A Case Summary of the Application of a Drug-eluting Stent Combined with a Drug-Coated Balloon in Left Main Coronary Artery Disease

Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017.These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions,and DCB treatment at the ostium of the left circumflex artery;six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography.Immediate postoperative angiography was used to evaluate the patency of the diseased vessels,and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well.Results:The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate(left main coronary artery(8.4±5.3)%,left anterior descending coronary artery(18.2±5.0)%,left circumflex artery(30.5±16.5)%).No serious clinical events occurred in any patients.Conclusion:A DES combined with a DCB is a safe and effective interventional treatment for left main artery coro-nary bifurcation lesions.

Risk of coronary arterial lesions in immunoglobulin resistant Kawasaki disease

Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.

Fundamentals of percutaneous coronary bifurcation interventions

Coronary bifurcation lesions(CBLs)account for 15%-20%of all percutaneous coronary interventions.The complex nature of these lesions is responsible for poorer procedural,early and late outcomes.This complex lesion subset has received great attention in the interventional cardiac community,and multiple stenting techniques have been developed.Of these,the provisional stenting technique is most often the default strategy;however,the elective double stenting(EDS)technique is preferred in certain subsets of complex CBLs.The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials;however,this technique consists of many steps and requires training.Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes.Intravascular imaging is necessary to determine the interventional strategy and postinterventional results.This review discusses the basic concepts,contemporary percutaneous interventional technical approaches,new methods,and controversial treatment issues of CBLs.

球囊近端优化技术在冠状动脉分叉病变介入治疗中的应用进展

球囊近端优化技术通过扩张冠状动脉分叉病变分叉嵴近段支架使支架形态更加贴合原血管解剖结构,从而显著改善了支架形态和贴壁,增加了临床获益。但是在临床实践中,该术式对术者有着非常高的技术要求,球囊的选择和定位不当均可导致手术失败和远期不良事件的发生。其次在实践中不断演化出基于该技术的多种联合术式,如rePOT技术、POKI技术和PBED技术等。因目前针对这些技术的大型临床研究较少,其在冠状动脉分叉病变的介入治疗中还存在诸多争议。本文通过系统回顾球囊近端优化技术的相关文献,并结合我们的临床经验做综述如下。

主支药物洗脱支架+分支药物涂层球囊术式治疗真性分叉病变患者的临床预后

目的 探究主支药物洗脱支架(DES)+分支药物涂层球囊(DCB)术式治疗真性分叉病变患者的有效性和安全性,以及DCB治疗分叉病变的临床预后。方法 单中心、回顾性研究。连续纳入2019年3月至2021年6月于内蒙古医科大学附属医院接受经皮冠状动脉介入治疗且诊断为真性分叉病变的患者131例。依据接受术式不同将其分组:被动球囊拘禁组43例、主动球囊拘禁组43例和主支DES+分支DCB组45例。比较术后6个月随访时各组的血管晚期管腔丢失,以及术后12个月内各组的主要不良心血管事件(MACE)发生率。结果 术后6个月随访时,三组主支血管的晚期管腔丢失比较,差异无统计学意义(P=0.107);而主支DES+分支DCB组分支血管的晚期管腔丢失均低于其他两组(均为P<0.05)。术后12个月随访时,MACE发生率分别为主动球囊拘禁组16.3%、被动球囊拘禁组18.6%和主支DES+分支DCB组4.4%,三组间比较差异无统计学意义(P=0.107)。与普通球囊组(主动球囊拘禁组+被动球囊拘禁组)相比,主支DES+分支DCB组的MACE发生率显著降低(4.4%比17.4%,P=0.036)。结论 主支DES+分支DCB术式治疗真性分叉病变时,可有效改善患者预后,使用DCB治疗分叉病变可取得良好的临床预后。

