IntroductionCurrently, there are many diagnostic strategies for in-stent restenosis (ISR) used clinically, including invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and Fractional Flow Reserve (FFR). CCTA is not recommended for post-stent implantation patients owing to suboptimal image quality caused by artifacts. The FFR application is limited by its procedural complexity. Precise evaluation may be achieved by using computed tomography-derived fractional flow reserve (CT-FFR), which combines computational fluid dynamics (CFD) with CCTA. Anatomical and functional assessments of ISR lesions could be integrated effectively as well in this way. However, the computational complexity and prolonged processing time may hinder its utility in clinical use.MethodsThis study is a multicenter, prospective, diagnostic study, aiming to establish a deep learning-based CT-FFR model for the accurate assessment of ISR and to validate its diagnostic performance using invasive FFR as the reference standard. This study will be carried out in Beijing Anzhen Hospital and 6 subcenters in China. We planned to prospectively enroll 331 post-stent implantation patients with available CCTA data since June 2022, and invasive FFR will be performed within 3 months when clinically indicated. Patient recruitment is currently ongoing. Among them, 250 patients from Beijing Anzhen Hospital will be used to adapt and extend the existing DEEPVESSEL model, a deep learning-based CT-FFR computational software designed for the non-invasive functional assessment of coronary artery disease and previously validated in de novo coronary lesions, for application in the assessment of in-stent restenosis (ISR), and 81 patients from the other 6 subcenters will be used in external validation. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value with their corresponding 95% confidence intervals (CIs) were calculated for CT-FFR. The receiver operating characteristic (ROC) curve was analyzed, and the area under the curve (AUC) was calculated. The McNemar test and Bland-Altman plot will be used to examine the diagnostic consistency between CT-FFR and invasive FFR. The correlation was analyzed by Spearman's correlation coefficient.Trial registration numberChiCTR2200058822.

Objective: This study is designed to systematically assess the safety and efficacy profiles associated with varying procedural sequences of endovascular aortic repair (EVAR) and percutaneous coronary intervention (PCI) in clinical practice. Methods: We conducted a retrospective cohort analysis encompassing patients diagnosed with aortic aneurysm and concomitant coronary artery disease (CAD) who underwent EVAR at Beijing Anzhen Hospital, Capital Medical University, between January 2010 and December 2022, with planned staged (preoperative or postoperative) or simultaneous PCI. The cohort was stratified into three groups: PCI followed by EVAR, EVAR followed by PCI, and simultaneous EVAR and PCI. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, cerebrovascular events, and aortic-related complications within 12 months post-intervention. Secondary endpoints included duration of hospital stay, total hospitalization costs, and incidence of in-hospital adverse events. Multivariate logistic regression analysis was employed to identify independent predictors of the primary endpoint. Results: The study cohort comprised 374 patients, with 209 (55.9%) undergoing PCI followed by EVAR, 133 (35.6%) receiving EVAR followed by PCI, and 32 (8.5%) undergoing simultaneous EVAR and PCI. Comparative analysis revealed no statistically significant differences in the incidence of in-hospital adverse events (p = 0.867) or the risk of primary endpoint events (p = 0.645) across the three treatment groups. Notably, the simultaneous treatment group demonstrated a significantly reduced total hospital stay (10.6 days) compared to the PCI followed by EVAR group (16.0 days) and the EVAR followed by PCI group (17.2 days) (p < 0.001), accompanied by lower hospitalization costs (p = 0.002). Conclusions: For patients with aortic aneurysm complicated by CAD requiring both EVAR and PCI, simultaneous intervention appears to be a safe and feasible therapeutic option. This approach significantly reduces hospital stay duration and associated costs without increasing the risk of in-hospital adverse events or compromising 12-month postoperative outcomes. However, this exploratory finding requires validation in large-scale randomized controlled trials.

