Interventional Treatment And Hydrodynamic Study Of Coronary Artery Aneurysms

Part I Hemodynamic analysis of single or double bare metal stents for coronary artery aneurysms interventionObjective The aim of this study was to investigate a novel method to treat coronary artery aneurysms(CAAs).Methods Three CAAs patients who underwent single or double bare-metal stent implantation were recruited.The CAAs and parent artery diameters were measured for model construction.Single-and double-stent implantation were simulated,and the changes in the CAAs haemodynamics after stenting were analysed.Results In Case 1,the flow velocity in the single-stent model was significantly lower than that in the double-stent model(0.0046±0.013 vs 0.0050±0.011,p<0.001),while the pressure(127.33±18.03 vs 121.19±26.92,p<0.001)and wall shear stress(WSS,0.28±1.19 vs 0.22±1.13,p<0.001)were significantly higher.In Case 2,the flow velocity(0.005±0.011 vs 0.007±0.01,p<0.001)and WSS(0.17±0.82 vs 0.23±0.88,p<0.001)in the double-stent model were significantly lower than those in the single-stent model,while the pressure was significantly higher(117.70±10.07 vs 110.64±6.34,p<0.001).The same tendency was also observed in Case 3.All CAAs occluded during the follow-up period without obvious in-stent restenosis.Conclusion Application of the single or double bare-metal stent technique,according to the neck diameter of the coronary artery aneurysms,can effectively change the flow in vessels and aneurysm haemodynamics to achieve occlusion.Part II Clinical analysis of 46 cases of coronary aneurysm treated by percutaneous coronary interventionObjective The purpose of this study was to analyze the therapeutic effect of different operation strategies on patients with coronary aneurysms and to find the appropriate treatment.Methods Retrospective analysis was performed on 46 patients who had previously received interventional treatment for coronary aneurysm in our hospital and cooperative hospitals.According to different operation strategies,they were divided into bare metal stent group(25 cases),drug-eluting stent group(14 cases)and hybrid stent group(7 cases).General clinical data and operation information were collected and the differences in clinical outcomes between the three groups were compared.Results In the bare metal stent group,there were significant differences in the length of coronary aneurysm diameter(10.76±5.08 vs 7.26±2.41,p=0.011),the number of stents implanted(1.67±0.48 vs 1.33±0.49,p=0.029),and the therapeutic efficiency(84.6%vs 42.9%,p<0.05)were significantly better than the drug-eluting stent group.In the hybrid stent group,the number of stents implanted(2.00±0 vs 1.33±0.49,P=0.002)and therapeutic effect(85.7%vs 42.9%,P<0.05)was also higher than that of drug-eluting stent group.However,no statistical difference was found between the bare metal stent group and the hybrid stent group in the number of stents implanted,in the long diameter and the therapeutic efficiency of coronary aneurysm.Conclusion The interventional treatment effect of bare metal stent and hybrid stent is more effective than that of drug-eluting stent for coronary aneurysm.For the larger diameter of coronary aneurysm,the double-layer metal bare stent may be more effective than that of drug-eluting stent for aneurysm treatment.Part III Association of lymphocyte-to-monocyte ratio,mean diameter of coronary arteries,uric acid with coronary slow flow in isolated coronary artery ectasiaObjective The pathophysiology of isolated coronary artery ectasia(CAE)with coronary slow flow(CSF)phenomenon is still unclear.The purpose of this study was to investigate the risk factors for isolated CAE complicated with CSF.Methods A total of 126 patients with isolated CAE were selected retrospectively.The patients were grouped into the no CSF(NCSF)group(n=55)and CSF group(n=71)according to the corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC).Data on demographics,laboratory measurements,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),CTFC and diameters of three coronary arteries were collected.Results The proportion of patients with male sex(84.5%vs 61.8%,p=0.004)and a smoking history(63.4%vs 43.6%,p=0.021)in the CSF group were greater than that in the NCSF group.The neutrophil-to-lymphocyte ratio(NLR)(2.08(1.68-3.21)vs 1.89±0.58,p=0.001),mean diameter of coronary arteries(Mean D)(5.50±0.85 vs 5.18±0.91,P<0.001),and uric acid(URIC)level(370.78±109.79 vs 329.15±79.71,p=0.019)were significantly higher in the CSF group,while the lymphocyte-to-monocyte ratio(LMR)(4.81±1.66 vs 5.96±1.75,p<0.001)and albumin(ALB)(44.13±4.10 vs 45.69±4.11,p=0.036)level were lower.Multivariable logistic analysis showed that the LMR(odds ratio:0.614,95%CI:0.464-0.814,p=0.001),Mean D(odds ratio:2.643,95%CI:1.54-4.51,p<0.001)and URIC(odds ratio:1.006,95%CI:1.001-1.012,p=0.018)level were independent predictors of CSFP in CAE.Conclusions The LMR,URIC level and Mean D were independent predictors of CSF in isolated CAE.