Objective: To evaluate the feasibility and usefulness of the Cheatham platinum(CP) stent in a broad spectrum of lesions. Methods: Retrospective analysis of 60 implanted CP stents(11-80 mm lengths, 12 covered) between ...Objective: To evaluate the feasibility and usefulness of the Cheatham platinum(CP) stent in a broad spectrum of lesions. Methods: Retrospective analysis of 60 implanted CP stents(11-80 mm lengths, 12 covered) between September 2001 and March 2004. Patients: 53 patients aged 2.5-68 years(median 17 years). Body weight ranged from 12-95 kg(median 52 kg). Thirty six patients had aortic(re)coarctation; seven of them had functionally interrupted aortic arches. Thirteen patients had pulmonary artery stenosis and four had stenosis of caval veins or conduits in a total cavopulmonary connection(TCPC). Results: Arterial pressure gradients dropped from 33 mmHg(range 20-80 mmHg) to 5 mmHg(range 0-10 mmHg) and pressure gradients in TCPC or caval veins dropped from 4 mm Hg(range 4-20 mmHg) to 0 mmHg(range 0-3 mmHg). All stents were placed in the target lesion without complications. Three stent fractures without clinical instability were noted. Conclusions: The CP stent is suitable for the treatment of vessel stenosis in congenital heart diseases from childhood to adulthood. Whether these good results will be stable in the long term needs to be investigated.展开更多
Background Post-stenting restenosis is a significant clinical problem, involving vascular smooth muscle cells ( VSMCs) proliferation and apoptosis. It is reported that c-myc antisense oligodeoxynucleotides (ASODNs) lo...Background Post-stenting restenosis is a significant clinical problem, involving vascular smooth muscle cells ( VSMCs) proliferation and apoptosis. It is reported that c-myc antisense oligodeoxynucleotides (ASODNs) local delivered by catheter can inhibit VSMCs proliferation. This study was designed to assess tissue distribution of c-myc ASODN local delivered using gelatin-coated platinum-iridium (R-lr) stents, and its effect on apoptosis of VSMCs.Methods Gelatin-coated Pt-lr stents that had absorbed caroboxyfluorescein-5-succimidyl ester (FAM) labeled c-myc ASODNs (550 μg per stent) were implanted into the right carotid arteries of 6 rabbits. Tissue samples were obtained at 45 minutes, 2 hours, and 6 hours. Tissue distribution of c-myc ASODNs was assessed by fluorescence microscopy. In addition, 32 rabbits were randomly divided into two groups. Rabbits in the control group (n =16) were implanted with gelatin-coated R-lr stents, and those in the treatment group (n =16) were implanted with gelatin-coated stents that had absorbed c-myc ASODNs. 7, 14, 30, or 90 days (n =4, respectively, for each group) after the stenting procedure, the stented segments were harvested, and histopathological examinations were performed to calculate neointimal area and mean neointimal thickness. The expression of c-myc was assessed using in situ hybridization (ISH) and immunohistochemical methods. Apoptotic VSMCs were detected using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) and transmission electron microscope (TEM).Results According to fluorescence microscopic results, FAM-labeled c-myc ASODNs were concentrated in the target vessel media at the 45 minutes time point, and then dispersed to the adventitia. Morphometric analysis showed that neointimal area and mean neointimal thickness increased continuously up to 90 days after stent implantation, but that total neointimal area and mean neointimal thickness were less in the treatment group than in the control group at all time points (P < 0. 0001). At day 7 and day 14 after stenting, there were no detectable apoptotic cells in either group. However, apoptotic cells were present in the neointima 30 and 90 days after stenting, and the number of apoptotic cells was less at 30 days than at 90 days. Meanwhile, c-myc ASODNs appeared to induce apoptosis in more cells in the treatment group than that in the control group. Typical apoptotic VSMCs were observable under TEM. The expression of c-myc was positive in the control group and negative or weakly positive in the c-myc ASODN treatment group, according to both ISH and immunohistochemical examination.Conclusion Gelatin-coated R-lr stent mediated local delivery of c-myc ASODNs is feasible. The localization of c-myc ASODN is primarily in the target vessel walls, c-myc ASODNs can inhibit VSMCs proliferation and induce its apoptosis after local delivery in vivo.展开更多
