Objective:Evaluate the safety of the bioresorbable scaffold (BRS) series implanted.Methods:This is a cohort study, which included 377 patients with acute coronary syndrome (ACS) who underwent elective percutaneous coronary intervention (PCI) with Neovas-BRS implantation from July 2019 to April 2022 at the Northern Command General Hospital. The patients were divided into the series BRS group ( n=63) and single BRS group ( n=314). We compared PCI related data between two groups, as well as all-cause death, cardiac death, non-fatal myocardial infarction, target vessel revascularization, stroke, and bleeding of type 2 to 5 defined by the Bleeding Academic Research Consortium of America (BARC) during follow-up. We also compared the major adverse cardiovascular and cerebrovascular events (MACCE), which includes all-cause death, non-fatal myocardial infarction, target vessel revascularization and stroke, as well as the net adverse clinical events (NACE), which includes MACCE and bleeding of BARC type 2 to 5. Procedural immediate success was defined as a residual stenosis of<20% with successful stent implantation and post-PCI target vessel flow grade up to TIMI 3. The images of 11 patients in the series BRS group who underwent optical coherence tomography (OCT) were analyzed. Results:A total of 377 patients were finally enrolled, aged (52.5±10.7) years, including 80.4% (303/377) males . The immediate success rate of PCI was 100% in both groups. The number of ≥50% stenotic lesions, number of target vessels, SYNTAX score, number of post-application expansion balloons, number of guidewires, total stent length, contrast volume and operation time were higher in the series BRS group than in the single BRS group (all P<0.05). There was no significant difference in the proportion of intravascular ultrasound and OCT application between the two groups. One patient in the single BRS group had an ischemic stroke during postoperative hospitalization, but there were no death, non-fatal myocardial infarction, target vessel revascularization, or BARC 2 to 5 bleeding events occurred during hospitalization in both groups. Follow up time was 352.0 (193.0, 421.0) days. There was no statistically significant difference between the two groups in the incidence of all-cause death (0 vs. 0.6% (2/314), P=1.000), cardiogenic death (0 vs. 0.3% (1/314), P=1.000), nonfatal myocardial infarction (0 vs. 1.0% (3/314), P=1.000), target lesion revascularization (3.2% (2/63) vs. 1.6% (5/314), P=0.736), BARC type 2 to 5 bleeding (3.2% (2/63) vs. 5.7% (18/314), P=0.604), MACCE (3.2% (2/63) vs. 2.9% (9/314), P=0.894), and NACE (6.3% (4/63) vs. 8.6% (27/314), P=0.553) during the follow-up period. OCT results of the 11 (17.5%) patients in the series BRS group indicated that 3 patients (27.3%) achieved non-overlapping connection, and the immediate stent expansion rate was (95.47±0.04) %. In 8 patients with BRS overlapping connections, immediate stent expansion rate was (90.32±0.44) %. Conclusion:In patients with low to intermediate-risk ACS, serial implantation of RBS in long coronary lesions is safe and feasible, and achieves the similar short-term outcomes as single BRS implantation.

Given that low-dose computed tomography significantly amplifies image noise due to the mitigation of radiation exposure,which degrades image quality and lowers the precision of clinical diagnoses,a novel model incorporating convolutional neural network and Transformer is established,in which an intra-patch feature extraction module is used to effectively preserve tiny details in the image.A double attention Transformer is constructed by incorporating a multiple-input channel attention module into the self-attention for tackling the problem of incorrect restoration of texture details during denoising using Swin Transformer.AAPM dataset is used for testing,and the results demonstrate that the proposed algorithm not only surpasses the existing algorithms in denoising performance,but also excels in preserving tiny details in the image.

