Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent...Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.展开更多
Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with s...Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.展开更多
Chronic total occlusion （CTO） occurs in approximately 20% known coronary atherosclerotic lesions, and CTO intervention has become a most challenging work. Although retrograde techniques have been applied and signifi...Chronic total occlusion （CTO） occurs in approximately 20% known coronary atherosclerotic lesions, and CTO intervention has become a most challenging work. Although retrograde techniques have been applied and significantly increased the success rate of CTO intervention, there are still some CTOs that cannot be opened.展开更多
Objective To identify clinical characteristics associated with the minimum lumen area （MLA） of proximal or middle intermediate lesions in the left anterior descending （LAD） artery, and to develop a model to predic...Objective To identify clinical characteristics associated with the minimum lumen area （MLA） of proximal or middle intermediate lesions in the left anterior descending （LAD） artery, and to develop a model to predict MLA. Methods We retrospectively analyzed demographic data, medical history, and intravascular ultrasound findings for 90 patients with intermediate lesions in the LAD artery. Linear regression was used to identify factors affecting MLA, and multiple regression was used to develop a model for predicting MLA. Results Age, number of lesions, and diabetes mellitus correlated significantly with MLA of proximal or middle intermediate lesions. A regression model for predicting MLA （mm2） was derived from the data： 7.00 - 0.05 × （age） - 0.50 × （number of lesions）. A cut-off value of 3.1 mm2 was proposed for deciding when to perform percutaneous coronary intervention. Conclusion This model for predicting MLA of proximal or middle intermediate lesions in the LAD artery showed high accuracy, sensitivity, and specificity, indicating good diagnostic potential.展开更多
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side...Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.展开更多
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.
文摘Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.
文摘Chronic total occlusion （CTO） occurs in approximately 20% known coronary atherosclerotic lesions, and CTO intervention has become a most challenging work. Although retrograde techniques have been applied and significantly increased the success rate of CTO intervention, there are still some CTOs that cannot be opened.
文摘Objective To identify clinical characteristics associated with the minimum lumen area （MLA） of proximal or middle intermediate lesions in the left anterior descending （LAD） artery, and to develop a model to predict MLA. Methods We retrospectively analyzed demographic data, medical history, and intravascular ultrasound findings for 90 patients with intermediate lesions in the LAD artery. Linear regression was used to identify factors affecting MLA, and multiple regression was used to develop a model for predicting MLA. Results Age, number of lesions, and diabetes mellitus correlated significantly with MLA of proximal or middle intermediate lesions. A regression model for predicting MLA （mm2） was derived from the data： 7.00 - 0.05 × （age） - 0.50 × （number of lesions）. A cut-off value of 3.1 mm2 was proposed for deciding when to perform percutaneous coronary intervention. Conclusion This model for predicting MLA of proximal or middle intermediate lesions in the LAD artery showed high accuracy, sensitivity, and specificity, indicating good diagnostic potential.
文摘Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.
