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Objective@#To investigate the efficacy and outcome of transcatheter patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS).@*Methods@#Sixty consecutive patients with cryptogenic stroke who undertook transcatheter PFO closure between May 2015 and September 2017 in Beijing Tiantan Hospital were enrolled in this prospective study.Transcranial Doppler (TCD) bubble test was performed and right-left shunt(RLS) was confirmed in all patients.Closure success rate,effective closure rate, complications, recurrence of ischemic stroke and new onset atrial fibrillation were evaluated.@*Results@#A total of 60 patients (42 male,age range 24-68 (47±11)years) were included in the study.PFO size (motionless state) was (1.6±0.6)mm.RLS before closure was graded and 11 patients had moderate RLS and 48 patients had large RLS (include 41 patients who experienced shower or curtain effect).Closure success rate was 100% (60/60).No severe complications were observed.At 6 months,45 patients completed TCD bubble test.Of these, 4 patients suffered from moderate to large residual and thus effective closure rate was 91%(41/45).The mean follow-up period was 2-29 (median 12) months. During the follow-up, only 1 patient experienced recurrent cerebral infarction.New onset atrial fibrillation was not detected.@*Conclusion@#Transcatheter PFO closure is effective,safe and related with a good outcome in reduction of recurrent CS for patients with PFO.
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Objective To explore the safety and feasibility of coronary angiography (CAG) via percutaneous left radial artery approach (LRA) compared with right radial artery approach (RRA) in aged patients, and determine whether LRA is a valid alternative for CAG. Methods A total of 502 consecutive patients who were aged 65 or older underwent diagnostic CAG were recruited and randomized to the LRA group (240 patients) or RRA group (262 patients). The study end points included total procedural duration, coronary time, fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications. Results Coronary procedural success rate was 96.2%(231/240) in LRA group and 96.2%(252/262) in RRA group. There was no significant difference (P>0.05). The radial cannulation time, fluoroscopy time, look through time, dose of radiation, contrast volume and the percentage of hydrophilic wire used in two group had no significant difference (P > 0.05). The catheter in place time in LRA was significantly shorter than that in RRA group:(2.7 ± 2.5) min vs. (3.3 ± 3.3) min, P=0.036). There was a trend toward shorter procedural duration in LRA group than that in RRA group, but there was no significant difference: (13.3 ± 6.1) min vs. (14.3 ± 6.2) min, P=0.075. Conclusions LRA approach has similar safety and feasibility in terms of performing coronary angiography compared with RRA.It seems to be a feasible alternative for CAG in aged patients.
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<p><b>OBJECTIVE</b>To assess the value of detecting the compositional features of carotid atherosclerotic plaques by 3.0T high resolution magnetic resonance imaging (MRI) in patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Consecutive 104 patients with coronary atherosclerosis confirmed by coronary angiography were prospectively recruited from January 2013 to January 2015 in Tiantan hospital. All patients were imaged with 3.0T high resolution MRI system. After exclusion patients with poor image quality, 97 patients were divided into 3 groups according to the degree of coronary artery stenosis: coronary atherosclerosis group (coronary stenosis between 1%-49%, n=16); single-vessel lesion group (single vessel lesion with stenosis between 50%-100%, n=48); multi-vessel lesion group (two or three vessel lesions with stenosis between 50%-100% or left main stem disease, n=33). The prevalence of total carotid plaque, calcified plaque, lipid-rich necrotic core, intra-plaque hemorrhage, plaque ulcer and rupture were compared among 3 groups.</p><p><b>RESULTS</b>The prevalence of total carotid plaque (81.3%(13/16), 72.9%(35/48), and 93.9%(31/33)) and calcified plaque (50.0%(8/16), 35.4%(17/48), and 42.4%(14/33)) were similar among the 3 groups (both P>0.05). The prevalence of carotid lipid-rich necrotic core in coronary atherosclerosis group was significantly lower than in single-vessel lesion group (18.8%(3/16) vs. 64.6%(31/48), P<0.01) and multi-vessel lesion group(18.8%(3/16) vs. 69.7%(23/33), P<0.01), but there was no significant difference between single-vessel lesion group and multi-vessel lesion group(P>0.05). Intra-plaque hemorrhage was detected in 2 patients of multi-vessel lesion group. There was no plaque ulcer or rupture in this cohort.</p><p><b>CONCLUSION</b>Carotid plaque features are associated with the severity of coronary atherosclerosis in CAD patients.</p>
