Feasibility study of guiding catheter passing through spasmodic vess els during percutaneous coronary intervention via radial artery access by the aid of PCI guiding wire and balloon / 中国介入心脏病学杂志

Objective To explore the safety and feasibility of guiding catheter passing through spasmodic vessels in patients undergoing percutaneous coronary intervention (PCI) via radial artery access by the aid of PCI guiding wire and balloon .Methods The clinical data of 33 coronary artery disease (CAD) patients undergoing PCI via radial artery access with radial artery or (and) brachial artery spasm ( group A ) were retrospectively analyzed .Among all these patients , guiding catheters were delivered through the spasmodic vessels successfully by the aid of PCI guiding wires and balloons .The clinical data of other 38 CAD patients having PCI during the same period performed by other operators via radial artery or ( and ) brachial artery approach and experienced vessel spasm were anlysed as the control ( group B ) .All patients in group B received conventional anti-spasm management during PCI .All vessel spasm was identified by angiography.For patients in group A , a diameter of 0.014 inch guiding wire was chosen to pass through the spasmodic vessel segment carefully and gently .The diameter of balloon should be chosen according to the diameter of guiding catheter .A balloon diameter of 2.0 mm and 2.5 mm was corresponded to 6F and 7F guiding catheter respectively .The balloon was advanced to the tip of guiding catheter , keeping a half in catheter and a half in vessel followed by inflating the balloon with a pressure of 8 atm.The balloon was kept inflated the guiding catheter was pushed in vitro carefully and slowly until the catheter passed through the spasmodic vessel segment .Then the balloon was deflated and pulled out together with PCI guiding wire . Exchanged a diameter of 0.035 inch wire and completed the positioning of guiding catheter .After finishing the PCI, radial or ( and) brachial angiography was performed again to observe if spasm disappeared and to determine if there any contrast medium exudation .For patients in group B , routine approach was applied including administration of nitroglycerine , diltiazem or nitroprusside etc . to relieve vessel spasm. Results The location of vessel spasm was similar in group A and group B ( P=0.150 ) , and the incidence rate of spasm in brachial artery was higher than that in radial artery in both groups .The chance of guiding catheter crossing the spasmodic vessel segment was significantly higher in group A than in group B ( 100%vs.39.5%, P=0.00).In patients whose guiding catheter could pass through the spasmodic vessel segment successfully , time spent in group A was shorter than in group B ( P=0.000 ) .The patient number which time spent was less than five minutes , five to 15 minutes and more than 15 minutes was 30 and 2 ( 90.1%vs.13.3%) , 3 and 7 ( 9.9% vs.46.7%) and 0 and 6 ( 0% vs.40.0%) in group A and in group B respectively.The incidence of forearm hematoma was lower in group A than in group B without statistical difference [6.1%(2/33) vs.18.4%(7/38), P =0.113].Conclusions It is safe and feasible for passing guiding catheter through spasmodic vessels during PCI via radial artery access by the aid of PCI guiding wire and balloon .

Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis / 老年心脏病学杂志（英文版）

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)

Comparison of multi-slice CT coronary artery imaging with coronary angiography / 中国组织工程研究

BACKGROUND: Primary studies suggest that coronary artery stenosis is highly exactly shown by 16-slice spiral CT coronary artery imaging.OBJECTIVE: To compare the accuracy and limitation between coronary angiography and multi-slice computed tomography (MSCT) coronary artery imaging to diagnose moderate and severe coronary artery stenosis. DESIGN, TIME AND SETTING: Clinical diagnostic study based on gold standard, which was carried out in the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. PARTICIPANTS: Twenty-eight patients with suspected coronary arteriosclerotic heart disease were examined by 64-slice spiral CT coronary artery imaging and coronary artery angiography during the 1-month hospitalization in the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. METHODS: 280 segments of 28 patients were quantitatively analyzed coronary artery stenosis by selective coronary artery angiography and multi-slice spiral CT imaging based on eye-measurement diameter method. MAIN OUTCOME MEASURES: True positive, true negative, false positive, false negative, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of coronary artery stenosis were measured by multi-slice spiral CT imaging.RESULTS: All 28 patients were included in the final analysis. Multi-slice spiral CT imaging showed that the sensitivity, specificity, positive predictive value, and negative predictive value were 46.5%, 97.6%, 86.8%, and 84.3%, respectively. If excluding the effect of 31 coronary segments with severe calcification, the sensitivity, specificity, positive predictive value and negative predictive value were 66.7%, 98.6%, 90.3% and 93.6%, respectively.CONCLUSION: Multi-slice spiral CT imaging is simple, reliable, noninvasive and safe; moreover, it has a good potential for diagnosing especially excluding coronary arteriosclerotic heart disease, but still some limits.

Intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction / 中国介入心脏病学杂志

Objective To assess clinical safety and effect of intracoronary transplantation of autologous bone marrow cells in patients with acute myocardial infarction(AMI).Methods Eighty four AMI patients who had received emergency thromblysis or primary PTCA were enrolled in this study.Elective PCI was undergone in these patients 10-14 days after infarction.During the procedure,50 patients received introcoronary transplantation of autologous bone marrow derived mononuclear cells and the other 34 patients received normal saline as control.All patients achieved TIMI Ⅲ flow after PCI.Dobutamin stress echocardiography,SPECT and F-18-Fluorodeoxyglucose-PET were performed 1 day before and 6 months after the transplantation.All patients finished a 2-year follow up and stress echo examination.Twenty nine patients from the transplantation group and 22 patients from the control group accepted 6-month SPECT reassessment.Results No major adverse events were recorded in all patients who received autologous bone marrow cells transplantation during follow up.Less nitroglycerin usage and increased excercise were observed in the transplantation group.Stress echocardiography showed improvement in LVEF(27.00%?0.89% pre-operation,36.80%?0.58% after 6 months and 40.94%?0.58% after 2 years,P