血管内超声评估“L-sandwich”术式在冠状动脉真性分叉病变介入治疗中的疗效——一项概念验证性研究

目的:探讨血管内超声(IVUS)评估“L-sandwich”术式在冠状动脉真性分叉病变介入治疗中的疗效。方法:将入选的99例冠状动脉真分叉病变(medina分型:1.1.1)患者分为“L-sandwich”术式组(n=38)、双支架术式组(n=32)和主支药物洗脱支架(DES)分支单纯药物涂层球囊(DCB)组(n=29)。所有患者术中及复查均使用IVUS评估。主要研究终点为随访12个月时的主支血管、分支血管口部及分支血管体部的晚期管腔面积丢失(LLAL),次要终点为12个月时各部位的最小管腔面积(MLA)以及主要不良心脏事件(MACE),MACE包括非致死性心肌梗死、心原性死亡和靶血管血运重建。本研究为概念验证性研究,统计分析在接受治疗(as-treated,AT)分析集中进行。结果:随访12个月时,“L-sandwich”术式组、双支架术式组和主支DES分支单纯DCB组患者主支血管的LLAL[(0.12±0.42)mm^(2)vs.(0.07±0.38)mm^(2)vs.(-0.01±0.31)mm^(2),P=0.419]、分支血管体部的LLAL[(-0.11±0.45)mm^(2)vs.(-0.10±0.28)mm^(2)vs.(0.24±1.04)mm^(2),P=0.078]差异均无统计学意义,分支血管开口LLAL双支架术式组最大,“L-sandwich”术式组最小[(-0.48±0.78)mm^(2)vs(.0.45±0.64)mm^(2)vs(.0.14±1.37)mm^(2),P<0.001];三组主支血管MLA相似[(8.39±1.65)mm^(2)vs.(8.28±0.98)mm^(2)vs.(8.02±1.37)mm^(2),P=0.565],分支血管开口MLA双支架术式组最大,主支DES分支单纯DCB组最小[(5.08±0.74)mm^(2)vs.(5.63±0.80)mm^(2)vs.(3.57±1.35)mm^(2),P<0.001],分支血管体部MLA“L-sandwich”术式组与双支架术式组类似,主支DES分支单纯DCB组最小[(5.94±0.72)mm^(2)vs.(5.86±0.59)mm^(2)vs.(3.74±1.07)mm^(2),P<0.001]。双支架术式组中2例患者行靶血管重建,其他组患者均无MACE发生(P=0.118)。结论:“L-sandwich”术式治疗冠状动脉真性分叉病变安全可行,随访12个月时比双支架术式分支血管开口LLAL更小,各部位MLA相似,且明显简化操作步骤。与分支单纯应用DCB相比具有更好的分支获益,同时也是分支单纯DCB出现严重夹层时的补救手术方式。

药物涂层球囊联合利伐沙班在冠状动脉分叉病变边支介入治疗中的应用

目的分析药物涂层球囊联合利伐沙班在冠状动脉分叉病变边支介入治疗中的应用效果。方法选取2020年10月—2022年10月宁德师范学院附属宁德市医院收治的68例冠状动脉分叉病变患者进行研究,应用随机数表方法分为对照组与观察组,各34例。两组患者行双导丝边支介入治疗期间,对照组应用利伐沙班治疗,观察组应用药物涂层球囊联合利伐沙班治疗,比较两组临床治疗效果。结果观察组患者不良心血管事件发生率低于对照组,差异有统计学意义(P<0.05);观察组患者的边支狭窄率、边支闭塞率低于对照组,差异有统计学意义(P<0.05);观察组患者血管性血友病因子(Von Willebrand Factor,vWF)、血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)、超敏C反应蛋白(High Sensitive C-Reactive Protein,hs-CRP)、糖化血红蛋白A1c(Hemoglobin A1c,HbA1c)水平均低于对照组,差异有统计学意义(P<0.05);观察组患者躯体健康评分、心理健康评分高于对照组,差异有统计学意义(P<0.05)。结论药物涂层球囊联合利伐沙班在冠状动脉分叉病变边支介入治疗中的应用效果良好,可有效减少患者的不良心血管事件发生,改善临床疗效,降低术后边支狭窄率与边支闭塞率,提升患者生活质量,发挥积极应用价值。

Impact of main vessel calcification on procedural and clinical outcomes of bifurcation lesion undergoing provisional single-stenting intervention: a multicenter, prospective, observational study

