吉薇
中国医学科学院阜外医院 高血压
OBJECTIVES:We aimed to investigate the long-term clinical outcomes of selective stenting versus percutaneous balloon angioplasty (PTA) in hypertensive patients with renal artery stenosis caused by Takayasu arteritis (RASTA).METHODS:We retrospectively analyzed the data of consecutive 152 RASTA patients from Fuwai Hospital between 2005 and 2012. All target lesions of renal arteries were firstly treated by plain PTA. After angioplasty, if flow-limited dissection and/or residual stenosis >50% of diameter on angiogram existed, a selective stenting was then followed to further morphological improvement.RESULTS:The baseline characteristics between PTA (n=93) and stenting groups (n=59) were indistinguishable. At two-year follow-up, the rates of normalized, improved, and unaltered hypertension were 27.4%, 63.4% and 12.3% in PTA group (n=93) versus 22.4%, 62.1% and 15.5% respectively in stenting group (p=0.79). Primary patency rate was 90.1% in renal arteries (125 lesions) treated with PTA versus 75.6% in renal arteries (64 lesions) treated with stent placement (p=0.008). Female, active stage of the disease requiring glucocorticoid and/or immunosuppressant agents, residual stenosis rate and stenting were significantly associated with the restenosis. In patients with restenosis, renal artery occlusion occurred more in stenting group (8/15), compared with that in PTA group (1/12) (p=0.019). The stenting group underwent more reintervention procedures than PTA group (13/63 versus 8/125, p=0.003).CONCLUSIONS:If PTA alone failed in treating RASTA, selective stenting resulted in similarly effective blood pressure reduction. Stenting also resulted in lower 2-year primary patency rate, higher occlusion rate and higher reintervention rate than those who did not need stenting.
International journal of cardiology 2016
OBJECTIVE:To evaluate the safety and feasibility of carotid artery stenting (CAS) for treating patients with coexisting carotid and coronary artery disease.METHODS:The clinical data of 237 consecutive patients [(66.1 ± 7.7) years old, 79.7% male] with coexisting carotid and coronary artery disease undergoing CAS in Fuwai hospital from January 2005 to June 2010. The patients were analyzed retrospectively.Indication for CAS was defined as carotid artery diameter reduction of > 60% (symptomatic) or > 80% (asymptomatic) with suitable carotid artery anatomy for stenting. Thirty-day rates of stroke, death and myocardial infarction after CAS were assessed.RESULTS:All patients suffered from coronary artery disease, of whom 87(36.7%) had unstable angina pectoris and 82(34.6%) had recent myocardial infarction (< 30 days). The procedural success rate of CAS was 99.2 % (235/237). Cerebral protection devices were used in 234 patients (99.6%). Among them, 36(15.2%) patients received simultaneous bilateral CAS and 79(33.3%) patients underwent simultaneous percutaneous intervention of other non-coronary arteries.Within 30 days after CAS, 127(53.6%) patients underwent coronary revascularization, including 118(49.6%) coronary artery bypass grafting and 9 (3.8%) percutaneous coronary intervention. The rate of major stroke, minor stroke, death and myocardial infarction from time of CAS to 30 days was 2.1% (5/237), 3.0% (7/237),0.4% (1/237) and 0.4% (1/237) respectively.CONCLUSION:Data from this study indicate that CAS is safe and feasible for treating patients with coexisting carotid and coronary artery disease with a low incidence of periprocedural complication rate.
Zhonghua xin xue guan bing za zhi 2013
BACKGROUND:Severe bilateral carotid stenosis caused by atherosclerosis has not been unusual in the elderly. Such patients have high stroke risk. Many studies show that carotid artery stenting (CAS) is an alternative to treat unilateral carotid stenosis. However, the optimal procedural strategy of bilateral carotid stenosis remains unclear. The purpose of our study was to evaluate the safety of simultaneous bilateral carotid artery stenting (SBCAS) compared with unilateral carotid artery stenting (UCAS).METHODS:In this single-center retrospective study, we analyzed 234 consecutive patients who underwent carotid stenting from January 2005 to December 2009. Thirty-nine patients (16.7%) of them underwent SBCAS, and the others (n = 195) underwent UCAS. Indication for CAS was defined as carotid artery diameter reduction > 60% (symptomatic) or > 80% (asymptomatic). Six-month and 30-day hemodynamic depression (HD), hyperperfusion syndrome (HPS), stroke, death and myocardial infarction (MI) after carotid stenting were assessed.RESULTS:SBCAS group had no more HD and HPS compared with UCAS group at 30 days (HD: 28.2% vs. 20.0%, P = 0.396; HPS: 2.6% vs. 2.1%, P = 0.262). Moreover, there was no statistically significant difference between SBCAS group and UCAS group in major stroke, death, MI and their combinations within 30 days (major stroke: 0 vs. 3.6%, P = 0.604; death: 2.6% vs. 1.5%, P = 0.520; MI: 2.6% vs. 0.5%, P = 0.306; and their combinations: 5.1% vs. 4.6%, P = 1.000) and 6 months (major stroke: 0 vs. 3.6%, P = 0.604; death: 5.1% vs. 2.1%, P = 0.262; MI: 5.1% vs.1.0%, P = 0.130 and their combinations: 7.7% vs. 5.1%, P = 0.459).CONCLUSIONS:The patients undergoing SBCAS had no more events than those undergoing UCAS in 30-day and 6-month follow-up. Our finding suggests that SBCAS appears to be as safe as UCAS.
Chinese medical journal 2012
