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Background: Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this study was to evaluate the safety and necessity of antiplatelet therapy on patients with Stanford Type B aortic dissection (TBAD) who underwent endovascular aortic repair (EVAR)., Methods: The present study retrospectively analyzed 388 patients with TBAD who underwent EVAR and coronary angiography. The primary outcomes were hemorrhage, death, endoleak, recurrent dissection, myocardial infarction, and cerebral infarction in patients with and without aspirin antiplatelet therapy at 1 month and 12 months., Results: Of those 388 patients, 139 (35.8%) patients were treated with aspirin and 249 (64.2%) patients were not treated with aspirin. Patients in the aspirin group were elderly (57.0 ± 10.3 years vs. 52.5 ± 11.9 years, respectively, χ2 = 3.812, P < 0.001) and had more hypertension (92.1% vs. 83.9%, respectively, χ2 = 5.191, P = 0.023) and diabetes (7.2% vs. 2.8%, respectively, χ2 = 4.090, P = 0.043) than in the no-aspirin group. Twelve patients (aspirin group vs. no-aspirin group; 3.6% vs. 2.8%, respectively, χ2 = 0.184, P = 0.668) died at 1-month follow-up, while the number was 18 (4.6% vs. 5.0%, respectively, χ2 = 0.027, P = 0.870) at 12-month follow-up. Hemorrhage occurred in 1 patient (Bleeding Academic Research Consortium [BARC] Type 2) of the aspirin group, and 3 patients (1 BARC Type 2 and 2 BARC Type 5) in the no-aspirin group at 1-month follow-up (χ2 = 0.005, P = 0.944). New hemorrhage occurred in five patients in the no-aspirin group at 12-month follow-up. Three patients in the aspirin group while five patients in the no-aspirin group had recurrent dissection for endoleak at 1-month follow-up (2.3% vs. 2.2%, respectively, χ2 = 0.074, P = 0.816). Four patients had new dissection in the no-aspirin group at 12-month follow-up (2.3% vs. 3.8%, respectively, χ2 = 0.194, P = 0.660). Each group had one patient with myocardial infarction at 1-month follow-up (0.8% vs. 0.4%, respectively, χ2 = 0.102, P = 0.749) and one more patient in the no-aspirin group at 12-month follow-up. No one had cerebral infarction in both groups during the 12-month follow-up. In the percutaneous coronary intervention (PCI) subgroup, 44 (31.7%) patients had taken dual-antiplatelet therapy (DAPT, aspirin + clopidogrel) and the other 95 (68.3%) patients had taken only aspirin. There was no significant difference in hemorrhage (0% vs. 1.1%, respectively, χ2 = 0.144, P = 0.704), death (4.8% vs. 4.5%, respectively, χ2 = 0.154, P = 0.695), myocardial infarction (2.4% vs. 0%, respectively, χ2 = 0.144, P = 0.704), endoleak, and recurrent dissection (0% vs. 3.4%, respectively, χ2 = 0.344, P = 0.558) between the two groups at 12-month follow-up., Conclusions: The present study indicated that long-term oral low-dose aspirin was safe for patients with both TBAD and coronary heart disease who underwent EVAR. For the patients who underwent both EVAR and PCI, DAPT also showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction.

Objective: To evaluate the safety and effectiveness of stenting for selective unprotected left main coronary artery (ULMCA) disease., Methods: The clinical data of 416 patients with ULMCA who underwent selective percutaneous coronary intervention (PCI) were analyzed., Results: In 291 of the 416 patients (70.0%), the ULMCA lesions were located in the distal bifurcation site. A total of 503 stents were successfully deployed in 414 patients and the mean stent number was (1.2+/-0.7) stents per patient. The success rate of stenting procedure was 99.5%. During hospital stay, no patient died. The major adverse cardiac event (MACE) during in-hospitalization was 0.5% (2/416). The target lesion revascularization (TLR) rate was 4.9%. During the follow-up 16 (3.9%) patients died including 12 cases (2.9%) of cardiac death. Angiography during follow-up conducted on 136 (33.1%) patients showed that binary in-stent restenosis occurred in 20 patients (14.7%, 20/136). TLR was performed by coronary artery bypass graft in 14 patients and by drug eluting stent (DES) implantation in 6 patients respectively. The total MACE rate was 8.3% (34/411)., Conclusion: Safe and with favorable clinical outcome, selective coronary stenting for ULMCA lesions can achieve a high technical success rate.