Background Few data on the combined effects of bifurcation and calcification on coronary artery disease(CAD)patients undergoing percutaneous coronary intervention(PCI)are available.This study evaluated the impact of main vessel(MV)calcification on the procedural and long-term outcomes in patients with CAD who underwent provisional single stent PCI.Methods This is a multicenter,prospective,observational study.Patients with bifurcation lesions were enrolled at 10 PCI centers in China from January 2015 to December 2017.Intravascular ultrasound or optical coherence tomography was performed in all patients to evaluate the MV calcification.Patients were treated with provisional single stent strategy using drug eluting stents and followed-up at 1 month,6 months and 12 months after discharge by telephone contact or outpatient visit.Repeated coronary imaging was performed within one year.We compared the procedural success rates in MV and in side branch(SB),and target lesion failure(TLF),defined as a composite of cardiac death,non-fatal myocardial infarction,definite or possible stent thrombosis and target lesion revascularization between patients with and without MV calcification.Results A total of 185 subjects were enrolled according to the inclusion and exclusion criteria of this study.MV calcification was detected in 119(64.3%,calcification group)and not found in 66(35.7%,non-calcification group)patients.The angiographic success rate of MV was 95.8%in the calcification group and 97.0%in the non-calcification group(P=0.91);the angiographic success rate of SB was 32.8%in the calcification group and 53.0%in the non-calcification group(P<0.05).During the one-year follow-up period,TLF occurred in 14(11.8%)patients in the calcification group and in 13(19.7%)in the non-calcification group{P=0.31).Multivariate regression analysis showed the same result(HR=1.23,95%CI:0.76-1.52,P=0.47).Calcification on group had higher recurrent angina than non-calcification group(13.51%vs.17.65%,P<0.05).Conclusions In patients with coronary bifurcation lesion treated with provisional one stent approach,calcification of MV is associated with lower SB procedural success rate,it could increase recurrence of angina;however,it was not associated with an increased risk of TLF.

Long-term clinical efficacy of ostial stenting to the left anterior descending artery with deep caudal projection

Purpose: Overlapping and foreshortening on conventional coronary angiography is one reason why the presence of ostial lesions in the left anterior descending artery (LAD) is an independent predictor of insegment restenosis. Our previous study using 3-dimensional reconstruction coronary angiography demonstrated the superiority of a deeper caudal projection in clearly showing the ostium of the LAD compared to the standard right or left anterior oblique caudal view. Therefore, the aim of this study was to determine the short-and long-term efficacy of the ostial stenting technique using a deep caudal projection angle. Methods: A total of 30 consecutive patients who underwent stent deployment to treat LAD lesions positioned at the proximal edge of the stent in the ostium with a deep caudal projection were analyzed retrospectively. Results: The projection of right anterior oblique caudal 40° was used in 26 patients and that of left anterior oblique caudal 40° was used in four patients. Intravascular ultrasound examinations showed complete coverage of the ostium by the stent in 29 patients. In one patient, the stent did not cover the ostium. The mean protrusion of the stent over the ostium was 0.66 ± 0.85 mm. During the follow-up period (1203.5 [982-1329] days), the rate of target lesion failure was 16.7%, and there were no cases with in-stent restenosis of the main branch in which a drug-eluting stent covering the ostium of the LAD was successfully deployed. Conclusions: Focal stent placement using a deep caudal projection is a feasible and effective therapeutic strategy for treating ostial lesions in the LAD.

川崎病致冠状动脉损害的诊断和急性期治疗新进展

川崎病是一种全身性血管炎性疾病,以心血管损害为严重并发症,特别是冠状动脉,表现为血管扩张、动脉瘤等损害。与冠状动脉损害有关的病因及发病机制尚未完全明确,可能为多因素触发所致。结合临床表现及超声心动图等辅助检查进行诊断和分类,早期识别和早期治疗是关键,本文对川崎病合并冠状动脉损害的发病机制及急性期诊治进展进行综述,为川崎病的诊治工作提供参考。

