Abstract: Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. References 1. Wheatley K., Phil D., Ives N. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med. 2009; 36: 1953 - 62. 2. Textor S. Despite results from ASTRAL, jury still out on stenting for atherosclerotic renal artery stenosis. Nephrology. Times .2010; 3: 2-7. 3. Kapoor N., Fahsah I., Karim R et al. Physiological assessment of renal artery stenosis: comparisons of resting with hyperemic renal pressure measurements. Catheter. Cardiovasc. Interv. 2010; 76(5): 726-32. 4. Rundback J.H., Sacks D., Kent K.C., et al. Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation. 2002; 106: 1572-1585. 5. Jones N., Bates E., Chetcuti S. Usefulness of tran- slesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease. Catheter. Cardiovasc. Interv. 2006; 68(3): 429-34. 6. Mitchell J., Subramanian R., White C. et al. Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: renal fractional flow reserve. Catheter. Cardiovasc. Interv. 2007; 69(5):685-9. 7. Kadziela J., Witkowski A., Januszewicz A. Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography. BloodPress. 2011; 20(4): 211-7. 8. Drieghe B., Madaric J., Sarno G. et al. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. European. Heart. Journal. 2007; 29 (4): 517-24. 9. Subramanian R., White C.J., Rosenfield K. et al. Renal fractional flow reserve: a hemodynamic evaluation of moderate renal artery stenoses. Catheter. Cardiovasc. Interv. 2005; 64: 480-486. 10. Leesar M., Varma J., Shapira A. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J. Am. Coll. Cardiol. 2009; 53(25): 2363-71. 11. Radermacher J., Chavan A., Bleck J. et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N. Engl. J. Med. 2001; 344: 410-417. 12. Doi Y., Iwashima Y., Yoshihara F. Et al. Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension. 2012; Jul 23. Epub ahead of print. 13. Zeller T., Ulrich F., Mflller C., Bbrgelin K., Sinn L. Angioplasty of severe atherosclerotic ostial renal artery stenosis: predictors of improved renal function after percutaneous stent-supported intervention. Circulation 2003; 108: 2244-2249. 14. Liew Y., Bartholomew J. Atheromatous embolization. hsc. Med. 2005; 10: 309-326. 15. Holden A. Is there an indication for embolic protection in renal artery intervention? Tech. Vasc. Interv. Radiol. 2011; 14(2): 95-100. 16. Rocha-Singh K., Eisenhauer A.,Textor S. Atherosclerotic peripheral vascular disease symposium II: intervention for renal artery disease. Circulation. 2008; 118: 2873-2878. 17. Feldman R., Wargovich T., Bittl J. No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter. Cardiovasc. Interv. 1999; 46(2): 245-8. 18. Kolluri R., Goldstein J., Rocha-Singh K. Percutaneous vascular interventions in renal artery diseases. Minerva. Cardioangiol. 2006; 54: 95-107. 19. Hiramoto J., Hansen K., Pan X. Atheroemboli during renal artery angioplasty: an ex vivo study. J. Vhsc. Surg. 2005; 41(6): 1026-30. 20. Holden A., Hill A. Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience. Journal Vascular. Surgery. 2003; 38: 962-968. 21. Perkovic V., Thomson K., Mitchell P. et al. Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Austral. Radiol. 2001; 45: 438-43. 22. Paulsen D., Klow N., Rogstad B. et al. Preservation of renal function by percutaneous transluminal angioplasty in ischaemic renal disease. Nephrol. Dial Transplant. 1999; 14: 1454-61. 23. Leertouwer T., Gussenhoven E., Bosch J. et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000; 216: 78-85. 24. Vignali C., Bargellini I., Lazzereschi M. et al. Predictive factors of in-stent restenosis in renal artery stenting: a retrospective analysis. Cardiovasc. Intervent. Radiol. 2005; 28: 296-302. 25. Corriere M., Edwards M., Pearce J. et al. Restenosis after renal artery angioplasty and stenting: incidence and risk factors. J. Vasc. Surg. 2009; 50(4): 813-819. 26. Leertouwer T., Gussenhoven E., van Overhagen H. et al. Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound. J. Vasc. Interv. Radiol. 1998; 9: 945-952. 27. Zeller T., Rastan A., Rothenpieler U. et al. Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents? Catheter. Cardiovasc. Interv. 2006; 68(1): 125-30. 28. Sapoval M., Zghringer M., Pattynama P. et al. Low- profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial. J. Vasc. Intern Radiol. 2005; 16(9): 1195-202.
Percutaneous coronary intervention in octogenarian patients with myocardial infarction (literature review)
DOI: https://doi.org/10.25512/DIR.2017.11.3.10
For quoting:
Berezhnoi K.Yu., Vanyukov A.E., Kokov L.S. "Percutaneous coronary intervention in octogenarian patients with myocardial infarction (literature review)". Journal Diagnostic & interventional radiology. 2017; 11(3); 79-84.
