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LASER THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION - RESULTS OF A CLINICAL FEASIBILITY STUDY

JOURNAL OF INTERVENTIONAL CARDIOLOGY 1994年第6期7卷 525-534页

作者： DENHEIJER, P VANDIJK, RB PENTINGA, ML HILLEGE, HL LIE, KI DepartmentofCardiology ThoraxcenterUniversityHospitalGroningenTheNetherlands.

Laser thrombolysis is a new, experimental, catheter based intervention aimed at selectivity removing intracoronary thrombus. This first clinical study was performed to assess the feasibility and safety of laser thrombolysis, as well as its potential therapeutic place in acute myocardial infarction. Eighteen patients with acute myocardial infarction, who were either noncandidates for, or failures on, intravenous fibrinolytic therapy were included for treatment with laser thrombolysis followed by balloon angioplasty. As a result of catheter and technical failures, the laser was actually fired in only 12 patients. Improvement in TIMI flow from grade 0-1 to grade 2-3 was observed in 10 of these 12 patients after laser application. The overall results of 18 patients were: increase in TIMI grade flow from 0.33 +/- 0.49 after wire passage to 1.28 +/- 1.23 (P = 0.0051) after attempted laser application, and to 2.67 +/- 0.97 after PTCA (P = 0.0004). Two patients with previous infarctions died from left ventricular failure despite successful laser thrombolysis. One patient died during emergency bypass surgery after a failed recanalization attempt. Perforation or laser related dissection did not occur. The concept of selective laser thrombus ablation seems to be safe and feasible, but substantial improvements of the laser delivery catheters are needed. Laser thrombolysis is not an effective stand-alone therapy in acute myocardial infarction, but other possible applications warrant further research and development efforts for this potentially useful interventional tool.

关键词：血管成形术气囊激光辅助血管成形术经腔经皮冠状动脉综合疗法冠状血管造影术冠状动脉血栓形成/放射摄影术冠状动脉血栓形成/外科学冠状动脉血栓形成/治疗可行性研究心肌梗死/外科学心肌梗死/治疗血栓溶解疗法女(雌)性人类男(雄)性中年人

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Dramatic improvement of LV function after coronary sinus thromboembolectomy

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ANNALS OF THORACIC SURGERY 2000年第3期70卷 961-963页

作者： Neri, E Tripodi, A Tucci, E Capannini, G Sassi, C Univ Hosp Thorac & Cardiovasc Dept Siena Italy

We present the case of a 79-year-old man suffering from chronic atrial fibrillation, severe left ventricular dysfunction, massive right atrial thrombosis, and pulmonary hypertension. Complete coronary sinus thrombosis was found incidentally during preoperative screening. Successful coronary sinus, right atrial, and pulmonary operative embolectomy was followed soon after by a dramatic improvement of cardiac performance;the patient's left ventricular function recovery, in particular, suggests that cardiac venous system played an important role in the genesis of myocardial impairment. (Ann Thorac Surg 2000;70:961-3) (C) 2000 by The Society of Thoracic Surgeons.

关键词：冠状动脉血栓形成/外科学冠状动脉血栓形成/超声检查超声心动描记术经食管栓子清除术心室功能左/生理学老年人人类男(雄)性

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Economic assessment of rheolytic thrombectomy versus intracoronary urokinase for treatment of extensive intracoronary thrombus: Results from a randomized clinical trial

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AMERICAN HEART JOURNAL 2001年第4期142卷 648-656页

作者： Cohen, DJ Ramee, S Baim, DS Sharma, S Carrozza, JP Cosgrove, R Jones, N Berezin, RH Cutlip, DE Ho, KKL Kuntz, RE Beth Israel Deaconess Med Ctr Div Cardiovasc Boston MA 02215 USA Harvard Clin Res Inst Boston MA 02115 USA Harvard Univ Sch Med Boston MA USA Harvard Univ Sch Publ Hlth Dept Hlth Policy & Management Boston MA 02115 USA Oschner Clin New Orleans LA USA Mt Sinai Hosp Div Cardiol New York NY 10029 USA

