Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Method...Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.展开更多
Objective:To evaluate the effect of diabetes on outcome of sirolimus-eluting stent.Methods:From December 2002 to May 2005,262 diabetes and 262 non-diabetics treated with sirolimus-eluting stents were studied.The follo...Objective:To evaluate the effect of diabetes on outcome of sirolimus-eluting stent.Methods:From December 2002 to May 2005,262 diabetes and 262 non-diabetics treated with sirolimus-eluting stents were studied.The follow-up angiography was performed in 8-month.Major adverse cardiac events(MACE)defined as death,myocardial infarction,or target lesion revascularization and follow-up angiography were analyzed.Results:Successful rate of stent implantation was 100%.There was no death during the procedure,hospitalization,and follow-up period.Acute myocardial infarction occurred in 1 diabetic at 2 days after PCI,and in 2 non-diabetics at follow-up period.Angiographic follow up at 8 months showed that absolute late lumen loss was 0.06 vs 0.04mm(P>0.05),relative late lumen loss was 2.32% vs 1.63%,and TLR rate was 12.60% vs 9.92% in diabetic group and non-diabetic group respectively.Logistic regression analysis showed that reference vessel lumen and relative late lumen loss were significantly associated with restenosis.Conclusion:Cypher stent implantation in diabetes is safe and effective,while relative late lumen loss may be related to restenosis.In a word,diabetes with small vessel may be considered to be risk factor for restenosis after Cypher stents implantation.展开更多
Objective To evaluate the effects of low-dose radioactive stents on the prevention of restenosis in rabbit model. Methods The stents were bombarded with suitable charged particles of adapted energy in the cyclotron to...Objective To evaluate the effects of low-dose radioactive stents on the prevention of restenosis in rabbit model. Methods The stents were bombarded with suitable charged particles of adapted energy in the cyclotron to create a proper mixture of the radionuclides 59 Fe, 60 Co, 58 Co, 51 Cr, and 54 Mn. The radioactive stents were implanted in the iliac arteries of rabbits. The effects of radioactive stents on prevention of restenosis were assessed by angiography, histomorphometry and immunocytochemistry. Results All the iliac arteries that had been implanted with radioactive stents were patent on angiography and had no radiation complication during the 1～2 months of follow-up. There was a significant reduction in neointimal area (0.37±0.14mm 2 vs. 0.81±0.10mm 2, P<0.01), percent area stenosis (6.7±2.9% vs. 13.2±1.4%, P<0.01) and PCNA immunoreactive rate (2.00±1.58% vs. 10.88±6.98%, P<0.05) in the radioactive stent group compared with the control stent group. Conclusion Radioactive stents with an active of 0.91～1.65 μCi could inhibit SMC proliferation and neointimal hyperplasia in animal restenosis model. The low-dose radioactive stents are safe and feasible for prevention of restenosis.展开更多
Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We r...Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery (RCA) that were related to the aneurysm, restenosis, thrombosis, and vessel occlusion.展开更多
Objective To evaluate the clinical efficacy of Palmaz-Sctatz(P-S)stent,and sum up the experience of P-S stent implantation.Methods The P-S stent were implanted in 79 patients with 85 coronarylesions.According abscence...Objective To evaluate the clinical efficacy of Palmaz-Sctatz(P-S)stent,and sum up the experience of P-S stent implantation.Methods The P-S stent were implanted in 79 patients with 85 coronarylesions.According abscences of in hospital death.emergency coronary arterybypass grafting(CABG),Q wave myocardial infarctina(MI)or repeatintervention,measured the primary successfui rate of stent implantation atpostoperatively and the bail out rate of acute coronary closure afterpercutaneous transluminal coronary angioplasty(PTCA).Clinical follow upin 74 of 82 lesions of successful stent implantation was obteined at 3-6month after operation,the restnotic rate was measured by quantitativecoronary angiography.The restenosis was defined as】50% diameterstenosis at follow up.Results In 79 patients with 85 coronary lesion.82 were successfulimplanted.the successful rate was 96%.The Q wave MI 2 patients andemergency CABG 1 patient in 3 patients of unsuccessful stent implantation,and that have not death and repeat interveation.The 28 patients weredelivered in 31 patients with acute coronary closure after PTCA.The bailout rate was 90%.12 have restenosis in 82 lesions of follow up at 3-6month after stent implantation,the restenotic rate was 16%.Conclusion The successful rate of P-S stent implantation was high.andthe occur rete of major adverse events was lower than other stents.Thebail out rate was high in acute coronnry closure after PTCA.The restenotierate at 3-6 month after stunt implantation has lower than other stents.Butthe P-S stent yes not suitable for medium winding blood vessel and was展开更多
Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridem...Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridemia with elevated levels of very low-density lipoprotein cholesterol （VLDL-C）. Increasing evidence suggested that VLDL-C was known as a significant risk factor for atherosclerosis and had been recommended as a treatment target by current dyslipidemia guidelines. However, the role of VLDL-C in the occurrence and development of ISR in coronary artery disease （CAD） patients with DM had not been studied. The aim of this study was to evaluate the association between the elevated levels of VLDL-C and the risk of ISR in CAD patients with DM. Methods： A total of 1390 diabetic patients, who underwent coronary drug-eluting stent （DES） implantation at Beijing Anzhen Hospital and followed up by angiography within 6–24 months, were consecutively enrolled. Patients＇ demographic and clinical characteristics, including age, gender, CAD risk factors, family history, life style, medical history, and coronary angiographic information, were collected carefully at baseline percutaneous coronary intervention and follow-up angiography. Multivariate Cox＆#39;s proportional hazards regression modeling using the step-wise method （entry, 0.05; removal, 0.05） was used to determine the independent risk associated with ISR in diabetic patients. Results： Finally, 1206 of patients were included in this study. ISR occurred in 132/1206 diabetic patients （10.9%） by follow-up angiography. Patients with ISR had elevated median serum VLDL-C levels compared with those without ISR （0.65 mmol/L vs. 0.52 mmol/L, P = 0.030）. The multivariate regression analysis showed that VLDL-C was significantly associated with the risk of ISR in diabetic CAD patients （hazard ratio [HR] = 1.15, 95% confidence interval [CI]： 1.03–1.29, P = 0.017）. The HR for the risk of ISR associated with VLDL-C level ≥0.52 mmol/L was 3.01 （95% CI： 1.24–7.34, P = 0.015）. Conclusion： The elevated level of serum VLDL-C was a significant and independent risk factor for ISR in diabetic CAD patients after coronary DES implantation.展开更多
Background Although some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely...Background Although some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely unknown. Since the number of infectious pathogens has been argued to be relative to the coronary artery diseases, we therefore examined whether there is a link between the number of infections and the incidence of in- stent restenosis after stent implantation. Methods One hundred and eighty-one patients were enrolled in this study. Infectious pathogens including serum anti-Chlymydia p neumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 antibodies and hepatitis B virus antigen were measured in all patients before coronary stent implantation. Coronary angiography was performed before, immediately after and 6 months after stent implantation. Results Restenosis rate 6 months post stent implantation was similar in patients with low pathogen burden （ 〈3 pathagens, 33.3% ） to those with high pathogen burden （ ≥3 pathogens, 29. 1% ）. Conclusions Previous infections with Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-l, human herpes simplex virus-2 and hepatitis B virus do not contribute to the incidence of restenosis after stent implantation.展开更多
Objectives.To summarize the primary outcome and late result of 76 casescoronary stenting and to evaluate the efficiency of preventing from acutecoronary closure and restenosis.Methods.Ninety-five coronary stents of 13...Objectives.To summarize the primary outcome and late result of 76 casescoronary stenting and to evaluate the efficiency of preventing from acutecoronary closure and restenosis.Methods.Ninety-five coronary stents of 13 different types were implanted in 108lesions of 86 coronary arteries in 76 patients (67 males and 9 females,57.3 = 9.1years old).Stent expansion was completed with the balloon pressure of 10-14 atmfor 30-60 seconds.There were de novo stenting in 52 cases,bailout stenting in 3,stenting of restenotic lesions in 3 and suboptimal stenting in 18.Two or morestents were implanted in 1 vessel in 12 cases,and 5 stents were implanted in RCAin 1 case.Bamyl and ticlid 0.25 bid were taken respectively 3 days beforeprocedure.Hepain 10000 IU was infused to arterial sheaths during procedure.Heparin 600-800 IU/hr was dripped intravenously after procedure and lasting for1-2 days.Bamyl and ticlid 0.25 bid were still taken respectively and extenuatedto once a day after 4 weeks.Results Ninety-four of 96 stems were successfully implanted with a success rateof 97.9% and residual stenosis of 9.1±7.6%.Two stents fall off in 2 patients dueto severe calcification but successfully extracted.No acute coronary eventsoccurred during procedure.Primary outcome:Seventy-four of 76 patients werefree of symptoms,and 1 patient had AMI due to acute thrombosis 6 hours afterprocedure and re-PTCA successfully.Late result:Clinical symptoms disappearedor relieved obviously in 69 of 76 (90.8%) patients,and 7 patients (9.2%) sufferedfrom angina including 3 case with AMI m 24.4=13.6 months follow-up.Angiography of these 7 cases showed restenosis in stent site in 5 cases andocclusion in 2 cases.All of them received -PTCA successfully,but 1 patientdied of cardiogenic shock later.Noninvasive test:Echocardiography was taken in15 cases of old myocardial infarction pre- and post-procedure.The wall moonscore of infarction area is 2.1 and 1.1 respectively,and the ejection fraction is0.39 and 0.48 respectively.Conclusions.Coronary stenting has the charactenstics of few acute coronaryevents and high success rata.It can decrease restenosis and occlusion effectively,and improve the cardiac function.展开更多
文摘Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.
