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Objective To evaluate the safety and efficacy of drug-coated balloon in small branch ostial lesions of coronary arteries (Medina type 0,0,1 lesion).Methods A total of 48 patients were enrolled in the study and they were randomly divided into the Drug-Coated Balloon (DCB) angioplasty group (22 cases) and the Cutting Balloon (CB) angioplasty group (26 cases).They underwent percutaneous coronary intervention (PCI) with either DCB or with CB in small branch ostial lesions of coronary arteries respectively,The immediate outcomes and long-term efficacy were investigated.Results There were no statistical differences between the two groups in baseline clinical date before PCI.There were no coronary perforation,pericardial tamponade,acute thrombotic events in the two groups.There was no significant difference in minimal lumen diameter (MLD) immediately after PCI between the two groups.During followup angiography,the MLD in the DCB group was significantly larger than in the CB group [(1.8 ± 0.2) mm vs.(1.5 ± 0.3) mm,P =0.006].There were no death,nonfatal myocardial infarction or revascularization recorded in the groups during 6 months of follow-up.Conclusion The immediate outcomes between DCB and CB were similar in small branch ostial lesions for coronary arteries angioplasty.The long-term efficacy of DCB angioplasty is better than CB angioplasty.
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Objective To investigate the effect and safety of Guard wire technology in percutaneous coronary intervention( PCI) of ostial lesions and the treatment of passing ostial lesions. Methods Thirty?five cases patients needing PCI of ostial lesions were selected and divide randomly in to A group(n=18) and B group(n=17) . A group used Guard wire technology and B group used common method. The X?ray exposure time,complications,the amount of contrast agents of two groups were analyzed. Forty?six cases patients needing the treatment of passing ostial lesions were divided randomly into C group( n=25) and D group( n=21) . C group used Guard wire technology and D group used common method. Complications of two groups were investigated. Results The X?ray exposure time, the amount of contrast agents and complications of A group were fewer than that of B group,the difference were significant((5. 7±0. 6) min vs. (9. 3±1. 1) min,(84. 3 ±6. 4) ml vs. (94. 1±10. 0) ml,6%(1/18) vs. 35%(6/17);t or χ2=-11. 80,-3. 50,4. 80;P<0. 05). The complications of C group was lower than that of D group,and the difference was significant( 4%( 1/25) vs. 29%( 6/21);χ2=5. 30,P<0. 05) . Conclusion Guard wire technology is safe and useful in percutaneous coronary intervention of ostial lesions and the treatment of passing ostial lesions,and it is feasible in clinical practice.
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Objective To evaluate the safety and clinical efficacy of stent implantation using a rapid artificial cardiac pacing technique on ostial lesions of left anterior descending artery (LAD).Methods From Jun 2008 to Nov 2010,38 patients with ostial lesions of LAD were recruited and randomly divided into two groups:patients with stent implantation using a rapid artificial cardiac pacing technique (pacing group,n =19 ) and patients with direct stent implantation (no-pacing group,n =19 ).Post-stenting examination was performed.Patients were followed-up for 9 months and coronary angiography was reviewed.The immediate success rate,major adverse cardiac events including death,reinfarction and target vessel revascularization,late lumen loss,sent thmmbosisin,rent-restenosis were compared between these two groups.Results There were no significant differences in the baseline values,disease characteristics and instant response to surgery between pacing and no-pacing groups(P ＞ 0.05 ).The time cost for stent placement was significantly shorter in the pacing group than that in the no-pacing group ( [ 16.5 ± 0.5 ] s vs.[46.6 ± 1.4 ] s,t =88.256,P =0.004 ).After surgery,there was no acute or subacute thrombosis,in-stent restenosis or occlusion for patients in the pacing group.In the no-pacing group,one patient developed acute thrombosis.The symptoms disappeared after thrombus aspiration and balloon dilatation by emergency percutaneous coronary intervention.Patients were followed up for 270 -275 days,and patients in the pacing group received post-stenting coronary angiography 9 months after stent implantation using a rapid artificial cardiac pacing technique,and no in-stent re-stenosis was found.During this period,nobody had adverse events such as death,myocardial infarction or target lesion revascularization,while five cases with in-stent restenosis (50％ -60％ )were found in the no-pacing group,without further target lesion reconstruction due to symptomless.Conclusion Compared with previous positioning technique,stent implantation using a rapid artificial cardiac pacing technique on treatment of ostial lesions of LAD is safer,and more effective.It is a favorable method for accurate positioning of bracket and can improve the prognosis,reduce the occurrence of acute thrombosis and in-stent restenosis.
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Ostial lesions present many challenges for percutaneous coronary intervention (PCI). Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wire technique and focused-force angioplasty.