Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

Article exists only in Russian.

Abstract:

Introduction: percutaneous coronary intervention plays an important role in treatment of acute myocardial infarction with ST-segment elevation. However, the benefit of performing delayed PCI is controversial (>12h after onset of symptoms typical for STEMI).

Aim: was to compare results of PCI and medical therapy (MT) in patients, who had been admitted to the hospital with verified STEMI, diagnosed 12 hours after the onset of symptoms, and to estimate their effect on clinical outcomes.

Material and methods: data of 100 patients was analyzed, PCI was performed in 62 patients and 38 patients underwent medical therapy. The task was to compare clinical outcomes, which included mortality and major adverse cardiac events (MACE).

Results: all-cause mortality in groups of delayed PCI and MT was 4 (6,45%) and 9 (23,6%) respectively (p <0,05). It was also recorded that minor cases of cardiac death occurred in the group of delayed PCI in comparison with the MT group, 1 (1,6%) and 6 (15,7%) respectively (p <0,05).

Conclusion: delayed PCI (12 hours after the onset of the myocardial infarction in STEMI patients) leads to improvement in all-cause mortality and cardiac death rates compared with conservative treatment.

Abstract:

Article presents a retrospective analysis of using the modified way experience in removing the occlusive substrate from cerebral vessels in the ischemic stroke acute phase after failed standard thrombectomy.

Aim: to study the efficacy and advantages of thrombectomy technique from intracranial arteries in patients with acute ischemic stroke combining a stent-retriever with reperfusion catheter in comparison with the standard stent retriever thromboextraction.

Methods: we analyzed 54 hospital charts of patients who had underwent endovascular recanalization of intracranial large vessel occlusion in acute ischemic stroke. Patients were divided into two equal groups, depending on thrombus removal method. Standard stent-retriever thrombectomy with a balloon guide-catheter was performed as the first stage in both groups. In 27 cases (1st group), after standard stent-retriever technique failed, we carried out combination of retriever extraction with distal aspiration and a guiding balloon-catheter. If we couldn’t safely insert stent-retriever into catheter of distal approach (during thrombectomy), we switched to vacuum aspiration from guiding balloon-catheter (vacuum-blocked) and removed stent-retriever, microcatheter and distal approach catheter simultaneously without reducing tension. In 27 patients (2nd group) after standard thrombectomy failed we repeated this technique several times.

Results: embolic complications relative risk was 2,249, 95% CI (1,126 - 4,492) and reperfusion mTICI 3 100% versus 74,07% rate was higher in the first group, in comparison with the second group. Other complications and hospital outcomes of disease did not differ between groups.

Conclusion: a stent retriever combined with distal aspiration and a simultaneous transition to vacuum-blocked extraction using after an unsuccessful standard thrombectomy increases the efficiency of complete reperfusion by 25%. Its use is 1,8 times safer than standard thrombectomy in terms of embolic complications.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Abstract:

Introduction: basilar artery thrombosis (BAT) is the cause of about 1% of ischemic strokes (IS). About 27% of strokes in posterior circulation are associated with BAT. Mortality in BAT without recanalization reaches 85-95%. In 80.7% of patients with BAT at the onset of disease a decrease in level of consciousness is observed, in 34% of them – coma.

Aim: was to show the possibility of performing thrombectomy (TE) in patients with BAT and reduced level of consciousness as the only effective way to prevent death in this pathology.

Materials and methods: two case reports of successful TE from basilar artery in patients with IS and decrease in level of wakefulness to coma, are presented.

Results: article describes two successful cases of TE in patients with angiographically confirmed BAT and decrease in the level of consciousness to moderate coma at the onset of disease. In two presented patients, TE made a complete restoration of BA blood flow. Good clinical outcomes were noted in both patients by 90th day of disease (modified Rankin scale 0-2 points). The Rivermead mobility index at discharge from hospital was 14 points, and the Bartel index by 90th day – complete independence from others in everyday life (from 90 to 100 points), and that once again indicates that TE in BAT is not only a life-saving procedure, but significantly improves functional and clinical outcomes of disease.

Conclusions: basilar artery thrombosis is a life-threatening condition that requires urgent reperfusion therapy as the only effective method of treatment. Endovascular treatment for basilar artery thrombosis should be considered in all patients, regardless the decrease in the level of consciousness at the onset of disease, because thrombectomy is a life-saving procedure.

