Structural design and biomechanical numerical analysis of body-fitted stent in stenotic vessels / 生物医学工程学杂志

To solve the problem of stent malapposition of intravascular stents, explore the design method of intravascular body-fitted stent structure and to establish an objective apposition evaluation method, the support and apposition performance of body-fitted stent in the stenotic vessels with different degrees of calcified plaque were simulated and analyzed. The traditional tube-mesh-like stent model was constructed by using computational aided design tool SolidWorks, and based on this model, the body-fitted stent model was designed by means of projection algorithm. Abaqus was used to simulate the crimping-expansion-recoil process of the two stents in the stenotic vessel with incompletely calcified plaque and completely calcified plaque respectively. A comprehensive method for apposition evaluation was proposed considering three aspects such as separation distance, fraction of non-contact area and residual volume. Compared with the traditional stent, the separation distances of the body-fitted stent in the incompletely calcified plaque model and the completely calcified plaque model were decreased by 21.5% and 22.0% respectively, the fractions of non-contact areas were decreased by 11.3% and 11.1% respectively, and the residual volumes were decreased by 93.1% and 92.5% respectively. The body-fitted stent improved the apposition performance and was effective in both incompletely and completely calcified plaque models. The established apposition performance evaluation method of stent considered more geometric factors, and the results were more comprehensive and objective.

Regression of asymptomatic intracranial arterial stenosis by aggressive medical management with a lipid-lowering agent

OBJECTIVE: The incidence rate of stroke as a result of intracranial arterial stenosis (ICAS) is higher in Asian countries than in the West. We aimed to analyze the regression, lack of change, or progression of asymptomatic ICAS after the administration of rosuvastatin and associated factors.METHODS: The patients who had undergone computed tomography angiography (CTA) at our hospital and had been diagnosed with ICAS with no ischemic event in the stenosed vascular territory were included in the study. They were administered 20mg of rosuvastatin per day. After a follow-up period of at least 6 months after treatment, the patients were examined using CTA again and the clinical information and imaging results were analyzed.RESULTS: In total, 48 patients were diagnosed with asymptomatic ICAS. During the final follow-up examination, it was found that the stenotic lesion regressed in 30 patients, whereas it remained unchanged or progressed without any adverse effects in 18 patients. In univariate analysis, the regressed group showed significantly higher differences in the levels of total cholesterol and low-density lipoprotein (LDL) between their initial and final values (both, p=0.031 for both). In the multivariate analysis, a significantly higher difference in the levels of LDL between its initial and final measurement was seen in the regressed group (p=0.035, odds ratio(OR) 3.9).CONCLUSIONS: Rosuvastatin was found to have better lipid-lowering effects for total cholesterol and particularly LDL in patients whose ICAS had regressed. We concluded that rosuvastatin administration can be recommended for the treatment of patients with asymptomatic ICAS.

High-resolution MRI imaging in patients with middle cerebral artery stenosis / 医疗卫生装备

Object To compare images of the vessel wall between symptomatic and asymptomatic atherosclerotic plaques of the middle cerebral artery (MCA) using high resolution magnetic resonance imaging (HR MRI).Methods HR MRI data were acquired in 36 patients with MCA atherosclerotic stenosis (≥50％) confirmed by MRA, CTA, of whom, 25 symptomatic patients and 11 asymptomatic ones were enrolled into a symptomatic group and an asymptomatic group respectively. The wall thickness and cross-sectional area of stenotic segments were measured and compared between the two groups. The data were analyzed by SPSS 17.0 statistical software.Results The cross-sectional area in the symptomatic group was (3.04±1.03)mm2,while the asymptomatic group was (3.28±0.96)mm2, and the difference between the two groups was not statistically significant (P>0.05). The symptomatic group had a larger wall thickness ((2.32±0.61)mm) when compared with the asymptomatic group ((2.10±0.77)mm), and higher prevalence of plaque enhancement after contrast injection (83.3％).Conclusion Different vessel wall properties on HR MRI are observed between symptomatic and asymptomatic MCA stenosis. Symptomatic MCA stenosis has a larger wall thickness and higher prevalence of plaque enhancement after contrast injection when compared with the asymptomatic.