Background: Long-term efficacy and safety of tacrolimus-eluting stent (Janus) for treatment of coronary artery disease in percutaneous coronary interventions (PCI) "real world" is uncertain. The aim of this study was to evaluate the efficacy and safety of Janus stent for treating coronary heart disease in PCI daily practice, the safety of 4-month clopidogrel therapy after Janus stent implantation and the feasibility for treating patients with acute myocardial infarction (AMI) for first time., Methods: From February 20, 2006 to August 26, 2006, a total of 200 patients were enrolled and randomly assigned to receive either Janus stent (n = 100) or bare metal stent (Tecnic Carbostent, n = 100). All patients were administered with clopidogrel for 4 months and aspirin for life long after stenting., Results: Baseline clinical and angiographic characteristics were comparable between the two groups. AMI was present in 37% of patients with Janus and 36% with Tecnic Carbostent. At an average of 246-day follow-up, major adverse cardiac events (MACE) was 6% with the Janus stent and 15% with the Tecnic Carbostent (P = 0.038). Primary events included 1 cardiac death, 1 myocardial infarction (MI) due to subacute stent thrombosis and 13 target lesion revascularizations (TLR) due to restenosis in patients with Tecnic Carbostent and 6 TLR due to restenosis in patients with Janus stent. Although all patients had discontinued clopidogrel for an average of 126 days, there was no additional thrombotic event in the two groups., Conclusions: Janus stent is efficient in reducing MACE compared with Tecnic Carbostent at an average of 8-month follow-up. Discontinuation of clopidogrel at 4 months after PCI is safe for patients with Janus stent, including AMI patients. Long-term efficacy of Janus stent in reducing restenosis requires further study.

Background: Coronary chronic total occlusion (CTO) remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for CTO., Methods: Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed., Results: There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8% (1147/1263) and 88.9% (1445/1625), respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals > or = 15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions (P < 0.05). Procedural failure occurred in 116 patients, caused by impossibility of guide-wire (81.0%) or balloon (19.0%) to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary fistula during in-hospital period. The overall in-hospital MACE rate was 0.6% (8/1263). Drug-eluting stents were used in 198 patients without in-hospital MACE., Conclusions: In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.

Objective: To evaluate short-term efficacy and safety of triple antiplatelet regimen (cilostazol combined with clopidogrel and aspirin) in patients who underwent percutaneous coronary intervention (PCI)., Methods: From October 2001 to April 2005, a total of 3135 patients underwent PCI in the General Hospital of Shenyang Command, People's Liberation Army, of which 1103 were treated with cilostazol 100 mg twice a day for 6 months in addition to aspirin and clopidogrel for 3 - 12 months as triple antiplatelet therapy regimen (triple group) after PCI, and 2032 of which received aspirin and clopidogrel for 3 - 12 months as dual antiplatelet therapy regimen after PCI (control group). The data of the incidence rates of major adverse cardiac events (MACE), subacute in-stent thrombosis (SAT), and hemorrhage events within 30 days after PCI of the two groups were retrospectively analyzed., Results: The baseline clinical characteristics were comparable between these two groups. However, the proportions of the patients receiving stent implantation, with multivessel coronary artery diseases, and receiving PCI for unprotected left main trunk diseases of the triple group (91.3%, 68.3%, and 7.1% respectively) were all significantly higher than those of the control group (89.1%, 63.3%, and 4.6%, P < 0.05, P < 0.01, and P < 0.01). The proportion of patients with chronic total occlusions who received PCI in the triple group was 10.8%, significantly lower than that of the control group (13.4%, P < 0.05). No death occurred during procedure in both groups. The 30 d mortality and the rate of MACE with 30 days after PCI of the triple group were 0.4% and 1.3%, both significantly lower than those of the control group (1.6%, and 2.6%, both P < 0.05). However, there were no significant differences in the incidence rates of SAT and major hemorrhage events between these 2 groups (0.7% vs 1.0% and 0.3% vs. 0.2% respectively, both P > 0.05)., Conclusion: This novel triple antiplatelet regimen (aspirin and clopidogrel combined with cilostazol) for PCI patients is safe and more efficient than the dual antiplatelet therapy regimen (clopidogrel and aspirin) in reducing mortality and incidence of MACE in a short-term period.

