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Clinical outcomes after percutaneous coronary intervention for in-stent chronic total occlusion.
支架内慢性完全闭塞经皮冠状动脉介入治疗后的临床结局。
- 影响因子:2.41
- DOI:10.4244/EIJ-D-19-00650
- 作者列表:"Yoon YH","Lee PH","Lee SW","Kwon O","Lee K","Kang DY","Ahn JM","Park DW","Kang SJ","Kim YH","Lee CW","Park SW","Park SJ
- 发表时间:2020-08-07
Abstract
AIMS:The aim of this study was to compare percutaneous coronary intervention (PCI) outcomes in relation to stent optimisation profiles between in-stent chronic total occlusions (CTOs) and de novo CTOs. METHODS AND RESULTS:We evaluated 1,516 consecutive patients who underwent PCI for 147 in-stent CTOs (9.3%) and 1,439 de novo CTOs between 2007 and 2018. The primary endpoint was target vessel failure (TVF) consisting of a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularisation. The final post-stenting intravascular ultrasound (IVUS) images were analysed. Target lesion complexity reflected by the Japanese CTO score was similar, albeit calcification was more prevalent in de novo CTOs, whereas occlusion length >20 mm was more frequent in in-stent CTOs. The technical success (88.4% vs 87.5%, p=0.84) and in-hospital adverse event (1.4% vs 3.6%, p=0.26) rates were similar between CTO types. Among those who received drug-eluting stents, the five-year TVF (11.0% vs 10.7%, p=0.99) and target vessel revascularisation (4.2% vs 3.7%, p=0.81) rates were similar between groups. Total stent length, minimum stent area (5.4±1.8 vs 5.5±1.8 mm2, p=0.77), and maximal plaque burden of the reference segments were largely comparable between groups. CONCLUSIONS:In-stent CTO PCI with drug-eluting stents optimised by IVUS guidance offers as acceptable long-term clinical results as those achieved in de novo CTOs.
摘要
目的: 本研究的目的是比较经皮冠状动脉介入治疗 (PCI) 结果与支架内慢性完全闭塞 (cto) 和从头cto之间的支架优化特征。 方法和结果: 我们评估了1,516例连续患者,这些患者在2007年至147年间接受了9.3% 次支架内cto (1,439) 和2018次从头cto。主要终点是由心脏死亡、靶血管相关心肌梗死或靶血管血运重建组成的靶血管衰竭 (TVF)。分析最终的支架置入后血管内超声 (IVUS) 图像。日本CTO评分反映的靶病变复杂性相似,尽管钙化在新生CTO中更常见,而闭塞长度> 20毫米在支架内CTO中更常见。技术成功率 (88.4% vs 87.5%,p = 0.84) 和院内不良事件 (1.4% vs 3.6%,p = 0.26) 在CTO类型之间相似。在接受药物洗脱支架的患者中,两组患者的5年TVF (11.0% vs 10.7%,p = 0.99) 和靶血管再血管化 (4.2% vs 3.7%,p = 0.81) 发生率相似。总支架长度、最小支架面积 (5.4 ± 1.8 vs 5.5 ± 1.8平方毫米,p = 0.77) 和参考节段的最大斑块负荷在组间基本相当。 结论: 采用IVUS指导优化的药物洗脱支架的支架内CTO PCI提供了与从头CTO获得的结果一样可接受的长期临床结果。
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METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.
心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。