Objective:To investigate the different types of renal artery involvement in Stanford type B aortic dissection (TBAD) and the comparison of clinical effecacy after thoracic endovascular aortic repair (TEVAR).Methods:This is a retrospective cohort study included 330 patients with TBAD and renal artery involvement treated with TEVAR from June 2002 to September 2021 in General Hospital of Northern Theater Command of the PLA. According to aortic CTA image, unilateral renal artery involvement conditions were divided into 5 types: the true lumen type (renal artery opening completely from the true lumen), false lumen type (renal artery opening completely from the false lumen), double lumen type (renal artery opening from the true and false double lumen), compression type (renal artery opening connected with the true lumen, but the renal artery opening was extremely squeezed by the inner membrane), open type (renal artery opening with intimal tear). There were seven types of bilateral renal artery involvement: true-true type (true lumen-true lumen type), true and false type (true lumen-false lumen type), true-double type (true lumen-double lumen type), true-opening type (true lumen-opening type), false-false type (false lumen-false lumen type), false-compression type (false lumen-compression type), double-double type (double lumen-double lumen type). The primary observation index of this study was the comparison of postoperative renal function and the incidence of clinical adverse events of different types of renal artery involvement. One-way ANOVA test, Kruskal-Wallis H test and paired sample rank sum test were used to compare postoperative renal function between different types of bilateral renal artery involvement. The Chi-square test or Fisher′s exact probability test were used to compare the near and long term adverse events between different types of bilateral renal artery involvement. Kaplan-Meier method was used to compare the all-cause mortality of patients with severe renal functional injury and non-severe renal functional injury before surgery. Results:The average age of the patients included in this study was (53±11) years, including 276 males (83.6%) and 54 females (16.4%). There were statistical difference in the level of serum creatinine (preoperative: H=18.686, P=0.005, postoperative: H=18.101, P=0.006) and cystatin C (preoperative: H=17.566, P=0.007, postoperative: H=10.433, P=0.016), pre-and post-operative, between the seven groups of TBAD patients with different renal artery involvement types ( P<0.05), and the false-false type group shown the worst kidney function. However, no statistically significant differences were shown when comparing their pre- and post-operative change values ( P>0.05). The 30-day follow-up result showed that there were statistically significant differences in the incidence of postoperative acute kidney injury ( χ2=15.623, P=0.007), aorta-related adverse events ( χ2=15.523, P=0.010), and intraoperative endoleak ( χ2=17.935, P=0.004) among the seven groups, and the false-false group was the highest (2/9, 5/9 and 5/9, respectively). In terms of long-term follow-up results, there were statistically significant differences in all-cause death ( χ2=14.772, P=0.011) and non-aortic death ( χ2=15.589, P=0.008) among the seven groups. Kaplan-Meier survival analysis showed that patients with worse pre-operative renal function showed higher long-term all cause death (17.7% vs. 4.8%, P=0.009). Conclusions:For TBAD patients with renal artery involvement, there were differences in renal function among different types, and TEVAR showed no significant effect on renal function in TBAD patients. The long-term all cause death was higher in patients with worse renal function pre-operative.

Objective:To investigate the risk factors of acute Stanford type B aortic dissection (TBAD) complicated with pleural effusion (PE) and the short-term and long-term outcomes of thoracic endovascular aortic repair (TEVAR).Methods:A case-control study. The clinical and imaging data of 1 083 patients with acute TBAD admitted to the General Hospital of Northern Theater Command from April 2002 to December 2020 were retrospectively analyzed, including 211 cases with pleural effusion and 872 cases without pleural effusion. The baseline analysis of the two groups of patients was performed. The risk factors associated with pleural effusion were analyzed by binary logistic regression, and the results were expressed as odds ratio ( OR) and 95% confidence interval ( CI). According to the quantity of pleural effusion, they were simultaneously divided into small pleural effusion group and medium large pleural effusion group, to compare the short-term and long-term effects of TEVAR patients with different amounts of pleural effusion. Results:The incidence of pericardial effusion (17.5% vs. 3.8%, P<0.001), anemia (21.3% vs. 12.5%, P=0.001), aortic spiral tear (49.8% vs. 37.8%, P=0.002), dissection tear over diaphragm (57.8% vs. 48.1%, P=0.011), serum creatinine [85 (69, 111) vs. 81 (67, 100) μmol/L, P=0.011] and white blood cell levels[(11.3±4.2)×10 9/L vs. (10.3±4.2)×10 9/L, P=0.002] in acute TBAD pleural effusion group were significantly higher than those in non-pleural effusion group, and the hemoglobin level was significantly lower than that in non-pleural effusion group [(128±20) vs. (133±17) g/L, P<0.05]. Logistic stepwise regression analysis showed that pericardial effusion ( OR=5.038,95% CI 2.962-8.568, P<0.001), anemia ( OR=2.047,95% CI 1.361-3.079, P=0.001), spiral tear ( OR=1.551,95% CI 1.030-2.336 , P=0.002) and elevated white blood cell ( OR=1.059,95% CI 1.011-1.102, P=0.005) were independent risk factors for TBAD complicated with pleural effusion. The incidences of all-cause death (4/19 vs. 1.5% vs. 0.9%, P<0.001), aortogenic death (4/19 vs. 0.7% vs. 0.7%, P<0.001) and aortic related adverse events (4/19 vs. 1.5% vs. 1.1%, P<0.001) in patients with large pleural effusion during TEVAR operation were significantly higher than those in patients with small pleural effusion and those without pleural effusion, and the differences were statistically significant. At 1 month follow-up after TEVAR, the incidence of all-cause death (4/16 vs. 3.3% vs. 1.6%, P<0.001), aortogenic death (4/16 vs. 0.8% vs.0.7%, P<0.001), aorta related adverse events (4/16 vs. 4.1% vs. 4.7%, P=0.013) and overall clinical adverse events (4/16 vs.9.8% vs. 6.7%, P=0.014) in the medium and large thoracic group were significantly higher than those in the small pleural effusion group and no pleural effusion group, and the differences were statistically significant. At 1 year follow-up after TEVAR, the incidence of all-cause death (4/15 vs. 4.9% vs. 3.9%, P=0.004), aortogenic death (4/15 vs.2.5% vs. 2.1%, P<0.001), aorta related adverse events (5/15 vs. 11.5% vs. 9.4%, P=0.012) and overall clinical adverse events (5/15 vs. 18.9% vs. 13.1%, P=0.029) in the medium and large thoracic group were significantly higher than those in the small pleural effusion group and no pleural effusion group, and the differences were statistically significant. Conclusions:Single center data showed that pericardial effusion, anemia, spiral tear and elevated white blood cell were independent risk factors for acute TBAD complicated with pleural effusion; the early (1 month) and long-term (1 year) rates of all-cause death, aortic mortality, aortic adverse events and overall clinical adverse events were significantly higher in TBAD patients with moderate pleural effusion after TEVAR, and moderate and large pleural effusion was an independent risk factor for near and long-term aortic related adverse events after TEVAR surgery.

