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A double-blind, randomized study of the effect of immediate intravenous nitroglycerin on the incidence of postprocedural chest pain and minor myocardial necrosis after elective coronary stenting

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AMERICAN HEART JOURNAL 2000年第1期139卷 35-43页

作者： Kurz, DJ Naegeli, B Bertel, O Triemli Hosp Dept Internal Med Div Cardiol CH-8063 Zurich Switzerland

Background Anginal chest pain without creatine kinase (CK) elevation is frequently observed in the first hours after coronary stenting. Possible causes of ischemic episodes are microembolism, side branch occlusion, coronary vasospasm, and disturbances of microvascular circulation. In a prospective, double-blind, randomized trial, we tested the effect of intravenous nitroglycerin on the incidence of angina and minor myocardial necrosis (MMN), as detected by cardiac troponin I increase, after elective coronary stenting. Methods and Results One hundred patients were randomly assigned to intravenous nitroglycerin (group A: n = 50, goal dose 100 mu g/min) or placebo (group B: n = 50, NaCl 0.9%) during 12 hours after stenting. Patients with acute myocardial infarction, known intolerance to nitrates, and hemodynamic instability during angioplasty were excluded. The 2 groups were comparable in respect to baseline and interventional variables, except for age (group A: 60 +/- 9 years, group B: 56 +/- 10 years;P = .04). The incidence of chest pain was not influenced by nitroglycerin (group A: 18%, group B: 22%;P = not significant). However, the occurrence of MMN was significantly reduced by nitroglycerin (group A: 5%, group B: 19%, P = .036). A rise in CK with significant CK-MB fraction was observed in only 2 patients in group B (both less than twice upper limit). Only 4 of the 10 patients with MMN also had chest pain. Conclusions Routine use of intravenous nitroglycerin after coronary stenting significantly reduced the occurrence of minor myocardial necrosis. However, the incidence of postprocedural chest pain remained unchanged.

关键词：心绞痛/血液心绞痛/预防和控制心绞痛/放射摄影术血管成形术经腔经皮冠状动脉生物学标记/血液冠状血管造影术冠心病/放射摄影术冠心病/治疗双盲法移植物闭塞血管/并发症移植物闭塞血管/药物疗法移植物闭塞血管/放射摄影术心脏/药物作用发病率注射静脉内心肌梗死/药物疗法心肌梗死/病因学心肌梗死/放射摄影术心肌/病理学坏死硝酸甘油/投药和剂量疼痛手术后/血液疼痛手术后/预防和控制疼痛手术后/放射摄影术前瞻性研究支架肌钙蛋白I/血液血管舒张药/投药和剂量女(雌)性人类男(雄)性中年人

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Intracoronary surface changes after Palmaz-Schatz stent implantation: Serial observations with coronary angioscopy

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AMERICAN HEART JOURNAL 1999年第5期138卷 962-967页

作者： Sakatani, H Degawa, T Nakamura, M Yamaguchi, T Toho Univ Dept Internal Med 3 Meguro Ku Tokyo 1538515 Japan

Background The objective of this study was to evaluate the appearance of the intraluminal surface after Palmaz-Schatz stent implantation by using coronary angioscopy. Methods and Results Coronary angioscopy was performed immediately after stenting and at 1, 3, and 6 months later in 43 patients with 45 lesions. The presence or absence of red thrombus and/or dissection and the extent of neointimal coverage of the stent struts were analyzed. immediately after stenting, red thrombus and dissection were observed in 9 (41%) and 12 (56%) of 22 lesions, respectively, and these rates decreased with time. Complete coverage of the stent struts by smooth white neointima was observed in 55% of 1 1 lesions at 1 month and in 80% of 21 lesions at 3 months. However, incomplete neointimal coverage was seen in 3 lesions at both 3 and 6 months. Conclusions In human coronary arteries, neointimal coverage of an implanted Palmaz-Schatz stent may take as long as 6 months or more.

关键词：心绞痛/外科学血管镜检查/方法抗凝药/治疗应用血管假体植入/仪器和设备冠状血管造影术冠状血管/病理学冠状血管/外科学药物疗法联合随访研究移植物闭塞血管/药物疗法移植物闭塞血管/病理学移植物闭塞血管/放射摄影术血小板聚集抑制剂/治疗应用假体失效复发可重复性结果回顾性研究支架女(雌)性人类男(雄)性中年人

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An unusual vascular graft infection by Aspergillus -: A case report and literature review

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ANGIOLOGY 1999年第2期50卷 169-173页

作者： Fuster, RG Clará, A di Stefano, S Legarra, J Sarralde, JA Univ Navarra Clin Univ Dept Cardiovasc Surg Navarra Spain

Vascular graft infection due to Aspergillus is a rare event. Only 11 previous case reports have been documented. All of these infections were in the aortic position, and infrainguinal arterial prosthetic graft involvement has been uncommon. The usual clinical presentation was back pain. Fever and systemic complaints were usually present. An unusual case that began with bilateral groin pain is reported and a review of the clinical presentation and the management of the other cases described in the literature is presented.