Background:The prevalence of very high-risk atherosclerotic cardiovascular disease (ASCVD) is significant in China, with suboptimal rates of low-density lipoprotein cholesterol (LDL-C) compliance exacerbating plaque instability and causing a higher incidence of major adverse cardiac events (MACEs). Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are effective in reducing LDL-C levels, increase the stability of vulnerable plaque, and influence the progression of atherosclerosis through multiple mechanisms as demonstrated in animal studies. However, there is currently a lack of in vivo evidence regarding the efficacy and safety of high-intensity statin therapy combined with PCSK9i in the secondary prevention of ASCVD in the Chinese population. This study aims to demonstrate the efficacy of high-intensity statins combined with PCSK9i on vulnerable plaques in very high-risk ASCVD patients through intravascular imaging and non-invasive endothelial function test. Methods:This randomized, open-label, prospective clinical study involves 240 patients with very high-risk ASCVD who meet the criteria outlined in the 2023 Chinese lipid management guidelines. Patients recruitment will be processed in Beijing Anzhen Hospital from January 2021 to December 2024. Patients with thin-cap fibroatheroma (TCFA) detected by optical coherence tomography (OCT) are randomly assigned in a 1:1 ratio to the evolocumab group (evolocumab 140 mg every 2 weeks plus atorvastatin 40 mg nightly) or the standard treatment group (atorvastatin 40 mg nightly). The primary endpoint is the absolute change of the minimum fibrous cap thickness (FCT) at a median follow-up of 1 year. The secondary endpoints are other OCT metrics, assessment of MACE rates, alterations in serum lipid profiles and markers of inflammation, endothelial function, and adverse drug reactions. Logistic regression, analysis of covariance (ANCOVA), Kaplan-Meier curve survival analysis, and Cox regression will be used to investigate the relationship between variables and endpoints. Discussion:The purpose of this study is to evaluate the efficacy of high-intensity statin therapy combined to PCSK9i for the secondary prevention of coronary artery disease in Chinese patients with very high-risk ASCVD. The results will provide evidence to optimize the management of this high-risk population. Trial Registration:This study was registered on chictr.org.cn (ChiCTR2000032570).

Objective To investigate the early and mid-term outcomes on percutaneous coronary intervention（PCI） in patients with coronary atherosclerotic heart disease and chronic renal failure（CRF） undergoing maintenance hemodialysis. Methods From April 2013 to October 2021, patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis were retrospectively analyzed in Beijing Anzhen Hospital, Capital Medical University. The pathological characteristics of coronary artery were summarized and the major adverse cardiac event（MACE） and changes in renal function during the perioperative period and during the postoperative follow-up were analyzed. Results Among 39 patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis, 34 cases were male and 5 cases were female, and aged（58±11）years. Three-vessel lesions accounted for the largest proportion of coronary artery lesions（48.7%, 19/39）, followed by double-vessel lesions（33.3%, 13/39）, and single-vessel lesions accounted for the least（17.9%, 7/39）. Most of them were coronary artery chronic total occlusion lesions（61.5%, 24/39）. Eleven patients（28.2%） underwent simple coronary balloon angioplasty and 28 patients（71.8%） underwent coronary stent implantation. The success rate of interventional operation was 100%. The serum creatinine of 39 patients before operation, 48 h after operation and 12 months of follow-up were（789±282）,（729±264）,（828±318）μmol/L respectively, and blood urea nitrogen were（21±7）,（17±5）,（22±7）mmol/L respectively, and there was no significant difference in different time（all P＞0.05）. The incidence of perioperative MACE was 5.1%（2/39）. During the follow-up period, 10 patients（25.6%） were readmitted due to cardiac events, and coronary angiography showed that 7 patients had in-stent restenosis to varying degrees. The incidence of MACE was 17.9%（7/39） and 30.8%（12/39） at 12 and 24 months after operation, respectively. Conclusions Satisfactory early and mid-term outcomes on PCI have been achieved in patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis. In-stent restenosis is the main cause of coronary event for these patients during follow-up and close follow-up is suggested. Long-term effect needs further follow-up confirmation with more cases.

Background: The optimal treatment strategy of chronic total occlusion (CTO) is currently debated. This meta-analysis aimed to evaluate the long-term clinical outcomes of successful percutaneous coronary intervention (PCI) of CTO. Methods: Electronic databases were searched for studies comparing long-term outcomes between successful PCI in patients with CTO using drug-eluting stents and failed procedures. Meta-analysis was conducted with major adverse cardiac events (MACE) and all-cause mortality during the longest follow-up as endpoints. The combined hazard ratios (HRs) were applied to assess the correlation between successful CTO PCI and MACE/all-cause mortality. Results: Eight studies consisting of 6,211 patients published between 2012 and 2020 met our inclusion criteria, and the CTO PCI success rate was 81.2%. Patients in the failed group were much older, and more likely to have morbidities (hypertension and prior myocardial infarction), reduced left ventricular ejection fraction, and severe lesion characteristics (multivessel disease and moderate/severe calcification). Pooled results indicated that successful CTO PCI was significantly associated with prognosis. Compared to failed recanalization, patients receiving successful procedures had an improved MACE (HR: 0.50, 95% CI: 0.40–0.61, p < 0.001). Subgroup analyses further revealed the prognostic value of successful CTO PCI. However, no difference was observed regarding all-cause mortality (HR: 0.79, 95% CI: 0.61–1.02, p = 0.074). Conclusions: The present study showed that CTO recanalization was associated with improved long-term outcomes. However, randomized trials are needed to confirm the results due to the mismatch of baseline characteristics.

