[In-hospital outcomes of endarterectomy and coronary artery bypass grafting in multiple diffuse lesions of coronary arteries]. / Gospital'nye rezul'taty éndarteréktomii i koronarnogo shuntirovaniia pri mnozhestvennom diffuznom porazhenii koronarnykh arterii.

BACKGROUND: According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. AIM: The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. PATIENTS AND METHODS: This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. RESULTS: The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. CONCLUSION: In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.

Influence of proximal drug eluting stent (DES) on distal bare metal stent (BMS) in multi-stent implantation strategies in coronary arteries.

The aim of this study was to investigate the drug distribution in arteries treated with DES-BMS stenting strategy and to analyze the influence of proximal DES on distal segments of BMS. A straight artery model (Straight Model) and a branching artery model (Branching Model) were constructed in this study. In each model, the DES was implanted at the proximal position and the BMS was implanted distally. Hemodynamic environments, drug delivery and distribution features were simulated and analyzed in each model. The results showed that blood flow would contribute to non-uniform drug distribution in arteries. In the Straight Model the proximal DES would cause drug concentration in BMS segments. While in the Branching Model the DES in the main artery has slight influence on the BMS segments in the branch artery. In conclusion, due to the blood flow washing effect the uniformly released drug from DES would distribute focally and distally. The proximal DES would have greater influence on the distal BMS in straight artery than that in branching artery. This preliminary study would provide good reference for atherosclerosis treatment, especially for some complex cases, like coronary branching stenting.

Long-term angiographic outcomes of sirolimus- and paclitaxel-eluting stent placement in diabetes, long lesions, and small vessels.

We conducted a lesion-based retrospective sub-analyses of diabetes mellitus (DM), diffuse long lesions (stented segment ≥40 mm; LLs), and small vessels (SVs; reference diameter ≤2.6 mm) in patients who received sirolimus- (SESs) or paclitaxel-eluting stents (PESs) for nonrandom treatment of de novo native coronary stenosis in a clinical practice setting. During the period from May 2007 to February 2009, 490 of 682 PES-treated and 293 of 386 SES-treated lesions were angiographically followed up within 1500 days of PCI, and the retrospective investigation was conducted in April 2013. The frequencies of target lesion revascularization (TLR; any recurrent PCI including both marginal stent restenosis) and binary in-stent restenosis (percentage diameter of in-stent stenosis >50%) upon follow-up angiography, evaluated by adjusting 25 baseline variables using propensity score matching analysis, after placement of SESs and PESs were the following: DM (n = 124 per arm), 14.5 vs. 15.3% (p = 0.842), and 14.5 vs. 16.1% (0.856); LLs (n = 81), 16.0 vs. 21.0% (0.433), and 12.3 vs. 22.2% (0.117); SVs (n = 107), 11.2 vs. 29.9% (<0.001), and 11.2 vs. 30.8% (<0.001), respectively. The p values of log-rank tests for the cumulative TLR-free ratios after SES and PES placement were 0.504 in DM, 0.625 in LLs, and <0.001 in SVs group, respectively. Thus, compared to PES, SES showed the equivalent efficacy for DM, the tendency to be superior for LLs due to approximately 24-45% reductions in TLR and binary restenosis rates, and the promising superiority for SVs on the angiographic outcomes during a long-term observational interval.

Evaluation of long stent implantation in diffuse coronary lesions for octogenarians / 老年心脏病学杂志（英文版）

Objective To evaluate angiographic and clinical outcomes of ≥ 20mm long stents or overlapped stent implantation in diffuse coronary lesions for octogenarians, in comparison with patients under sixty. Methods Two groups (Group O: 47 lesions in 44 octogenarians, aged 81± 3 years; Group Y: 64 lesions in 58 patients under sixty, aged 54 ± 4 years) were compared with a 6-month follow-up. Results Success rate of the procedures was 100%. None had in-hospital major adverse cardiac events (MACE). There was no significant difference in angiographic restenosis between the groups at follow-up (Group O vs Group Y, 29.8 % vs 26.6 %, P = NS). The revascularization of target vessel and MACE was less in Group Y, but these showed no statistical significance (15.6% vs 23.4% and 20.7% vs 25.0%, respectively). Conclusions Long stent implantation for diffuse coronary lesions in octogenarians appears safe and feasible, with high procedural success and favorable long-term outcomes.

Review of Magnetic Resonance Diffusion-Weighted Imaging in Liver / 中国普外基础与临床杂志

Objective To review the examination techniques and the current research progress of the magnetic resonance diffusion weighted-imaging (DWI) used in liver. Methods The recent and relevant literatures about the principles and the current study situation of liver DWI were scrutinized and analyzed retrospectively. In addition, the existing problems of liver DWI were discussed. Results DWI could demonstrate the normal and abnormal structure and function through measuring the diffusion motions of water molecule in the liver. With the improving technology and better understanding of diffusion dynamics, DWI has been used for the diagnosis and differential diagnosis for hepatic diseases. Conclusion DWI as a non-invasive examine method, may provide valuable functional information for clinical diagnosis and treatment.

Initial CT Findings of the Early Death after Head Injury

We examined the initial CT findings of the early(within on week) death after head injury, retrospectively. The patient population consisted of 182 patients who were admitted to the Soonchunhyand University Chonan Hospital, and were examined by CT, from August 1986 to May 1990 after head injury. We compared clinical features and radiological findings between the group of focal lesion and the group of diffuse lesion. The focal lesion was found in 47.8%, while the diffuse lesion was found in 45.6%. Statistically significant differences were found in the age, Glasgow Coma Score(GCS) on admission, injury Severity Score(ISS), hypotension, and hypoxia. The focal lesion was more common in the aged, while the diffuse lesion was common in the young(less than 40 years of age). Patients with high GCS(more than 8) constitued 25.3% of the focal lesion, while only 6.0% of the duffuse lesion had the high GCS. ISS was higher than 30 in 67.5% of the diffuse lesion, while 32.2% of the focal lesion had ISS of 30 or more. The causes of injury was pedestrian traffic accident in 46.5% and passanger's traffic accident in 31.8%. Midline shift(more than 3mm), compressed ventricles, and obliteration of the suprasellar cistern and quadrigeminal cistern were observed in 34.1%, 82.4%, 67.6%, and 58.2%, respectively. Lesions with severe midline shift were focal in 93.1% and lesions without midline shift were diffuse in 88.4%(P<0.005). Cranial vault fracture was noticed in 68.2%, and basal skull fracture was found in 28.8%. The frequency of basal skull fracture was high in the diffuse lesion(P<0.005). In this study, we could presumed that 17.2% to 25.3% of the patients with focal lesions could be saved, if proper treatment was given. Since the diffuse lesion was responsible for nearly half of the early death after head injury, proper treatment or prevention should be made. Prevention of the diffuse lesion seems to be possible by correction of hypotension and hypoxia for the diffuse lesions were intimately related to them. At any event, further studies on the diffuse brain injury are required.