Impact of interventional therapy on top of standard drug therapy on left ventricular structure and function in HFrEF patients complicating with middle aortic syndrome caused by Takayasu arteritis / 中华心血管病杂志

Objective: To evaluate the impact of interventional therapy on top of drug therapy on cardiac function and structure in heart failure with reduced ejection fraction (HFrEF) patients complicating with middle aortic syndrome caused by Takayasu arteritis (TA-MAS). Methods: It was a retrospective longitudinal study. The data of patients with TA-MAS and HFrEF, who received interventional therapy on top of drug therapy in Fuwai Hospital from January 2010 to September 2020, were collected and analyzed. Baseline clinical data (including demographic data, basic treatment, etc.) were collected through the electronic medical record system. Changes of indexes such as New York Heart Association (NYHA) classification, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) before and after therapy were analyzed. Results: A total of 10 patients were collected. There were 8 females in this patient cohort, age was (18.4±5.0) years and onset age was (15.3±5.0) years. All 10 patients received standard heart failure medication therapy in addition to hormone and/or immunosuppressive anti-inflammatory therapy, but cardiac function was not improved, so aortic balloon dilatation and/or aortic stenting were performed in these patients. The median follow-up was 3.3(1.3, 5.6) years. On the third day after interventional therapy, the clinical symptoms of the 10 patients were significantly improved, NYHA classfication was restored from preoperative Ⅲ/Ⅳ to Ⅱ at 6 months post intervention(P<0.05). Compared with preoperation, NT-proBNP (P=0.028), LVEDD (P=0.011) and LVMI (P=0.019) were significantly decreased, LVEF was significantly increased (P<0.001) at 6 months after operation. Compared with preoperation, NT-proBNP (P=0.016), LVEDD (P=0.023) and LVMI (P=0.043) remained decreased, LVEF remained increased (P<0.001) at 1 year after operation. Conclusion: Results from short and medium term follow-up show that interventional therapy on top of heart failure drug therpay can effectively improve left cardiac function and attenuate cardiac remodeling in patients with TA-MAS comorbid with HFrEF.

The Impact of Renal Artery Stenting Techniques on Interventional Therapy Upon Anatomical Correlation of Abdominal Aorta and Renal Artery / 中国循环杂志

Objective: To evaluate the impact of renal artery stenting techniques upon anatomical correlation of abdominal aorta and renal artery. Methods: A total of 182 patients with unilateral atherosclerotic renal stenosis and received renal artery stenting in our hospital from 2012-01 to 2013-12 were retrospective studied. Based on the angle of infrarenal abdominal aorta and renal artery, the patients were divided into 3 groups: Group A (91-120)°, n=20, Group B (61-90)°, n=125 and Group C, (30-60)°, n=37. According to the tortuosity of infrarenal abdominal aorta and/or iliac artery, the patients were divided into 2 groups: Non-tortuosity group, n=146 and Tortuosity group, n=36. Operative techniques included in ①wire anchoring alone, ②wire anchoring+balloon rod assisting and③anchoring with wire and balloon. The ratio of upper extremity artery approaching (brachial or radial artery), X-ray exposure time, operation time, contrast dosage and relevant complications were compared among different groups upon stent placing. Results: Compared with Group A and Group B, the following parameters were increased in Group C: ratios for using technique ② + ③ (100.0% vs 20.0%, 31.2%), for extremity artery approaching (10.8% vs 0.0%, 1.6%); X-ray exposure time (9.2±3.8) min vs (5.2±3.1) min, (5.3±2.8) min, operation time (27.4±6.5) min vs (18.6±5.7) min, (20.5±6.1) min; contrast dosage (59.3±8.4) ml vs (44.8±7.2) ml, (48.4±7.3) ml and the incidences of relevant complications (8.1% vs 0.0%, 0.8%), all P<0.05. The above parameter were similar between Group A and Group B. Compared with Non-tortuosity group, the following parameters were elevated in Tortuosity group: ratios for using technique ②+③ (72.2% vs 11.6%), for extremity artery approaching (11.1% vs 1.4%), the total incidences of X-ray exposure time, operation time, contrast dosage and relevant complications (8.3% vs 0.7%), all P<0.05. Conclusion: The acute angle of infrarenal abdominal aorta and renal artery as well as the tortuosity of infrarenal abdominal aorta may increase the difficulty in renal artery interventional therapy .

Safety and Feasibility Assessment for Treating Severe External Carotid Artery Stenosis and Ipsilateral Internal Carotid Artery Occlusion by External Carotid Artery Stenting / 中国循环杂志

Objective: To assess the safety and feasibility for treating the patients with severe external carotid artery (ECA) stenosis and ipsilateral internalcarotid artery (ICA)occlusion by external carotid artery steting (ECAS). Methods: A total of 17 consecutive patients with severe ECA stenosis and ipsilateral ICA occlusion treated in our hospital by ECAS from 2008-01 to 2013-06 were retrospectively studied. Post-operative improvements of cerebral ischemia and neurocognitive function [Mini-mental state examination (MMSE) and Montreal cognitive assessment (MOCA)] were evaluated, complications at peri-operative and 12 months follow-up period were recorded. Results: The patients' mean age was (65.4±8.0) years including 13(76.5％) male. The success rate of ECAS was 100％;2 patients had hemodynamic depression at peri-operative period and were completely recovered by 2 days treatment.1 patient suffered from contralateral minor stroke at 12 months follow-up time, the other 16 patients were without cerebral ischemia symptoms. No complication occurred at peri-operative and 12 months follow-up period. Compared with pre-operative condition, MMSE score [(25.1±1.4) vs (23.3±1.8), P<0.01] and MOCA score [(23.9±1.2) vs (22.2±1.6), P<0.01] were increased at 3 months after ECAS; both scores were continuously increasing during 12 months follow-up period. Conclusion: ECAS may improve cerebral ischemia and cognitive function in patients with severe ECA stenosis and ipsilateral ICA occlusion.