文摘Objective:To evaluate the effect of diabetes on outcome of sirolimus-eluting stent.Methods:From December 2002 to May 2005,262 diabetes and 262 non-diabetics treated with sirolimus-eluting stents were studied.The follow-up angiography was performed in 8-month.Major adverse cardiac events(MACE)defined as death,myocardial infarction,or target lesion revascularization and follow-up angiography were analyzed.Results:Successful rate of stent implantation was 100%.There was no death during the procedure,hospitalization,and follow-up period.Acute myocardial infarction occurred in 1 diabetic at 2 days after PCI,and in 2 non-diabetics at follow-up period.Angiographic follow up at 8 months showed that absolute late lumen loss was 0.06 vs 0.04mm(P>0.05),relative late lumen loss was 2.32% vs 1.63%,and TLR rate was 12.60% vs 9.92% in diabetic group and non-diabetic group respectively.Logistic regression analysis showed that reference vessel lumen and relative late lumen loss were significantly associated with restenosis.Conclusion:Cypher stent implantation in diabetes is safe and effective,while relative late lumen loss may be related to restenosis.In a word,diabetes with small vessel may be considered to be risk factor for restenosis after Cypher stents implantation.
文摘Objective To evaluate the effects of low-dose radioactive stents on the prevention of restenosis in rabbit model. Methods The stents were bombarded with suitable charged particles of adapted energy in the cyclotron to create a proper mixture of the radionuclides 59 Fe, 60 Co, 58 Co, 51 Cr, and 54 Mn. The radioactive stents were implanted in the iliac arteries of rabbits. The effects of radioactive stents on prevention of restenosis were assessed by angiography, histomorphometry and immunocytochemistry. Results All the iliac arteries that had been implanted with radioactive stents were patent on angiography and had no radiation complication during the 1～2 months of follow-up. There was a significant reduction in neointimal area (0.37±0.14mm 2 vs. 0.81±0.10mm 2, P<0.01), percent area stenosis (6.7±2.9% vs. 13.2±1.4%, P<0.01) and PCNA immunoreactive rate (2.00±1.58% vs. 10.88±6.98%, P<0.05) in the radioactive stent group compared with the control stent group. Conclusion Radioactive stents with an active of 0.91～1.65 μCi could inhibit SMC proliferation and neointimal hyperplasia in animal restenosis model. The low-dose radioactive stents are safe and feasible for prevention of restenosis.
文摘Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery (RCA) that were related to the aneurysm, restenosis, thrombosis, and vessel occlusion.
文摘Objective To evaluate the clinical efficacy of Palmaz-Sctatz(P-S)stent,and sum up the experience of P-S stent implantation.Methods The P-S stent were implanted in 79 patients with 85 coronarylesions.According abscences of in hospital death.emergency coronary arterybypass grafting(CABG),Q wave myocardial infarctina(MI)or repeatintervention,measured the primary successfui rate of stent implantation atpostoperatively and the bail out rate of acute coronary closure afterpercutaneous transluminal coronary angioplasty(PTCA).Clinical follow upin 74 of 82 lesions of successful stent implantation was obteined at 3-6month after operation,the restnotic rate was measured by quantitativecoronary angiography.The restenosis was defined as】50% diameterstenosis at follow up.Results In 79 patients with 85 coronary lesion.82 were successfulimplanted.the successful rate was 96%.The Q wave MI 2 patients andemergency CABG 1 patient in 3 patients of unsuccessful stent implantation,and that have not death and repeat interveation.The 28 patients weredelivered in 31 patients with acute coronary closure after PTCA.The bailout rate was 90%.12 have restenosis in 82 lesions of follow up at 3-6month after stent implantation,the restenotic rate was 16%.Conclusion The successful rate of P-S stent implantation was high.andthe occur rete of major adverse events was lower than other stents.Thebail out rate was high in acute coronnry closure after PTCA.The restenotierate at 3-6 month after stunt implantation has lower than other stents.Butthe P-S stent yes not suitable for medium winding blood vessel and was
文摘Background： High rate of in-stent restenosis （ISR） remained an unsolved clinical problem in clinical practice, especially among patients with diabetes mellitus （DM）. Diabetic patients often had hypertriglyceridemia with elevated levels of very low-density lipoprotein cholesterol （VLDL-C）. Increasing evidence suggested that VLDL-C was known as a significant risk factor for atherosclerosis and had been recommended as a treatment target by current dyslipidemia guidelines. However, the role of VLDL-C in the occurrence and development of ISR in coronary artery disease （CAD） patients with DM had not been studied. The aim of this study was to evaluate the association between the elevated levels of VLDL-C and the risk of ISR in CAD patients with DM. Methods： A