ABSTRACT
Propósito del estudio: el objetivo primario del estudio fue valorar la tasa de eventos cardiacos mayores después de cirugía de revascularización coronaria por angioplastia con stent en el injerto de vena safena, comparados con los de angioplastia con stent en la arteria coronaria nativa, tanto en el periodo de hospitalización como a largo plazo. Métodos: estudiamos a 127 pacientes, 49 con stent en injerto de vena safena (grupo 1) y a 78 con stent en arterias coronarias innatas (grupo 2). Resultados: no hubo diferencias significativas en la edad, ni en frecuencia de diabetes, tabaquismo, hipertensión arterial, dyslipidemia, fracción de expulsión del ventrículo izquierdo o clase funcional entre los grupos. La incidencia del fenómeno de no reflujo persistente fue mayor en el grupo 1 (10.2% contra 1.2%, p = 0.0001) y la suma de eventos cardiacos sólo fue distinta durante el primer mes (10.2% contra 2.5%, p = 0.041). La supervivencia sin eventos cardiacos a 36 meses fue menor en los pacientes del grupo 1 (65.0% contra 89.1%, p = 0.024). Conclusiones: La suma de eventos cardiacos mayores fue mayor en el grupo 1 y la supervivencia sin dichos eventos a 3 años fue superior en los pacientes con endoprótesis en arteria coronaria natural.
Objective: Our main objective was to compare the in-hospital and long-term outcomes of saphenous vein graft stenting and native coronary artery stenting in patients with previous coronary artery bypass grafting. Methods: We studied 127 patients who had prior coronary artery bypass; they were divided in two groups, according to the kind of percutaneous coronary intervention performed. The first group included 49 patients with saphenous vein graft stenting and the second group included 78 patients who underwent native coronary artery stenting. Results: There was no significant difference in age, incidence of diabetes, smoking, arterial hypertension, dyslipidemia, left ventricular ejection fraction or in the New York Heart Association functional class between both groups. The incidence of no reflow phenomenon was higher in group 1 (10.2% vs. 1.2%, p = 0.0001). The cumulative incidence of major adverse cardiac events was different between groups at 1 month (10.2% vs. 2.5%, p = 0.041). There was a lower MACE (major adverse cardiovascular events) free survival at 36 months in the saphenous vein graft stenting group (65.0% vs. 89.1%, p = 0.024). Conclusions: Major in-hospital complications occurred more frequently in the saphenous vein graft stented group. MACE-free survival at 3 years was higher in the native coronary artery stent patients.
Subject(s)
Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Vessels/surgery , Stents , Saphenous Vein/surgery , Saphenous Vein/transplantation , Cardiovascular Diseases/epidemiology , Postoperative Complications/epidemiology , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Objective To study changes of neuroendocrine in patients with ST segment elevation acute myocardial infarction (STEMI) after using distal protection device (GuardWire PlusTM). Method Seventy patients with STEMI received percutaneous coronary intervention (PCI) in Municipal Hospital Qingdao, during September 2004 to December 2006. They were randomdy (random numbs) enrolled in this prospective and control study. All the patients were divided into 2 groups: the distal protection device group (GW) and the non-distal protection device group (NGW).The inclusion criteria were:onset within 6 hours, chest pain more than 30 minutes without response to nitroglycerin, two or more adjacent ST segnents elevated over 0.2 mv,the proximal or middle diameter of infarction artery over 3 mm, and the increased plasma creatine kinase. The exclusion criteria were fluctuation in hemodynamics, severe heart failure, arteriopathy of left main coronary artery, mechanical complications of acute myocardial infarction and multi-vessel disease scheduled for coronary artery bypass. The plasma levels of endothelin(ET) , plasma renin activity (PRA),aldosterone (ALD),angiotensin Ⅱ (Ang Ⅱ), norepinephrine (NE) and epinephrine (E) were measured on the day of operation and on the 1st,2nd,3rd and 5th day after operation, respectively. The t-test was used to compare those neuroendocrine elements between two groups. Results There were no differences in plasma levels of all the neuroendocrine elements between two groups before operation. Compared with the NGW group, the levels of neuroendocrine elements in the plasma rapidly decreased in the GW group at 1 d after the operation ( P ＜ 0.05). Conclusions In patients with ST segment elevation acute myocardial infarction, the distal protection device can decrease the changes in neuroendocrine.
