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Extra corporeal membrane oxygenation (ECMO) for refractory out?of?hospital cardiac arrest (OHCA) has been shown to improve outcome in many Western countries. There are no reports of ECMO being used to support OHCA in India till date. We report a case of a young man who developed cardiac arrest (CA) while driving and was given bystander cardiac massage. He was brought to tertiary care center where an ECMO was utilized for refractory CA. The patient subsequently underwent emergency coronary artery stenting and was weaned off ECMO and ventilation. We discuss the case and highlight the role of bystander cardiopulmonary resuscitation.
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Objective:To investigate the effect of mind mapping on the discharge readiness of patients undergoing first coronary stent implantation, so as to provide basis for seeking effective discharge guidance in clinical practice.Methods:One hundred patients who were hospitalized in the Department of Cardiology, the Second Affiliated Hospital of Dalian Medical University from December 2019 to August 2020 and who underwent coronary stent implantation for the first time were selected as the study objects. They were divided into the control group and the experimental group with 50 cases in each group by the random number table method. The control group was given routine discharge guidance, and the experimental group was given discharge guidance using mind mapping. Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale were used to compare the differences of discharge readiness and discharge guidance quality between the two groups after intervention.Results:The personal status, adaptability, predictive support and the total score of discharge readiness in the experimental group were (25.18 ± 3.79), (45.24 ± 3.63), (36.62 ± 3.63), (107.04 ± 8.92) points, which were all higher than those in the control group (23.34 ± 3.04), (41.68 ± 3.62), (35.14 ± 2.14), (100.16 ± 7.36) points, with statistically significant differences ( t values were -4.91--2.48, all P<0.05). The actual acquired content, guiding skills and results, total scores of discharge guidance quality of patients in the experimental group were (56.66 ± 6.06), (94.46 ± 4.33), (151.12 ± 8.26) points, which were all higher than those in the control group (45.38 ± 9.19), (89.44 ± 10.87), (134.82 ± 14.31) points, with statistically significant differences ( t values were -7.25, -3.03, -6.97, all P<0.05). Conclusions:Mind mapping can effectively improve the discharge preparation degree and discharge guidance quality of patients undergoing coronary stent implantation for the first time, and it is a simple and practical discharge guidance tool.
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Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)in patients of left ventricular dysfunction with coronary artery disease.Methods 147 patients with left ventricular dysfunction were divided into PCI group(n=60)and CABG group(n=87).Clinical,angiographic and revascularization data were collected for analysis.Patients were by SPSS 13.0 software.P value of less than 0.05 was considered statistically significant.Results In-hospital MACCE rates and mortality ofthe two groups were comparable[(6.7%vs 9.2%,P＞0.05)and(1.7%vs 8.0%,P＞0.05)].Multivariate Logistic regression analysis indicated that in-hospital MACCE risk of the two groups were similar(OR≥3.03,95%CI 0.27～34.48,P＞0.05).22-month follow-up showed no signficance in MACCE rates (16.0%vs 13.8%,P＞0.05)and in repeated revaseularization rates(8.O%vs 1.7%,P＞0.05)between the two groups.Multivariate Cox regression analysis indicated that follow-up MACCE risk of the two groups were comparable (HR≥1.35,95%C/0.44～4.13,P＞0.05).Conclusion In coronary artery disease patients with left ventricular dysfunction,PCI and CABG have similar in-hospital and long-tem MACCE rates.Long-terra effect of PCI would be further increased with the wide use of drug-eluting stents.