川崎病患儿血清miR-221-3p水平与冠状动脉病变及IVIG治疗反应的关系

目的探讨川崎病(KD)患儿血清微小RNA(miRNA)-221-3p水平与冠状动脉病变(CALs)及静脉注射免疫球蛋白(IVIG)治疗反应的关系。方法选取2019年5月至2021年5月该院收治的186例KD患儿作为KD组,另外纳入同期200例非KD发热儿童作为对照组。采用实时荧光定量聚合酶链反应法检测血清miR-221-3p表达水平。结果KD组血清miR-221-3p相对表达水平高于对照组(P<0.05)。发生CALs的患儿血清miR-221-3p相对表达水平高于未发生CALs的患儿(P<0.05);IVIG治疗无反应患儿的血清miR-221-3p相对表达水平高于IVIG治疗有反应患儿(P<0.05)。血清miR-221-3p用于区分KD和非KD发热患儿的曲线下面积(AUC)为0.762(95%CI:0.715~0.809)。KD患儿血清miR-221-3p相对表达水平与清蛋白、肌酸激酶、淋巴细胞计数、C反应蛋白水平呈正相关(P<0.05)。血清miR-221-3p预测CALs发生和IVIG治疗无反应的AUC分别为0.763(95%CI:0.671~0.856)、0.758(95%CI:0.663~0.854)。经Logistic回归分析,血清miR-221-3p相对表达水平升高是CALs发生(HR=6.341,95%CI:2.876~13.979,P<0.001)或IVIG治疗无反应(HR=5.262,95%CI:2.700~10.257,P<0.001)的独立预测因子。结论血清miR-221-3p表达是IVIG治疗无反应和随后CALs形成的一个预测因子。

药物涂层球囊在冠脉支架内再狭窄及小血管病变中的临床应用研究

目的:观察药物涂层球囊在冠脉支架内再狭窄与小血管病变中的临床应用效果。方法:收集2017年1月—2020年12月期间内蒙古科技大学包头医学院第一附属医院就诊的小血管病变患者49例,分别为小血管病变支架治疗组25例、小血管病变药物涂层球囊治疗组24例;支架内再狭窄患者45例,分别为支架内再狭窄支架治疗组24例、支架内再狭窄药物涂层球囊治疗组21例,比较小血管病变及支架内再狭窄患者分别应用支架或药物涂层球囊的临床治疗效果差异。结果:药物球囊组靶病变术前狭窄程度、术前最小管腔直径、术后即刻狭窄程度、术后即刻管腔狭窄直径、病变长度、参考管腔直径、复查时最小管腔直径与支架组比较差异无统计学意义(P>0.05);药物球囊组复查时狭窄程度低于支架组(P<0.05),不良心血管事件发生率、出血事件发生率也低于支架组(P<0.05)。结论:采用药物涂层球囊治疗冠脉支架再狭窄及小血管病变患者,对复查时血管管腔再狭窄程度有良好的影响,并且能够有效降低不良心血管事件发生率及出血发生率,对改善预后发生积极影响。

早期使用静脉注射用丙种球蛋白治疗川崎病发生耐药的危险因素分析

目的 寻找本地区川崎病(Kawasaki disease,KD)病人早期使用静脉注射用丙种球蛋白(intravenous immunoglobulin,IVIG)发生耐药的危险因素。方法 对2017年1月至2021年6月在苏州大学附属儿童医院住院治疗并且在发热病程小于5 d时使用IVIG的川崎病病人进行回顾性分析。对IVIG敏感组、IVIG抵抗组病人流行病学资料、临床特征、实验室指标等进行危险因素分析。结果 共有122例符合条件的川崎病病人纳入研究,23例为IVIG抵抗,占18.85%。IVIG抵抗组与IVIG敏感组病人之间性别、年龄均差异无统计学意义。IVIG抵抗组病人急性期及随访半年后冠状动脉损害(coronary artery lesions,CALs)发生率与IVIG敏感组相比差异无统计学意义。IVIG抵抗组病人治疗前中性粒细胞百分比(N)、C反应蛋白(CRP)、血清总胆红素(TB)[(24.44±23.07)μmol/L比(9.89±8.17)μmol/L]水平显著高于IVIG敏感组(P<0.05),血小板计数(PLT)[(271.17±62.08)×10^(9)/L比(358.94±88.70)×10^(9)/L]、血钠(Na^(+))水平显著低于IVIG敏感组(P<0.05);多因素logistic回归分析显示:PLT及TB与川崎病病人发生IVIG抵抗显著相关(P<0.05)。结论 PLT及TB可作为预测川崎病病人于发热病程小于5 d时使用IVIG发生抵抗的重要指标。