Analysis of Clinical Risk Factors of Cerebral Artery Stenosis in Young Persons with Cerebral Infarction / 现代医院

To explore the clinical risk factors of cerebral artery stenosis in young persons with cerebral infarction. Methods From January 2013 to December 2016, 90 youth persons with cerebral infarction in our hospital were divided into stenosis group and non-stenosis group. The possible risk factors of vascular stenosis were statistically analyzed. Results There were 59 cerebral artery stenosis patients in all 90 cases. The incidence was 65. 6％. Univariate analysis showed that there was significant difference in gender, smoking, drinking, hypertension, diabetes, uric acid and blood lipid in patients of stenosis group and non arterial stenosis group(P＜0. 05). Multivariate Logistic regression analysis showed that smoking, drinking, hypertension, diabetes, hyperuricemia and dyslipidemia were the main risk factors (P＜0. 05). Conclusion Cerebral artery stenosis is an important factor of cerebral infarction in youth persons. Smoking, drinking, hypertension, diabetes, hyperuricemia, dyslipidemia are the risk factors. We should have reasonable diet, give up smoking and alcohol, exercise moderately, adopt a healthy lifestyle, control blood pressure, blood sugar, blood lipid levels, thereby reducing the risk of cerebral infarction in youth persons.

Application value of TRANCE technology in lower limb arterial occlusive disease / 医疗卫生装备

Objective To explore the application value of triggered angiography non-contrast enhanced (TRANCE) technology in diagnosing lower limb arterial occlusive disease.Methods Totally 22 lower limb arterial occlusive disease patients were randomly selected,and then underwent TRANCE and DSA examinations.The arteries from the abdomen to the lower limb were divided into abdominal aorta,common iliac artery,external iliac artery,internal iliac artery,superficial femoral artery,deep femoral artery,popliteal artery,anterior tibial artery,posterior tibial artery and peroneal artery.Totally 337 sections displayed clearly were chosen to go through examinations by TRANCE and DSA.Results Of the 337 sections there were 312 ones with the same stenoses found by TRANCE and DSA,TRANCE found 16 sections with worse stenoses and 9 milder ones than by DSA.There were 153 sections with the same moderate stenoses (≥50％) displayed by TRANCE and DSA;Of the 153 sections,there were 15 ones with worse stenoses and 6 ones with milder stenoses found by TRANCE than by DSA.Kappa value of the two methods was 0.905.Conclusion TRANCE technology is a non-invasive,safe and nonradiative diagnosing method for the lower limb arterial occlusive disease.

Study the Diagnosis Value of Transcranial Doppler Ultrasound for Intracranial Artery Stenosis in Patients with Cerebral Infarction / 现代生物医学进展

Objective:To study the diagnosis value of Transcranial Doppler ultrasound for intracranial artery stenosis in patients with cerebral infarction.Methods:A total of 140 patients with acute cerebral infarction,transient ischemic attack and posterior circulation ischemic attack in Department of Neurology,Xinjiang cardiovascular and cerebrovascular disease hospital from October 2014 to October 2016 were selected as research object,CT angiography (CTA) and TCD detection were performed in all patients.Used CTA examination results as the gold standard,the detection results of intracranial artery stenosis in two groups were compared,the diagnostic value of TCD and the diagnostic results of TCD to the degree of bilateral middle cerebral artery (MCA) stenosis were analyzed.Results:CTA diagnosis showed that 140 patients had a total of 105 patients with intracranial artery stenosis,in the anterior and posterior circulation vessel of 1155 intracranial segments,CTA detection showed that 249 vessels were narrow,TCD detection showed that 236 vessels were narrow.Com-pared with CTA,TCD was better in the diagnosis of patients (Kappa value＞0.75).The diagnostic sensitivity and positive predictive value of TCD for MCA were the highest,which were 91.26％ and 93.07％,the consistency was the best (Kappa value =0.917).CTA detection showed that 210 MCA vessels had 103 stenoses,mild stenosis 17,moderate stenosis 41,severe stenosis 45,TCD detection showed that the stenosis was 101,mild stenosis 16,moderate stenosis 40,severe stenosis 45.The Kappa test showed that the diagnostic results of TCD to the degree ofMCA stenosis was better consistency compared with CTA (Kappa value=0.884.Conclusion:TCD has a high diagnostic value for cerebral artery stenosis in patients with cerebral infarction,and it is consistent with the diagnosis of CTA.

Relationship of ambulatory pulse pressure and severity of intracranial arterial stenosis / 实用医学杂志

Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.

Relationship of ambulatory pulse pressure and severity of intracranial arterial stenosis / 实用医学杂志

Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.

Cerebral Arterial Stenosis in Patients with Spontaneous Intracerebral Hemorrhage

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. METHODS: A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. RESULTS: Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. CONCLUSION: 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.

