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Infarct artery reocclusion after primary angioplasty, stent placement, and thrombolytic therapy for acute myocardial infarction

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AMERICAN HEART JOURNAL 2001年第5期141卷 704-710页

作者： Wilson, SH Bell, MR Rihal, CS Bailey, KR Holmes, DR Berger, PB Mayo Clin Div Cardiovasc Dis Rochester MN 55905 USA

Background The benefits of thrombolytic therapy for acute myocardial infarction (AMI) are limited by reocclusion of the infarct-related artery, which occurs in 25% to 30% of patients after successful reperfusion. The frequency of reocclusion after balloon angioplasty and stenting in this setting is less well documented. The aim of this study was to analyze the frequency and timing of reocclusion alter percutaneous transluminal coronary angioplasty (PTCA) and stent placement during AMI from all available studies compared with previously published reocclusion rates after thrombolysis. Methods and Results The previously published thrombolysis data included 4231 patients in 19 studies with greater than or equal to 75 patients. Only PTCA studies with greater than or equal to 50 patients and stent studies with greater than or equal to 30 patients, in which routine angiographic follow-up was obtained in greater than or equal to 60% of patients, were included. Ten PTCA studies with a total of 1943 patients were analyzed, with follow-up angiography in 1391 (72%). Reocclusion rates ranged from 5% to 16.7%. The stent studies included 698 patients from 7 studies, with follow-up angiography in 92%. Reocclusion rates ranged from 0% to 6%. With the use of logistic regression analysis with allowance for overdispersion, there was a significantly lower rate of reocclusion after PTCA (odds ratio, 0.38;confidence interval, 0.24 to 0.57;P < .0001) and stent placement (odds ratio, 0.11;confidence interval, 0.05 to 0.22;P < .0001) compared with thrombolysis. Reocclusion after stent placement was lower than after PTCA (odds ratio, 0.28;confidence interval, 0.13 to 0.6;P < .0001). Conclusions Reocclusion after PTCA and stent placement during AMI is less frequent than after thrombolysis. This may contribute to the superior outcome of patients treated with PTCA end stent placement in this setting.

关键词：血管成形术经腔经皮冠状动脉血管假体植入/仪器和设备置信区间冠状血管造影术心电描记术纤维蛋白溶解药/治疗应用发病率心肌梗死/流行病学心肌梗死/放射摄影术心肌梗死/治疗比值比复发回顾性研究支架血栓溶解疗法时间因素治疗失败人类

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Immediate and follow-up findings after stent treatment for severe coarctation of aorta

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期83卷 400-406页

作者： de Lezo, JS Pan, M Romero, M Medina, A Segura, J Lafuente, M Pavlovic, D Hernández, E Melián, F Espada, J Univ Cordoba Hosp Reina Sofia Serv Cardiol Cordoba 14004 Spain Univ Las Palmas Las Palmas Gran Canaria Spain

Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. Few clinical studies have shown that the stent repair of severe coarctation of aorta provides excellent initial results, and little is known on the follow-up of these patients. We assessed the immediate and follow-up results obtained in a series of 48 patients (mean age 14 +/- 12 years) with severe coarctation of the aorta who were treated by Palmaz stent implantation;30 of them (63%) underwent angiographic follow-vp studies at a mean of 25 +/- 11 months after treatment. Quantitative serial analysis of the aortogram (baseline, after treatment, and at follow-up) was performed. Significant relief (mean residual gradient 3 +/- 4 mm Hg) was always obtained after scent implantation. The isthmus, when hypoplastic (60%), was always expanded with the stent. One associated aneurysm became occluded after the implant. Complications included aortic disruption, stent migration, and decreased or absent femoral pulses. At angiographic follow-up, the stent remained always in place, without recoil. in 22 patients (73%), there were no detectable neointimal proliferation at late angiogram;however, 8 patients (27%) had some degree of intimal thickening (1 to 5 mm), causing mild restenosis in 3 patients treated at early age, and nonsignificant lumen reduction in 5. The serial aortogram analysis revealed a minor but, significant increase in nonstented aortic diameters that seemed related to the normal growth of children. No need for stent reexpansion was observed at 2-year follow-up (mean). Two patients (7%) developed late small aneurysm formation at the stented wall;both were occluded by the insertion of coils through the stent orifices. We conclude that stent treatment for severe coarctation of aorta provides excellent immediate and long-term results in young adults and children. However, at early age, restenosis by intimal growth

关键词：主动脉缩窄/放射摄影术主动脉缩窄/外科学主动脉造影术血管假体植入/仪器和设备随访研究心脏导管插入术观察者偏差手术后并发症回顾性研究疾病严重程度指数支架治疗结果青少年成年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Optimal balloon angioplasty versus elective stent implantation

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期34卷 1907-1909页

作者： Colombo, A Briguori, C Ctr Cuore Columbus I-20145 Milan Italy

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Prognostic value of absolute versus relative measures of the procedural result after successful coronary stenting: Importance of vessel size in predicting long-term freedom from target vessel revascularization

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AMERICAN HEART JOURNAL 2001年第5期141卷 823-831页