References 

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https://doi.org/10.1016/S1474-4422(16)30177-6

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https://doi.org/10.1161/STR.0000000000000211

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10.   Weber R, Minnerup J, Nordmeyer H, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry. Eur J Neurol. 2019; 26(2): 299-305.

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11.   Kang DH, Jung C, Yoon W, et al. Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study. J Am Heart Assoc. 2018; 7(14): 009419.

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https://doi.org/10.1016/S1474-4422(19)30395-3

13.   Potter JK, Clemente JD, Asimos AW. Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion. Am J Emerg Med. 2021; 42: 221-224.

https://doi.org/10.1016/j.ajem.2020.11.055

Abstract:

Introduction: up to the present day, there were no published multicenter randomized researches, that could compare combined concept of thrombectomy, including different methods of stent-retrievers traction with elements of aspiration and thrombolysis. There is no data on the effect of embolic complications after extraction of thrombus from cerebral arteries on outcomes of treatment.

Aim: was to increase the effectiveness of treatment of patients with ischemic stroke basing on a comparison of results of various methods of endovascular thrombectomy from cerebral vessels and intravenous thrombolysis, and on the base of assessment of effect of distal embolism on treatment outcomes in acute period of ischemic stroke.

Materials and methods: we carried out statistical analysis of results of different methods of thrombectomy in 75 patients and intravenous thrombolysis in 75 patients in acute phase of ischemic stroke. Effect of embolic complications after thrombectomy on outcomes of treatment of ischemic stroke was determined.

Results: groups of patients were comparable in age, neurological deficit, sex, localization and stroke subtype. The first group is burdened by the proportion of documented cerebral artery occlusion, diabetes mellitus and ischemic stroke in anamnesis. Differences in deaths and disability rates were not reliable. Thrombectomy demonstrated neurological deficit regression at all evaluation intervals, as well as the superiority of 2 times at achievement of functionally independent outcome in comparison with intravenous thrombolysis group.

Conclusions: a concept to thrombectomy, that supposes different methods of use of stent-retrievers and aspiration demonstrates better functional outcomes in treatment of ischemic stroke in the acute phase compared with intravenous thrombolysis. Embolic complications of reperfusion treatment adversely affect ischemic stroke outcomes and should be considered as a factor requiring minimization.

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Abstract

Article provides a literature review on problems of diagnosing of intracranial aneurysms (IA) rupture and its complications.

Aim: was to study relevant data on the use of computed tomography (CT), as well as other imaging methods, in patients with ruptured aneurysms in the acute period.

Materials and methods: a search was conducted for publications on this topic, dating up to December 2019, using main Internet resources: PubMed databases, scientific electronic library (Elibrary), Scopus, ScienceDirect, Google Scholar.

Results: we analyzed 45 literature sources, covering the period from 1993 to 2019, which include 3 meta-analyzes, 5 descriptions of studies evaluating the effectiveness of various visualization methods for ruptured IA. Both foreign and Russian publications were involved.

Conclusion: native CT is the leading visualization method to detect hemorrhages in nearest hours after the rupture of IA. CT angiography in combination with digital subtraction angiography (DSA), according to the vast majority of authors, allows to make thorough preoperative planning in the shortest time, as well as to identify unruptured aneurysms. Based on the obtained data, it is advisable to conduct a study to assess the role of CT in the acute period of IA rupture, as well as in the diagnosis of complications in the early postoperative period.

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41.   Krylov VV, Grigor'eva EV, Hamidova LT, et al. Comparative analysis of computed tomography and intracranial Doppler ultrasonography data in patients with cerebral angiospasm. Nevrologicheskij zhurnal. 2016; 21(6):344-352 [In Russ].

42.   Saribekyan AS, Balickaya NV, Rumyancev YuI, et al. The significance of the study of cerebral blood flow by CT perfusion in assessing the risk of developing cerebral ischemia in patients with ruptured intracranial arterial aneurysms. Voprosy nejrohirurgii im. NN Burdenko. 2019; 83(3): 17-28 [In Russ].

43.   Greenberg ED, Gobin YP, Riina H, et al. Role of CT perfusion imaging in the diagnosis and treatment of vasospasm. Imaging Med. 2011; 3(3): 287-297.

44.   Krylov VV, Dash'yan VG, Shatohin TA, et al. Choice of terms for open surgical treatment of patients with rupture of cerebral aneurysms complicated by massive basal subarachnoid hemorrhage (Fisher 3). Nejrohirurgiya. 2015; 3: 11-17 [In Russ].