ABSTRACT
Distal protection devices such as FilterWire EX have been widely used in carotid artery stenting, however, the large amount of atherothrombotic debris entrapped in the filter could reduce or stop antegrade flow. We present a case of pseudo-no-reflow phenomenon after postdilatation of the stent in a patient with asymptomatic carotid artery stenosis. After several passes using an Export Aspiration catheter, normal flow in the internal carotid artery was restored. Aspiration thrombectomy can successfully recover pseudo-no-reflow phenomenon.
Subject(s)
Aged , Humans , Male , Blood Vessel Prosthesis Implantation , Carotid Arteries/diagnostic imaging , Carotid Stenosis/diagnosis , No-Reflow Phenomenon , Stents , Thrombectomy/instrumentationABSTRACT
Objective To study the effect of a distal protection device (Pereusurge GuardWire: GW) on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention. Method Acute STEMI patients treated with primary PCI were eligible to be studied. Inclusion criteria were: (1) within 12 hours from the onset of chest pain;(2) culprit leision with diameter stenosis≥70% and TIMI flow grade≤2. Exclusion criteria were:(1) patients undergoing thrombolytic therapy before PCI; (2) a culprit lesion in the left main coronary artery;(3)reference vessel diameter
ABSTRACT
Distal embolization, such as plaque debris and thrombus during percutaneous coronary and carotid interventions, often lead to virtually untreatable small vessel occlusions and the no-reflow phenomenon, which may cause periprocedural end organ ischemia and infarction. This is clinically important as the one-year mortality is doubled in patients with a periprocedural myocardial infarction. To prevent a distal embolization a number of distal protection devices have been developed, with others still under development, such as a balloon occlusion device (PercuSurge GuardWire), numerous filter devices (FilterWire EX, AngioGuard, Mednova Neuroshield, AccuNet) and a catheter occlusion device (Parodi Anti-Emboli System). The usefulness and roles of distal protection devices, for cardiovascular intervention, are reviewed.
Subject(s)
Humans , Angioplasty, Balloon , Balloon Occlusion , Catheters , Infarction , Ischemia , Mortality , Myocardial Infarction , No-Reflow Phenomenon , ThrombosisABSTRACT
Objective To evaluate the efficacy and safety of distal embolic protection device(DPD) on acute myocardial infarction(AMI) with ST-segment elevation.Methods Two hundred and sixty-seven patients with ST-segment elevation AMI treated in emergency with percutaneous coronary intervention(PCI) from Jan.1,2004 to Dec.31,2005 in the Department of Cardiology,Xijing Hospital were studied retrospectively.169 patients were included in control group and 98 in DPD group.Patients in control group were treated with emergency PCI,while those in DPD group were treated with DPD during emergency PCI.The incidence of "no-reflow" phenomenon,thrombolysis in myocardial infarction(TIMI) 3 flow,and ST segment resolution were observed,and mortality in-hospital and left ventricular ejection fraction(LVEF) at 1 week after PCI were compared between the two groups.Results The incidence of "no-reflow" was 3.06%(3/98) in DPD group and 13.61%(23/169) in control group(P
ABSTRACT
Objective To evaluate the safety and efficacy of distal protection device(GuardWire PlusTM) during high risk PCI in patients with acute myocardial infarction(AMI).Methods Seventy-two patients with AMI admitted from September 2004 to May 2006 who received PCI were categotized into the GuardWire PlusTM group(GW group,n=38) and the conventional guidewire group(NGW group,n=34) according to the device used.The basic clinical characteristics,angiographic results,degree ST of resolution and changes in serum CK-MB and cTnI levels were compared.LVEF was measured by echocardiography at discharge and again at 3 months after PCI.Results All the distal protection deveices were applied successfully in the GW group.A greater percentage of patients in the GW group had post procedural ST-segment resolution ≥50% compared with the NGW group(68.4% vs 41.2%,P
ABSTRACT
Objective To evaluate the effects and safety of PercuSurge distal protection device(DPD) in coronary intervention in patients with acute myocardial infarction. Methods From December 2003 to December 2005, 174 acute myocardial infarction patients who received primary coronary intervention were included into this study. Patients were divided into the DPD group (n=78) and the control group (n=96) according to whether Percusurge DPD was attempted during emergency PCI. The basic clinical characteristics, angiographic results, and follow up data before discharge were compared. TIMI flow grades and myocardial blush grades were performed in all cases after emergency PCI. Results Success application was achieved in 72 out of 78 patients with PercuSurge DPD with varies extent of material collected from the basket. There was no significant difference between the two groups in basic clinical characteristics and angiogram before PCI. Post-PCI TIMI flow grades (94.9% vs 79.2%) and myocardial blush grades (2.65?0.68 vs 2.22?0.94) were significantly higher in the DPD guoup than in the control group(P