Anticoagulants ; Antithrombins/therapeutic use* ; Coronary Disease ; Heparin ; Hirudins ; Humans ; Peptide Fragments ; Percutaneous Coronary Intervention ; Recombinant Proteins ; Treatment Outcome

Objective: To evaluate the long-term efficacy of a second generation biodegradable polymer sirolimus-eluting stent (EXCEL2) in treating patients with de novo coronary artery diseases. Methods: CREDIT Ⅱ trial was a prospective, multicenter, randomized, controlled study, conducted at 15 Chinese cardiac centres from November 2013 to December 2014. In this analysis, eligible patients for coronary stenting (n=419) were randomized to receive either the EXCEL2 stent (n=208) or the EXCEL stent (n=211). The primary endpoint was target lesion failure (TLF) at 3 years after PCI defined as a composite endpoints of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI-TLR). Secondary endpoints included patient-oriented composite endpoint (PoCE) including all-cause death, all MI, or any revascularization at 3 years and independent components, and stent thrombosis according to Academic Research Consortium′s (ARC) definition. Results: Among 419 enrolled patients, 413 (98.6%) patients completed 3-year clinical follow-up. Compared with the EXCEL group, 3-year TLF (5.4%(11/204) vs. 11.5% (24/209), P=0.025) and PoCE (9.8% (20/204) vs. 20.1% (42/209), P=0.003) were significantly lower in the EXCEL2 group. The cumulative event rate of CI-TLR (2.0% (4/204) vs. 5.7% (12/209), P=0.042) and any revascularization (4.9% (10/204) vs. 14.4% (30/209), P=0.001) were statistically lower in the EXCEL2 group than in the EXCEL group. There were no significant difference between two groups in terms of all-cause death and all MI. Rates of stent thrombosis were low without significant difference between the two groups (EXCEL2 vs. EXCEL, 1.0% (2/204) vs. 2.9% (6/209), P=0.285). Conclusion 3-year clinical follow-up results demonstrate that EXCEL2 stents are effective and safe in treating CAD patients with de novo coronary lesions.