45.   Kokov LS. Diagnostic and interventional radiology: today and tomorrow. Zhurnal im. NV Sklifosovskogo Neotlozhnaya medicinskaya pomoshch'. 2019; 8(2): 120-123 [In Russ].

Abstract

Aim: was to estimate condition of aorta branches in case of aortic dissection, using multislice computed tomography (MSCT): we estimated frequency and type of changes of main branches of the aorta involved in the dissection.

Material and methods: a retrospective analysis of 104 patients with aortic dissection (AD) was performed. All patients were admitted to Scientific-Research Institute of Emergency Medicine named after N.V Sklifosovsky All studies were carried out on a multispiral (80x0.5) tomograph in early stages of the disease.

Results: MSCT method allowed to obtain data of the high frequency of transition of aortic dissection to main branches (63.5%), mainly to iliac arteries (81% and 77% of aortic dissection type A and B respectively), both in isolation and in combination with other branches. However, the frequency of occurrence of hemodynamically significant stenosis, both static and dynamic, was significantly higher in groups of visceral branches and brachiocephalic arteries (82% and 71%, respectively).

Conclusion: the CT method allows to evaluate in detail the lumen of the aorta and branches of aorta, and to determine type and degree of stenosis of aortic branches involved in the dissection. Revealed patterns of combining of involvement in different groups of aortic branches in the pathological process, allow to procced more optimized diagnostic search for complications of dissection, including MSCT.

References

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6.     Gamzaev AB ogly, Pichugin VV, Dobrotin SS. Diagnosis, surgical treatment tactics and methods for ensuring operations for aortic dissection. In: Medvedev AP, Pichugin VV. Emergency heart surgery: current and unresolved issues. Nizhny Novgorod; 2015.p.237-281. [In Russ]. 

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15.   Bonaca MP, O'Gara PT. Diagnosis and management of acute aortic syndromes: dissection, intramural hematoma, and penetrating aortic ulcer. Curr Cardiol Rep. 2014;16(10):536. PMID:25156302 https://doi.org/ 10.1007/s11886-014-0536-x

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17.   Strayer RJ, Shearer PL, Hermann LK. Screening. evaluation, and early management of acute aortic dissection in the ED. Curr Cardiol Rev. 2012;8(2): 152-157. PMID: 22708909 https://doi.org/10.2174/ 157340312801784970

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19.   Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg. 2011 ;92(4):1376-1382. PMID:21855849 https://doi.org/10.1016/j.athoracsur.2011.05.011

20.   Kruger T, Conzelmann LO, Bonser RS, Borger MA, Czerny M, Wildhirt S, et al. Acute aortic dissection type A. Br J Surg. 2012;99( 10): 1331-1344. PMID:22961510 https://doi.org/10.1002/bjs.8840

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23.   Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Kardiol Pol. 2014;72(12):1169-252. PMID:25524604 https://doi.org/10.5603/kp.2014.0225

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Abstract:

The article presents an analysis of the choice of strategy for the treatment of ischemic stroke in the acute period, based on literature review.

Aim: was to develop the concept of effective thromboextraction (TE), based on the evaluation of factors influencing results of reperfusion treatment of ischemic stroke (IS), methods of endovascular restoration of cerebral blood flow

Materials and methods: meta-analysis of 44 sources of domestic and foreign literature is performed. The analysis of factors limiting the effectiveness of various reperfusion approaches and the analysis of modern methods of thrombectomy are performed.

Results: it is established, that SMAT (Solumbra) and PROTECT techniques have an advantage in comparison with aspiration approaches to thrombectomy in reducing the period to full reperfusion; methods with temporary occlusion of the source vessel (BGC) SAVE and PROTECT significantly reduce the risk of stroke spread to new vascular areas of the brain and increase the frequency of successful recanalization.

Conclusion: at present time, the PROTECT is the most effective technique in the frequency of successful recanalization, the degree and speed of achieved reperfusion, as well as in the prevention of distal embolization. Extrapolation of experience and principles from other sections of interventional radiology, development of new methods and strategies of brain reperfusion, depending on the morphology of thromboembolism, its size, localization and extent may contribute to improving results of endovascular treatment of ischemic stroke.

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Abstract:

Aim: was to evaluate the importance of pre-procedural cephalic vein (CV) angiography for pacemaker (PM) implantation better results.

