The neutrophil-to-lymphocyte ratio in peripheral blood in patients with hepatocellular carcinoma before argon-helium cryoablation: its influence on the prognosis / 介入放射学杂志

Objective To investigate the influence of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood in patients with hepatocellular carcinoma (HCC) before argon-helium cryoablation on the patient's prognosis.Methods The related clinical and pathological data of 72 HCC patients,who had received percutaneous argon-helium cryoablation,were retrospectively analyzed.Based on the preoperative NLR value,the patients were divided into low NLR group (NLR＜3.5) and high NLR group (NLR ＞ 3.5).The postoperative overall survival time of the patients in the two groups were statistically analyzed,and the risk factors that might affect the prognosis were evaluated by using univariate and multivariate analysis.Results Argon-helium cryoablation was carried out in all patients.The median overall survival time was 22.4 months;the median overall survival time of the high NLR group and the low NLR group was 13.2 months and 24.2 months respectively,the difference in the overall survival time between the two groups was statistically significant (P=0.003).Univariate analysis showed that the primary tumor size,liver function Child-Pugh classification,albumin,total bilirubin,cholinesterase and NLR value were the related factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Multivariate analysis revealed that the primary tumor size and NLR value were the independent prognostic factors that affected the postoperative overall survival time of HCC after argon-helium cryoablation (P＜0.05).Conclusion Preoperative NLR value in peripheral blood can be used as a prognostic indicator for patients with HCC undergoing argonhelium cryoablation;the larger the primary hepatic lesion is and/or the higher the NLR value is,the worse the prognosis of the patient will be.

Thrombosis and morphology of plaque rupture using optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis.</p><p><b>METHODS</b>We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded.</p><p><b>RESULTS</b>The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076).</p><p><b>CONCLUSIONS</b>Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.</p>

Evaluation of neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The vessel healing in patients with coronary artery aneurysms (CAA) that form after drug-eluting stent (DES) implantation is not clear. This study aims to assess the vessel healing in patients with CAA formation after DES implanation.</p><p><b>METHODS</b>From June 2008 to August 2011, follow-up coronary angiography was conducted on 1160 patients who underwent percutaneous coronary intervention (PCI). The average period of follow-up was about (18.95 ± 13.05) months. A total of 175 patients who underwent DES implantation into de novo lesions and who underwent coronary angiography and optical coherence tomography (OCT) examination during follow-up were identified. Patients were divided into the CAA group (n = 31) and non-CAA group (n = 144) based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted; in addition, the neointimal thickness and the frequency of strut malapposition and strut uncoverage were also noted.</p><p><b>RESULTS</b>A greater proportion of incomplete neointimal coverage (17.17% vs. 1.90%, P < 0.001) and strut malapposition (18.20% vs. 1.38%, P < 0.001) were observed in the CAA group. The neointimal thickness in the CAA group was significantly thinner than that in the non-CAA group ((146.6 ± 94.8) µm vs. (192.5 ± 97.1) µm, P < 0.001), as detected via OCT. Patients with CAA formation had a higher frequency of cardiac events including angina pectoris (25.81% vs. 6.25%, P = 0.001) and acute myocardial infarction (9.68% vs. 0.13%, P = 0.002) and thrombosis (16.13% vs. 0.69%, P < 0.001). The longitudinal length of the CAA in the cardiac event group was significantly longer than in the no cardiac event group ((20.0 ± 9.07) mm vs. (12.05 ± 5.38) mm, P = 0.005).</p><p><b>CONCLUSION</b>CAA formation after DES implantation is frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage.</p>

Optical coherence tomography assessment of edge dissections after drug-eluting stent implantation in coronary artery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation.</p><p><b>METHODS</b>Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study.</p><p><b>RESULTS</b>Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072).</p><p><b>CONCLUSIONS</b>The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.</p>

Ex vivo assessment of coronary lesions by optical coherence tomography and intravascular ultrasound in comparison with histology results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results.</p><p><b>METHODS</b>OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results.</p><p><b>RESULTS</b>Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01).</p><p><b>CONCLUSIONS</b>Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.</p>

