RESUMO
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 .
RESUMO
Ohjective To study the effects of emphysema on peripheral skeletal muscle biomechanics,pathomorphology and oxidative metabolism in rats.Methods Twenty Sprague-Dawley rats were used and randomized equally into a control group and an emphysema group.A dose of 40 U/100 g body weight of porcine pancreatic elastase was instilled into the trachea of the animals of the emphysema group to model emphysema,while the same volume of saline was instilled into those of the control group.Twenty weeks after instillation,in situ mechanical properties of gastrocnemius were evaluated.Gastrocnemius fiber type composition and capillary density (CD) were assessed by using ATPase staining.Lipofuscin accumulation (LI/F) was determined with the ferric-ferricyanide reduction test technique.Immunohistochemistry was used for the detection of nitric oxide synthases (NOS) in gastrocnemius.The muscle biopsy homogenate was used to measure the activity of superoxide dismutase (SOD),catalase (CAT),NOS,total antioxidant capacity (T-AOC) and the content of nitric oxide (NO).Results Emphysema increased fatigability and decreased the recovery rate of gastrocnemius muscle [(145.0 ± 55.4) s vs (55.2 ± 29.3)s,P ＜ 0.05].Compared to control,the gastrocnemius muscle in rats with emphysema had a lower CD [(513.9±71.1)n/mm2 vs (578.6 ±59.9)n/mm2,P ＜0.05] and a decreased proportion of type I fibers [(16.0 ±5.0)％ vs (30.7 ±4.1) ％,P ＜0.05],with a reciprocal increase in type II b/x fibers [(27.3 ±4.8)％vs (11.0±3.2)％,P＜0.05].LI/F was higher (3.3±0.5 vsl.7±0.4,P＜0.05) and the activity of SOD,CAT and T-AOC was increased in emphysema group.Compared with control,rats with emphysema demonstrated a lower expression of endothelial NOS (eNOS) (1.9 ± 0.5 vs 3.4 ± 0.6,P ＜ 0.05),and an equivalent expression of neuronal NOS (nNOS) (4.7 ± 1.0 vs 5.1 ± 0.8,P ＞ 0.05) in the gastrocnemius muscle.The inducible NOS (iNOS) was not found in both groups.Conclusions Emphysema could induce biomechanical,pathomorphological and oxidative metabolic changes in peripheral skeletal muscle.
RESUMO
Objective To investigate the ultrasonic characteristics of angiographical normal left main (LM) branch of coronary artery observing with intravaseular ultrasound(IVUS). Methods Seventy-six patients whose coronary angiogram showed the lesions restricted only in left anterior descending (LAD) branch or left cireumflex(LCX) branch and no lesion was found in LM branch were enrolled and IVUS was performed. The plaque burden was measured and the quality of atherosclerosis was identified in lesion site of LAD or LCX by IVUS. Meanwhile,the absence or existence of lesions in LM was identified,and the quality of lesions was analyzed if it showing those existed lesions. The diameter and area of lumen in left main were measured and diameter and area of vessel were also measured. The plaque burden were measured for those who atheroselerosis existed in LM. Results IVUS showed 28 cases completely normal, 12 cases with intimal membrance hyperplesia,36 cases with plaque and 2 cases with intimal membrance flap in patients which LM was angiographically normal. Among those there were 30 eccentric plaques and 6 concentric plaques. For 36 patients whose lesions existed in LM observed by IVUS,there were 25 cases (69.4%) with soft plaque,4 eases (11.1%) with fibrous plaque,2 cases (5.6%) with calcific plaque,5 cases (13.9%)with mixed plaque. IVUS showed lumen diameter was (5.32±0.68)mm and lumen area was (23.34±5.27)mm2 for female patients; and lumen diameter was (5.90±0.50)mm and lumen area was (27.75±4.47)mm2 for male patients. The difference had significane when comparing lumen diameter and lumen area between male and female patients (P=0.042 and P=0.048, respectively). Vessel diameter was (5.90±0.47)mm and vessel area was (27.58±4.21)mm2 in patients with intimal membrance hyperplesia; lumen diameter was (4.39±0.54)mm and lumen area was (17.45±5.23)mm2,vessel diameter was (5.99±0.67)mm and vessel area was(26.61±6.27)mm2 n patients with atherosclerotic plaque.Diameter stenosis percentage was(26.17±7.87)%and plaque burden was(34.79±9.37)%in LM.Conclusions IVUS can find those lesions in LM which CAG cannot detect and identify the quality and severity of lesion precisely.