Methods: 94 patients (pts) (55 women) aged 23-93 years old were included into the study Pts were randomized into two groups (1:1). Group I (n=47; 24 females): angiography of CV was made before PM implantation. In Group II PM implantation was performed without previously angiography Endpoints: time of procedure, efficacy doses

Results: fluoroscopy time and length of procedure in group I were less than in group II (p=0.0002 and p<0.0001 respectively). Four types of CV anatomy were found. Thus, I type of CV anatomy was most favorable for procedure due to angle between v.cephalica and subclavian vein less then 900. Conclusion: the acute angle of cephalic-axillary confluence is the most common type of CV anatomy and is associated with most success of procedure. Implantation of PM taking into consideration variants of anatomical structure of v cephalica in the subclavian area can reduce the radiation dose, possibility of complications, as well as reduce the duration of the intervention. Preoperative evaluation of the anatomical structure of veins of upper limbs before implantation of permanent pacemakers is a rational approach that allows choosing the method of conducting endocardial electrodes in the right heart.

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Article exists only in Russian.

Abstract:

Introduction: for assessment of the significance of coronary artery stenosis, it is necessary to determine the minimum area of the residual square of the vessel lumen (VLRS) that can provide adequate blood flow to myocardial needs. This value is called «threshold» or «borderline». Numerous studies on this issue using modern intravascular and isotope techniques, randomized clinical trials have shown that the values of the «borderline» value of VLRS for proximal coronary arteries are within 3-4 mml. According to the literature, the angiographic method for assessing the severity of stenosis is not sufficiently informative and unreliable. In this article, a combination of coronary angiography with use of balloon catheter is proposed, that allows to eliminate disadvantages of the angiographic method in solving the task is shown.

Aim: was to investigate possibilities of the method of determining the VLRS of coronary artery (CA) in the stenosis region and to assess its hemodynamic significance based on coronary angiography (CG) using a balloon catheter

Materials and methods: the essence of the proposed approach is the obstruction of the artery at the site of stenosis with a balloon catheter with a known cross-sectional area; the VLRS value in this case is equal to or smaller than the area of the balloon catheter. In case of obstruction of the artery by balloon catheter with a transverse area up to 4 mm2, stenosis was considered to be hemodynamically significant and revascularization was recommended; with preserved intensive blood flow, stenosis is considered hemodynamically insignificant.

Results: angiogram evaluation was performed in 120 patients with IHD with «intermediate» stenoses of proximal coronary arteries (from 40 to 70%) using the described technique. In 84% of cases, VLRS was estimated at 3,14 mm2 or less; in 8% of the VLRL was 3,86 mm2 or less. In such areas of coronary arteries, stenosis was considered hemodynamically significant. These patients underwent revascularization of the myocardium - balloon angioplasty and stenting of the coronary artery In 8% of cases, VLRS was more than 4 mm2, coronary stenosis in such cases was recognized as hemodynamically insignificant, and endovascular treatment was not performed in these patients.

Conclusion: the proposed approach for assessment of the area of the residual square of coronary artery lumen at the site of constriction provides an opportunity for an optimal choice of treatment tactics. 

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10.   Toshihiko Nishioka et al., Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity. Cоmparison with stress myocarlial perfusion imaging. JAAC 1999; 33:1870-1878.

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12.   Pijls N.H., De Bruyne B., Peels K., Van Der Voort PH., Bonnier H.J., Bartunek J. et al. Measurement of fractional flow reserve to assess the functional severity of coronary - artery stenoses. N. Engl. J. Med. 1996; 334 (26):1703-1708.

13.   Pijls N.H.,Van Gelder B.,Van der Voort P,Peels K.,Bracke F.A.,Bonnier H.J. et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995; 92 (11): 3183-3193.

14.   Bech G.J., Pijls N.H., De Bruyne B., Peels K.H., Michels H.R., Bonnier H.J. et al. Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation. 1999; 99(7):883-888.

15.   Lachance P, Dery J.P, Rodes-Cabau J., Potvin J.M., Barbeau G., Bertrand O.F. et al. Impact of fractional flow reserve measurement on the clinical management of patients with coronary artery disease evaluated with noninvasive stress tests prior to cardiac catheterization. Cardiovasc. Revasc. Med. 2008; 9 (4):229-234.

16.   Guagliumi G., Sirbu V., Petroff C., Capodanno D., Musumeci G., Yamamoto H. et al. Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow. EuroIntervention. 2013; 8(10): 1172-1181.

