Abstract:

Aim: was to perform a retrospective comparative analysis of clinical and angiographic results of primary endovascular treatment of ischemic stroke in patients who had contraindications for adjuvant thrombolytic therapy, and results of applying standard pharmaco-invasive (thrombolysis and thrombus extraction) treatment.

Material and methods: angiography was performed in 61 patients. The main criterion for the selection of patients for cerebral angiography according to MSCT-angiography, was a confirmed occlusion of a large intracranial vessel (the internal carotid artery or the middle cerebral artery at M1-2 segment). After MSCT-angiography, in the absence of contraindications, (STT) systemic throbolytic therapy (Alteplaza in the standard dose) was started and patients were sent to an endovascular operation, where selective angiography of the syndrome-responsive artery was performed, followed by an endovascular procedure, according to standard procedure. For endovascular treatment, Penumbra Reperfusion catheters - ACE 68 , were used in combination with 3MAX catheters, or stent-retrievers (Trevo, PRESET, ERIC). In a number of cases, the use of retrievers was supplemented with an assisting thrombus aspiration («Solumbra» method). The criterion for the effectiveness of endovascular treatment was the achievement of blood flow in the syndrome-responsible artery TICI 2b - 3. 6 patients with lesion of distal segments of middle cerebral artery (M3-4) or with no occlusion of large intracranial occlusion were excluded from the study.

Results: all 55 patients who received endovascular treatment, retrospectively were divided into two groups depending on the performance of adjuvant STT Group of combined treatment (STT and endovascular procedure (EVP)) included 24 patients; 31 patients were included in the primary EVP group.

Conclusions: basing on results of the study it can be supposed that primary endovascular treatment of ischemic stroke without thrombolysis can provide comparable efficacy and safety of treatment.

References

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Abstract:

Article describes a case report of successful treatment of coronary artery perforation using handmade stent-graft, ex tempore made of coronary balloon and two bare-metal stents. Article also reports results of follow-up, including control angiography and optical coherence tomography 3 months later. 

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4.     Sarli B., Baktir A.O., Saglam H., Kurtul S., Dogan Y., Aring H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J. 2013; 35(3):164-6 • DOI: 10.5152/etd.2013.20.

5.     Copeland K.A., Hopkins J.T., Weintraub W.S., Rahman E. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv. 2012; 80(1):53-7.

Abstract:

Aim. Was to analyze atherosclerotic disease dynamics and long-term results (up to 5 years) after implantation of bare-metal stents (BMS) and sirolimus-eluting stents (SES) in patients with multivascular coronary disease

Methods and results. We have analyzed clinicaland angiographic results data of percutaneous coronary interventions (PCI) of 585 patients with multivascular coronary disease during 5-years of follow-up period. 264 patients were treated with BMS, 321 - with SES We used Cypher drug-eluting stents (sirolimus-eluting stents) in the first group and BX Velocity bare-metal stents in the second group of patients

During first year of follow-up the incidence of symptoms reoccurrence in BMS and SES groups was 22,3% and 11,8% (р < 0,05) repeated PCI was performed in 15,6% and 3,9% (р < 0,05), CABG - 2,8% and 0,3% (р < 0,05), the incidence of myocardial infarction (MI) was 1,4% and 0,9%. The restenosis rate in BMS and SES groups was 19,7% and 2,3% (р < 0,05), late thrombosis (LT) - 0,3% and 1,4% The survival without MACE was higher in SES group

During 5 years of follow-up the cumulative incidence of symptoms reoccurrence in BMS and DES groups was 30,7% and 22,7% repeated PCI was performed in 23,9% and 18,1% (р < 0,05), CABG - 6,4% and 4,7%, the incidence of myocardial infarction (MI) was 6,5% and 7,8%. The progression of atherosclerosis in early stented segments in BMS and SES groups was 6,6% and 10,1%, late thrombosis (LT) - 0,4% and 2,1%. There was no difference in survival without MACE between groups

Conclusions. By the end of the first year of follow-up the incidence of angina reoccurrence and repeat revascularization in patients with multivascular coronary disease was higher in BMS group compared with SES group. The survival without MACE was also higher in SES group. By the end of the fifth year of follow-up there was no difference in angina reoccurrence, repeated revascularization and surviva without MACE because the late thrombosis and atherosclerosis progression in early stented segments was more common in DES group. 

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