Background Despite advances in mechanical and pharmacologic therapy, thrombus-containing lesions are at high risk for adverse events and remain a challenging subset for percutaneous coronary revascularization. Recently, rheolytic thrombectomy with the AngioJet device has been shown to safely remove intracoronary thrombus, but the overall cost-effectiveness of this technique is unknown. Methods We determined in-hospital and 1-year follow-up costs for 349 patients with overt intracoronary thrombus who were randomly assigned to treatment with intracoronary urokinase (6- to 30-hour infusion followed by definitive revascularization;n = 169) or immediate thrombectomy with the AngioJet device (n = 180) as part of the Vein Graft AngioJet Study (VeGAS) 2 trial. Catheterization laboratory costs were based on measured resource utilization and 1998 unit costs, whereas all other costs were estimated from hospital charges and cost center-specific cost-to-charge ratios. Results Compared with urokinase, rheolytic thrombectomy reduced the incidence of periprocedural myocardial infarction (12.8% vs 30.3%, P < .001) and major hemorrhagic complications (2.8% vs 11.2%, P < .001) and shortened length of stay by nearly 1 day (4.2 vs 4.9 days;P = .02). As a result, AngioJet treatment reduced procedural costs, hospital room/nursing costs, and ancillary costs with resulting hospital cost savings of approximately $3500 per patient during the initial hospitalization ($15,311 vs $18,841, P < .001). These cost savings were maintained at 1 year of follow-up ($24,389 vs $29,109, P < .001). Conclusions Compared with standard treatment with intracoronary urokinase, rheolytic thrombectomy both improves clinical outcomes and reduces overall medical care costs for patients with extensive intracoronary thrombus.

关键词：血管成形术经腔经皮冠状动脉/经济学血管成形术经腔经皮冠状动脉/方法冠状动脉血栓形成/药物疗法冠状动脉血栓形成/经济学冠状动脉血栓形成/外科学纤维蛋白溶解药/投药和剂量纤维蛋白溶解药/经济学纤维蛋白溶解药/治疗应用卫生保健费用血液流变学输注动脉内血栓切除术/经济学血栓切除术/仪器和设备血栓切除术/方法治疗结果人类

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ULTRASONIC THROMBUS ABLATION - INVITRO ASSESSMENT OF A NOVEL DEVICE FOR INTRACORONARY USE

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1993年第1期6卷 69-76页

作者： HARTNELL, GG SAXTON, JM FRIEDL, SE ABELA, GS ROSENSCHEIN, U 1 From the Departments of Cardiology New England Deaconess Hospital and Harvard Medical School Boston Massachusetts2 Tel-Aviv Medical Center Tel-Aviv University Israel

An ultrasonic thrombolysis device designed for intracoronary use was developed and evaluated in vitro to assess efficacy in achieving clot ablation without deleterious effects, such as heat generation and production of large particles during clot ablation. Studies on 31 samples with a bench-top version demonstrated that clot ablation was rapid (typically 2 mL in under 2 minutes) and no macroscopic particles were released. The fluid produced did not reclot. Studies with a clinical version of the device that can be passed through a 10Fr PTCA guiding catheter confirmed that clot ablation was rapidly achieved. Little particulate material was produced and the maximum temperature achieved did not exceed 52-degrees-C. The device functions well in vitro, releasing little particulate material and causing limited local heating. It seems suitable for intracoronary use and will undergo further in vivo testing.

关键词：导管消融术/仪器和设备导管消融术/方法冠状动脉血栓形成/病理生理学冠状动脉血栓形成/外科学设备设计评价研究人类超声学

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A simple method of treating coronary air embolism after cardiopulmonary bypass

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ANNALS OF THORACIC SURGERY 1999年第5期68卷 1867-1868页

作者： Chaudhuri, N Hickey, MS Glenfield Gen Hosp Dept Cardiothorac Surg Leicester LE3 9QP Leics England

Coronary air embolism is a potential complication of cardiac operations performed with cardiopulmonary bypass, especially open heart operations. There are many recommended methods described in the literature to treat the sequelae of coronary air embolism, none universally effective. We describe a simple and safe method to treat the condition, which we have found very effective in our practice. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心肺转流术冠状动脉血栓形成/外科学栓塞空气/外科学灌流手术后并发症/外科学注射器人类

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An unusual iatrogenic cause of right coronary air embolism

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ANNALS OF THORACIC SURGERY 1999年第2期68卷 575-576页

作者： Baker, RC Graham, ANJ Phillips, AS Campalani, G Royal Victoria Hosp Dept Cardiac Surg Belfast BT12 6BA Antrim North Ireland Royal Victoria Hosp Dept Anesthesia Belfast BT12 6BA Antrim North Ireland

A 62-year-old woman undergoing redo mitral valve replacement was noted to have persistent intracardiac air following standard deairing procedures. Transesophageal echocardiography (TEE) identified air bubbles entering the left atrium from the right superior pulmonary vein. Exploration of the pleural cavity revealed a fistula between the pulmonary parenchyma and the right superior pulmonary vein caused by the atriotomy closure suture transfixing the edge of the lung, which was repaired with immediate disappearance of the air emboli. This demonstrates that transesophageal echocardiography is an invaluable aid to ensuring complete deairing after open heart procedures. (C) 1999 by The Society of Thoracic Surgeons.

