Modified Fired Glycyrrhizae Decoction as adjunct therapy on the hemodynamics and myocardial enzymes of the patients with coronary arrhythmia after bifurcation lesion surgery / 国际中医中药杂志

Objective:To explore the effects of modified Fired Glycyrrhizae Decoction on hemodynamics and levels of myocardial enzymes in coronary arrhythmia (CA) after bifurcation lesion (BCL) surgery.Methods:According to simple random method, 100 patients with CA after BCL surgery in the hospital who met the inclusion criteria were divided into two groups between May 2019 and May 2021, 50 in each group. The control group was treated with intravenous drip of amiodarone and routine treatment, while the observation group was treated with modified Fired Glycyrrhizae Decoction on basis of control group. Both groups were treated for 2 weeks. Before and after treatment, TCM syndromes were scored. The quality of life was assessed by World Health Organization Quality of Life Scale (WHOOLQ-100). The plasma or serum specific viscosity, fibrinogen and ESR were detected by non-invasive hemodynamic detector. The levels of cardiac troponin (cTnT), creatine kinase (CK) and brain natriuretic peptide (BNP) were detected by ELISA. The disappearance time of symptoms was observed. The adverse reactions were recorded. And the clinical responsive effect was evaluated.Results:The difference in total response rate between observation group and control group was not statistically significant [92.0% (46/50) vs. 90.0% (45/50); χ2=0.12, P=0.727]. After treatment, scores of fluster and shortness of breath, panic and irritability, and mental fatigue in the observation group were significantly lower than those in the control group ( t=7.38, 9.88, 4.87, P<0.01), and scores of physical function, independence and social relations were significantly higher than those in the control group ( t=8.69, 6.32, 5.76, P<0.01). After treatment, levels of plasma specific viscosity, fibrinogen and ESR in the observation group were significantly lower than those in the control group ( t=13.59, 8.30, 8.80, P<0.01). After treatment, levels of serum cTnT [(33.45±3.44) mg/L vs. ( 39.71±4.02) mg/L, t=8.37], CK [(70.49±7.32) U/L vs. (82.15±8.41) U/L, t=7.40] and BNP [(223.41±20.36) ng/L vs. (244.58±20.74) ng/L, t=5.15] in the observation group were significantly lower than those in the control group ( P<0.01). The disappearance time of palpitation, chest tightness and dizziness in the observation group was significantly earlier than those in the control group ( t=10.44, 11.91, 5.75, P<0.01). During treatment, differences in incidence of adverse reactions between observation group and control group was statistically significant [4.0% (2/50) vs. 32.0% (16/50); χ2=4.00, P=0.046]. Conclusion:The modified Fired Glycyrrhizae Decoction combined with routine western medicine can improve clinical symptoms, hemodynamics and levels of myocardial enzymes in CA patients after BCL surgery, and improve the clinical curative effect.

Efficacy of cutting balloon versus semi-compliant balloon for predilation of coronary bifurcation lesions / 中国组织工程研究