目的 目前经皮冠状动脉(冠脉)药物洗脱支架治疗降低了急性冠脉综合征患者的死亡率,然而冠脉支架内再狭窄(ISR)仍是临床中亟待解决的问题.分析支架内再狭窄的相关因素是减少其发生的关键.方法 回顾分析于2016年1月至2019年5月于北京安贞医院住院复查冠脉造影的连续病例201例,排除合并感染、支气管哮喘,风湿免疫性疾病、支架植入术后小于12个月的患者(16例),ISR患者(88例,ISR组)以及非ISR患者(97例,非ISR组)纳入研究.比较2组临床特征,血液生化指标差异.受试者工作特征曲线(ROC曲线)及多因素Logistic回归分析血清学指标与支架内再狭窄的相关性.结果 ISR组患者血清三酰甘油[(1.55±1.02)vs.(1.23±0.57)mmol/L]、血清小而密低密度脂蛋白[(0.68±0.30)vs.(0.58±0.23)mmol/L)]、血清补体C1q[(184.96±37.22)vs.(157.98±20.93)mmol/L]、花生四烯酸介导的血小板聚集率[(11.85±16.79)vs.(6.94±2.53)％]显著高于非ISR组,差异均具有统计学意义.ROC曲线显示血清补体C1q与ISR呈正相关,其诊断ISR的曲线下面积为0.738,P<0.01.以168.95 mg/L为血清补体C1q截点值,其诊断ISR的灵敏度为65.2％,特异度为75％.多因素Logistic回归分析显示,血清补体C1q>168.95 mg/L与ISR呈正相关(OR=4.62,95％CI:2.05～10.40,P<0.01).结论 血清补体C1q水平与经皮冠脉药物洗脱支架内再狭窄密切相关,是支架内再狭窄的诊断因素之一.血清补体C1q是经皮冠脉药物洗脱支架内再狭窄防治的潜在靶点,其在冠脉支架内再狭窄中的作用机制有待进一步研究.

OBJECTIVE:The aim of this study was primarily to determine efficacy after alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM), as compared to medical therapy.METHODS:This retrospective study included 163 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital between March 2001 and August 2019, consisting of the medical group (n = 105) and the ASA group (n = 58). All-cause mortality and HCM-related death were mainly observed.RESULTS:Follow-up was completed in 161 patients and the median follow-up was 6.0 years. Compared to medically treated patients, patients post-ASA had comparable survival free of all-cause mortality (98.3% and 95.1% vs. 93.0% and 83.1% at 5 and 10 years, respectively; p = 0.374). Survival free of HCM-related death was also similar between ASA and medical groups (98.3% and 95.1% vs. 94.3% and 86.2% at 5 and 10 years, respectively; p = 0.608). However, compared to medical therapy, ASA had advantages on the improvement of NYHA class (1.4 ± 0.6 vs. 2.1 ± 0.5, p = .000) and lower occurrence of new-onset atrial fibrillation (AF) (7.8% vs. 20.4%, p = .048). Multivariate analysis demonstrated that resting LVOT gradient at the last clinical check-up was an independent predictor of all-cause mortality (HR = 1.021, 95%CI 1.002-1.040, p = .027).CONCLUSION:This registry suggests that mildly symptomatic patients with HOCM treated with ASA have comparable survival to that of medically treated patients, with the improvement of NYHA class and lower occurrence of new-onset AF. All-cause mortality is independently associated with resting LVOT gradient at the last clinical check-up.

