Objective To evaluate the effectiveness and safety of successive interventional treatment in patients with thoracic aortic dissection and coronary heart disease by endovascular graft exclusion(EVGE)and percutaneous coronary intervention(PCI)respectively.Methods From January,2005 to July,2007,8 patients with Stanford B aortic dissection and coronary heart disease received successive EVGE and PCI in our centre.All patients were performed with EVGE 3-7 days prior to their PCI.Results The site of dissection tears were confirmed by aortic angiography which located within 0~10 mm from the exterior margin of left subclavian artery in 1 patient,11-30 mm in 4 patients and 31-50 mm in 3 patients.One patient had two tear gaps.Dissection of or distal to the renal arteries were involved in 7 patients.Talent graft(Medtronic Corporation,U.S.)was used in one patient and Aegis grafts(Microsport Medical Corporation,China)in 7 patients.Eight trunk tectorial membrane stents were used with lengths ranged from 100 to 140 mm with diameters ranged from 34 to 38 mm.Left subclavian artery was thoroughly covered by the proximal section of the graft in one patient,which resulted in a weak left radial artery pulse but with no obvious ischemic symptom of the left upper limb and brain.Procedures were technically successful in all patients and no severe complication such as death,paraplegia,and kidney insufficiency occurred after the procedure during hospitalization.Post-procedural aortography showed no leakage in 4 patients and minor leakage in 4 patients.Two patients had residual thoracic back pain which could be relieved by drugs.Coronary angiography showed that 4 patients had single-vessel disease,2 had double-vessel disease and one had triple-vessel disease.The mean stenosis rate of the target lesions was 85.6%?14.0% and the mean diameter of the reference vessels was 2.8?0.3 mm.Twelve stents were inplanted in 11 target vessels in 8 patients.The mean length of stents was 23.5?13.6 mm.The procedural success rate of PCI was 100% and no severe complication occurred.No mortality,delayed endo-leak,adverse cardiac events and repeat intervention was recorded during a mean follow-up period of 18.0?8.5 months.Conclusion It is safe and feasible to treat Stanford B aortic dissection and coronary heart disease by successive inter vention of EVGE and PCI.The effect of anticoapulation therapy after PCI on EVGE still requires further investigation.

Objective To analyze the trends and status of percutaneous coronary intervention(PCI)in Shenyang General Hospital of P.L.A.during a 18-year period.Methods Between August 1989 and April 2007,a total of 10 225 patients with 17762 target lesions had undergone PCI.Their clinical and angiographic baseline characteristics,PCI strategies and perioperative outcomes were retrospectively analyzed.All data were collected from PCI database of our hospital.Results Patients' age ranged from 22 to 92 years old(mean,59.9 years).A total of 2057 patients(20.2%)were with diabete,8647(84.6%)with acute coronary syndromes,1428(14.0%)with acute myocardial infarction(AMI)and underwent emergent PCI,477(4.7%)with cardiogenic shock;6701(65.5%)with multivessel disease,483(4.7%)with left main disease and 1795(17.2%)with chronic total occlusions(CTO).Overall patient success rate was 98.5% and lesion success rate was 98.3%.Procedural success was obtained in 99.6% of patients with left main disease and 90.5% of CTO lesions.About 89.8% of all patients underwent coronary stenting.Mean implanted stent number was 1.45 per patient.In-hospital mortality was 4.4%(63/1428)for AMI patients who underwent emergent PCI and 19.7%(42/213)for AMI patients with cardiogenic shock.Overall perioperative mortality was 1.1%(113/10 225),including 2 deaths during procedure(0.02%)and 80(0.8%)deaths after procedure.Two patients(0.02%)underwent emergent CABG.Acute or subacute stent thrombosis occurred in 58 patients(0.57%)and slow flow or no-reflow occurred in 127 patients,which accounted for 8.9% of AMI patients who underwent emergent PCI.Overall incidence of perioperative complications was 3.6% and the rate of procedure related complications was 0.48%.Conclusion In skilled cardiac center,PCI is associated with high procedural success rate,low incidence of complications and good short-term outcomes.PCI should be the first choice for treating patients with coronary artery disease,especially for high risk patients with AMI,cardiogenic shock or left main disease,etc.