Age characteristics and distribution of cerivocerebral large artery lesions in inpatients with cerebral ischemia:an analysis of multi-center research results / 中国脑血管病杂志

Objective To investigate the differences of distribution characteristics and risk factors of large artery lesions in patients with ischemic cerebrovascular disease in different age groups in order to provide the basis for the prevention and treatment of stroke in different age groups.Methods From June 2015 to May 2016,a total of 10 711 consecutive inpatients with transient ischemic attack (TIA) and ischemic stroke from 20 centers nationwide were enrolled.Each 10 years was used as an age group from 40 years.All the patients were divided into 5 age groups.The differences of the different risk factors for cerebrovascular disease among the 5 groups were compared.All patients were separated by gender.The chi square test was used to compare the incidences of large artery stenosis of the intracranial and external and anterior and posterior circulation,and the number of vascular lesions in the same sex in different age groups.Results (1) The risk factors of elderly patients were mainly hypertension,diabetes mellitus,and atrial fibrillation (χ2=61.938,χ2=13.349,and χ2=55.940;all P<0.01).The smoking history,family history of cerebrovascular disease,and obesity were more frequent among the young and middle-aged people (χ2=131.505,χ2=7.298,and χ2=100.911,all P<0.01).(2) The linear trend chi square test results showed that the proportion of multivessel diseases in female and male extracranial arterial lesions increased gradually with the increase of age.(χ2=54.799,χ2=161.370,all P<0.01).The proportion of multivessel diseases in the intracranial artery in female decreased gradually (χ2=5.328,P=0.021),and that in male did not have obvious trend of change (χ2=0.289,P=0.591).(3) The linear trend chi square test results showed that the incidence of simple intracranial arterial stenosis in female and male intracranial arterial stenosis decreased gradually with the increase of age (χ2=20.090,χ2=42.351,all P<0.01),and the incidence of simple extracranial arterial stenosis increased gradually (χ2=40.311,χ2=90.698,all P<0.01).The incidence of both intracranial and extracranial artery stenoses increased gradually (χ2=12.077,χ2=45.887,all P<0.01).The incidence of simple posterior circulation vascular stenosis increased gradually in female (χ2=16.434,P<0.01),but that did not have obvious trend of change in male (χ2=1.701,P=0.192).The incidence of stenosis of both anterior and posterior arteries in female and male increased gradually (χ2=4.587,P=0.032;χ2=35.156,P<0.01).Conclusions The distribution of atherosclerotic lesions in ischemic cerebrovascular disease of the different age groups was different.No matter female or male patients,the majority of the young and middle-aged patients were intracranial artery lesions,and the elderly patients were mainly extracranial artery lesions.The majority of elderly women had posterior circulation artery lesions.Understanding the characteristics in patients with intracranial arterial lesion in different age groups will help to develop individualized stroke prevention and treatment strategies for the population of different age groups.

Effect of living-related donor renal transplantation with mild renal arterial stenosis on early renal function and postoperative complication in recipients / 器官移植

Objective To evaluate the effect of living-related donor renal transplantation with mild renal arterial stenosis upon the early renal function and postoperative complications of the recipients. Methods Clinical data of 1 4 donors and recipients undergoing living-related donor renal transplantation with mild renal arterial stenosis and 50 donors and recipients receiving standard living donor renal transplantation from healthy relatives were retrospectively analyzed. The levels of serum creatinine (Scr ) in the donors were statistically compared between two groups. The serum levels of Scr at postoperative 1 ,3 and 6 months in the recipients were statistically compared between two groups. The survival rate of kidney graft,and the incidences of delayed graft function (DGF),acute rejection and pulmonary infection were compared between two groups. Results Postoperative Scr levels of the donors did not significantly differ between two groups(all P>0. 05 ). The Scr levels of the recipients at postoperative 1 ,3 and 6 months did not significantly differ between two groups (all P>0. 05 ). The survival rate of kidney graft,and the incidences of DGF,acute rejection and pulmonary infection in the recipients did not significantly differ between two groups (all P >0. 05 ). Conclusions Living-related donor renal transplantation with mild renal arterial stenosis exerts no significant effect upon renal function and postoperative complication in the recipients,who are eligible for the donors for renal transplantation.