Abstract: Cardiovascular disease is a leading cause of mortality and morbidity in octogenarian patients. The number of such patients and the number of percutaneous coronary interventions are increasing. Methods: literature report is based on data, searched in PubMed database, Elibrary, electronic catalog of the Russian State Library, published until January 2017. Results: review showed reasons why this group of patients refers to high-risk patients. Also, we analyzed modern approaches to the treatment of such patients, significance of PCI, intraoperative factors affecting the outcome of treatment of patients with myocardial infarction. Conclusion: worse results of PCI in elderly patients in comparison with younger group have multifactorial reasons. Different authors point on higher percent of comorbidity, and previous MI, worse cardiac function, higher iatrogenity Based on received data, we showed clinical problems in these patients, the solution of which would improve results of treatment of this group of challenging patients. References 1. Mark Mather, Linda A. Jacobsen, and Kelvin M. Pollard. Aging in the United States. Population Bulletin 70, no. 2 (2015). 2. Predpolozhitel'naja chislennost' naselenija Rossijskoj Federacii do 2030 goda. [Presumptive population of the Russian Federation until 2030]. Statisticheskij bjulleten'. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2016 [In Russ]. 3. Roth, Gregory A. et al. «Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality.» The New England journal of medicine 372.14(2015):1333-1341. PMC. Web. 9 Jan. 2017. 4. Zdravoohranenie v Rossii 2015. [Healthcare in Russia 2015]. Statisticheskij sbornik. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2015 [In Russ]. 5. Bogomolov A.N. Retrospektivnyj analiz rezul'tatov koronarnogo stentirovanija u bol'nyh pozhilogo i starcheskogo vozrasta. Dis. kand. med. nauk. [Retrospective analysis of coronary stenting in elderly and very elderly patients. Cand. of Dr. med. sci. diss]. SPb. 2013 [In Russ]. 6. Bauer T., Mollmann H., Weidinger F., Zeymer U., SeabraGomes R., Eberli F., Serruys P, Vahanian A., Silber S., Wijns W., Hochadel M., Nef H.M., Hamm C.W., Marco J., Gitt A.K. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol. 2011; 151:164-169. 7. Antonsen L., Jensen L.O., Terkelsen C.J., Tilsted H. H., Junker A., Maeng M., Hansen K.N., Lassen J.F., Thuesen L., Thayssen P Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with STsegment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013; 81:912-919. 8. Daniel I. Bromage, Daniel A. Jones, Krishnaraj S. Rathod. Outcome of 1051 Octogenarian Patients With STSegment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. Journal of the American Heart Association. 2016;5:e003027. 9. Caretta G., Passamonti E., Pedroni PN., Fadin B.M., Galeazzi G.L., Pirelli S. Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty. Clin Cardiol. 2014; 37:9:523-529. 10. Spoon D.B., Psaltis PJ., Singh M., et al. Trends in cause of death after percutaneous coronary intervention. Circulation. 2014; 129:1286-1294. 11. Goch A., Misiewicz P, Rysz J., Banach M. The clinical manifestation of myocardial infarction in elderly patients. Clin Cardiol. 2009; 32:E46-E51 12. Dangas G.D., Singh H.S. Primary percutaneous coronary intervention in octogenarians: navigate with caution. Heart. 2010; 96:813-814. 13. Semitko S.P. Metody rentgenjendovaskuljarnoj hirurgii v lechenii ostrogo infarkta miokarda u bol'nyh starshego
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Abstract: Acute traumatic aortic rupture is associated with extremely high mortality and requires urgent diagnosis and treatment. Materials and methods: patient P, 33 years 28.12.2013, fall from a height of 5 floors. On the day of admittion to hospital he was hospitalized to the reanimation department with a diagnosis of «multiple trauma, traumatic shock». For nearest hours after admission MSCT of head, neck, chest organs, abdomen and pelvis were performed. Results: in series of images of the head and neck revealed multiple fractures of facial bones anc skull base, hemo-sinus. MSCT chest without contrast enhancement: expanding boundaries revealed the presence of the upper mediastinum content density of 65 Hounsfield units (Ed.N) around the arch and descending aorta, in tissues of the posterior mediastinum. Volume of about 35 cm3 - in the pericardial cavity, ribs on the left with a displacement of fragments, left-sided hemothorax (260 cm3). During examination of abdomen and pelvis in the native phase: in subhepatic space in the liver portal, volume of about 50 cm3 with density of blood multiple fractures of the pelvis. CT with contrast-enhanced bolus revealed uneven expansion in the thoracic aorta isthmus length of 60 mm, with the presence at this level of linear structures intraluminal wall surface (wall laceration), and a narrow zone of extravasation of the contrast