单支架与双支架策略对冠状动脉分叉病变预后的影响

目的探讨冠状动脉分叉病变(CBL)介入治疗中单或双支架的应用情况,比较不同介入策略的临床预后,从而为CBL的介入治疗积累更多的临床证据。方法纳入石家庄市人民医院心内一科366例接受经皮冠脉介入治疗(PCI)的真性CBL患者。根据CBL介入策略分为即刻单支架(PS)组286例和双支架(TS)组80例。入院后收集患者的临床及预后相关资料,分析两组主要不良心血管事件发生情况。结果PS组随访191例,TS组随访58例。随访期间两组患者不良心血管事件发生率均不高且无统计学意义(12.96%vs.17.24%,P=0.364),但两组患者在靶血管血运重建(2.51%vs.10.34%,P=0.035)、支架内再狭窄(3.66%vs.12.07%,P=0.035),发生率有统计学意义。结论CBL患者介入治疗中,PS组与TS组相比在靶血管血运重建、支架内再狭窄的发生率上具有一定优势。

Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions

Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR） （0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

心肌声学造影评估冠脉慢性完全闭塞病变介入治疗效果及预后的价值

目的探讨心肌声学造影(myocardial contrast echocardiography,MCE)评估冠脉慢性完全闭塞病变(chronic total occlusion,CTO)介入治疗效果及预后的价值。方法选取2021年4月—2022年3月广西壮族自治区民族医院超声医学科收治的行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠状动脉慢性完全闭塞病变患者60例为研究对象。所有患者于PCI术前1 d及术后3个月行MCE检查。根据“金标准”,分析目测半定量法、图像定量法对存活心肌的诊断效能。结果与金标准相比,心肌声学造影目测半定量法对存活心肌的评估敏感度73.39%,假阴性率26.61%,假阳性率25.96%,特异度74.04%,准确性73.66%,阳性预测值79.80%,阴性预测值66.57%;心肌声学造影图像定量法对存活心肌的评估为敏感度88.07%、假阴性率11.93%、假阳性率28.53%、特异度71.47%、准确性81.15%、阳性预测值81.18%、阴性预测值81.10%。结论心肌声学造影图像定量法用于评估冠状动脉慢性完全闭塞病变介入治疗,可以更客观、更准确地评估存活心肌数目,判断冠状动脉微循环的血流灌注,能为临床医师提供一定参考。

Impact of Side Branch Lesion Length on Clinical Outcome after Coronary Stenting Techniques in Patients with Coronary Artery Bifurcation Disease:A Meta-Analysis

Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is currently recommended in most cases.This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies,clarifying their scope of application.Methods:Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed,Cochrane,Web of Science,and EBSCO literature databases without limitations on published date or language.Major adverse cardiovascular events(MACEs)were stipulated as main outcomes.Secondary outcomes of interest were all-cause mortality,cardiovascular mortality,target lesion revascularization(TLR),target vessel revascularization,myocardial infarction(MI),and stent thrombosis.Both pooled analysis and sub-group analysis were performed.Results:Twenty-three randomized controlled trials with 6380 participants were included.Eighteen studies compared the provisional strategy with 2-stent approaches.No significant difference in MACEs(relative risk(RR),1.16;95%confidence interval(CI),0.90-1.48;I2=62%)was found between 1-stent and 2-stent techniques.However,when SB lesion length was used as the separation condition,the 2-stent strategy was associated with fewer MACEs(RR,1.87;95%CI,1.46-2.41;I2=70%),TLRs(RR,2.13;95%CI,1.50-3.02;I2=59%),and MIs(RR,2.17;95%CI,1.19-3.95;I2=52%)than the provisional strategy in those where SB lesions measured>10 mm long.Conclusions:In the current work,there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes.However,2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is>10 mm due to fewer cases of TLR and MI.

