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| 1 | Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation显示文摘Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P<0.01], plaque burden [(52±12)% vs (36±15)%, P<0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P<0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P<0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P<0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P<0.01) and residual plaque burden≥50% (OR=7.3, P<0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma. | Gary S.Mintz Stéphane G.Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D.Dangas Roxana Mehran Edward M.Kreps Michael Collins Gregg W.Stone Jeffrey W.Moses GE Junbo Martin B.Leon | 2007 | 上海医学2007，30，S1： | 0 |
| 2 | 多聚紫杉醇洗脱支架与裸金属支架治疗复杂冠心病患者的比较显示文摘背景:与裸金属支架相比,药物洗脱支架可降低非复杂病变的再狭窄发生率。尚未在复杂狭窄病变中评价药物洗脱支架的应用情况。
目的:在比既往试验更复杂的患者人群中研究多聚缓释紫杉醇洗脱支架的安全性和效果。
设计、地点及参试者:于2003年2月至2004年3月在66家大学和社区医疗机构进行前瞻性、安慰剂对照、双盲、多中心试验。1 156例患者接受了单支冠状动脉狭窄(血管直径,2.25~4.0 mm;病变长度,10~46 mm)支架植入治疗,包括664例(57.4%)患有复杂或既往未曾研究的病变(需要2.25 mm、4.0mm和/或多个支架),并于9个月时进行临床和血管造影随访。干预:患者随机分配接受1个或多个裸金属支架(n=579)或者外观相同的紫杉醇洗脱支架(n=577)。主要观测指标:9个月时因缺血而需要靶血管血运重建。结果:基线特征匹配良好。糖尿病患者占31%。平均(SD)参照血管直径为2.69(0.57)mm,参照病变长度为17.2(9.2)mm,B:/C型病变占78%。每个病变平均植入1.38(0.58)个支架(总平均长度[SD],28.4[13.1]mm);需要多个支架的病变占33%。使用直径2.25 mm和4.0 mm支架的病变分别为18%和17%。与裸金属支架相比,紫杉醇洗脱支架可使9个月靶病变血运重建率从15.7%降至8.6%(P<0.001),靶血管血运重建率从17.3%降至12.1%(P=0.02)。心源性死亡或心肌梗死(裸金属支架5.5%,紫杉醇洗脱支架5.7%)和支架血栓形成发生率两者类似(两组均为0.7%)。在整个研究队列,血管造影再狭窄从33.9%降至18.9%(P<0.001),包括采用2.25 mm支架(49.4%比31.2%;P=0.01)、4.0mm支架(14.4%比3.5%;P=0.02)和多个支架(57.8%比27.2%;P<0.001)的患者。
结论:与裸金属支架相比,在有复杂病变的患者人群中植入紫杉醇洗脱支架可有效降低临床和血管造影再狭窄的发生率。 | Gregg W.Stone Stephen G.Ellis Louis Cannon J.Tift Mann Joel D.Greenberg Douglas Spriggs Charles D O’Shaughnessy Samuel DeMaio Patrick Hall Jeffrey J.Popma Joerg Koglin Mary E.Russell 倪永斌(译) 孙艺红(译) 胡大一(校) | 2006 | 美国医学会杂志(中文版)2006，25，3： | 0 |
| 3 | Assessment of inconclusive left main coronary lesions: lessons from an intravascular ultrasound study显示文摘Objective Angiographic assessment of a left main coronary artery (LMCA) stenosis is often difficult and unreliable. Intravascular ultrasound (IVUS) assessment of absolute lumen dimensions has been shown to correlate with fractional flow reserve (FFR) and to predict clinical outcome in patients with a LMCA stenosis. Methods During 21 months period (October, 2004 to July, 2006), 153 patients (Ostial lesions, n=47; Non-ostial lesion, n=106) underwent IVUS evaluation specifically to assess the severity of an angiographically inconclusive LMCA narrowing. IVUS analysis included plaque morphology; external elastic membrane (EEM), lumen, plaque cross-sectional areas (CSA), plaque burden (plaque CSA/ EEM) and remodeling index (lesion EEM CSA/reference EEM CSA). Results Overall, minimum lumen area (MLA) and diameter (MLD) and plaque burden measured 8.2 mm2, 2.6 mm, and 59.3 %, respectively. An MLA<6.0 mm2 (which has been shown to correlate with a FFR <0.75) was seen 41.5% in ostial lesions and 44.5% in non-ostial lesions. In particular, ostial LMCA lesions had a larger MLA and a smaller plaque burden than non-ostial lesions (Table). Conclusions Patients referred for LMCA evaluation commonly have insignificant narrowing. Negative remodeling was prominent at the LMCA ostium. These patients deserve IVUS assessment before revascularization. | Gary S.Mintz Stéphane G.Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D.Dangas Roxana Mehran Edward M.Kreps Michael Collins Gregg W.Stone Jeffrey W.Moses Junbo Ge Martin B.Leon | 2007 | 上海医学2007，30，S1： | 0 |
| 4 | Volumetric intravascular ultrasound comparisons of drug-eluting stent thrombosis and in-stent restenosis显示文摘Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P<0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P<0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA <4.0 mm2 (73.3% vs 35.6%, P=0.01) or <5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR. | Gary S.Mintz Stéphane G.Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D.Dangas Roxana Mehran Edward M.Kreps Michael Collins Gregg W.Stone Jeffrey W.Moses GE Junbo Martin B.Leon | 2007 | 上海医学2007，30，S1： | 0 |
| 5 | Rationale and Design of a Randomized Controlled Trial of Bivalirudin with a Prolonged High-Dose Infusion Versus Heparin Monotherapy During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction:The BRIGHT-4 Trial显示文摘Intravenous anticoagulant therapy is critical to prevent ischemic events without increasing the risk of bleeding in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Heparin and bivalirudin are the most commonly used adjunctive anticoagulant agents during PPCI.However,the superiority of the 2 most optimal regimens with these agents in patients undergoing PPCI remains controversial.The BivaliRudin with prolonged high-dose Infusion durinG PPCI versus Heparin Trial 4(BRIGHT-4)is a large-scale,prospective,multicenter,active-control,parallel-group,open-label,randomized trial designed to test whether bivalirudin with a post-PCI high-dose infusion is superior to heparin monotherapy in STEMI patients undergoing PPCI.A total of 6000 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a 1:1 ratio.Patients allocated to the bivalirudin group will be treated with a high-dose bivalirudin infusion(1.75 mg/(kg·h))after PCI for 2 to 4 hours.In the heparin group,the use of glycoprotein IIb/IIIa inhibitors will be reserved for the development of procedural thrombotic complications.The efficacy and safety of bivalirudin will be evaluated at 30 days,6 months,and 12 months after the randomization.The primary endpoint is a composite of all-cause death or Bleeding Academic Research Consortium(BARC)types 3 to 5 bleeding at 30 days after randomization.The BRIGHT-4 study protocol has received approval from the ethics committee of General Hospital of Northern Theater Command(Shenyang,China).The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines.The results will be published following the Consolidated Standards of Reporting Trials statement in a peer-reviewed scientific journal(Trial registration number:NCT03822975). | Zhenyang Liang Yi Li Gregg W.Stone Yaling Han | 2022 | Cardiology Discovery2022，2，4： | 0 |
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