目的 利用有限元方法模拟主动脉覆膜支架与考虑残余应力的主动脉血管壁的耦合作用,研究支架对主动脉血管壁应力分布的影响.方法 采用应力驱动的主动脉各向异性生长模型,降低轴向和周向跨壁应力梯度,从而在理想化健康人双层主动脉模型中生成三维残余应力场;建立覆膜支架模型实现其虚拟植入;对覆膜支架作用下的主动脉血管壁进行应力分析.结果 残余应力场对应的主动脉张开角117.5°在正常范围内,残余应力的存在降低了血管壁在周向和轴向的跨壁应力梯度.支架作用下血管壁最大应力位于覆膜支架波峰与血管壁接触处.支架放大率为20％时,血管壁最大周向、轴向应力分别为412、132 kPa,面内切应力σrθ、σrz均为78 kPa.残余应力作用下,最大径向、周向与轴向应力分别下降14.9％、40.5％和33.8％,最大切应力σrθ、σrs和σθz分别下降2.5％、7.1％、27.0％.支架放大率从10％增加到20％,最大径向、周向与轴向应力分别增加316％、129％、41％,最大切应力σrθ、σrz和σθz分别增加661％、450％、466％.结论 残余应力有效降低了血管壁应力梯度.残余应力和支架放大率对血管壁的应力分布及最大应力有较大影响.

目的:分析Stanford B型主动脉壁内血肿合并出现不同形态的局限的血池样强化病灶的影像学表现,及相对应不同类型影像学表现的临床预后是否有所不同.方法:选择2016年1月至2017年6月,在首都医科大学附属北京安贞医院,行全主动脉CT血管成像(CTA)且表现为Stanford B型壁内血肿合并局限的血池样强化病灶的患者50例,存在病灶75个.同时根据病灶的影像学表现是否存在内膜破口或分支血管将病灶分为两组,破口组和分支组,又将分支组依据是否存在内膜开口与主动脉相通分为两组,分支1组和分支2组.所有患者均进行CTA随访.结果:破口组和分支组病灶存在明显影像学上的差异,分支亚组影像学特征特异性并不明显.分支组病灶随访预后明显优于破口组病灶,分支1组随访预后优于分支2组.13例患者在随访过程中出现了相关并发症(病灶明显增大7例,夹层4例,瘤样扩张1例,持续性疼痛1例)进行了外科手术或腔内修复术等方法治疗.随访时间为12个月或截止至进行了干预治疗,随访过程中无相关死亡事件.结论:Stanford B型主动脉壁内血肿,合并血肿内血池样强化病灶中破口组,和分支组病灶之间存在影像学特征上的差异,Stanford B型壁内血肿合并存在内膜破口的病灶时,继续进展的概率较大,应引起临床重视.

临床资料 患者女,84岁.4d前无诱因腹部剧烈疼痛,无腹胀及腹泻,无意识丧失,就诊于当地医院,予对症保守治疗,病情无好转,转至我院.入院查体:神志清,体温36.5℃,P97次/min,R20次/min,BP175/95 mmHg(1 mmHg=0.133 kPa).RBC 3.03×1012/L,HGB 96 g/L,HCT 29.7％,PLT 101×109/L.既往史:患者4年前诊断为“腹主动脉瘤”,行“腹主动脉支架腔内隔绝术(EVAR)”,术后即刻造影,支架位置形态良好,未见内漏.术后3个月复查,支架近端Ⅰ型内漏;术后5个月复查,Ⅰ型内漏消失,支架周围瘤腔内血栓化(图1①②).术后2年复查主动脉CTA,主动脉支架形态未见异常,主动脉瘤腔较前增大(80 mm×88 mm),动脉期扫描未见明显内漏,延迟15 s扫描,于瘤体外周可见少量对比剂显影,考虑为Ⅱ型内漏,建议继续观察(图1③④).患者60余年前肺结核病史,25年前行“左侧乳房良性肿瘤切除术”.高血压史30余年,血压最高达:210/150 mmHg,长期口服降压药,血压目前控制于160/90 mmHg.糖尿病病史5年余.