Objective: To Compare the efficacy and safety of Rapamycin (Cypher) and Paclitaxel (TAXUS) eluting stents for multi-vessel coronary diseases., Methods: From June 2003 to December 2004, a total of 416 patients with multi-vessel coronary diseases were randomly treated with Rapamycin (n = 210) and Paclitaxel (n = 206) eluting stents. Patients with left main lesion, acute myocardial infarction, revascularization were not included. Acute and long-term outcomes were compared between the two groups., Results: Baseline clinical characteristics, including risk factors of coronary heart disease, coronary lesion type, heart function, rates of success and complication of percutaneous coronary intervention procedure in the two groups were comparable. Number of stents implanted was not significantly different between the two groups (3.24 +/- 1.25 vs 3.19 +/- 1.38, P > 0.05). Mean follow-up duration was (19.5 +/- 8.9) months. Follow-up rate (96.2 vs 95.1%), angina pectoris reoccurrence (4.0 vs 6.1%), restenosis (7.1 vs 9.6%), major adverse cardiac event (6.4 vs 8.8%) and event free survival (93.1 vs 91.3%) during follow-up were not significantly different between the two groups. Subacute stent thrombosis rate tended to be higher in Paclitaxel eluting stent group compared with Rapamycin eluting stent group (1.0% vs 0.5%, P > 0.05). At 6 to 9 months angiographic follow-up, the in-stent minimal lumen diameter (MLD) and the in-segment MLD were similar between the two groups., Conclusions: Satisfactory acute and long term outcomes for patients with multi-vessel coronary disease were achieved by both Cypher and TAXUS stent implantation and the safety and efficacy of the two kinds of stents were comparable.

Objective: To evaluate the effects of cilostazol on long-term clinical outcomes in patients underwent coronary stent implantation., Methods: One hundred patients who underwent coronary stenting were randomly assigned to receive cilostazol 200 mg/d for 6 months (n = 50) or ticlopidine 500 mg/d for 1 month (n = 50). Aspirin 100 mg/d was administrated concomitantly with cilostazol or ticlopidine. Angiographic follow-up was carried out at 6 months and clinical follow-up for 3 years after stenting., Results: Angiographic restenosis occurred in 5 of 34 patients (14.7%) in cilostazol group and 10 of 37 patients (27.0%) in ticlopidine group (P = 0.204). At the end of three-year follow-up, the incidence of major adverse cardiac and cerebral events (MACCE) was greatly reduced in cilostazol group compared with ticlopidine group (16% vs 36%, P = 0.023). Changes of Seattle angina questionnaire (SAQ) physical limitation score showed no significant difference between two groups (21.8 +/- 12.3 vs 16.8 +/- 15.9, P = 0.086). However, changes the improvement of angina frequency score much more was significant in cilostazol group (22.6 +/- 12.7) compared with that in ticlopidine group (16.1 +/- 13.3, P = 0.015). Recurrent angina occurred in 38% of patients in cilostazol group and 54% in ticlopidine group, respectively (P = 0.105). Readmission due to cardiac and cerebral vascular diseases was much less in cilostazol group than that in ticlopidine group (20% vs 40%, P = 0.029)., Conclusions: Cilostazol treatment significantly reduced MACCE and improved the quality of life pf patients in three-year clinical follow-up after coronary stenting.