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Objective To analyze the trends and status of percutaneous coronary intervention(PCI)in Shenyang General Hospital of P.L.A.during a 18-year period.Methods Between August 1989 and April 2007,a total of 10 225 patients with 17762 target lesions had undergone PCI.Their clinical and angiographic baseline characteristics,PCI strategies and perioperative outcomes were retrospectively analyzed.All data were collected from PCI database of our hospital.Results Patients' age ranged from 22 to 92 years old(mean,59.9 years).A total of 2057 patients(20.2%)were with diabete,8647(84.6%)with acute coronary syndromes,1428(14.0%)with acute myocardial infarction(AMI)and underwent emergent PCI,477(4.7%)with cardiogenic shock;6701(65.5%)with multivessel disease,483(4.7%)with left main disease and 1795(17.2%)with chronic total occlusions(CTO).Overall patient success rate was 98.5% and lesion success rate was 98.3%.Procedural success was obtained in 99.6% of patients with left main disease and 90.5% of CTO lesions.About 89.8% of all patients underwent coronary stenting.Mean implanted stent number was 1.45 per patient.In-hospital mortality was 4.4%(63/1428)for AMI patients who underwent emergent PCI and 19.7%(42/213)for AMI patients with cardiogenic shock.Overall perioperative mortality was 1.1%(113/10 225),including 2 deaths during procedure(0.02%)and 80(0.8%)deaths after procedure.Two patients(0.02%)underwent emergent CABG.Acute or subacute stent thrombosis occurred in 58 patients(0.57%)and slow flow or no-reflow occurred in 127 patients,which accounted for 8.9% of AMI patients who underwent emergent PCI.Overall incidence of perioperative complications was 3.6% and the rate of procedure related complications was 0.48%.Conclusion In skilled cardiac center,PCI is associated with high procedural success rate,low incidence of complications and good short-term outcomes.PCI should be the first choice for treating patients with coronary artery disease,especially for high risk patients with AMI,cardiogenic shock or left main disease,etc.
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Objective: To assess the regional systolic and diastolic function of left ventricle before and after coronary stent implantation by pulsed wave Doppler tissue imaging (PW-DTI). Methods: Twenty-six patients with coronary artery disease ( CAD) involving only left anterior descending coronary artery ( LAD) were examined within 1-3 days before, 7 days and 30 days after coronary stenting with PW-DTI. Peak systolic , peak early diastolic, and peak late diastolic motion velocities ( Sm, Em, and Am respectively) were measured at 6 different sites on the basal and medial segments corresponding to the anteroseptal, postero-septal, lateral, anterior, inferior, and posterior walls of the left ventricle. Results:In corresponding segments depending on LAD blood flow supply, Sm was increased significantly 7 days after the stenting proce- dure. Em was also increased 7 days after the procedure in most of the corresponding segments. There were little changes in other segments that were independent on LAD blood flow supply. Conclusion: These findings suggest that there is an early improvement in the regional systolic and diastolic function of the left ventricle after the coronary stenting, and that PW-DTI techniques could evaluate quantitatively the regional ventricular performance in patients receiving percutaneous coronary intervention.
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Objective To evaluate angiographic and clinical outcomes of ≥ 20mm long stents or overlapped stent implantation in diffuse coronary lesions for octogenarians, in comparison with patients under sixty. Methods Two groups (Group O: 47 lesions in 44 octogenarians, aged 81± 3 years; Group Y: 64 lesions in 58 patients under sixty, aged 54 ± 4 years) were compared with a 6-month follow-up. Results Success rate of the procedures was 100%. None had in-hospital major adverse cardiac events (MACE). There was no significant difference in angiographic restenosis between the groups at follow-up (Group O vs Group Y, 29.8 % vs 26.6 %, P = NS). The revascularization of target vessel and MACE was less in Group Y, but these showed no statistical significance (15.6% vs 23.4% and 20.7% vs 25.0%, respectively). Conclusions Long stent implantation for diffuse coronary lesions in octogenarians appears safe and feasible, with high procedural success and favorable long-term outcomes.
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Intracoronary stent implantation is a safe and effective treatment for coronary artery disease.In-stent restenosis has been significantly reduced by utilization of drug eluting stents.This article reviews the results of long-term follow-up after intracoronary stent implantation and their implication.
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Objective We evaluated the long term outcome of percutaneous transluminal coronary stenting in patients with unstable angina and severe ischemic left ventricular (LV) dysfunction inadequately controlled by medical therapy Methods We analyzed data on 69 lesions in 46 elective patients (66?12 years old, 72% male) with LV ejection fraction (LVEF)≤40% who presented between 1997 and 1999 and underwent coronary stenting Results Acute clinical success (
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Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)in patients with coronary artery disease and diabetes mellitus.Methods The DESIRE(drug-eluting stent impact on revascularization)is a single-center registry comparing coronary revascularization in our institution before and after the introduction of drug-eluting stents.Between July 2001 and June 2002,July 2003 and June 2004,1040 patients were referred for revascularization(PCI or CABG)during hospitalization.Clinical,angiographic,revascularization data clinical condition in hospital and the follow-up results were collected for retrospective analysis.In the present study,patients with diabetes were selected and divided into PCI and CABG groups.The primary endpoint is in-hospital and follow-up major adverse cardiovascular and cerebral events(MACCE).Results Compared with the CABG group,the PCI group had lower in-hospital MACCE rates(P0.05),but the PCI group had higher rates of repeat revascularization than that of the CABG group(P0.05).Conclusion Although PCI has lower in-hospital MACCE rates in diabetic patients,the follow-up MACCE rates of PCI and CABG are comparable,and PCI has even higher rates of repeat revascularization than CABG.With the increasing use of drug eluting stents,PCI might have better performance.