17.   Ozaki Y, Violaris A.G., Kobayashi T., Keane D., Camenzind E., Di Mario C. et al. Comparison of coronary luminal quantification obtained from intracoronary ultrasound and both geometric and videodensitometric quantitative angiography before and after balloon angioplasty and directional atherectomy. Circulation. 1997; 96(2): 491-499.

18.   Nissen S.E., Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical application. Circulation. 2001; 103(4):604-616.

19.   Ma YF., Fam J.M., Zhang B.C. Critical analysis of the correlation between optical coherence tomography versus intravascular ultrasound and fractional flow reserve in the management of intermediate coronary artery lesion. Int. J. Clin. Exp. Med. 2015; 8(5):6658-6667.

20.   Waksman R, Legutko J, Singh J et al. Fractional Flow Reserve and intravascular Ultrasound Relationship Study. J. Am. Coll. Cardiol. 2013; 61:917-923.

21.   Ivanov V.A., Movsesyants M. Yu., Trunin I. V. Vnutrisosudstye metody issledovaniya v intervencionnoj kardiologii [Intravascular methods of investigation in interventional cardiology.]. M., GEOTAR-Media. 2008: с. 212. [In Russ].

22.   СЫ M., Zhu D., Guo L.J. et al. Usefulness of lumen area parameters determined by intravascular ultrasound to predict functional significance of intermediate coronary artery stenosis. Chin. Med. J. (Engl) 2013; 126: 1606-1611.

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25.   Pijls N.H., Fearon W.F., Tonino P.A., Siebert U., Ikeno F., Bornschein B. et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J. Am. Coll. Cardiol. 2010; 56 (3):177-84.

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Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Abstract:

The aim of the study was to assess the powers of complex ultrasonography in different stages of endovascular closure of atrial septal defects (ASD). 31 patients 13-56 years old (mean age 23,65 ±5,2 years) with septal defects were included into the study. Ultrasound (US) monitoring performed during the procedure of endovascular closure, and as a follow-up. There were prevalence (35,4%) of the patients with central ASD with rims of 5 mm and more. Abcence of anterio-superior or aortic rim, or its deficiency, noted in 19,2% of cases. Patent foramen ovale (PFO) registered in 25,81% of patients. Incidence of multiple ASDs and ASD in aneurysm occurred to be similar and was as high as 9,67%. In 2 cases of multiple ASDs, and 2 cases of PFO, transseptal puncture was used as an approach to left atrium, for the reason of complex anatomy of the septum. After the closure, transthoracic US showed reliable decrease of the right atrium, right ventricle, and pulmonary artery (PA) size. The majority of patients (64%) showed normalization of PA pressure and left ventricle enlargement in a week after the procedure. Two-dimensional echocardiography (EchoCG) with color Doppler mapping (CDM) is the key method for ASD imaging and assessing its suitability for endovascular closure. Transesophageal EchoCG can help in verification of the ASD anatomy and refinement of the ASD rims. Ultrasound guidance during the procedure of endovascular closure allows optimal positioning of the device, immediate assessment of the homodynamic effects, and timely diagnosis of complications.

Reference

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15.   Chen C.Y., Lee C.H., Yang M.W., Chung H.T., Hsieh I.C., Ho A.C. Usefulness of transesophageal echocardiography for transcatheter closure of ostium secundum atrial septum defect with the amplatzer septal occluder. Chang. Gung. Med.J. 2005; 28 (12): 837-845.

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18.   Radhakrishnan S., Marwah A., Shrivastava S. Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children-feasibility and early results. Indian Pediatr. 2000; 37 (11): 1181-1187.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Abstract:

The aim of the study was to assess effectiveness and safety of ioversol (Optiray). The contrast media used for angiography and endovascular interventions in 286 patients with coronary disease, peripheral atherosclerosis, liver and biliary disease, hysteromyoma etal. Optiray provided good visualization in 100% of cases at all vascular territories; it did not cause significant hemodynamic changes and was shown to have low allergenic capacity. As a rule, Optiray also did not affect aminotransferases serum concentrations or renal function, but in 1,4% of patients, in preexisting renal function impairment or known risk factors (diabetes, arterial hypertension) a rise of blood creatinine level was seen.

The results allow the authors to conclude that Optiray (Ioversol) satisfies all the requirements for modern contrast media. 

Reference

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9.     Enzweiler C.N., Hohn S.A., Lembcke A.E. etal. Contrast enhancement in electron beamtomography of the heart: comprasion of amonomeric and a dimeric iodinated contrast agent in 59 patients. ActaRadiol. 2006; 13: 95-103.