Objective: To compare the clinical effects of rapamycin-eluting stent implantation and coronary artery bypass grafting (CABG) in treatment of the patients with multi-vessel coronary disease., Methods: From January 2002 to December 2004, 262 patients with multi-vessel coronary disease underwent CABG, and 250 age, clinical characteristics, and characteristics of coronary disease-matched patients chose to receive rapamycin-eluting stent implantation. 6-9 months after the treatment angiography of the coronary artery was conducted. All the patients were followed up for 19 +/- 14 months. The clinical outcomes were compared., Results: No intra-operative death occurred in the rapamycin-eluting stent implantation group with an operation success rate of 100%, significantly higher than that of the CABG group with 9 intra-operative deaths and an operation success rate of 96.6% (P < 0.01). Three perioperative deaths occurred in the rapamycin-eluting stent implantation with a perioperative death rate of 1.2%, not significantly different from that of the CABG group (1.9% with 5 perioperative deaths). The total death rate during hospitalization of the rapamycin-eluting stent implantation group was 1.2%, significantly lower than that of the CABG group (5.3%, P < 0.05). The rate of in-hospital major adverse cardiac event (MACE) of the rapamycin-eluting stent implantation group was 1.6%, significantly lower than that of the CABG group (5.3%, P < 0.05). There was no significant difference in MACE rate and angina pectoris recurrence during follow-up and event-free survival rate between these 2 groups., Conclusion: A better treatment for the patients with multi-vessel coronary disease, rapamycin-eluting stent implantation has the clinical effects comparable to those of the CABG.

Objective: To evaluate the safety and efficacy of protective measures for renal function during interventional procedures in patients with chronic renal insufficiency., Methods: Changes in renal function in 90 patients of coronary artery disease with chronic renal insufficiency admitted from January 1994 to July 2002 during intraoperative intervention were analyzed. These patients were divided into three groups: in group A patients underwent coronary angiography (SCA) with conventional peri-intervention treatment; in group B patients underwent SCA and treated with low dose dopamine plus saline hydration peri-intervention; in group C patients underwent percutaneous transluminal coronary angioplasty (PTCA) and stenting, and treated with low dose dopamine plus saline hydration during peri-intervention., Results: Coronary intervention was successful in all patients of three groups. Contrast medium-associated nephropathy (CAN) was found in 28 patients after the procedures, and them 11 occurred in group A (36.7%), 5 in group B (16.7%), and 12 in group C (40.0%), respectively. The incidence of CAN was highest in group C, and lowest in group B (P<0.01). All patients recovered and discharged after medical treatment, and no hemodialysis was necessary. Higher incidence of CAN was found in patients with congestive heart failure than patients without heart failure (64.5%, 20/31 cases vs. 13.6%, 8/59 cases; P<0.01), and also higher incidence of CAN was found in diabetic patients than non-diabetic patients (42.6 , 23/54 cases vs. 13.9%, 5/36 cases; P<0.01)., Conclusion: The patients with coronary artery disease with chronic renal insufficiency are able to tolerate the interventional procedures well with safety and ideal prognosis, if they are properly protected with dopamine and fluid during the procedure.

Objective: This study aims to investigate failure factors in retrograde wire-guided cannulation (retrograde approach) for the treatment of coronary chronic total occlusion (CTO).Methods: Data of 285 patients treated for CTO using retrograde approach in the General Hospital of Shenyang Military Region from August 2004 to May 2016 were collected.Results: The average age of the 285 patients was 63.89 ± 11.3 years old. Multivariate analysis revealed that the operation risk factors include the number of diseased vessels, collateral circulation, as well as whether anterograde intervention for CTO target vessels was previously performed (OR = 0.875, 95% CI = 0.779-0.940, P= 0.026) and whether other vessels were intervened (OR = 22.372, 95% CI = 2.059-243.031, P= 0.011).Conclusion: Based on the present study, the success rate of retrograde approach for CTO was negatively correlated with the number of diseased vessels and collateral circulation. It was furthermore of importance whether anterograde intervention for CTO target vessels was previously performed and whether other vessels beside CTO vessels were intervened, which were also risk factors. [ABSTRACT FROM AUTHOR]