关键词：主动脉/外科学主动脉疾病/药物疗法主动脉疾病/微生物学主动脉疾病/外科学曲霉菌病/诊断曲霉菌病/药物疗法曲霉菌病/外科学股动脉/外科学随访研究移植物闭塞血管/药物疗法移植物闭塞血管/微生物学移植物闭塞血管/外科学缺血/病因学缺血/外科学腿/血液供给聚对苯二甲酸乙酯类聚四氟乙烯假体相关感染/诊断假体相关感染/药物疗法假体相关感染/外科学再手术血栓形成/病因学血栓形成/外科学人类男(雄)性中年人

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Reduced thrombus burden with abciximab delivered locally before percutaneous intervention saphenous vein grafts

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AMERICAN HEART JOURNAL 2000年第5期139卷 824-829页

作者： Barsness, GW Buller, C Ohman, M Schechter, E Pucillo, A Taylor, MA Miller, MJ Reiner, JS Churchill, D Chandler, AB Gonzalez, M Smith, J Tommaso, C Berdan, LG Wildermann, NM Hasdai, D Holmes, DR Mayo Clin Rochester MN 55905 USA Duke Clin Res Inst Durham NC USA Vancouver Gen Hosp Vancouver BC Canada Vet Adm Med Ctr Oklahoma City OK 73104 USA Westchester Cty Med Ctr Valhalla NY 10595 USA Deborah Heart & Lung Ctr Browns Mills NJ USA Pitt Cty Hosp Greenville NC USA George Washington Univ Med Ctr Washington DC 20037 USA Washington Reg Med Ctr Fayetteville AR USA Univ Hosp Augusta GA USA Columbia Pk Med Ctr Orlando FL USA Florida Heart & Vasc Inst Tampa FL USA Rush N Shore Hosp Skokie IL USA Mayo Clin Rochester MN USA

Background Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. Methods We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had greater than or equal to 60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. Results Median percent diameter stenosis improved from 69% to 45% (P = .0001) after local delivery, and TIMI thrombus grade greater than or equal to 1 incidence reduced from 68% to 34% (P = .0001). TIMI flow grade was not significantly affected (P = .12). All patients had a successful intervention (less than or equal to 50% residual stenosis). Conclusions Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.

关键词：抗体单克隆/投药和剂量冠状血管造影术/药物作用冠状动脉分流术冠状动脉血栓形成/药物疗法冠状动脉血栓形成/放射摄影术移植物闭塞血管/药物疗法移植物闭塞血管/放射摄影术免疫球蛋白Fab片段/投药和剂量输注泵试点项目血小板聚集抑制剂/投药和剂量血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂术前用药法支架治疗结果静脉/移植老年人女(雌)性人类男(雄)性中年人

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Hemodialysis graft declotting with the "lyse and wait" technique: A new name for an old recipe

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 1999年第1期10卷 96-97页

作者： Turmel-Rodrigues, LA Clin St Gatien F-37000 Tours France

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Clinical study of adjuvant photodynamic therapy to reduce restenosis following femoral angioplasty

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BRITISH JOURNAL OF SURGERY 1999年第10期86卷 1258-1263页

作者： Jenkins, MP Buonaccorsi, GA Raphael, M Nyamekye, I McEwan, JR Bown, SG Bishop, CCR UCL Middlesex Hosp Vasc Unit Dept Surg London England UCL Middlesex Hosp Natl Med Laser Ctr Dept Surg London England

Background: Photodynamic therapy (PDT) reduces neointimal hyperplasia and negative remodelling following balloon injury in small and large animal models. This clinical study investigated the role of adjuvant PDT following femoral percutaneous transluminal angioplasty (PTA). Methods: Eight PTAs in seven patients (two women) with a median age of 70 (range 59-86) years were performed with adjuvant PDT. All patients had previously undergone conventional angioplasty at the same site which resulted in symptomatic restenosis or occlusion between 2 and 6 months. Each was sensitized with oral 5-aminolaevulinic acid 60 mg/kg, 5-7 h before the procedure. Following a second femoral angioplasty, up to 50 J/cm(2) red light (635 nm) was delivered to the angioplasty site via a laser fibre within the angioplasty balloon. Patients were kept in subdued light overnight and discharged the following day. Outcome was assessed by duplex imaging at 24 h, 1, 3 and 6 months and by intravenous digital subtraction angiogaphy at 6 months. A peak systolic velocity ratio (PSVR) of more than 2.0 at the angioplasty site was taken to represent restenosis. Results: All patients tolerated the procedure well without adverse complications or death. All were rendered asymptomatic which was sustained throughout the study interval. All vessels remained patent and no lesion attained the duplex definition of restenosis. Median (interquartile range) PSVR across stenotic segments was 4.7 (3.7-5.7) before angioplasty, 1.1 (0.9-1.3) at 24 h and 1.4 (1.0-1.8) at 6 months after intervention (P = 0.04 compared with preoperative value). Conclusion: This pilot study suggests that endovascular PDT is safe and may reduce restenosis following angioplasty. The data justify a randomized controlled trial.

关键词：血管成形术气囊/方法血流速度缩窄病理性/治疗股动脉移植物闭塞血管/药物疗法光化学疗法试点项目前瞻性研究复发危险因素血管未闭老年人老年人 80以上女(雌)性人类男(雄)性中年人

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