目的:探讨一体式分叉型覆膜支架应用于介入治疗孤立性髂动脉瘤(IIAAs)的安全及有效性.方法:回顾性分析本中心自2011年8月至2016年7月,共7例男性患者,年龄49～ 82岁,平均年龄(69±10.5)岁,因IIAAs接受一体式分叉型覆膜支架介入治疗.其中单侧病变3例;双侧病变4例,4例合并髂内动脉瘤.6例患者使用Microport Aegis-B一体式分叉型覆膜支架,1例使用Powerlink一体式分叉型覆膜支架,远端共使用9枚髂动脉延长支架.1例患者行髂内动脉预栓塞以避免Ⅱ型内漏.术后分别于1、6、12个月及以后每年一次行临床及影像随访.结果:7例患者均成功置入一体式覆膜支架,技术成功率为100％.一体式支架主体近端直径为24～ 26 mm,长度为80～ 90 mm.6例患者单侧髂内动脉开口覆盖,1例患者双侧髂内动脉开口覆盖,无盆腔及臀肌缺血发生,围术期无严重并发症发生.平均随访时间(32.5±19)个月(12～70个月).患者随访期内无支架移位,无支架相关死亡等严重并发症.1例随访内发现轻度Ⅱ型内漏.结论:一体式分叉型覆膜支架治疗ⅡAAs安全有效,近中期疗效满意,特别是对于近端锚定区不足或双侧受累的患者有其独到特殊的应用优势.

目的 探讨主动脉缩窄(CoA)合并症及CoA外科术后并发症介入治疗的可行性.方法 2009年6月至2016年12月北京安贞医院6例CoA合并急性主动脉综合征或CoA外科术后并发假性动脉瘤患者接受介入治疗.男5例,女1例;年龄44～56(50.3±5.01)岁.患者术前均经主动脉CT血管造影(CTA)确诊.根据患者主动脉解剖及病理生理特点制定介入治疗方案,4例患者(2例主动脉缩窄合并B型主动脉夹层,1例主动脉缩窄合并穿通性溃疡,1例外科术后缩窄复发合并假性动脉瘤),行胸主动脉腔内修复术(TEVAR)治疗;1例患者CoA外科术后吻合处假性动脉瘤形成采用TEVAR,并对外科姑息的缩窄进行栓塞;1例CoA合并B型主动脉夹层,外科先行升主动脉至降主动脉人工血管转流,再对缩窄处进行封堵.结果 介入治疗技术成功率100％.围术期无并发症发生.随访10～60个月,无主动脉相关死亡和再次介入或外科手术干预治疗.结论 解剖条件合适的CoA合并症或CoA外科术后并发假性动脉瘤患者可首先尝试TEVAR治疗.解剖条件不合适的CoA合并B型主动脉夹层患者可行复合手术.此类患者应根据解剖及病理生理特点个体化选择手术方式及介入器材.

Anastomotic leak after aortic dissection surgery is a common and critical complication.Interventional therapy is less invasive and effective.This case reported that anastomotic leak was found after surgery for type A aortic dissection.The risk of reoperation was high.The minimally invasive method was used to release the occluder to the anastomotic leak.The effect was accurate. Key words: Anastomotic leak after surgery for type A aortic dissection, Occluder

目的 评价同期胸主动脉腔内修复术(TEVAR)与肾动脉覆膜支架植入术治疗Stanford B型主动脉夹层(AD)伴近肾动脉较大再破口的中期疗效.方法 2014年1月至2016年1月间共对15例Stanford B型AD患者行同期TEVAR与肾动脉覆膜支架植入术.其中男12例,女3例;年龄35～67岁,平均(48.93±6.42)岁.术前完善胸主动脉CTA检查.局部麻醉联合静脉强化麻醉下行经股动脉置管TEVAR术,隔绝近端原发破口,同期行肾动脉覆膜支架移植术隔绝近肾动脉水平较大再破口.收集分析影像学和实验室检查资料,出院后随访1～3年,评估治疗效果.结果 所有患者均顺利完成手术,成功率为100％.15例共植入主动脉覆膜支架18枚,支架近端直径28～42 mm,远端直径24～42 mm,长度150～230mm;植入肾动脉覆膜支架15枚(右肾动脉9例,左肾动脉6例),支架直径5～8 mm,长度2.5～5 mm,其中3例予球囊后扩张.术前平均血清肌酐值为(82.41±12.32) mmol/L,术后12个月为(75.88±11.36) mmol/L.随访显示3例假腔完全重塑吸收,5例完全血栓化,7例部分血栓化,肾动脉覆膜支架通畅率100％.结论 同期TEVAR与肾动脉覆膜支架植入术治疗B型AD伴近肾动脉较大再破口患者安全有效,部分患者可达到一期治愈.