Evaluation on the neointimal coverage post drug-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the neointimal coverage after the implantation of various drug eluting stents (DES) by optical coherence tomography (OCT).</p><p><b>METHODS</b>The study comprised of 62 patients implanted DES for (15.3 ± 5.7) months. Patients were divided into three groups according to the type of implanted stent: Cypher group (patient = 26, stent = 57), Endeavor group (patient = 17, stent = 23) and Firebird group (patient = 19, stent = 32). OCT images of the stent were analyzed by software equipped by Light Lab system. Intimal thickness of 64 µm, 168 µm and 366 µm represents 10%, 25% and 50% lumen area loss, respectively. Neointimal coverage was thin with intimal thickness ≤ 64 µm, satisfactory with intimal thickness between 65 µm and 366 µm and hyperplasia and restenosis with intimal thickness > 366 µm.</p><p><b>RESULTS</b>The percent of complete neointimal coverage was similar among groups (P > 0.05). The thickness of neointimal coverage in Cypher and Endeavor and Firebird group was (178.7 ± 11.9) µm, (228.7 ± 17.1) µm and (170.3 ± 13.3) µm, respectively (all P < 0.05). The symmetry of Cypher stent was better than Firebird stent, and the symmetry of Firebird stent was better than Endeavor stent.</p><p><b>CONCLUSION</b>There was significant difference on neointimal coverage after various types of DES implantation, and OCT can be used to evaluate the symmetry of neointimal coverage post implantation of various DES.</p>

Coronary plaque response after drug eluting stent implantation assessed by serial optical coherence tomography analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In general, percutaneous coronary intervention (PCI) relieves vessel stenosis by implantation of a stent, however, the relationship between plaque characteristics and response after stenting is not clear.</p><p><b>METHODS</b>We enrolled 68 patients (68 vessels) with diagnosed unstable angina pectoris that prospectively underwent PCI and an optical coherence tomography (OCT) examination was done before and after stenting. Coronary plaques were classified as fibrous, lipid-rich and calcified plaque according to OCT examination, and fibrous cap thickness, lumen eccentricity, stent expansion, stent malapposition, tissue prolapse, thrombosis, dissection and stent symmetry were noted.</p><p><b>RESULTS</b>The frequency of prolapse was higher in lipid-rich plaques than fibrous plaques (85% vs. 40%, P < 0.001). Dissection most often occurred in fibrous plaque compared with lipid-rich and calcified plaques (60% vs. 32% vs. 29%, P < 0.001). The frequency of stent strut malapposition in calcified plaques was higher than firous and lipid-rich plaques (71% vs. 40% vs. 5%, P < 0.001). In-stent micro-thrombosis was detected only in lipid-rich plaques, with a frequency of 37% (15/41). The risk factors of micro-thrombosis after PCI were cap thickness (OR 0.903, 95%CI 0.829 - 0.985), lumen eccentricity (OR 1.147, 95%CI 1.012 - 1.30), and stent length (OR 1.495, 95%CI 1.032 - 2.166).</p><p><b>CONCLUSION</b>Plaque response after PCI is associated with its characteristics, and of those, micro-thrombosis after stenting in lipid-rich plaques was the most significant finding and can be predicted.</p>