Relationship between cerebral artery stenosis and obstructive sleep apnea / 中华全科医师杂志

Objective To investigate the relationship of obstructive sleep apnea and atherosclerotic cerebral artery stenosis.Methods One hundred and twenty patients with acute cerebral infarction were enrolled in the study.Patients underwent polysomnography monitoring;according to the results, the sleep apnea/hypopnea index ( AHI) was ≥5/h in 60 patients ( OSA group) and AHI was 0.05).The rates of increased BMI [(26.07 ±2.39)vs.(23.59 ±2.73) kg/m2] and hypertension [70%(42/60)vs.43%(26/60)] in OSA group were higher than those in non-OSA group (t=5.304,χ2 =7.603, all P0.05 ) . The severity of cerebral artery stenosis in OSA group was higher than that in non-OSA group (χ2 =17.801, P0.05).Conclusion The study indicates that there is a close relationship between OSA and stenosis of atherosclerotic cerebral arteries.

Correlation between hemodynamic change of extracranial cerebral vessels evaluated by ultrasound and intracranial arterial stenosis / 中华超声影像学杂志

Objective By analyzing the correlation between Doppler spectrum of extracranial cerebral vessels ECV and intracranial arterial stenosis IAS to identify the value of hemodynamic change of ECV in predicting IAS Methods One hundred and four patients with moderate to severe IAS or intracranial arterial occlusion were enrolled in the case group while 32 patients without obvious cerebrovascular disease in the same period were enrolled in the control group Ultrasound examinations of ECV were performed for all patients the hemodynamic parameters of bilateral common carotid artery CCA internal carotid artery ICA and vertebral artery VA were recorded and compared between case and control group Results Compared with control group the ECV of patients with IAS had lower velocity and higher resistance index RI Of all the parameters end diastolic velocity EDV of ICA and EDV of VA were most accurate in predicting IAS with best cut off value of 21 3 cm/s 9 6 cm/s and accuracy of 76 1 % 81 0% respectively Conclusions The ECV of IAS patients tend to have lower velocity and higher RI Analysis of hemodynamic parameters of ECV might be useful in predicting IAS.

Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

OBJECTIVE: Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. MATERIALS AND METHODS: A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. RESULTS: Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. CONCLUSION: Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

Value of endovascular stenting for symptomatic intracranial artery stenosis / 实用放射学杂志

Objective To evaluate the curative effect,safety,and medium-term effect of intracranial artery stenosis stent (ICASS) for the treatment of the symptomatic intracranial artery stenosis.Methods ICASS was performed in 21 cases with the symptomatic intracranial artery stenosis.The stenting success rate,the improvement rate of stenosis post-stenting and the incidence of complications were observed.The change of the scores of the Modified Rankin Scale (MRS)and National Institutes of Health Stroke Scale (NIHSS)between pre-and post-stenting (1 month,3 months,6 months,12 months and 2 years)and the occurrence of ischemic cerebrovascular events after stenting were compared and analyzed respectively.Results Except one case failed because of intracranial hemorrhage during the operation,other 20 patients were treated with endovascular stent plasty successfully,the total technical achievement ratio was 95.2%.The aver-age stenosis ratio decreased from (73.4±7.9)% to (13.7±9.2)%.The complications incidence was 4.8% within the peroperative. 9 patients were reviewed with DSA in 6 months,the average ratio of stenosis was (29.5 ±12.2)%,no patient was found with the restenosis.Compared with pre-stenting,the score of MRS and NIHSS at the follow-up duration of 3 months,6 months,12 months and 2 years post-stenting of patients were significant improved (all P < 0.05 ).During the follow-up period,2 patients were found with new transient ischemia attack (TIA),1 patient had non-targeted vascular CI without other target vascular therapy-related com-plications.Univariate analysis indicated that patients with elderly (≥ 75 years old),or hypertension,or diabetes,or dyslipidemia,or in the set of events to endovascular treatment for longer than 1 month,or with more than two independent risk factors for patients with underlying diseases treatment,or without systemic therapy,whom would be much more easily to reoccur the cerebrovascular events in post-operation(all P <0.05 ).Conclusion ICASS should be an effective and safe therapeutic method to the symptomatic intracra-nial arterial stenosis.The medium-term efficacy is significant.Serious complications might still be emerge with endovascular stent plasty,so close attention must be paid with.