Objective To evaluate the long?term efficacy of a second generation biodegradable polymer sirolimus?eluting stent (EXCEL2) in treating patients with de novo coronary artery diseases. Methods CREDITⅡtrial was a prospective, multicenter, randomized, controlled study, conducted at 15 Chinese cardiac centres from November 2013 to December 2014. In this analysis, eligible patients for coronary stenting (n=419) were randomized to receive either the EXCEL2 stent (n=208) or the EXCEL stent (n=211). The primary endpoint was target lesion failure (TLF) at 3 years after PCI defined as a composite endpoints of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI?TLR). Secondary endpoints included patient?oriented composite endpoint (PoCE) including all?cause death, all MI, or any revascularization at 3 years and independent components, and stent thrombosis according to Academic Research Consortium＇s (ARC) definition. Results Among 419 enrolled patients, 413 (98.6%) patients completed 3?year clinical follow?up. Compared with the EXCEL group, 3?year TLF (5.4%(11/204) vs. 11.5% (24/209), P=0.025) and PoCE (9.8% (20/204) vs. 20.1% (42/209), P=0.003) were significantly lower in the EXCEL2 group. The cumulative event rate of CI?TLR (2.0% (4/204) vs. 5.7% (12/209), P=0.042) and any revascularization (4.9% (10/204) vs. 14.4% (30/209), P=0.001) were statistically lower in the EXCEL2 group than in the EXCEL group. There were no significant difference between two groups in terms of all?cause death and all MI. Rates of stent thrombosis were low without significant difference between the two groups (EXCEL2 vs. EXCEL, 1.0% (2/204) vs. 2.9% (6/209), P=0.285). Conclusion 3?year clinical follow?up results demonstrate that EXCEL2 stents are effective and safe in treating CAD patients with de novo coronary lesions.

Objective: To investigate the effect of excimer laser coronary atherectomy (ELCA) in the interventional treatment of acute coronary syndrome (ACS). Methods: This prospective study enrolled 31 patients with ACS who underwent ELCA treatment in our hospital from November 8, 2016 to December 13, 2017. The efficacy and complications of ELCA were observed, and patients were followed up for postoperative observation of major adverse cardiovascular and cerebrovascular events (including target vessel revascularization, stroke, stent thrombosis, coronary artery bypass grafting, and death). Results: The patients were aged (65.0±10.8) years old and 25 were males (80.6%).There were 5 cases (16.1%) ST-segment elevation myocardial infarction, 3 cases (9.7%) non-ST-segment elevation myocardial infarction, and 23 cases (74.2%) unstable angina in this cohort.There were 9 cases (29.0%) in-stent restenosis, 11 cases (35.5%) saphenous vein graft, 2 cases (6.5%) chronic total occlusive disease, and 4 cases (12.9%) calcification.Two patients with chronic complete occlusive disease and 1 patient with calcified lesion were examined by intravascular ultrasound (IVUS). The other lesions were not examined with IVUS and optical correlation tomography (OCT).The ELCA success rate was 100% (31/31) and the PCI success rate was 100% (31/31).Intraoperative use of 0.9 mm diameter catheters accounted for 38.7% (12/31), 1.7 mm diameter catheters accounted for 32.3% (10/31), and 1.4 mm diameter catheters accounted for 29.0% (9/31).One patient with ST-segment elevation myocardial infarction experienced no reflow of coronary artery during operation. The other 30 patients had no complications such as perforation, small dissection, large dissection, distal occlusion, slow blood flow and collateral occlusion. One cardiac death(3.2%) occurred during the postoperative follow-up of (6.4±1.9) months. Conclusion Our preliminary study results indicate that the use of ELCA in the interventional therapy of ACS is safe and effective.

Objective To analyze the clinical, imaging and interventional data of patients with chronic total occlusion (CTO) lesions without myocardial infarction (MI) and to summarize the clinical and imaging characteristics of these patients. Methods The data of 2651 patients with CTO verified by coronary angiography between January 1995 and December 2014 were analyzed retrospectively. Results There were 1466 CTO patients (55. 3%) without MI (the control group) and 1185 CTO patients (44. 7%) with MI ( the MI group). The age, percentage of female patients, unstable angina, hypertention, mean triglyceride levels, left ventricular ejection fraction ( LVEF) were lower in the MI group than in the control group ( all P﹤0. 05). The rates of heart failure and serum creatinine levels were higher in the MI group than the control group (both P﹤0. 05). The rate of multi-vessel disease was higher in the control group than in the MI group (81. 4% vs. 76. 5%, P﹤0. 05). According to the target CTO vessel location, patients in the control group had lower rates of CTO in LAD (36. 2% vs. 40. 7%, P=0. 007) and higher rates of CTO in LCX (17. 0%vs. 12. 7%, P﹤0. 001). Patients in the control group without MI had better collateral circulation than that in the control group (32. 7% vs. 27. 0%, P﹤0. 001). There were no differences in success rate of PCI and complete revascularization between the two groups. Conclusions The present study showed that the CTO patients without MI were associated with better collateral development compared with the CTO patients with MI. Age, gender, unstable angina encouraging ischemic preconditioning and hypertension may be beneficial by facilitating collateral development through endogenous cardioprotective mechanisms.