Objective To investigate the efficacy and safety of intravenous diltiazem in patients with perioperative angina pectoris in coronary artery revascularization.Methods Totally 128 patients with angina pectoris during perioperation of coronary artery revascularization received intravenous diltiazem.The efficacy was determined by angina symptom,changes of blood pressure (BP) and heart rate (HR),and acute heart events after 2 weeks.Results Ninety-one cases had no relapse and 37 were obviously improved of angina symptoms.BP and HR were safely lowered after intravenous diltiazem.Of the 128 cases,85 received successful PCI and were discharged 1-3 weeks postoperatively;41 of 43 cases successfully received CABG;2 died of ventricular fibrillation and heart failure.There was not side-effect in all patients.Conclusion Intravenous diltiazem is effective and safe for with angina pectoris during perioperation of coronary artery revascularization.

60 years old with coronary artery disease in hospital from Jan.2002 to Aug 2004 who accepted coronary intervention.They were divided into Tansradial group(TRA,n=382) and Transfemoral group(TRF,n=382).The success rate and time of puncture,x-ray exposure time,procedure duration,dose of dye,complication in puncture site and pulmonary embolism were observed in the two groups.Results 368 out of 382 cases success in TRA group and 372 cases in TRF group.The success rate was not different.The success rate of puncture,x-ray exposure time,procedure duration and dose of dye had no difference between the two groups.But the complication in puncture site and pulmonary embolism were more in TRF group than in TRA group.The coronary intravascular ultrasound and cutting balloon technique were successfully done in two groups.The mean in-hospital time was less in TRA group (2.1?0.6 days) than in TRF group (4.2?1.6days,P

Objectives\ To analyse the development of coronary intervention in our heart center of a general hospital in recent 13 years.Methods\ Coronary interventions were performed in 3945 target lesions of 2466 patients with coronary heart disease who were from 22 to 86 years old(averaged 58 8 yrs)with 80 5% of male,including 335 cases of acute myocardial infarction,64 cardiogenic shock,2106 acute coronary syndrome,1329 multivessel disease,and 21 left main disease.The proportion of complicated B2 and C type lesions were 77 1% and chronic total occlusion were 21 4%,PTCA and stenting were the main intervention operation(97 4%),and rotation,direct atherectomy,cutting,intravascular radiation and cover stenting were also perfromed for the remaining 2 6% patients.Results\ The mean annual case increase rate was 61 2% from 1995 to 2001 The toltal patient and lesion success rates were 98 1% and 97 1%,respectively.The mortality during intervention were 0 08% and for cardiogenic shock were 28 1% during hospitalization.Conclusions\ The data suggest that the success rate and incidence of complications for coronary intervention in the heart center with well-dereloped technigues are comparable with those reported in foreign literatures.

Objective To evaluate the safety and feasibility of transradial approach for coronary angiography.Methods Five hundred and ten cases of suspected coronary artery disease received coronary angiography by transradial approach.Results The procedures were successfully performed in 503 cases. Seven failed, of them, three failed in acupuncture, 1 had deformed radial artery,2 were with severe tortuosity of nonname artery and one case was due to left subclavian artery occlusion. The radial artery was occluded in one case after operation.There was no other severe complication. Conclusions Transradial approach for coronary angiography is safe and feasible.Its advantage lies in higher success rate and less complication.