NT-proBNP,hs-CRP and echocardiography:predictive value for the degree of coronary artery lesion / 重庆医学

Objective To investigate the correlation between NT‐proBNP ,hs‐CRP level ,echocardiography and early avascu‐lar necrosis of coronary artery syndrome (ACS) ,coronary artery lesion degree .Methods 142 patients admitted in this hospital for chest pain from March 2013 to February 2014 were enrolled ,and all patients′history ,electrocardiogram (ECG) ,plasma levels of N‐terminal pro‐Brain Natriuretic Peptide (NT‐proBNP) ,hypersensitive C‐reative protein (hs‐CRP) and cTnT were recorded or tested within 24 hours ,while left ventricular ejection fraction (LVEF) and left ventricular end‐diastolic diameter (LVEDd) were recorded by echocardiography .According to the history and coronary angiography results conducted during hospitalization ,patients were di‐vided into acute ST segment elevation myocardial infarction (STEMI) group ,acute non‐ST segment elevation myocardial infarction (NSTEMI) group ,unstable angina pectoris (UA) group and control group (normal coronary angiography ,cTnT and ECG) .Pa‐tients with abnormal coronary angiography results were further divided into single vessel lesion group ,double vessel lesion group and triple vessel lesion group .The differences of plasma NT‐proBNP level ,hs‐CRP level and LVEF in each group ,and multivariate linear regression analysis were conducted to find out the independent risk factors for elevated plasma NT‐proBNP .Results 102 ACS patients and 40 normal patients were enrolled .Plasma levels of NT‐proBNP ,hs‐CRP and LVEF in NSTEMI group (n=30) and STEMI group (n=32) were significant different from UA group (n=40) and control group (n=40) respectively (P<0 .05) . The NT‐proBNP levels in control group and triple vessel lesion group (n=41) were respectively significant different from both sin‐gle vessel lesion group (n=30) and double vessel lesion group (n=31) (P<0 .05) .Multivariate linear regression analysis showed that ,plasma hs‐CRP level (P=0 .007) ,coronary artery lesion degree (P=0 .00) and history of diabetes (P=0 .006) were positive associated factors of NT‐proBNP level ,while LVEF was the negative associated factors of NT‐proBNP level(P=0 .036) .Conclusion Plasma NT‐proBNP level ,hs‐CRP level and LVEF are closely related to ACS ,and they might play an important role in determi‐ning the extent of early ischemic necrosis and clinical classification .Plasma NT‐proBNP level could be an important molecular mark‐er to reflect the degree of coronary artery lesion .

Hipertensión pulmonar severa asociada a enfermedad de Takayasu / Severe pulmonary hypertension associated with Takayasu arteritis / Hipertensão pulmonar severa associada a doença de Takayasu

Se presenta el caso de una mujer de 57 años de edad, con antecedente de hipertensión arterial crónica, y cuadro de 2 años de evolución de disnea, síntomas generales, malestar, fatigabilidad e intolerancia al ejercicio, deterioro de la capacidad funcional y episodios ocasionales de presíncope. Al examen físico se le encontraron cifras tensionales elevadas, con diferencia de más de 10 mm Hg entre las presiones del miembro superior derecho y las del izquierdo, soplo holosistólico grado III/VI en los focos de la base, soplo subclavio izquierdo y disminución de la intensidad de los pulsos periféricos del miembro superior izquierdo. Los síntomas la obligaron a consultar en varias oportunidades a instituciones de salud de la ciudad, donde le hicieron estudios que mostraron hipertensión pulmonar severa y disfunción ventricular derecha, confirmadas por cateterismo cardíaco. Se le hicieron angiotomografía de tórax y angiografía arterial pulmonar que fue sugestiva de estenosis arterial pulmonar bilateral. En la resonancia magnética cardíaca se hallaron estenosis (6 mm) concéntrica que comprometía el origen de la rama para el lóbulo superior y afectación circunferencial de la rama izquierda (8 mm) y de la rama para el lóbulo inferior. En la aorta y los vasos del cuello se observaron irregularidades endoluminales tanto en la resonancia como en la angiotomografía. Con estos hallazgos se hicieron los diagnósticos de arteritis de Takayasu e hipertensión pulmonar severa asociada, y se inició tratamiento con prednisolona y metotrexate.

We describe the case of a 57 year-old woman with chronic hypertension, dyspnea, general symptoms, malaise, fatigability and exercise intolerance, impaired functional capacity and occasional episodes of pre-syncope. Physical examination disclosed arterial hypertension, with a difference of more than 10 mm Hg between the pressures of the right and the left upper limbs, holosystolic murmur grade III/VI in the aortic valve area, left subclavian murmur, and decreased intensity in the peripheral pulses of the left arm. Noninvasive studies showed severe pulmonary hypertension and right ventricular dysfunction, also confirmed by cardiac catheterization. Chest tomography and pulmonary arterial angiography showed bilateral pulmonary artery stenosis. Cardiac magnetic resonance revealed concentric stenosis (6 mm), affecting the origin of the upper lobe branch and circumferential involvement of the left branch (8 mm) and the branch to the lower lobe. Endoluminal irregularities were observed in the aorta and the neck vessels, both in the resonance and the angiography. With these findings diagnoses of Takayasu arteritis and associated severe pulmonary hypertension were established. Treatment was started with prednisolone and methotrexate.