Background Aortic coarctation(CoA)is a common congenital cardiovascular defect. Until now,there is no unified conclusions about the therapeutic options of the native aortic coarctation(CoA)in adolescents and adults. M...Background Aortic coarctation(CoA)is a common congenital cardiovascular defect. Until now,there is no unified conclusions about the therapeutic options of the native aortic coarctation(CoA)in adolescents and adults. Methods From May 2010 to April 2018,consecutive 23 patients(median age 25 years,range 15-57 years)with native CoA underwent endovascular repair by applying covered Cheatham platinum(CP)stent in our center. Related variables were retrospectively collected and analyzed. Results Ten cases were complicated with other congenital heart diseases. Hypertension was confirmed in 21(91.3%)patients. In these patients,thirteen cases(61.9%)had a normal blood pressure without drug treatment during follow-up.The systolic right arm blood pressure significantly decreased from a mean of 150.7±6.4 mmHg pre-operation to 128.0±12.5 mmHg discharge(P<0.001),and the diastolic pressure decreased from 82.0±10.0 to 73.1±6.8 mmHg(P<0.001). The diameter of the coarcted segment increased from 5.0±2.3 to 16.9±2.3 mm(P<0.001). The peak systolic gradient significantly decreased from 64.9±20.9 to 7.1 ±6.1 mm Hg(P<0.001). The median follow-up was 30 months(range 1 months to 7.9 years). Complications were found in 4 people within one month:1 suspected cardiovascular-related death,1 new aortic dissection,1 splenic infarction,and 1 path-related arterial occlusion.Conclusions Our limited experience demonstrated that stent implantation is a reliable technique for the management of native aortic coarctation in adolescents and adults. Our intermediate-term results seem encouraging,however,the early complications should be considered. A larger series of cases with a longer follow-up is needed to substantiate these results.展开更多
主动脉瓣狭窄(aortic stenosis,AS)是一种较常见的心脏瓣膜病变,而合并主动脉缩窄(coarctation of the aorta,CoA)十分罕见,发病率<1%。近年来覆膜支架置入已被广泛用于治疗CoA,而经导管主动脉瓣置换术(transcatheter aortic valve r...主动脉瓣狭窄(aortic stenosis,AS)是一种较常见的心脏瓣膜病变,而合并主动脉缩窄(coarctation of the aorta,CoA)十分罕见,发病率<1%。近年来覆膜支架置入已被广泛用于治疗CoA,而经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)作为介入新技术也逐渐在临床推广应用,但是同时经导管介入治疗CoA和AS在国内经验尚少,这对手术医师和麻醉医师来说均是一个巨大挑战。报道1例"一站式"经股动脉置入支架治疗CoA、经颈动脉TAVR治疗AS的成功病例,术后主动脉内压力阶差基本消失且未出现反流。展开更多
文摘Objective: To evaluate the feasibility and usefulness of the Cheatham platinum(CP) stent in a broad spectrum of lesions. Methods: Retrospective analysis of 60 implanted CP stents(11-80 mm lengths, 12 covered) between September 2001 and March 2004. Patients: 53 patients aged 2.5-68 years(median 17 years). Body weight ranged from 12-95 kg(median 52 kg). Thirty six patients had aortic(re)coarctation; seven of them had functionally interrupted aortic arches. Thirteen patients had pulmonary artery stenosis and four had stenosis of caval veins or conduits in a total cavopulmonary connection(TCPC). Results: Arterial pressure gradients dropped from 33 mmHg(range 20-80 mmHg) to 5 mmHg(range 0-10 mmHg) and pressure gradients in TCPC or caval veins dropped from 4 mm Hg(range 4-20 mmHg) to 0 mmHg(range 0-3 mmHg). All stents were placed in the target lesion without complications. Three stent fractures without clinical instability were noted. Conclusions: The CP stent is suitable for the treatment of vessel stenosis in congenital heart diseases from childhood to adulthood. Whether these good results will be stable in the long term needs to be investigated.