Jailed球囊技术在冠状动脉分叉病变介入治疗中的效果研究

目的 探讨拘禁闭陷(Jailed)球囊技术在冠状动脉分叉病变介入治疗中的效果。方法 60例冠状动脉分叉病变介入治疗的患者,依据治疗方法不同分为Jailed球囊技术治疗组与分支血管球囊对吻术组,各30例。分支血管球囊对吻术组患者采用分支血管球囊对吻术治疗, Jailed球囊技术治疗组患者采用Jailed球囊技术治疗。比较两组手术相关指标,心血管不良事件发生情况,术后即刻、术后1年病变主支血管最大狭窄率与分支血管开口狭窄率。结果 Jailed球囊技术治疗组患者的介入操作时间(52.43±5.56)min、曝光时间(9.14±1.35)min均短于分支血管球囊对吻术组的(80.32±4.76)、(23.75±2.06)min,置入支架数量(1.50±0.15)枚、造影剂用量(90.35±3.75)ml均少于分支血管球囊对吻术组的(3.00±0.45)枚、(145.62±4.47)ml,手术费用(2.45±0.26)万元低于分支血管球囊对吻术组的(3.24±0.31)万元,差异均有统计学意义(P<0.05)。术后1年,两组病变主支血管最大狭窄率与分支血管开口狭窄率均低于本组术后即刻,且Jailed球囊技术治疗组病变分支血管开口狭窄率低于分支血管球囊对吻术组,差异均有统计学意义(P<0.05)。Jailed球囊技术治疗组患者的心血管不良事件发生率6.67%(2/30)低于分支血管球囊对吻术组的33.33%(10/30),差异有统计学意义(P<0.05)。结论 Jailed球囊技术用于冠状动脉分叉病变介入治疗中的效果显著优于分支血管球囊对吻术,值得推广。

不同分支球囊保护策略治疗冠状动脉分叉病变的临床效果比较

目的比较不同分支球囊保护策略在冠状动脉分叉病变患者中的临床治疗效果。方法260例冠状动脉分叉病变患者,按不同分支球囊保护策略分为单支架组和双支架组,每组130例。单支架组采用单支架分支球囊保护策略,双支架组采用双支架球囊保护策略。比较两组围术期指标、冠状动脉造影(CAG)检查结果及并发症发生情况、主要心血管不良事件(MACE)发生情况。结果单支架组手术时间(43.64±5.03)min短于双支架组的(49.83±5.37)min,球囊使用数量(3.46±0.31)个、支架植入数量(1.86±0.28)枚及导丝使用数量(2.04±0.41)个少于双支架组的(4.25±0.56)个、(2.35±0.35)枚、(2.35±0.53)个,对比剂用量(151.71±28.18)ml少于双支架组的(175.52±32.32)ml,差异有统计学意义(P<0.05)。两组主支、分支的心肌梗死溶栓实验(TIMI)血流3级比例及血管残余狭窄≥30%比例比较,差异无统计学意义(P>0.05)。两组术中分支血管慢血流、术中分支血管闭塞、术后心肌酶谱增高及术后心肌梗死发生率比较,差异无统计学意义(P>0.05)。随访6个月,单支架组MACE发生率8.46%与双支架组的7.69%比较,差异无统计学意义(P>0.05)。结论单支架与双支架分支球囊保护策略治疗冠状动脉分叉病变临床效果确切,但与双支架球囊保护策略比较,单支架球囊保护策略能减少支架、球囊、导丝使用及对比剂用量,手术时间更短,更具有优势。

中等程度冠状动脉狭窄的血管内超声特点与治疗决策选择

目的 应用血管内超声 (IVUS)观察冠状动脉造影中等程度冠状动脉狭窄的血管内超声特点 ,选择治疗决策。方法 应用血管内超声仪检查 3 8例血管造影狭窄程度 40 %～ 60 %患者的 43处冠状动脉病变 ;测量管腔以及血管直径和面积。结果 43处病变中 ,脂质斑块为 3 0处 ,纤维、钙化、混合斑块分别为 4、2、5处 ,2处未发现明显病变或仅轻度内膜增生 ;其中 4处可见明显血栓影。 41处粥样硬化斑块中偏心斑块 3 6处 ( 87.8% ) ,向心斑块 5处 ( 12 .2 % )。 3 0处脂质斑块大部分可见薄的纤维帽 ,其中 5处 ( 16.7% )明显的纤维帽不完整。病变血管直径狭窄百分比 ( 4 0 .73± 13 .2 1) % ;面积狭窄百分比 ( 5 6.75± 12 .68) %。对IVUS示面积狭窄 >5 0 %的 2 5处、<5 0 %的 1处 ( 60 .5 % )且有典型临床症状的病变行进一步介入治疗 ,对IVUS示面积狭窄 <5 0 %的 17处 ( 3 9.5 % )病变未行进一步介入治疗。结论 IVUS可进一步明确血管造影中等程度冠状动脉病变的性质、严重性和稳定性 。