Se apresenta o caso de uma mulher de 57 anos de idade, com antecedente de hipertensão arterial crônica, e quadro de 2 anos de evolução de dispneia, sintomas gerais, mal-estar, fatiga e intolerância ao exercício, deterioração de sua capacidade funcional e episódios ocasionais de pré-síncope. No exame físico se lhe encontraram cifras tensionais elevadas, com diferença a mais de 10 mm Hg entre as pressões do membro superior direito e as do esquerdo, sopro holossistólico grau III/VI nos focos da base, sopro subclávio esquerdo e diminuição da intensidade dos pulsos periféricos do membro superior esquerdo. Os sintomas a obrigaram a conferir em várias oportunidades a instituições de saúde da cidade, onde lhe fizeram estudos que mostraram hipertensão pulmonar severa e disfunção ventricular direita, confirmadas por cateterismo cardíaco. Se lhe fizeram angiotomografia de tórax e angiografia arterial pulmonar que foi sugestiva de estenoses arterial pulmonar bilateral. Na ressonância magnética cardíaca se acharam estenoses (6 mm) concêntrica que comprometia a origem do ramo para o lóbulo superior e afetação circunferencial do ramo esquerdo (8 mm) e do ramo para o lóbulo inferior. Na aorta e os vasos do pescoço se observaram irregularidades endoluminais tanto na ressonância como na angiotomografia. Com estes achados se fizeram os diagnósticos de arterite de Takayasu e hipertensão pulmonar severa associada e se iniciou tratamento com prednisona e metotrexato.

Correlation between ambulatory aterial stiffness index and extracranial and intracranial arterial stenosis / 实用医学杂志

Objective To evaluate the relationship between ambulatory arterial stiffness index (AASI) and intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease. Methods Degree of intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease was assessed by CT angiography (CTA). Then all patients were divided into 4 groups according to the numbers of branches with stenosis: no stenosis group, 1 branch group, 2 branches group, and 3 and more than 3 branches group. Dynamic blood pressure was monitored to calculate the AASI. Results There was no significant difference of AASI among the extracranial arterial stenosis groups (P=0.614). AASI was positively correlated with the degree of intracranial artery stenosis (r=0.743, P<0.05), and with 3 and more intracranial artery branches stenosis (r=0.797, P<0.05). Conclusion AASI is closely correlated with the degree and numbers of branches of intracranial artery stenosis.

Perioperative complications of stent angioplasty for intracranial arterial stenosis：clinical analysis and therapeutic strategy / 介入放射学杂志

Intracranial artery stenosis is one of the main causes inducing transient ischemic attack (TIA) or cerebral ischemic stroke. Being a minimally-invasive and reliably-effective technique, intracranial artery stent angioplasty has brought about a new approach for the treatment of intracranial artery stenosis , and thus provides more opportunities to the patients who are not suitable for intracranial vascular bypass surgery. However, the higher occurrence of perioperative complications caused by stent angioplasty should be seriously taken into consideration by clinical physicians. In order to reduce the occurrence of complications , in this paper the perioperative complications of stent angioplasty for intracranial artery stenosis are analyzed , and the therapeutic strategies as well as the proper approaches are discussed.

Mechanical analysis on treatment of vertebral artery stenosis by stents with different links / 医用生物力学

Objective To investigate the mechanical effect of stents with different links on the treatment of vertebral artery stenosis, and provide scientific guidelines for the design of stent structure and clinical procedure of stenting intervention. Methods Models of three kinds of stents with different types of links (namely, L-stent, V-stent and S-stent according to the shape of links) and vertebral artery with stenosis were established by using Pro/Engineering, then the same boundary conditions were exerted on the three models to simulate the stent deployed in the vertebral artery by finite element analysis using ABAQUS. Results Compared with L-stent and V-stent, S-stent had a better compliance, generating smaller stress in the arterial wall, causing relatively weak vascular straightening. Due to smaller stress and axial shortening generated in the stent strut, S-stent made less lesion on the arterial wall. Conclusions The therapeutic effect of S-stent is the best among the three kinds of stents, which could reduce in-stent-restenosis, and has good prospect in clinical application.