文摘Background Post-stenting restenosis is a significant clinical problem, involving vascular smooth muscle cells ( VSMCs) proliferation and apoptosis. It is reported that c-myc antisense oligodeoxynucleotides (ASODNs) local delivered by catheter can inhibit VSMCs proliferation. This study was designed to assess tissue distribution of c-myc ASODN local delivered using gelatin-coated platinum-iridium (R-lr) stents, and its effect on apoptosis of VSMCs.Methods Gelatin-coated Pt-lr stents that had absorbed caroboxyfluorescein-5-succimidyl ester (FAM) labeled c-myc ASODNs (550 μg per stent) were implanted into the right carotid arteries of 6 rabbits. Tissue samples were obtained at 45 minutes, 2 hours, and 6 hours. Tissue distribution of c-myc ASODNs was assessed by fluorescence microscopy. In addition, 32 rabbits were randomly divided into two groups. Rabbits in the control group (n =16) were implanted with gelatin-coated R-lr stents, and those in the treatment group (n =16) were implanted with gelatin-coated stents that had absorbed c-myc ASODNs. 7, 14, 30, or 90 days (n =4, respectively, for each group) after the stenting procedure, the stented segments were harvested, and histopathological examinations were performed to calculate neointimal area and mean neointimal thickness. The expression of c-myc was assessed using in situ hybridization (ISH) and immunohistochemical methods. Apoptotic VSMCs were detected using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) and transmission electron microscope (TEM).Results According to fluorescence microscopic results, FAM-labeled c-myc ASODNs were concentrated in the target vessel media at the 45 minutes time point, and then dispersed to the adventitia. Morphometric analysis showed that neointimal area and mean neointimal thickness increased continuously up to 90 days after stent implantation, but that total neointimal area and mean neointimal thickness were less in the treatment group than in the control group at all time points (P < 0. 0001). At day 7 and day 14 after stenting, there were no detectable apoptotic cells in either group. However, apoptotic cells were present in the neointima 30 and 90 days after stenting, and the number of apoptotic cells was less at 30 days than at 90 days. Meanwhile, c-myc ASODNs appeared to induce apoptosis in more cells in the treatment group than that in the control group. Typical apoptotic VSMCs were observable under TEM. The expression of c-myc was positive in the control group and negative or weakly positive in the c-myc ASODN treatment group, according to both ISH and immunohistochemical examination.Conclusion Gelatin-coated R-lr stent mediated local delivery of c-myc ASODNs is feasible. The localization of c-myc ASODN is primarily in the target vessel walls, c-myc ASODNs can inhibit VSMCs proliferation and induce its apoptosis after local delivery in vivo.
基金High-level Hospital Construction Project,Guangdong,China(No.DFJH201807)。
文摘Background Aortic coarctation(CoA)is a common congenital cardiovascular defect. Until now,there is no unified conclusions about the therapeutic options of the native aortic coarctation(CoA)in adolescents and adults. Methods From May 2010 to April 2018,consecutive 23 patients(median age 25 years,range 15-57 years)with native CoA underwent endovascular repair by applying covered Cheatham platinum(CP)stent in our center. Related variables were retrospectively collected and analyzed. Results Ten cases were complicated with other congenital heart diseases. Hypertension was confirmed in 21(91.3%)patients. In these patients,thirteen cases(61.9%)had a normal blood pressure without drug treatment during follow-up.The systolic right arm blood pressure significantly decreased from a mean of 150.7±6.4 mmHg pre-operation to 128.0±12.5 mmHg discharge(P<0.001),and the diastolic pressure decreased from 82.0±10.0 to 73.1±6.8 mmHg(P<0.001). The diameter of the coarcted segment increased from 5.0±2.3 to 16.9±2.3 mm(P<0.001). The peak systolic gradient significantly decreased from 64.9±20.9 to 7.1 ±6.1 mm Hg(P<0.001). The median follow-up was 30 months(range 1 months to 7.9 years). Complications were found in 4 people within one month:1 suspected cardiovascular-related death,1 new aortic dissection,1 splenic infarction,and 1 path-related arterial occlusion.Conclusions Our limited experience demonstrated that stent implantation is a reliable technique for the management of native aortic coarctation in adolescents and adults. Our intermediate-term results seem encouraging,however,the early complications should be considered. A larger series of cases with a longer follow-up is needed to substantiate these results.
文摘主动脉瓣狭窄(aortic stenosis,AS)是一种较常见的心脏瓣膜病变,而合并主动脉缩窄(coarctation of the aorta,CoA)十分罕见,发病率<1%。近年来覆膜支架置入已被广泛用于治疗CoA,而经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)作为介入新技术也逐渐在临床推广应用,但是同时经导管介入治疗CoA和AS在国内经验尚少,这对手术医师和麻醉医师来说均是一个巨大挑战。报道1例"一站式"经股动脉置入支架治疗CoA、经颈动脉TAVR治疗AS的成功病例,术后主动脉内压力阶差基本消失且未出现反流。