关键词：吻合术外科动静脉瘘/病因学动静脉瘘/外科学动静脉瘘/超声检查冠状动脉血栓形成/病因学冠状动脉血栓形成/外科学冠状动脉血栓形成/超声检查超声心动描记术经食管栓塞空气/病因学栓塞空气/外科学栓塞空气/超声检查心脏瓣膜假体植入二尖瓣闭锁不全/外科学手术后并发症/病因学手术后并发症/外科学手术后并发症/超声检查肺动脉/外科学肺动脉/超声检查再手术呼吸道瘘/病因学呼吸道瘘/外科学呼吸道瘘/超声检查女(雌)性人类中年人

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Controlled Reperfusion During Emergency Coronary Artery Bypass Surgery After Angioplasty Failure Restores Immediate Segmental Contractility

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Journal of Interventional Cardiology 1991年第1期4卷 53-62页

作者： BEYERSDORF, FRIEDHELM SARAI, KOPPANY MAUL, FRANK D. WENDT, THOMAS FRIESEWINKEL, ORTWIN SATTER, PETER Departments of Thoracic and Cardiovascular Surgery Johann Wolfgang Goethe-University Frankfurt Germany Nuclear Medicine Johann Wolfgang Goethe-University Frankfurt Germany Johann Wolfgang Goethe-University Frankfurt Germany

This study tests the hypothesis that careful control of the composition of the initial reperfusate and the conditions of the reperfusion during emergency CABG will restore immediate segmental contractility in the previously ischemia area despite ischemic intervals of > 2 hours. Between January 1987, and October 1990, 41 consecutive patients with acute coronary occlusion (90% due to PTC A failures) were reperfused during emergency myocardial revascularization according to one of two different protocols: in 25 patients the reperfusate was normal blood given at systemic pressure (“uncontrolled reperfusion”);in 16 patients the ischemic segment was reperfused during the first 20 minutes with a regional blood cardioplegic solution (substrate‐enriched, hyperosmotic, hypocalcemic, alkalotic, diltiazem‐containing) at 37°C at a pressure of 50 mmHg. Thereafter, total bypass was prolonged for an additional 30 minutes before extracorporeal circulation was discontinued (“controlled reperfusion”). Assessment of regional contractility (echocardiography, radionuclide ventriculography), electrocar‐diographic evidence of myocardial infarction, release of CK and CK‐MB enzymes, and hospital mortality were performed. Quantification of regional contractility was done with a scoring system from 0 (normokinesis) to 4 (dyskinesis). Data are expressed as mean ± standard error of the mean. Both groups were well matched for age, sex, and the distribution of the occluded artery. In the controlled reperfusion group there was a higher incidence of previous infarctions (50% vs 30%), additional significant stenosis (1.1 ± 0.2 vs 0.8 ± 0.1), and cardiogenic shock (38% vs 20%) as compared to uncontrolled reperfusion. Furthermore, the interval between coronary occlusion and reperfusion was significantly longer in the controlled reperfusion group (3.9 ± 0.3 vs 2.2 ± 0.3 hr, P < 0.05) with a range between 2 and 6 hours. Regional contractility (assessed on the 7^th postoperative day) returned to

关键词：心麻痹液/治疗应用冠状动脉分流术/方法冠状动脉血栓形成/外科学评价研究心脏/病理生理学心肌再灌注/方法女(雌)性人类男(雄)性中年人

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Do new devices add to the results of PTCA in acute myocardial infarction?

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AMERICAN HEART JOURNAL 1999年第2期138卷 S158-S163页

作者： Moses, J Moussa, I Interventional Cardiology Lenox Hill Hospital 130 E 77th St New York NY 10021 United States

Several randomized trials have established that timely mechanical reperfusion with the use of balloon angioplasty is superior to thrombolytic therapy in patients with acute myocardial infarction. Furthermore, recent data from prospective randomized trials suggest that primary stent implantation may further improve the results of balloon angioplasty by reducing the need for repeat interventions at follow-up. The role of IIb-IIIa plot slat receptor antagonists as adjunctive therapy to catheter-based coronary interventions in acute myocardial infarction is promising, but the incremental benefit that these agents add to stent implantation awaits the results of dedicated randomized trials. Mechanical thrombolysis or thrombectomy devices may have a role in a minority of patients with large thrombus burden.

关键词：血管成形术经腔经皮冠状动脉综合疗法冠状动脉血栓形成/外科学随访研究心脏导管插入术心肌梗死/药物疗法心肌梗死/治疗心肌再灌注血小板聚集抑制剂/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂血小板糖蛋白GPⅠb-Ⅸ复合物血小板膜糖蛋白类前瞻性研究受体抗原 B细胞/拮抗剂和抑制剂受体细胞表面/拮抗剂和抑制剂再治疗支架血栓切除术/仪器和设备血栓溶解疗法人类

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