作者： Ziada, KM Kapadia, SR Belli, G Houghtaling, PL De Franco, AC Ellis, SG Whitlow, PL Franco, I Nissen, SE Tuzcu, EM Cleveland Clin Fdn Dept Cardiol F25 Cleveland OH 44195 USA

Background The procedural result is a major determinant of the incidence of 6-month target vessel revascularization (NR) after successful coronary stenting. However, the prognostic implications of the different measures of the procedural result or procedural end points have not been directly compared. In this study, we sought to assess and compare the impact of achieving different procedural end points on the long-term (2-year) incidence of TVR. Methods and Results We studied 234 patients in whom 1 or 2 stents were successfully deployed and ultrasound imaging performed after angiographic optimization. End points included a visually estimated angiographic residual stenosis <10% and ultrasound stent-to-mean reference lumen area >80%. After 2 years, TVR was required in 48 (20.5%) patients. Qualitative predictors of TVR were vein graft lesions, 3-vessel disease, and baseline TIMI flow grade <3. Quantitatively, reference diameter by quantitative coronary angiography (QCA), final minimum lumen diameter (MLD) by QCA, and in-stent minimum lumen area (MLA) by ultrasound were predictive of TVR. Stent-to-reference ratios were not significantly predictive of TVR. By multivariable analysis, vein graft location and MLA by ultrasound were the only significant predictors of TVR (relative risk, 2.9 [1.5, 5.4] and 0.72 [0.6, 0.9], respectively). Receiver operator curves for MLD by QCA and MLA by ultrasound were similar in predicting TVR. Neither was significantly superior to reference vessel diameter. Conclusions Commonly used angiographic and ultrasound stent-to-reference ratios do not predict the incidence of TVR. Absolute measures of the lumen size (MLA by ultrasound and MLD by QCA) were the most important quantitative predictors of TVR within 2 years. This emphasizes the role of the vessel size as the limiting factor in determining the long-term outcome of coronary stenting.

关键词：血管假体植入/仪器和设备冠状血管造影术冠心病/放射摄影术冠心病/外科学冠心病/超声检查冠状血管/超声检查无病生存预后回顾性研究支架超声检查介入性女(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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The use of stent-grafts in thoracic aortic disease

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CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 2000年第4期23卷 249-251页

作者： Reidy, JF Taylor, P Guys Hosp Guys & St Thomas Hosp Trust Dept Radiol London SE1 9RT England

Heparins are glycosaminoglycans that, in addition to their anticoagulant activity, have interactions with growth factors and other glycoproteins. These interactions may stimulate neointimal hyperplasia when heparin is delivered locally on stents and stent-grafts. Modifying the structure of heparin to retain anticoagulant activity while minimizing these stimulatory effects on the vascular endothelium is desirable and may be achieved by understanding the relationships between the structure and function of the various parts of the heparin molecule.

关键词：血管造影术主动脉胸/诊断显像主动脉胸/外科学主动脉疾病/诊断主动脉疾病/死亡率主动脉疾病/外科学血管假体植入/仪器和设备血管假体植入/死亡率包被物质生物相容性超声心动描记术经食管多酯类假体设计不锈钢支架存活率体层摄影术 X线计算机人类

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Use of stents for angioplasty-induced venous rupture

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 1999年第8期10卷 1135-1136页

作者： Zaleski, GX Funaki, B Racine Radiologist Grp Racine WI USA Univ Chicago Hosp Dept Radiol Chicago IL 60637 USA

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Stent graft construction with use of autologous vein

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 1999年第8期10卷 1131-1133页

作者： Millward, SF Hajjar, G Veinot, JP Marriner, R Ottawa Civic Hosp Ottawa ON K1Y 4E9 Canada

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Emergency cannulation for proximal perfusion in descending thoracic aorta procedures

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ANNALS OF THORACIC SURGERY 1999年第2期68卷 587-589页

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

Acute cardiac failure during descending thoracic aorta operations, although rare, may have catastrophic consequences. Under these circumstances, the use of partial veno arterial bypass is advantageous, allowing an assisted perfusion of both proximal and distal circulation districts. Traditionally, the ascending aorta or the aortic arch are the preferred sites of cannulation for proximal arterial reinfusion, but some limitations, such as extensive calcifications or extreme fragility of these segments, may hamper or at least delay this action. Herein, we describe a simple technique for rapid cannulation of proximal aorta in emergency circumstances. (C) 1999 by The Society of Thoracic Surgeons.

关键词：吻合术外科/仪器和设备主动脉/外科学主动脉瘤胸/外科学血管假体植入/仪器和设备心肺转流术/仪器和设备导管留置急症设备设计心脏导管插入术/仪器和设备手术中并发症/外科学人类

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Use of an introducer jacket to assist loading of a polytetrafluoroethylene covered Wallstent graft

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JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 1999年第7期10卷 993-994页

作者： Owens, C Yaghmai, B Landau, D Warner, D Univ Illinois Med Ctr Dept Cardiovasc & Intervent Radiol Chicago IL 60612 USA Univ Illinois Med Ctr Dept Vasc Surg Chicago IL 60612 USA

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