Background: The aim of the study was to present our experience with covered stent graft to close the tear induced by distal stent after Frozen Elephant Trunk operation (FET). Methods: From November 2012 to July 2015, 21 patients suffering from distal Stent Graft New Entry (d-SINE) after FET accepted interventional treatment with a covered stent graft. Computer Tomographic Angiography (CTA) was performed at 3, 6 and 12 months after surgery to observe the position and shape of the stent and the eventual endoleaks. Results: All patients were implanted with a covered stent graft. After surgery, angiography showed that the stents were in the proper position and fully expanded. Two patients died after surgery. Followup was 24-55 (mean, 40 ± 10) months. No stroke, paraplegia, or death occurred. CTA showed that the stents had a proper form and were in the correct position without any displacement or endoleak. False lumen expansion did not occur. Parts of the false lumen showed thrombosis. Conclusion: The results suggest that implantation of covered stents in the descending aorta to manage d-SINE after FET may achieve a good therapeutic effect.

Objective To investigate the value of iFlow in hemodynamic evaluation of type B aortic dissection.Methods A total of 39 patients with type B aortic dissection undergoing thoracic endovascular aortic repair(TEVAR) from January to March 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled.Digital subtraction angiography (DSA)examination was performed during operation;the iFlow software was used for image process to acquire color coded blood flow chart.The peak time of true lumen and false lumen was measured and the correlation between peak time and distance of measuring points was analyzed.Results In 37 patients who successfully had the examination,the peak time had no significantly differences among 4 measuring points of true lumen(P ＞ 0.05);the peak time of false lumen measuring points was (3.4 ± 1.3),(3.8 ± 1.4),(4.0 ± 1.4),(4.5 ± 1.3) s,respectively;there were statistically significant differences among 4 measuring points (F =3.920,P ＜ 0.05).The peak time of true lumen and false lumen increased with distance of measuring points of descending aorta(r2 =0.034,0.075;P ＜0.05).The general peak time of true lumen was (2.9 ±0.8)s;the general peak time of false lumen was (3.9 ± 1.4) s;there was a significant difference of blood flow velocity between true lumen and false lumen(P ＜ 0.01).Conclusion iFlow can be used for hemodynamic evaluation of type B aortic dissection.

Objective To analyze the effects of endovascular repair for Stanford B aortic dissection with one-stent graft implantation and two-stent graft implantation on aortic remodeling.Methods Totally 100 patients with Stanford B aortic dissection who had endovascular repair from January 2012 to December 2013 in Beijing Anzhen Hospital,Capital Medical University had one-stent graft implantation (one-stent group,50 cases) and two-stent graft implantation (two-stent group,50 cases).The aortic diameter was measured at proximal landing zone and distal landing zone,the application of chimney technique or vascular reconstruction technique was base on the condition of proximal landing zone.Aortic morphological changes were analyzed before and after operation.Results All patients were successfully operated.The mean length of aortic coverage in one-stent group was significantly shorter than that in two-stent group[(191 ± 14) mm vs (261 ±7) mm] (P ＜0.01).The mean cone angle of holder in one-stent group was significantly less than that in two-stent group [1.9 (0.0,4.0) mm vs 9.0 (8.0,10.0) mm] (P ＜ 0.01).The stent thrombus 3 month after operation was 88.0％ (88/100) in all patients;there was no significant difference between one-stent group and two-stent group [92.0％ (46/50) vs 84.0％ (42/50)] (P ＞ 0.05).Aortic diameters at proximal landing zone,left atrial horizontal,diaphragm horizontal and renal artery horizontal had no significant differences between groups(P ＞ 0.05).The aortic diameter at distal landing zone,aortic true lumen diameters at left atrial horizontal,diaphragm horizontal,renal artery horizontal and aortic true lumen diameter/false lumen diameter rate(R1) at renal artery horizontal in two-stent group were significantly less than those in one-stent group before treatment[(11 ±4) mm vs (14 ± 4) mm,(11.8 ± 2.6) mm vs (13.7 ± 3.4)mm,(12±4)mmvs (14±4)mm,(8.5±2.7)mmvs (10.8±2.9)mm,(0.7 ±0.4) vs (0.9±0.4)] (P ＜ 0.05);aortic true lumen diameters and aortic true lumen diameter/false lumen diameter rate (R2) had no significant differences between groups after operation (P ＞ 0.05).Dilation rates of aortic true lumen at left atrial horizontal,diaphragm horizontal,renal artery horizontal and the value of R2/R1 in two-stent group were significantly higher than those in one-stent group [(2.0 ± 0.5) ％ vs (1.7 ± 0.4) ％,(1.7 ± 0.5) ％ vs (1.4 ± 0.6) ％,(1.50 ± 0.50) ％ vs (1.10 ± 0.20) ％,(1.9 ± 0.8) vs (1.3 ± 0.7)] (P ＜ 0.05).Two-stent group had 1 case of transient paraplegia and the symptom was alleviated after cerebrospinal fluid drainage.One-stent group had 1 case of mild proximal inner leakage.There were no death and malperfusion complications during 3 months after operation.Conclusions Both endovascular repair for Stanford B aortic dissection with one-stent and two-stent implantation are effective.Two-stent implantation is good for aortic true lumen dilation in patients with tenuity of aortic artery.