Objective To evaluate in-hospital and mid-term results of endovascular type B aortic dissection by stent graft.Methods From May 2002 to September 2006, 46 patients with type B aortic dissection underwent stent graft implantation. The study included 36 men and 10 women with mean age of 62?18 years old. Twenty one patients underwent stent-graft implantation in the acute phase and the other 25 patients in the chronic phase. All patients were followed up for 1 to 52 months (average 17?16 months) and the clinical data of the patients were analyzed. Results No patients died during hospitalization and within 30 days after operation. Transient post-implantation syndrome occurred in 11 patients. Left subclavian artery was totally occluded in 2 patients. Endoleak occurred in 5 patients and in 4 of them the leak closed spontaneously after three months of follow-up. Late endoleak occurred in 1 patient after one year. One patient developed paraplegia at 6 months after the operation. The follow-up CT scan at 3 months documented occlusion of the intimal tear by the stent-grafts and complete thrombosis of the false lumen in all patients. The true lumen of the aorta was enlarged and there was no evidence of migration or twisting of the stent-grafts. Ascending aortic dissection occurred in 1 patient after one year. Three patients died within the follow-up period. The mortality during the follow-up period was 6.7%. The actuarial survival curve by the Kaplan-Meier method showed a 4-year survival rate was 89.3%. Conclusion In-hospital and mid-term results showed that endovascular repair was effective in the treatment of type B aortic dissection.

Objective To investigate the surgical indication,complication management and therapeutic effect in treating Stanford B aortic dissection by using endovascular graft exclusion (EVGE).Methods Eight patients with Stanford B aortic dissection who underwent the procedure of mini-traumatic EVGE from April 2002 to April 2003 were analyzed.Tubular graft stents were introduced over the entry tear of aorta via the femoral or iliac artery.The lengths of the graft stents were 97-99mm and the diameters 34-42mm.Results The procedure was technically successful in all patients and no severe complications occurred during the perioperative period. All patients were alive with no delayed endoleak found during the follow-up of an average of (9.5?4.6) months.Conclusion EVGE is safe and efficient for Stanford B aortic dissection and it can be the first choice for treating these patients.

Objective To assess the outcome of renal artery stenosis approached by percutaneous transluminal renal angioplasty (PTRA) and stents.Methods Seventy-two patients (50 males and 22 female) were diagnosed as renal stenosis by renal angiography.Of them,68 cases were with atherosclerosis.The PTRA was done via femoral access site.Changes in blood vessel diameter and blood flow nd complications were recorded.Renal angiograph was performed to check the restenosis.Patient’s blood pressure and serum creatine level before and after the were observed.Results Angiograph showed unilateral artery lesion in 60 cases and bilateral stenosis in 12 cases.The ostium was involved in 72 sites and mid-part in 8.The lumen diameter of stenosis was 60%-95%.The stents were successfully implanted in 68 cases with 78 stents and 4 cases only by balloon.The lumen diameter of lesion increased from 2.0mm (0.8-2.6mm) to 6.5mm (4.0-8.0mm).TIMI flow decreased in 3 cases and renal function was impaired in 4 cases,but not severe.Blood pressure in 42 cases with hypertension decreased significantly.One case was complicated with perirenal hematoma.and there was no perioperative death.Conclusion PTRA and stenting treatment for renal artery disease are feasible and safe.

Objective To explore the in-hospital clinical results of percutaneous coronary intervention (PCI) in patients with multi-vessel coronary disease during past 11 years. Methods Data related to rates of success, complications and clinical effects of 4 365 patients who were hospitalized in our center and underwent PCI for their target multi-coronary arteries from 1995 to 2005 were analyzed. Among them 3 833 patients had acute coronary syndrome (ACS, 87.8%), among whom 1 480 suffered form acute myocardial infarction within 30 days (38.6%), 2 353 unstable angina pectoris (61.4%), and the remaining 532 patients had stable angina pectoris (12.2%). Results Overall success rate of PCI procedure for all patients and target lesions were 96.9% ( 4 230/ 4 365) and 98.8% ( 11 185/ 11 320), respectively. The total in-hospital all-reason mortality was 1.3% (56/ 4 365) and the mortality during PCI procedure was 0.05 % (2/ 4 365).The complication rate related to PCI procedure was 7.2% (314/ 4 365). After PCI procedure the angina-free survival rate for all patients was 96.2% ( 4 147/ 4 309) at discharge and the average hospital stay was 13?9 days. Conclusion The success rate of PCI procedure in patients with multi-vessel coronary disease is high, and the rates of complications and in-hospital mortality are low, all indicating that with PCI therapy an ideal short-term effect in patients with multi-vessel coronary disease can be achieved.