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BACKGROUND AND OBJECTIVES: The elderly is the fast growing segment of the population in Korea. Elderly patients undergoing coronary revascularization are considered a high-risk group. Few data exist that relate the results of stenting in treating coronary artery disease in the elderly population. This study sought to compare the short- and long-term outcomes of elderly patients undergoing coronary artery stenting with those of younger patients. METHODS: All elderly patients 70 years of age who underwent coronary artery stenting between January 1997 and July 1999 (n = 106) at our centers were compared to the patients <70 who underwent coronary artery stenting during the same time period (n = 597). METHODS: Elderly patients presented with lower ejection fraction (52.9% vs. 57.4%, p = 0.001), more unstable angina (47% vs. 31%, p = 0.003), and more multivessel disease (67% vs. 51%, p = 0.005) than younger patients. Major in-hospital complications including death (0.9% vs. 0.5%, p = NS), procedural acute Q-wave myocardial infarction (0.9% vs. 0.3%, p = NS), and emergency CABG (0% vs. 0.3%, p = NS) did not differ between two groups. And also vascular complication rate was similar between two groups(1.9% vs. 1.0%, p = NS). Angiographic follow-up, obtained in both groups, demonstrated similar restenosis rates (26.5% vs. 24.9%, p = NS). Long-term clinical follow-up at 12 months showed major adverse cardiac events including death, acute myocardial infarction, and repeat revascularization were significantly higher in elderly patients than in younger patients (18.3% vs. 12.6%, p = 0.04). CONCLUSIONS: Elderly patients with higher risk factors who underwent coronary artery stenting had similar rates of in-hospital procedural complications and similar rates of 6 months angiographic restenosis, compared to younger patients. Overall rates of major adverse cardiac events in the elderly population at 12 months postcoronary artery stenting were significantly higher than those of younger patients.
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Aged , Humans , Angina, Unstable , Arteries , Coronary Artery Disease , Coronary Vessels , Emergencies , Follow-Up Studies , Korea , Myocardial Infarction , Risk Factors , StentsABSTRACT
BACKGROUND AND OBJECTIVES: Primary coronary stenting has been shown to be an effective reperfusion therapy for acute myocardial infarction(AMI). However, few data exist regarding long-term follow-up. We examine the long-term clinical and angiographic outcomes after primary coronary stenting in the early setting of AMI. METHODS: Between September 1995 to October 1999, coronary stenting was attempted in 181 consecutive patients admitted with the diagnosis of AMI within 6 hours from the onset of the chest pain. Clinical events, including death, MI, coronary bypass surgery and repeat angioplasty, were recorded for 1 year. Angiogram were obtained at baseline, after stent, at 2 weeks and 6 months. RESULTS: 168 patients(92.8%) of all patients had complete 1 year clinical follow-up. In-hospital deaths occured in 5 patients(3%). One hundred five patients(62.5%) had follow-up angiography at 6.4+/-2.1 months after stent implantation and restenosis occured in 21.9%. Clinical events after 1 year included death in 6.5%, myocardial infarction in 1.2%, bypass surgery in 1.8% and repeat angioplasty in 7.7%. Freedom from any adverse cardiac event at 1 year was 82.2%. CONCLUSION: Primary stenting is safe and feasible in patients of AMI, even in large thrombus containing lesion and results in excellent long-term outcomes.
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Humans , Angiography , Angioplasty , Chest Pain , Diagnosis , Follow-Up Studies , Freedom , Infarction , Myocardial Infarction , Reperfusion , Stents , ThrombosisABSTRACT
The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, case-controlled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9+/-14.5 months and 17.6+/-14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3+/-9.6 months and 11.1+/-8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.
