ABSTRACT
Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.
ABSTRACT
Objective To evaluate the clinical features of in-stent restenosis after drug eluting stent (DES) implantation and investigate the relationship between different patterns of DES restenostic lesions and long-term prognosis.Methods All scoronary heart disease patients who underwent repeated pereutaneous coronary intervention (PCI) for DES in-stent restenosis from September 2006 to December 2009 were enrolled.All patients were divided into focal group and non-focal group according to the pattern of restenosis.All patients were prospectively followed up for major adverse cardiovascular event (MACE) including death,repeat PCI and myocardial infarction.Results Totally 88 patients (40 with focal restenosis,48 with non-focal restenosis) were enrolled.There were no significant differences between two groups in age,gender,risk factors,clinical presentation and medical therapy (P ＞ 0.05).Compared with that in focal group,the patients in non-focal group had a higher portion of in-segment restenosis [58.3％ (28/48) vs.12.5％(5/40),P＜ 0.01],higher stenosis rate [(78.1 ± 10.0)％ vs.(70.0 ± 9.7)％,P ＜ 0.01],more need for another DES[81.2％(39/48) vs.17.5％(7/40),P＜ 0.01],and longer stent implanted [(25.0 ± 7.0) mm vs.(17.4 ±3.4) mm,P ＜0.01].After following up for (2.2 ± 1.0) years,there were no significant differences between two groups in MACE and each component (P ＞ 0.05),however,compared with that in focal group,there was a trend of increase in MACE in non-focal group[22.9％(11/48) vs.10.0％(4/40),P=0.092].Conclusion It suggests that patients with non-focal restenosis have a more severe lesion angiographically,which usually results in another DES implanted,and has a worse long-term prognosis.
ABSTRACT
Objective To investigate the incidence and risk factors of renal artery stenosis (RAS) in patients with coronary artery disease (CAD). Methods Retrospective analysis was made based on the clinical and angiographic data of patients with CAD and RAS proved by angiography during May 2003 and August 2004. Results Forty-eight (13.7%) out of 350 CAD patients were identified with significant RAS. Multi-variance logistic analysis showed that age over 70 years old, serum creatinine greater than 120 ?mol/L, history of hypertension and multi-vessel coronary disease were the independent predictive factors. Conclusion The incidence of RAS in CAD patients was 13.7%. Routine renal angiography was recommended for CAD patients.
ABSTRACT
Objective To explore the characters of the aged patients with coronary disease undergoing percutaneous transluminal coronary angioplasty in clinical presentation, procedural success, and in-hospital outcomes. Methods Data were collected as a part of a prospective registry of all percutaneous coronary interventions performed by authors between January 2001 and October 2002. Comparisons between 2 age groups (≥70 years and
ABSTRACT
Objective To evaluate the feasibility and the safety of the direct coronary stent implantation Methods Retrospectively reviewed the clinical and angiographic data of 139 patients received direct coronary stent implantation, follow up was performed in 95 of these patients Results The direct coronary stenting procedure was successful in 133 (95 7%) of 139 cases In residual 6 (4 3%) failure cases, the stent could not cross the lesion and was successful retrieved in 2 cases, balloon predilation was added In 4 cases the stent did not completely cover the lesion or dissection appeared after direct stenting, the second stent was deployed Angiographic success was achieved in all the 139 cases without major adverse coronary events during in hospital In 7 (7 4%) of 95 cases the target lesion needed repeat PTCA because of significant restenosis during 1～23 months (median 4 7 months) of clinical follow up Conclusion Direct coronary stent implantation is feasible and safe in selective patients It can save the cost of one balloon catheter