BACKGROUND: There is no efficient and unified optimal scheme for treating coronary bifurcation diseases. Simple strategies such as drug-eluting stent implantation in the main branch and drug-coated balloon dilation in the sub-branches are mostly adopted. However, direct drug-coated balloon dilation cannot overcome the problem of elastic retraction of vascular wall, and there is still a risk of branch loss in the long term. OBJECTIVE: To investigate the efficacy and safety of a cutting balloon versus a semi-compliant balloon for predilation of coronary bifurcation lesions. METHODS: From August 2016 to May 2018, 110 patients with coronary bifurcation lesions admitted at Jiaozuo People’s Hospital were selected, including 83 males and 27 females, aged 18-88 years. The patients were randomized into observation and control groups (n=55/group) and received percutaneous coronary intervention. The main branch in the observation group was predilated by a cutting balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a cutting balloon prior to drug-coated balloon dilation. The main branch in the control group was predilated by a semi-compliant balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a semi-compliant balloon prior to drug-coated balloon dilation. Immediate postoperative angiography was performed to determine the forward blood flow TIMI grading of main branches and sub-branches and whether vascular dissection occurred. Coronary angiography quantitative analysis was used to detect the reference diameter, minimum inner diameter and stenosis degree of main and sub-branches before, immediately, 6 and 12 months after surgery. Major cardiovascular adverse events within 12 months after surgery were recorded in both groups. The study was approved by the Ethics Committee of Jiaozuo People’s Hospital. RESULTS AND CONCLUSION: (1) Immediate postoperative angiography showed that the TIMI level 3 rate of the main branches and sub-branches in the observation group was higher than that in the control group (P=0.007, 0.015), the incidence of vascular dissection was lower than that in the control group (P=0.023, 0.012), and the emergency target vessel reconstruction rate was lower than that in the control group (P=0.006, 0.026). (2) The success rate of coronary artery maintenance immediately and at 6 and 12 months after surgery in the observation group was higher than that in the control group (all P < 0.001). (3) The minimum inner diameter of main branches and sub-branches in the observation group was larger than that in the control group immediately and at 6 and 12 months after surgery (all P < 0.01). The degree of inner diameter stenosis was smaller than that in the control group (all P < 0.01). (4) The target vessel restenosis rate of main branch and sub-branches in the observation group was lower than that in the control group within 12 months after surgery (P=0.038, 0.043). The incidence of major cardiovascular adverse events was lower than that in the control group (P=0.025). (5) These results indicate that in coronary bifurcation lesions, drug-eluting stent implantation is suitable for main branch lesions and drug coated balloon is suitable for sub-branch lesion. Cutting balloon predilation is safer and more effective than semi-compliant balloon predilation. Cutting balloon predilation can also reduce the rate of target restenosis and the incidence of major cardiovascular adverse events.

Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions / 中华心血管病杂志

Objective@#To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions.@*Methods@#A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year.@*Results@#There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66).@*Conclusions@#The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

Understanding the Coronary Bifurcation Stenting

Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.

Use of double lumen microcatheter in interventional treatment of chronic total occlusion lesions at bifurcation / 中国介入心脏病学杂志

Objective To evaluate the efficacy and safety of double lumen microcatheters in chronic coronary artery total occlusion(CTO)lesions at bifurcation during percutaneous coronary intervention(PCI).Methods From October 2013 to March 2015,we retrospectively analysed the application of double lumen microcatheter with bifurcation CTO lesions and reviewed the patients' clinical features,coronary angiography,intervention operation success rate,complications rates and incidence of major adverse cardiac events(including all-cause death,nonfatal myocardial infarction and target vascular remodeling).Results Twenty-three CTO lesions at bifurcation were treated with double lumen microcatheters,stenting were performed in 21 lesions and 2 lesions only received PTCA due to small blood vessel size.The operation success rate was 100％.All the 11 right coronary lesions and 3 left coronary lesions were managed using single stenting technique.Double stenting strategy was used in 9 left coronary lesions including 4 cases with mini-crush technique,4 cases with modified culottes technique and one case with modified T technique.All double stenting procedures were completed by kissing balloon expansion.There was no major adverse cardiac event occured during and after operation.Conclusion Double lumen microcatheters are useful in PCI treatment of bifurcation CTO lesions.

Prognosis and Risk Factors of PCI-treated Senile Patients with Unprotected Left Main Coronary Artery Disease: A Follow-up Study / 医学研究杂志

Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery (ULMCA) disease treated with PCI.Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study.All patients were older than 60.The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up.All the major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated throughout the follow-up period.Based on those data,Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors.Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5 (13,36.5) months and an estimated median MACCE-free survival time of 66 months by K-M method.During the follow up,all-cause mortality,non-fatal myocardial infarction,non-fatal cerebrovascular events and target vessel revascularization rates were 6.59％,0.55％,0.55％ and 15.93％ respectively,the incidence of all MACCE was 23.63％.A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI.According to the multivariate-adjusted Cox regression analysis,diameter of left main stent (HR =0.37,95％ CI:0.17-0.82,P =0.014),bifurcation lesion (HR =1.92,95％ CI:1.O1-3.62,P =0.045),smoking index ＞ 50pack / year (HR =3.78;95％ CI:1.29-11.05,P =0.015) were the independent risk factors of MACCE.EuroSCORE Ⅱ ≥2％ (HR =3.96,95％ CI:1.15-13.61,P =0.029) was the independent risk factor of all-cause death.Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable.Most MACCEs occurred in the first 2 years after the PCI.Small left main stents diameter,bifurcation lesions,smoking index ＞ 50 pack/year and EuroSCORE Ⅱ ≥2％ were the risk factors for poor prognosis in patients with ULMCA disease.

The Application of the Technique in the Protection of PCI / 昆明医科大学学报

Objective To explore the treatment of percutaneous coronary intervention (PCI), and to comparatively study on the protection of side support by using the active and passive expansion technique.Method 78 patients with coronary artery disease were protected by using balloon technique, there were two groups: the active expansion group (n=41) and the side support balloon (n=37), the TIMI classification、myocardial perfusion rating (MBG), TIMI myocardial perfusion rating (TMP) and the incidence of marginal vascular interlayer were observed and analyzed. Results After the main support was put in, the proportion of patients with side branches of TIMI、 MBG and TMP was at level 3 and the proportion of patients with active balloon expansion was 93％, the margin expansion group was 84％, the difference was not statistically significant (P＞0.05); the incidence of intersecting vascular interlayer in active dilatation group was 24％, the margin expansion group was 8％, and there were statistical differences (P＜0.05). Conclusions Using the technique of holding balloon to protect the side branches, both the active expansion of the side support balloon and the expansion of the side support balloon can significantly reduce the risk of the main stent placement in the posterior branch of the blood vessel, however the incidence of side branch vascular interlayer was lower.

Impact of Bifurcation Angle on Side Branch Occlusion During Coronary Bifurcation Intervention in Relevant Patients / 中国循环杂志

Objective:To investigate the impact of bifurcation angle (BA) on side branch occlusion (SBO) during percutaneous coronary intervention (PCI) in relevant patients. Methods: A total of 1171 consecutive patients with 1200 bifurcation lesions who received one stent technique were studied. Based on the median BA of 52°, the patients were divided into 2 groups:Low angle group, n=587 patients with 600 bifurcation lesions and High angle group, n=584 patients with 600 bifurcation lesions. SBO was deifned by either side branch blood lfow disappeared or TIMI grade decreased after PCI. The occurrence rate of SBO was investigated and the impact of BA on SBO during PCI was evaluated by multivariate Logistic regression analysis. Results:SBO occurred in 88/1200 (7.33%) bifurcation lesions. The occurrence rate of SBO in High angle group was igher than Low angle group (10.5%vs 4.2%, P Conclusion:High BA was an independent predictor of SBO after the main vessel stent implantation, which should not be ignored in clinical practice.

Risk Prediction Model and Scoring System Analysis in Patients With Side Branch Occlusion During Coronary Bifurcation Intervention / 中国循环杂志

Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.

Intravascular ultrasound-guided interventional treatment of coronary true bifurcation lesions:a clinical ;study / 介入放射学杂志

Objective To investigate the application of intravascular ultrasonography in guiding the performance of interventional management for coronary true bifurcation lesions. Methods A total of 62 patients with coronary true bifurcation lesions, who were admitted to authors’ hospital during the period from April 2010 to Jan. 2014 to receive double stenting treatment, were included in this study. The patients were randomly divided into intravascular ultrasonography group (IVUS group, n=32) and coronary angiography group(CA group, n=30). The minimal lumen diameter(MLD), the minimal lumen area(MLA), the reference lumen diameter (RLD), the length of the lesion and the diameter and length of the implanted stent were determined, and the results were compared between the two groups. During the follow-up period lasting for 12 months after percutaneous coronary intervention, the incidence of in - stent thrombus, target lesion revascularization (TLR) and major adverse cardiac events were recorded. Results The MLD values of the main artery and branches in IVUS group were higher than those in CA group, but the difference was not significant (P>0.05). The MLA, RLD, the diameter and length of the implanted stent in IVUS group were significantly larger than those in CA group (P0.05). Conclusion Intravascular ultrasound- guided double stent implantation for coronary true bifurcation lesions can help optimize the performance of stenting and improve the long-term outcome of percutaneous coronary intervention.

Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in two-stent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into one-stent group (167 lesions, 158 patients) and two-stent group (41 lesions, 41 patients). Prior to intervention, SB ostium minimal luminal diameter (MLD) was smaller in two-stent group than in one-stent group (1.08+/-0.55 mm vs. 1.39+/-0.60 mm; P=0.01). But, immediately after PCI, SB MLD of two-stent group became greater than that of one-stent group (2.41+/-0.40 mm vs. 1.18+/-0.68 mm; P<0.01). Six to nine months after PCI, this angiographic superiority in SB MLD of two-stent group persisted (1.56+/-0.71 mm vs. 1.13+/-0.53 mm; P<0.01), although there was larger late loss in two-stent group (0.85+/-0.74 mm vs. 0.05+/-0.57 mm; P<0.01). In terms of target lesion revascularization and target vessel revascularization rates, one-stent group showed better results than two-stent group. We could attain wider long term SB ostium after two-stent strategy than after one-stent strategy.

Theoretical prediction of side branch compromise after main branch stenting in coronary bifurcation / 老年心脏病学杂志（英文版）

One of the main problems of treatment of bifurcation lesions is side branch (SB) stenosis appearing after stent placement in the main vessel.The aim of this study was to create quantitative method for prediction of side branch compromise extent.We accepted that the main mechanism for SB ostial stenosis is flow divider (FD) displacement from stent struts after stent implantation in the main vessel.Using easily measurable parameters from coronary angiography,as SB diameter,angle α (initial angle between axes of parent vessel and SB axis) and angle α' (angle between above mentioned axes after stent placement) we can calculate percentage diameter stenosis at branch ostium (%DS):%DS = sin (α - α')/(tan α).In boundary condition of full FD displacement %DS = cos α.We tested our theoretical predictions with fluoroscopic observation of elastic wall model of bifurcation (45°distal angle between branches)permitting wall deformations with stent.There is full coincidence of values of %DS and percentage area stenosis (%AS).The regular formulas for calculations of %DS and %AS overestimate stenosis severity between 10% and 25%.Our model tests have shown full coincidence between predicted values for %DS and observed values.We demonstrate that part of the SB ostium is not visible in regular angiography and contributes to ostial lumen area.This is a method that permits quantitative prediction of side branch compromise.

Clinical observation on sirolimus-eluting stent implantation in left main coronary artery bifurcation lesions / 中国医师进修杂志

Objective To evaluate the acute and long-term results of stenting for left main coronary artery (LMCA) bifurcation lesions. Methods Forty consecutive patients with LMCA bifurcation lesion and normal left ventricular function were included. Sirolimus-eluting stents were performed in all patients. Results (1)The average diameter of LMCA was (0.81?0.48)mm before stenting and increased to (3.53?0.22)mm after stenting.(2)The procedural success rate was 100.0%. In-hospital events including stent thrombosis,Q-wave myocardial infarction,and emergency bypass surgery did not occur in any patients,and non-Q-wave MI in one patient (2.5%).(3)Clinical follow-up was obtained in all patients at (8.43?3.24) months. There were no death and no myocardial infarction during follow-up. The major adverse cardis events rate was 20.0%.(4)The angiographic follow-up rate was 67.5% (27 of the 40 eligible patients),and the restenosis rate was 18.5% (parent vessel only 11.1%,side branch only 3.7%,and both 3.7%).(5)Different type of operation had no influence on restenosis rate during angiographic follow-up. Conclusion Sirolimus-eluting stent implantation for LMCA bifurcation stenosis appears safe and effective with regard to acute and midterm complications.