Impact of different proton pump inhibitors on the antiplatelet activity of clopidogrel in combination with aspirin for patients undergoing coronary stent implantation / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To evaluate the impact of different proton pump inhibitors on the antiplatelet activity of clopidogrel.</p><p><b>METHODS</b>A total of 60 hospitalized patients undergoing percutaneous coronary intervention were randomly assigned to receive omeprazole group 40 mg/d (20 patients), pantoprazole group 40 mg/d (20 patients) and control group (20 patients). All patients also received standard clopidogrel therapy, continuing 30 days treatments. The percentage clotting inhibition was measured by the use of thrombelastogram and the maximal platelet aggregation rate (MPAR) was measured by turbidity method at the first day before admission and 15 or 30 days after treatment. Major adverse cardiac and cerebral events (MACCE) and hemorrhagic events within 30 days were recorded.</p><p><b>RESULTS</b>The baseline clinical characteristics, angiography and PCI result were compared among the three groups. At the first day before admission and 15 or 30 days after treatment, no significant difference was shown in the percentage clotting inhibition measured by thrombelastogram and the maximal platelet aggregation rate (MPAR) measured by turbidity method among the three groups. Though the platelet agglutination inhibition rate measured at 15 and 30 days increased and MPAR measured at 15 and 30 days declined compared with the baseline data (P < 0.05), no significant difference was found between levels measured at 15 and 30 days (P > 0.05). The rates of MACCE had no significant difference among the three groups. Compared with control group, the rates of hemorrhagic event were significantly decreased in omeprazole or pantoprazole group (P < 0.05), but no significant difference was shown between the omeprazole and pantoprazole group.</p><p><b>CONCLUSION</b>No significant impact of different proton pump inhibitors on the antiplatelet activity of clopidogrel has been found in patients undergoing coronary stent implantation and short-time combined administration is safe.</p>

Optical coherence tomography for evaluation of neointimal proliferation after placement of a new drug eluting stent / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate neointimal proliferation following placement of a new drug-eluting stent (BUMA) by optical coherence tomography (OCT).</p><p><b>METHODS</b>Twenty-two patients with coronary artery disease were randomized into BUMA group (n=15) and Endeavor group (n=7) and underwent OCT imaging after 9 months of stent implantation.</p><p><b>RESULTS</b>The neointima hyperplasia (NIH) thickness in BUMA group were significantly smaller than that in endeavor group (0.220-/+0.140 mm vs 0.269-/+0.207 mm, P<0.001), and the uncovered Struts were significantly lower in BUMA group than in Endeavor group (5.65% vs 6.56%, P<0.0001). The luminal late loss in BUMA group was also significantly lower (34.87-/+11.50 vs 40.82-/+18.53, P=0.025).</p><p><b>CONCLUSION</b>BUMA stent is safe and effective for treatment of coronary artery disease.</p>

Evaluation of the late stent malposition after drug-eluting stent implantation by optical coherence tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the characteristic of late stent malposition after drug-eluting stent implantation by optical coherence tomography (OCT).</p><p><b>METHODS</b>The study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year ago [average (14.8 +/- 5.2) months]. OCT images of the stent were analyzed at interval of 0.5 mm. The stent malposition was detected, the thickness of intima and gap between the stent strut and vessel wall were measured.</p><p><b>RESULTS</b>Stent malposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n = 4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others [(0.06 +/- 0.05) mm vs. (0.05 +/- 0.03) mm, P > 0.05].</p><p><b>CONCLUSION</b>The causes of late stent malposition include the primary malposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the ostium of side branch. Thinner intima coverage was also observed on the stent struts with malposition.</p>

Association between stent fracture and restenosis after drug-eluting stent implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study was performed to evaluate the relationship between the stent fracture and restenosis after drug-eluting stent implantation.</p><p><b>METHODS</b>The study enrolled 536 patients with angiographies during stenting procedure and follow-up, the patients were divided into DES group (n=397) and BMS group (n=139). The coronary angiography images were analyzed to detect restenosis and stent fracture.</p><p><b>RESULTS</b>Restenosis rate was significantly lower in DES group (31/397, 7.8%) compared that in BMS group (30/139, 21.6%, P<0.05). Stent fracture (n=5) was found only in DES group and not in BMS group (P<0.05). Restenosis were found in all stent fracture segments. The stent fracture developed at the angulated tortuosity lesions.</p><p><b>CONCLUSION</b>Stent fracture is one of the causes of restenosis after drug-eluting stents implantation and related to implantation of long DES stent at the location of angulated tortuosity lesions.</p>