Objective To use intravascular ultrasound (IVUS) to assist thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU), which could obtain accurate anatomical information of thoracic aortic wall in pre- and post- operative. Methods From October to December in 2015, 11 patients, all males (65.0±3.6), suffered from Stanford type B AD were utilized IVUS during TEVAR to observe the exact range of false lumen of AD, the proximal landing zone, true/ false lumen, intimal tear, branch vessels in preoperative, as well to evaluate the sealing effect of stent grafts, sticking with aortic wall, and branched blood supply changes in postoperative. Results For all 11 patients, in which one with PAU accompanied with IMH, others with Stanford type B AD (7 patients involving in visceral blood supply malformation, 63.6%), there were no intraoperative death and technical success rate was 100%. All patients were detected by using IVUS to obtain accurate data during TEVAR. Conclusion The operation of IVUS is convenient and easy to control during TEVAR, which can acquire precise aortic pathologies, as well worthy to market this technique in intraoperative.

ObjectivesUsing iFlow technology to evaluate actually the inlfuence of left subclavian artery (LSA) stent to blood flow for the patients with the left subclavian artery ‘chimney’ stent implantation (LSACSI) during thoracic endovascular aortic repair (TEVAR), as well combined with the following-up with postoperative aortic CTA to assess the inlfuence factors of patency rate of chimney stent.MethodsFrom 2013 to 2013, retrospective analysis , patients (130 males and 84 female mean age 60.31± 5.46 years) suffered with Stanford type B aortic dissection (AD) in our department were underwent TEVAR, in which 192 patients with single TEVAR and 22 patients with TEVAR and LSACSI. iFlow software was used to analyze the image of patients with pre- and post- operative thoracic aortic angiography, in which the region of interest (ROI) were designed at the arch of aorta (pre- stent grafts), the beginning of innominate artery, LSA, left vertebral artery (LVA), and left axillary artery (LAA) in the middle level, respectively. The parameters were collected as ROI Area, ROI Peak/Ref Peak, ROI Peak Time, and ROI AUC/Ref AUC in statistical analysis.Results There were no signiifcant differences in ROI of patients underwent TEVAR with LSACSI, in comparison to without LSACSI based on ROI Peak Time.ConclusionFor patients suffered with Stanford type B AD but short proximal landing zone, it was safe to patients underwent TEVAR and LSACSI, in which chimney stent could supply with enough blood flow to LSA, LVA and LAA. During TEVAR, iFlow technology used in one-step to assess the hemodynamic change of LSA was an efficient method and worthy to deeply debate for clinic doctors in terms of evaluating the efifciency and predicting the prognosis.

目的:评价应用不同封堵器经冠状动脉侧治疗先天性冠状动脉瘘(CAF)安全性及效果.方法:2012年至2015年间,连续12例患者(年龄18～62岁,男性7例,女性5例)在本中心确诊为冠状动脉瘘并试行经导管介入封堵术,封堵前完成血液动力学评估及冠状动脉造影,依造影结果选择封堵器.结果:12例患者共存在13处瘘口,1例为双支病变.9例成功完成介入封堵术,1例因新瘘再形成行二次介入,故累计完成10例封堵术.使用ADO Ⅱ封堵器4例,纤维弹簧圈3例,电离弹簧圈2例,血管塞联合弹簧圈1例.术后造影2例存在少量残余分流,其中1例随访中新瘘再生.无冠状动脉损伤或冠状动脉内血栓形成等并发症发生.中位随访时间15.2个月.结论:经冠状动脉侧置入封堵冠状动脉瘘安全有效,术式更为简便易行.