agent on the inner contour of the aorta. At the lever portal detected delimited zone of active extravasation of contrast material as a result of breaking its proper hepatic artery which is essentially as a thrombosis of pseudoaneurysm with zone of thrombosis around the periphery and subcapsular rupture of the left lobe of the liver Ultrasound examination - left-sided hydrothorax, echo signs of free fluid in the abdominal cavity, liver hematoma in the area of the portal, diffuse changes in kidneys («shock» kidney). Patient underwent primary surgical dressing of face wounds, osteosynthesis of right femur with external fixation device (EFD). Endoprothesis of descending thoracic aorta was performed 29.12.2013. After implantation of the prothesis, celiacography was performed, in which in liver portal, in the place of proper hepatic artery division to the right and left hepatic artery - large-size false aneurysm was revealed. CT scanning, performed on the 5th day after aortic replacement: there are signs of segmental atelectasis of the lower lobe of the left lung, minimum infiltrative changes in fiber anterior mediastinum, hematoma of the posterior mediastinum (31 cm3. Previously was 191 cm3), and hemopericardium (15 cm3 compared with 35 cm3) In the process of dynamic observation, it was found that up to 30 days, false aneurysm of proper hepatic artery increased in size, in this regard, the patient was operated on 24.01.14. Follow-up CT scan with contrast enhancement: branches of the hepatic artery are well visualized, artery aneurysm is not defined 12.02.14, was the dismantling of EFD and manufactured fixation of the right femur pin. After 65 days after the injury and the start of treatment the patient was discharged under the supervision of the surgeon and cardiologist in the community. References 1. Andreeva T.M. Travmatizm v Rossiyskoy Federatsii na osnove dannykh statistiki FGU «TsITO im. N.N. Priorova Rosmedtekhnologiy». [Traumatism in the Russian Federation on the basis of statistical data of FGU «TsITO im. N.N. Priorova Rosmedtekhnologiy»]. Electronic scientific journal «Social aspects of health of the population». 2010; № 4(16). [In Russ] 2. Kolesnikov E.S. Kliniko-epidemiologicheskaya kharakteristika tyazheloy sochetannoy kranio-torakalnoy travmy v krupnom promyshlennom tsentre. Avtoreferat. Diss. kand. tekh. nauk [The kliniko-epidemiologic characteristic of a severe combined kranio-thoracic trauma in the large industrial center: Abstract Dr. techn.sci.diss.]. Omsk. 2009: 23. [In Russ]. 3. Asif Huda Ansari, Ahmed S. Ahmed, Navin P. Lal. Traumatic aortic injury: a case report. Turkish Journal of Trauma & Emergency Surgery. 2009;15(6):621-623. 4. Victor X. Mosquera, Milagros Marini, Javier Muniz et al. Blunt traumatic aortic injuries of the ascending aorta and aortic arch: A clinical multicentre study. Injury, Int. J. Care Injured. 2013; (44): 1191-1197. 5. Kaavya N. Reddy, Tim Matatov, Linda D. Doucet et al. Grading system modification and management of blunt aortic injury. Chinese Medical Journal. 2013;126 (3):442-445. 6. Дж. Э. Тинтиналли, РЛ. Кроум, Э. Руиз. Неотложная медицинская помощь. Перевод с англ. В.И. Кандрора, М.В. Неверовой, А.В. Сучкова, А.В. Низового, Ю.Л. Амченкова; М.:Медицина. 2001; 334. 7. Dzh. E. Tintinalli, R.L. Kroum, E. Ruiz. Neotlozhnaya meditsinskaya pomoshch'. Perevod s angl. V.I. Kandrora, M.V. Neverovoy, A.V. Suchkova, A.V. Nizovogo, Yu.L. Amchenkova [Emergency medicine]. 8. Jun Woo Cho, M.D., Oh Choon Kwon, M.D., Sub Lee, M.D., Jae Seok Jang, M.D. Traumatic Aortic Injury: Singlecenter Comparison of Open versus Endovascular Repair. Korean J. Thorac. Cardiovasc. Surg. 2012;45:390-395. 9. Estrera A.L., Miller C.C., Salinas-Guajardo G., Coogan S.M. et al. Update on blunt thoracic aortic injury: 15-year single-institution experience. J. Thorac. Cardiovasc. Surg. 2012; doi: 10.1016/j.jtcvs.2012.11.074. [Epub ahead of print]. 10. O’Conor C.E. Diagnosing traumatic rupture of the thoracic aorta in the emergency department. Emerg. Med. J. 2004; 21:414-419. 11. Panagiotis N. Symbas, Andrew J. Sherman, Jeffery M. Silver et al. Traumatic Rupture of the Aorta Immediate or Delayed Repair? Ann. Surg. Jun. 2002; 235(6): 796-802. 12. Троицкий А.В., Хабазов РИ., Лысенко Е.Р, Беляков Г.А., Грязнов О.Г., Соловьева Е.Д., Азарян А.С. Первый опыт гибридных операций при торакоабдоминальных аневризмах аорты. Диагностическая и интервенционная Радиология. 2010; 4(1): 53-66. 13. Troickij A.V., Habazov R.I., Lysenko E.R., Beljakov G.A., Grjaznov O.G., Solov'eva E.D., Azarjan A.S. Pervyj opyt gibridnyh operacij pri torakoabdominal'nyh anevrizmah aorty[Thoracoabdominal aneurysms: first experience of operation]. Diagnosticheskaja i intervencionnaja Radiologija. 2010; 4(1): 53-66 [In Russ]. 14. Woodring J.H. The normal mediastinum in blunt traumatic rupture of the thoracic aorta and brachiocephalic arteries. J. Emerg. Med. 1990; 8: 467-476.