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Humans , Case-Control Studies , Coronary Artery Bypass , Coronary Vessels , Follow-Up Studies , Heart , Kidney Failure, Chronic , Mortality , Myocardial Ischemia , Retrospective Studies , Stents , Transplants , Ventricular Function, LeftABSTRACT
BACKGROUNG AND OBJECTIVES: Diabetes mellitus is a significant risk factor for adverse outcome after PTCA, which is associated with an increased late mortality and target lesion revascularization (TLR) rates. The beneficial role of coronary stenting on the clinical and angiographic outcomes of diabetic patients is not clearly defined. The aim of this study was to evaluate the early and mid-term outcomes in diabetic patients undergoing elective stenting of native coronary lesions compared with those in non-diabetic patients. MATERIALS AND METHODS: Between July 1997 and June 1998, coronary stenting was performed on 46 lesions in 38 diabetic patients and 126 lesions in 117 non-diabetic patients. Follow-up angiography at mean day of 189+/-45 was performed in 58.7% (91 patients) and analysed by quantitative coronary angiography (QCA). RESULTS: There was a higher incidence of multi-vessel disease in diabetic patients than non-diabetic patients but not statistically significant (71.1% vs 51.3%, p=0.106). There were no differences in major procedural complications and in-hospital events (myocardial infarction, angina and death) in diabetics and non-diabetics. During the follow-up, the incidence of target lesion revascularizton (TLR) and cardiac event free survival did not differ between two groups. CONCLUSION: Coronary stenting in diabetics resulted in a low rate of immediate procedural com-plications and early major adverse cardiac event (MACE), similar to non-diabetics. There were no differences in the mid-term clinical and angiographic outcomes in diabetics and non-diabetics.
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Humans , Angiography , Coronary Angiography , Diabetes Mellitus , Disease-Free Survival , Follow-Up Studies , Incidence , Infarction , Mortality , Risk Factors , StentsABSTRACT
BACKGROUND: The Freedom (TM) stent, which is one of recently developed balloon-expandable coil stents, has advantages of low profile and good trackability and flexibility. We evaluated the initial results and the late restenosis rate of Freedom (TM) stent in patients with coronary artery disease. METHOD: A total of 40 Freedom stents were implanted in 32 consecutive patients (38 lesions). The clinical diagnosis of the subjects were stable angina in 1 patient, unstable angina in 19, and acute myocardial infarction in 12. The indications of stenting were primary stenting in 11 stents, suboptimal result after PTCA in 26, and bailout procedure in 1. A mean diameter of reference artery was 3.1 mm (SD, +/-0.4) and mean of lesion length was 10.9 mm (SD, +/-5.6). Stents were implanted with a mean maximal balloon pressure of 12.1 atm (SD, +/-2.2). Follow-up angiography was done at least 3 months (mean duration, 8.7+/-3.7) after stenting for 28 lesions of 22 patients. RESULTS: All 40 stents were implanted safely except one, which was complicated with side branch occlusion. There was no case of stent thrombosis and clinical success rate was 97% (31/32). Minimal luminal diameter (MLD) was increased from 0.7 (SD, +/-0.4) to 3.0 mm (SD, +/-0.4) and % of diameter stenosis (%DS) was decreased from 78 (SD, +/-13) to 2% (SD, +/-5) immediately after stenting. The overall restenosis rate was 28% (8/28). The restenosis rate was increased in the complex lesions (complex, 38% vs simple, 0%: p=0.05) and lesion of small vessel ( or = 3.0 mm, 20%:p=0.11). CONCLUSION: FreedomTM stent is safe and feasible in patients with various morphology of coronary lesions including small and tortuous arteries, and in lesion associated with side branches. But lesions of small vessel and complex morphology are tend to be associated with higher rates of restenosis.
