血栓形成后增加内皮功能精品PPT精品课件.pptVIP

L-精氨酸代谢途径 未来研究方向 体外试验 (内皮细胞) 凝血酶、纤维蛋白暴露于精氨酸酶阻断剂 活化中性粒细胞效应 体外试验 (啮齿动物模型) 在血栓形成的肾下腹主动脉使用精氨酸酶阻断剂 基因敲除鼠模型 人体试验 人动脉标本—内皮细胞功能 使用溶栓治疗与L-精氨酸行RCT研究 结 论 暴露于凝血酶的内皮细胞增加了精氨酸酶的活性 NO 产生能力不受影响 局部使用L-精氨酸和精氨酸酶阻断剂可以调整内皮细胞异常功能 目的性增加NO可能是一个有前途的治疗方法 Questions? Enhancing Endothelial Function After ThrombosisVikram S. Kashyap, M.D., F.A.C.S. Associate Professor of Surgery Department of Vascular SurgeryThe Cleveland Clinic New Horizons in Cardiovascular Treatment (Angiogenesis and other) December 11, 2008 Case 53 y.o. female with acute R leg pain for 4 days. No R leg pulses, faint femoral Doppler signal (Rutherford Class IIA ischemia) PMH—Aortic reconstruction in the early 1990s, R iliac stent 2002 Previous L hip disarticulation secondary to ischemia/infection in the 1998 Heparin allergy—bivalirudin (Angiomax) used for this case Aortogram L brachial approach Aortography Power-pulse thrombolysis with Angiojet 20 cm infusion catheter, tPA at 0.5 mg/hr Lysis check angiogram at 12 hours, repeat PMT 10 cm infusion catheter, Continue tPA Technique in this case—lysis check 24 hours Thrombolysis uncovers the culprit lesion PTA with a 7 mm balloon Completion arteriography Culprit lesion Completion arteriogram Benefits of Thrombolytic Therapy A “culprit lesion” can be identified—the underlying reason for the acute occlusion Reperfusion injury may be attenuated More options are available - endovascular only: angioplasty+/- stenting - a limited surgical operation (patch angioplasty, endarterectomy) - elective placement of a new bypass can be performed after full work-up (cardiac, vein mapping, etc.) Despite initial success, sometimes… Despite initial success, sometimes… Acute arterial thrombosis remains a vexing clinical entity Clinical outcomes following thrombectomy or thrombolysis are occasionally suboptimal secondary to vasospasm or rethrombosis Rethrombosis occurs in up to 20% of patients (thrombogenic intimal surface—thought to cause platelet dependen