RESUMO
BACKGROUND: Stent under-expansion and procedurally related abnormal lesion morphologies (e.g. dissection, thrombus) are associated with stent restenosis and acute, subacute and chronic thrombosis.OBJECTIVE: To explore whether larger post-procedural final minimum stent area can be acquired and more procedurally related complications can be identified in stent implantation guided by intravascular ultrasound.DESIGN, TIME AND SETTING: Retrospective analysis was performed at the Heart Center of Beijing Chaoyang Hospital, Capital Medical University between January 2004 and February 2005.PARTICIPANTS: Fifty patients with coronary artery disease with 52 lesions were enrolled in the study and underwent stenting guided by intravascular ultrasound. The patients were characterized as non-diffused lesion with vessel diameter ≥ 2.5 mm. Patients with severe left main lesion were excluded.METHODS: Qualitative and quantitative analyses were carried out in 50 patients with 52 lesions before and after stent implantation. The stent diameter and the end-point of therapy were determined by intravascular ultrasound standard.MAIN OUTCOME MEASURES: The differences of end point for stent implantation and the enlargement of lumen area gained by stent implantation were compared between cardioangiography and by intravascular ultrasound.RESULTS: The average stent diameter guided by intravascular ultrasound was larger than by cardioangiography (P=0.011); the peak balloon pressure was higher in intravascular ultrasound group than cardioangiography group (P < 0.001), and area stenosis percentage measured by quantitative coronary angiogram was smaller in intravascular ultrasound group than cardioangiography group (P=0.044). ②Cardioangiography showed success rate was 96.2% and intravascular ultrasound showed the success rate was only 37.7% after first balloon high-pressure dilation. Intravascular ultrasound subgroup analysis showed higher peak balloon pressure (P < 0.001), larger lumen diameter (P < 0.001), larger lumen area (P < 0.001), and smaller area stenosis percentage (P < 0.001). No obvious stenosis was found at the proximal and distal segments of the stent observed by cardioangiography, while atherosclerotic lesions at proximal segment were found in 39 cases (75.0%) and at distal segment were in 23 cases (44.2%) observed by intravascular ultrasound. The lumen area was larger in non-fatty plaque than in fatty plaque after stent implantation (P < 0.001). Compared with non-fatty plaque, the enlargement of vessel area was 1.30 mm2 smaller, while plaque compression was 0.48 mm2 larger. CONCLUSION: Stent implantation guided by intravascular ultrasound can acquire larger final lumen area and identify more procedurally related complications.
RESUMO
Objectives To investigate the proliferation and apoptosis of smooth muscle cells(SMCs) after implantation of NiTi radioactive stents. Methods Radioactive and nonradioactive stents were implanted in abdominal aortas of 76 rabbits.The proliferation and apoptosis of SMCs were observed using immunohistochemistry and TUNEL.Results (1) Neointima areas on radioactive stents were less than those on nonradioacvtive stents at 1-month and 3-month respectively (P0 05).(2)The expressions of PCNA were lower in radioactive stent groups at different times compared with those of controls(P0.05).Conclusions (1) Radioactive stents can reduce the neointima areas on the implanted stents.(2)Radioactive stents can inhibit the proliferation of SMCs.(3)Radioactive stents promote the apoptosis of SMCs.