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Humans , Angina, Stable , Angina, Unstable , Angiography , Arteries , Constriction, Pathologic , Coronary Artery Disease , Diagnosis , Follow-Up Studies , Freedom , Myocardial Infarction , Phenobarbital , Pliability , Stents , ThrombosisABSTRACT
BACKGROUND: Thrombus-containing lesions (TCL) are associated with lower initial success rates and higher restenosis rates after balloon dilation. Furthermore, it has been considered as an absolute contraindication of coronary stenting. With advances in antithrombotic regimens and implantation techniques, coronary stenting has been widened to lesions with adverse morphologic features or to patients with acute coronary syndrome. Here we report the early clinical and angiographic results of coronary stenting in TCL. METHODS: We studied 24 consecutive patients (58+/-8 years, 18 males) undergoing coronary stenting in TCL. Fifteen patients (63%) were treated for acute myocardial infarction (AMI) and 9 (37%) for unstable angina. Stenting was performed as the primary therapy in 23 patients (96%) and secondary after angioplasty failure in I patient (4%). RESULTS: 1) Twenty-five stents were deployed successfully in all 24 patients with TCL. Distal flow with TIMI grade 3 was obtained immediately in 21 patients (88%). Ventricular fibrillation occurred in 3 patients (13%) during the procedure-related death or emergency bypass surgery did not occur. Marked CK elevation (over 5000U/L) was observed in 5 patients (21%) with AMI who underwent primary stenting. Two of these 5 patients (8%) had distal flow with TIMI grade 2 consistent with distal embolization, and one (4%) had distal flow with TIMI grade 0, suggesting acute stent occlusion. All 24 patients (100%) were event-free and showed clinical improvement at the last follow-up visit (71+/-15 days). 2) Quantitative angiography demonstrated excellent angiographic results after stenting (minimal luminal diameter 0.3+/-0.3 vs. 3.4+/-0.3mm, diameter stenosis 90.1+/-10.7 vs. -13.3+/-8.1%, p<0.005 respectively). Acute gain was 3.1+/-0.3mm (p<0.005). CONCLUSIONS: With low incidents of complications, coronary stenting could be used successfully for select patients with TCL as a primary therapeutic option under aggressive antithrombotic therapy. Although early clinical results were excellent, the long-term benefits remain to be established.
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Humans , Acute Coronary Syndrome , Angina, Unstable , Angiography , Angioplasty , Constriction, Pathologic , Emergencies , Follow-Up Studies , Myocardial Infarction , Phenobarbital , Stents , Ventricular FibrillationABSTRACT
BACKGROUND AND OBJECTIVES: This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting. MATERIALS AND METHODS: The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment 5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure. RESULTS: 1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02). CONCLUSIONS: EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.
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Humans , Angiography , Angioplasty , Constriction, Pathologic , Follow-Up Studies , StentsABSTRACT
BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) is one of the most widely used therapeutic procedures in the treatment of patients with coronary artery disease. However, acute closure and late restenosis remain a major limitation of PTCA despite extensive efforts to prevent. Coronary artery stents have been proposed as a treatment modality for acute closure and restenosis. We evaluated the initial success rate, complications, the restenosis rate, and the clinical outcomes after coronary artery stenting. METHODS: We implanted 56 stents(Palmaz-Schatz(PS) stent : 38 ; #3.0-14, #3.5-7, #4.0-17, Gianturco-Roubin(GR) stent : 18 ; #2.5-4, #3.0-10, #3.5-1, #4.0-3) in 51 patients(male : 40, mean age : 58+/-1 year). The clinical characteristics of the subjects were unstable angina in 26(51%), stable angina in 2, and myocardial infarction in 23(45%) patients(acute : 18). Follow-up angiography was done at a mean duration of 5.4 month(1-12) after coronary stenting for 34 lesions(61%) of 30 patients. RESULTS: 1) The indications of stenting(n=56) were De novo in 33(59%), bailout procedure in 15(27%), suboptimal result after PTCA in 6, and restenosis after PTCA in 2 stents. The location of lesions were LAD in 24, RCA in 27, and circumflex artery in 5 lesions. Angiographic morphologic characteristics were type B in 38(BI : 3, B2 : 35) and type C in 18 lesions. 2) The angiographic and clinical success rate was 96%(54/56) and 94%(52/56). There were no significant difference in stent modality, lesion site and morphology, and indication of stent. 3) Procedural complications were 1 acute closure which was recanalized by emergency coronary artery bypass graft(CABG), 1 death with subacute closure, 2 dissection, and 5 hemorrhages requiring transfusion. 4) The overall restenosis rate was 26%(9/34). The restenosis rate was reduced significantly in PS stent[PS : 9%(2/22) vs GR : 58%(7/12), P or =3.5mm of stent size[> or =3.5mm : 6%(1/18) vs 3.5mm : 50%(8/16), p 12atm) [High pressure(+) : 7%(1/14) vs High pressure(-) : 40%(8/20), p<0.05]. 5) The restenosis sites were managed with re-PTCA in 4, elective CABG in 1, and medical follow-up in 4 patients. CONCLUSION: Coronary stenting is an effective and safe procedure for the management of coronary artery disease. The PS stent and GR stent are considered as a safe means for bail-out, and the PS stent can reduces the restenosis rate especially.