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Humans , Coronary Artery Disease , Hemorrhage , Magnetic Resonance Imaging , Necrosis , Plaque, Atherosclerotic , Prevalence , Prospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.</p><p><b>METHODS</b>Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.</p><p><b>RESULTS</b>The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P < 0.001). Recurrent myocardial infarction, and selective coronary stenting of patients with thrombolytic therapy were higher than that of patients in the primary stenting group (7.6% vs 1.5%, P < 0.05; 20.6% vs 0, P < 0.001, respectively). Left ventricular ejection fraction (LVEF) in patients in the thrombolysis group was lower than that of the stent group (55.6% +/- 13.4% vs 65.8% +/- 9.2%, P < 0.001). Total hospitalization time of the thrombolysis group was longer than that of the stent group (16 +/- 7 d vs 11 +/- 4 d, P < 0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%, P > 0.05).</p><p><b>CONCLUSION</b>Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Myocardial Infarction , Therapeutics , Recombinant Proteins , Therapeutic Uses , Stents , Thrombolytic Therapy , Tissue Plasminogen Activator , Therapeutic UsesABSTRACT
Objective To evaluate the clinical effectiveness of direct coronary stenting without predilatation in acute myocardial infarction (AMI) Methods Intracoronary stent was directly deployed without ballon predilation in 22 patients within 12 hours from onset Single vessel disease was in 12 patients (54 5%),double vessel disease in 4 patients(18 2%) and triple vessel disease in 6 patients(27 3%) Infarct related arteries (IRA) were left anterior descending artery in 12 patients (54 5%), left circumflex in 5 patients (22 7%), right coronary artery in 5 patients (22 7%) Thrombolysis in myocardial infarction TIMI 1 flow in 5 patients (22 7%), TIMI 2 flow in 13 patients (59 1%) TIMI 3 flow in 4 patients (18 2%) Results Twenty two stents were implanted (1 stent/patient) Post stenting residual stenosis decreased to 3 2?2 9%, stent deployment was successful in 100% of the cases, There were no complications, no death, no Q wave or non Q wave myocardial infarction and no repeated recanalizations during the hospitalization Conclusion Direct coronary stenting without predilatation can be performed in AMI with its high successful rate and low complication
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Objective The purpose of this study was to determine the feasibility and efficiency of direct stent implantation with intravascular ultrasound (IVUS) guidance Methods 12 native vessel target lesions in 12 patients were studied by coronary angiography and direct stent implantation Ultrasound imagines obtained at the treatment site before and after stenting were analyzed quantitatively for in lesion vessel wall diameter, in lesion minimal lumen diameter and in lesion vessel length Direct stent deployment was performed with IVUS guidance The ends of follow up were acute or subacute thrombosis and major cardiac events (MCE: cardiogenic death, angina pectoris, myocardial infarction and revascularization correspondence with target vessel) Results Direct stenting was successfully performed in 12 patients with IVUS guidance Coronary angiography showed that there was no residual stenosis and TIMI 3 flow was obtained in all patients Further balloon dilation of the stent was performed by observation of the IVUS imagines in two patients The final IVUS imagines showed that ratio of minimal lumen diameter/maximum lumen diameter ≥0 7 and in lesion minimal lumen diameter increased from 1 2?0 87 mm to 3 4?2 8 mm No thrombosis and MCE were found in all patients in 1 4 months follow up Conclusion Direct stenting with IVUS guidance in selected patients had higher success rates, less complications and better clinical results
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Objective To evaluate the clinical efficacy of primary intracoronary stenting in the infarct related artery in elderly patients after acute myocardial infarction(AMI). Methods Percutaneous transluminal coronary angioplasty(PTCA) plus primary coronary stenting was performed for 41 AMI patients(≥70 years) within 12 hours from the onset of chest pain. Infarct related arteries were left anterior descending artery in 21 patients(51 2%), left circumflex in 7(17 1%), right coronary artery in 13(31 7%). Thrombolysis in myocardial infarction (TIMI) showed that blood flow was grade 0 in 29 patients, grade 1 in 7, grade 2 in 5. Results Forty eight stents were implanted in the infarct related artery for 41 patients. One patient died of cardiac shock during the procedure, and the success rate was 97 6%(40/41). Grade 3 of blood flow after TIMI was gained in 37 patients(90 2%). One patient died of renal failure while hospitalizing. The clinical successful rate was 95 1%(39/41). Thirty six patients were followed up, 1 patient with restenosis of infarct related artery was performed cutting balloon angioplasty, and 1 patient with congestive heart failure was rehospitalized. Other 34 patients did not manifested angina pectoris. Conclusions Primary coronary stenting for the infarct related artery in elderly patients after AMI is safe and effective with a high successful rate and less complications.
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0 05) One patient of group A had in stent thrombosis after procedure Fifty one patients of group A and 41 of group B were followed up (from 1 to 39 months) after procedure, and 48 of group A and 37 of group B without cardiac events, such as death, AMI 3 patients of group A and 4 of group B were repeated coronary angiography because of chest pain There were 1 patient with restenosis and 2 with severe stenosis in non infarct related artery in group A, and 1 with restenosis and 3 with severe stenosis in non infarcted related artery in group B Conclusion Compared with short stenting in short lesions, long coronary stenting in long or diffuse infarct related artery disease after AMI is the same as a high procedure success rate, low complication and good clinical outcomes