group (138 cases)and coronary stented group(126 cases).They all received Exercise Test(ET)、Ultrasound Cardiogram(UCG)and Ambulatory Electrocardiography (AECG)at admission and before discharge, respectively. The coronary artery lesions were categorized into type A.B.C according to the methods reported by ACC/AHA . It was that the data between two groups including clinical information, cronary artery lesion characteristicis, procedural success rate, major complications, Minimum Lumen Diameter (MLD),residual stenosis, collateral circulation scores both before and after procedure had been compared. Following up were performed 6 months to 3 years after procedure. Results The study showed that there were no significant different in two groups including the clinical information, positive rate of ET, EF, results of AECG. But the rate of type B2/C lesions were higher in CS group than that in PTCA group( P <0.05). Both PTCA Group and CS Group had extremely success rate in type A and type B1, but CS had a higher success rate than that in PTCA in type B2 and type C (94.28%VS 89.2%, P <0.05). CS group had a lower rate of complication in procedure than that of PTCA group. There are no signifiance in MLD between the two groups (0.53± 0.22)mm vs (0.42±0.26)mm,( P >0.05) before procedure. But MLD was signifantly higher in CS group than that in PTCA group (2.51±0.66)mm vs (3.08±0.66)mm,( P <0.001) after procedure.The collateral circulation scrores were signifantly decreased after procedure (1.7±0.6) vs (0.8±0.4); (2.1±0.3) vs (0.3±0.4) in both PTCA Group and PTCA Group respectivesly,( P <0.001). Residual stenosis were higher in PTCA group(15±6%)than that in CS group (6±3%, P <0.001). The positive rate of ET, exercise capacity, ST depressions, EF and wall motion were all improved significantly both in PTCA group and CS group, CS group has a higher effect in exercise capacity, MLD, EF and ischemia duration.Seventy nine patients were followed up and the rate of cardiac events in the CS group were lower than in PTCA group.Conclusions 1.Coronary stenting had a high success rate and low complication in treatment of severe and complex coronary artery lesions.2.Coronary stentig reduced residual stenosis, improved blood supply, salvaged the hibernating and /or stunned myocardium, improved the left ventricular function. CS have offered a new, safe and effective metbods for treatment of left main trunk lesions; 3.Coronary stenting has broden the indication for invasive treatment of coronary artery diseases.
文摘目的：对比观察冠状动脉复杂病变介入治疗术中及术后应用替罗非班的疗效和安全性。方法150例冠状动脉复杂病变患者，随机分为 A组（冠脉造影明确后即静脉应用替罗非班并行PCI治疗）和B组（PCI术后即刻应用替罗非班）。比较两组PCI术后 T IM I3级血流率、术后6～12h超敏肌钙蛋白（hs-T nT ）、术后1周左室射血分数、术后1个月内主要心血管事件及出血和血小板减少事件的发生率。结果 A组 PCI术后即刻 TIMI3级血流率有高于B组倾向72／75 vs 66／75，χ2＝3．26，P＝0．05），A组术后6h、12hhs-TnT浓度显著低于B组（94±12．8vs104±6．2pg／mL，P＜0．001；69±11．4 vs 78±13．2 pg／mL ，P＜0．001），其余观察指标两组间无显著差异（P＞0．05）。结论论复杂冠脉病变介入术中早期应用替罗非班较术后应用可能获得更好的心肌灌注水平，降低介入手术相关心肌损伤，不增加严重出血及血小板减少发生率。