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Humans , Angina, Stable , Angina, Unstable , Angiography , Arteries , Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Emergencies , Follow-Up Studies , Hemorrhage , Myocardial Infarction , StentsABSTRACT
BACKGROUND: Recent randomized studies have shown a reduction of restenosis rate after denovo coronary stenting as compared to classical PTCA. The purpose of this study was to evaluate a new medication protocol using antiplatelet therapy(ticlodipine, aspirin) and heparin in conjunction with routine high pressure ballooning after stenting. METHODS AND RESULTS: Seventy two patients(47 males and 25 females, mean age : 58+/-11 years) underwent Palmaz-Schatz coronary stenting in 76 coronary lesions. Their clinical characeristice were ; 38 cases(63%) of unstable angina, 14 cases(19%) of stable angina and 20 cases(28%) of acute myocardial infarction(MI, Q : 16 cases, non-Q : 4 cases). In 15 out of 20 acute MI cases, stents were implanted in the infarct-related arteries. Primary elective stenting was indicated for 40 lesions(53%) ; 34 for de novo and 6 for restenosis after PTCA. Stents were implanted in 27 lesions(35%) with suboptimal result after PTCA and 9 lesions(12%) as a bailout procedure ; 8 threatened closures and 1 acute closure. All patients were treated with heparin for 48 hours and antiplatelet agents(aspirin 100-200mg/day and ticlopidine 200-500mg/day) after the procedure. All stents were greater than 3.0mm in size. Postdilatation was obtained with a max balloon diameter of 3.5+/-0.6mm(balloon-to-vessel ratio of 1.12+/-0.20) at a max inflation pressure of 14.4+/-2.8 atm. Percent diameter stenosis decreased from 70.4+/-15.5% to -1.2+/-4.8%(p<0.0001), and minimal luminal diameter increased from 0.94+/-0.57mm to 3.15+/-0.51mm(p<0.0001) after stenting. During mean follow-up duration of 5.1+/-3.0 months there were 3 cases(4.2%) of myocardial infarction, 2(2.7%) of repeat angioplasty, 1(1.4%) of CABG and 1(1.4%) of death. CONCLUSION: Palmaz-Schatz coronary stenting with poststenting routine high pressure ballooning appears to be safe and feasibile without anticoagulation and without use of intravascular ultrasound in selected patients.
Subject(s)
Female , Humans , Male , Angina, Stable , Angina, Unstable , Angioplasty , Arteries , Constriction, Pathologic , Coronary Artery Disease , Follow-Up Studies , Heparin , Inflation, Economic , Myocardial Infarction , Phenobarbital , Stents , Ticlopidine , UltrasonographyABSTRACT
Objective To determine the lesion characteristics and effect of intervention on diseased grafts in older patients. Methods Thirty-eight patients with angina after coronary artery bypass grafts (CABG) were enrolled into Nanjing First Hospital. Interventions were performed after multiple-view angiogram and formal consent from relatives received. Angiographic follow-up was conducted within 6 months. Cardiac events were recorded during the 6-month clinical follow-up. Results Of the 38 patients (36 males and 2 females), the average age was 63.2 years. Angina occurred 11.5 months after CABG. Angipgrams were performed 4.8 years after CABG. Diabetes was complicated in 10 cases and old myocardial infarction in 8, respectively. Left ventricular ejection fraction was increased from 52%?10% to 58%?14% (P
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Objective To investigate the changes and clinical significance of platelets aggregation rate of patients with coronary heart disease before and after percutaneous transluminal coronary stenting Methods There are 13 patients underwent coronary angiography and 20 patients underwent percutaneous transluminal coronary stenting Their blood samples were taken from the coronary sinus and coronary artery before and after interventional therapy Results The level of platelets aggregation rate in percutaneous transluminal coronary stenting group was higher after interventional therapy ( P