total of 1390 diabetic patients, who underwent coronary drug-eluting stent （DES） implantation at Beijing Anzhen Hospital and followed up by angiography within 6–24 months, were consecutively enrolled. Patients＇ demographic and clinical characteristics, including age, gender, CAD risk factors, family history, life style, medical history, and coronary angiographic information, were collected carefully at baseline percutaneous coronary intervention and follow-up angiography. Multivariate Cox＆#39;s proportional hazards regression modeling using the step-wise method （entry, 0.05; removal, 0.05） was used to determine the independent risk associated with ISR in diabetic patients. Results： Finally, 1206 of patients were included in this study. ISR occurred in 132/1206 diabetic patients （10.9%） by follow-up angiography. Patients with ISR had elevated median serum VLDL-C levels compared with those without ISR （0.65 mmol/L vs. 0.52 mmol/L, P = 0.030）. The multivariate regression analysis showed that VLDL-C was significantly associated with the risk of ISR in diabetic CAD patients （hazard ratio [HR] = 1.15, 95% confidence interval [CI]： 1.03–1.29, P = 0.017）. The HR for the risk of ISR associated with VLDL-C level ≥0.52 mmol/L was 3.01 （95% CI： 1.24–7.34, P = 0.015）. Conclusion： The elevated level of serum VLDL-C was a significant and independent risk factor for ISR in diabetic CAD patients after coronary DES implantation.
基金This work was supported by Major National Basic Research fromChinese Ministry of Science and Technology Grant ( No.G2000056903), and Science and Technology Commission ofShanghai Municipality (No.02JC14026)
文摘Background Although some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely unknown. Since the number of infectious pathogens has been argued to be relative to the coronary artery diseases, we therefore examined whether there is a link between the number of infections and the incidence of in- stent restenosis after stent implantation. Methods One hundred and eighty-one patients were enrolled in this study. Infectious pathogens including serum anti-Chlymydia p neumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 antibodies and hepatitis B virus antigen were measured in all patients before coronary stent implantation. Coronary angiography was performed before, immediately after and 6 months after stent implantation. Results Restenosis rate 6 months post stent implantation was similar in patients with low pathogen burden （ 〈3 pathagens, 33.3% ） to those with high pathogen burden （ ≥3 pathogens, 29. 1% ）. Conclusions Previous infections with Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-l, human herpes simplex virus-2 and hepatitis B virus do not contribute to the incidence of restenosis after stent implantation.
文摘Objectives.To summarize the primary outcome and late result of 76 casescoronary stenting and to evaluate the efficiency of preventing from acutecoronary closure and restenosis.Methods.Ninety-five coronary stents of 13 different types were implanted in 108lesions of 86 coronary arteries in 76 patients (67 males and 9 females,57.3 = 9.1years old).Stent expansion was completed with the balloon pressure of 10-14 atmfor 30-60 seconds.There were de novo stenting in 52 cases,bailout stenting in 3,stenting of restenotic lesions in 3 and suboptimal stenting in 18.Two or morestents were implanted in 1 vessel in 12 cases,and 5 stents were implanted in RCAin 1 case.Bamyl and ticlid 0.25 bid were taken respectively 3 days beforeprocedure.Hepain 10000 IU was infused to arterial sheaths during procedure.Heparin 600-800 IU/hr was dripped intravenously after procedure and lasting for1-2 days.Bamyl and ticlid 0.25 bid were still taken respectively and extenuatedto once a day after 4 weeks.Results Ninety-four of 96 stems were successfully implanted with a success rateof 97.9% and residual stenosis of 9.1±7.6%.Two stents fall off in 2 patients dueto severe calcification but successfully extracted.No acute coronary eventsoccurred during procedure.Primary outcome:Seventy-four of 76 patients werefree of symptoms,and 1 patient had AMI due to acute thrombosis 6 hours afterprocedure and re-PTCA successfully.Late result:Clinical symptoms disappearedor relieved obviously in 69 of 76 (90.8%) patients,and 7 patients (9.2%) sufferedfrom angina including 3 case with AMI m 24.4=13.6 months follow-up.Angiography of these 7 cases showed restenosis in stent site in 5 cases andocclusion in 2 cases.All of them received -PTCA successfully,but 1 patientdied of cardiogenic shock later.Noninvasive test:Echocardiography was taken in15 cases of old myocardial infarction pre- and post-procedure.The wall moonscore of infarction area is 2.1 and 1.1 respectively,and the ejection fraction is0.39 and 0.48 respectively.Conclusions.Coronary stenting has the charactenstics of few acute coronaryevents and high success rata.It can decrease restenosis and occlusion effectively,and improve the cardiac function.
