Acute coronary syndrome in women below 50 years of age: risk factors and clinical and angiographic features / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the risk factors and angiographic features of acute coronary syndrome (ACS) in women below 50 years of age.</p><p><b>METHODS</b>A total of 131 women with ACS aged 50 years or younger were enrolled in this study as the case group, with another 425 women aged below 50 years with normal coronary angiographic findings as the control group. The risk factors and clinical and coronary angiographic features of ACS were analyzed.</p><p><b>RESULTS</b>Compared with the control group, significantly higher frequencies of dyslipidemia, hypertension (especially diastolic hypertension), diabetes, or a positive family history for coronary artery disease (CAD) were found in ACS group (P<0.05) . The proportion of post-menopausal women and the menopausal ages were similar between the two groups (P>0.05), but the mean diastolic pressure was significantly higher in ACS group than in the control group (P<0.05). Among the menopausal women, the conventional risk factors for ACS were similar between the two groups with the exception of family history CAD, which was more frequent in ACS group. Serum total cholesterol and triglyceride levels were significantly higher in ACS group than in the control group (P<0.05), but the levels of high- and low-density lipoprotein cholesterol levels were comparable between them. Positive findings of urine protein were more frequent in ACS group. In ACS group, 54.2% of the patients had a single diseased artery, 29.6% had more than one diseased artery, and 16.0% had slightly diseased or even normal coronary arteries; the lesion was found most commonly in the left anterior descending artery.</p><p><b>CONCLUSION</b>In women with ACS below 50 years of age, the risk factors of ACS included the conventional risk factors of CAD and a positive finding of urine protein. Menopause is not associated with an increased incidence of ACS. A substantial portion of these ACS patients can have slightly diseased and even normal coronary arteries.</p>

A new technique for bilateral angiography in a single radial access / 中华心血管病杂志

<p><b>OBJECTIVE</b>To develop a new technique of bilateral angiography in a single radial access (BASiRalA) which can reduce a puncture site.</p><p><b>METHODS</b>From March 2011 to February 2012, 13 cases of coronary heart disease patients with chronic total occlusion (CTO) were treated (6 CTOs in right coronary artery and 7 in left anterior descending artery). All patients underwent percutaneous coronary intervention (PCI) via the right radial artery access and 6 F guiding catheters were delivered to the diseased artery. Once the wires crossed the CTO lesions and were uncertain if the wires were in true lumen or not, BASiRalA was performed. The Finecross microcatheters were advanced out of the 6 F guiding catheter, then withdraw 6F guiding catheter to the opening of diseased artery, the soft wires were manipulated into the middle portion of opposite coronary artery. After that, the microcatheters were advanced to this segment or the branches relative to the collateral vessels connected with CTOs. After pulling out the wires, microcatheter injections can be performed for contralateral angiography. BASiRalA related complications were observed after the procedure.</p><p><b>RESULTS</b>BASiRalA technique was applied to 13 CTOs and 10 procedures succeeded (76.92%). BASiRalA failed in 3 cases and the wires and microcatheters could not be advanced to the opposite coronary arteries within 20 minutes. Alternatively, contralateral angiography via femoral arteries was performed in these 3 patients. The average time of BASiRalA technique was 7 (5 - 13) minutes and the shortest time of wires crossing to the opposite coronary artery was 5 seconds. There was no procedure induced complication during procedure or post procedure.</p><p><b>CONCLUSION</b>BASiRalA technique is feasible in treating CTO patients by PCI.</p>

Retrograde percutaneous recanalization of chronic total occlusion of the coronary arteries via epicardial coronary collateral artery in 5 patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>to explore the feasibility of percutaneous recanalization by retrograde approach via epicardial collaterals.</p><p><b>METHODS</b>retrograde percutaneous coronary intervention (PCI) via epicardial collaterals was performed in 5 patients with previously failed antegrade PCI from April 2009 to November 2009. 7 F guiding catheters were engaged in donor artery. Hydrophilic wires and microcatheters were crossed to the distal ends of chronic total occlusion (CTO) lesions via epicardial collaterals. Four retrograde wires were exchanged into stiffer wires and further crossed the CTO, eventually went into the 6 F antegrade guiding catheters and were jailed by a 2.5 mm balloon. After dilatations of retrograde balloons, the lesions were crossed by antegrade wires, and finalized by conventional PCI method. One case was recanalized with retrograde wire trapping technique and another case was recanalized by reverse CART technique.</p><p><b>RESULTS</b>the epicardial collaterals were reached from left anterior descending branch (LAD) to distal right coronary artery (RCA) via apex in 3 patients, from left circumflex branch via left atrium branch to posterior descending artery and RCA in 1 patient and from obtuse marginal artery to diagonal artery and LAD in 1 patient. CTO was successfully recanalized and stents were implanted in 4 patients and failed in 1 patient despite successful wire positioning to the distal end of CTO. There was no procedure-induced cardiovascular event in all cases.</p><p><b>CONCLUSIONS</b>epicardial collaterals may not be used as a routine route in retrograde approach PCI due to the potential risk of myocardial rupture and pericardial tamponade. In some cases with unavailable or unsuitable septal collaterals, epicardial collaterals may be used as an alternative route for CTO recanalization.</p>