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12.   Carraro M., Malalan F., Antonione R. et al.Effects of a dimeric vs a monomeric nonioniccontrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur. Radiol. 1998; 8: 144-147.

13.   Deray G., Bagnis C., Jacquiaud C. et al. Renal effects of low and isoosmolar contrast media on renal hemodynamic in normal and ischemicdog kidney. Invest. Radiology. 1999; 34: 1-4.

14.   Hayami I.S., Ishigooka1 M.G., Suzuki1 Y.T., Mitobe K.I. Comparison of the nephrotoxicity between ioversol and iohexol. International Urology and Nephrology. 1996; 3: 615-619.

15.   Misawa M., Sato Y., Hara M. et al. Use of nonionic contrast medium, iopromide (Proscope 370), in pediatric cardiovascular angiography. Nihon ShoniHoshasen Gakkai Zasshi. 2000; 16: 42-44.

16.   Кармазановский Г.Г. «Старое» неионное рентгеноконтрастное вещество иоверсол -«новый игрок» на российском рынке контрастных средств. Медицинская визуализация. 2007; 2: 135-139.

17.   Корниенко В.Н., Пронин И.И., Такуш С.В., Фадеева Л.М. Новые возможности контрастирования в нейрорадологии. Медицинская визуализация. 2006; 6: 126-133.

Abstract:

Internal carotid artery (ICA) pathological kinking considered to be one of the main causes of stroke. Aim of our study was to assess endovascular possibilities to manage this condition. Carotid stenting performed in 15 non-fixed human corpses with ICA kinking (6 - L-shaped, 5 - S-shaped, 4 - looping) under hydrodynamic monitoring.

It is shown that endovascular correction (stenting) of kinked ICA straightens the artery, considerably reduces pressure gradient, and increases volume of flow. At the same time carotid stenting, performed for ICA kinking, does not distress the vessel wall, in particular, it causes no significant intimal trauma. 

Reference

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6.     Покровский А.В. Патологическое удлинение и извитость (петлеобразование, кольцеобразование) брахиоцефальных артерий. В кн.: Е.И. Чазов «Болезни сердца и сосудов». Руководство для врачей. М.: Медицина. 1992; 299-302.

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Abstract:

РТА and stenting of lower limb s arteries was performed in 28 diabetic patients with critical limb ischemia. Technical success rate of interventions was 96,3%. Clinical success rate after the procedure was 64,3%. Mean values of basal ТсРО2 on the foot after operation increased on 11 mm of mercury. At a favorable outcome of treatment ankle-brachial index values increased on 0,2-0,4. Ischemia recurrence rate was 25%. All recurrences of ischemia were observed in period of 3 to 9 months. Cumulative limb salvage rate in 6 months was 80 %, in 12 months - 75%.

In short period of observation PTA and stenting in diabetic patients is able to eliminate the necessity of amputation in majority of patients. Considering weight of the general condition of such patients, presence of accompanying diseases, risk of development of complications of surgical treatment, РТА can be considered as operation of the first choice. 

Reference

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Article exists only in Russian.

Article exists only in Russian.

Abstract:

Endovascular methods of treatment for coronary heart disease are of considerable current use. Stenting of coronary arteries is the most widely used intervention in management of coronary heart disease. Present-day models of coronary stents make it possible to selectively perform direct stenting in certain roentgenomorphology of the lesion concerned. The authors analysed the outcomes of direct and conventional stenting of coronary arteries in 74 patients presenting with coronary heart disease. No differences as to the mortality rate were observed between the groups. The group of direct stenting demonstrated lower percentage of ischemic events: myocardial infarction on the background of acute or subacute thrombosis of the stent (1 - in the direct-stenting group, 3 - in the conventional-stenting group), transitory myocardial ischaemia (1 case in the direct-stenting group, 3 cases in the conventional-stenting group). Of the angiographic peculiarities, dissection complicated a total of three procedures of traditional stenting, and did not occur in the direct-stenting group. The no-reflow syndrome was noted to have developed in one case in the stenting group with predilatation. Of the technical peculiarities in the direct-stenting group, we observed a statistically reliable decrease in the average duration of the intervention by 11,76 minutes (P = 0,039), that of roentgenoscopy by 5,91 minutes (P = 0,027), a decrease in the average consumption of the radiopaque medium by 68,36 ml (P < 0,01), and a decrease in the average expenditure of coronary balloon catheters by 0,59 pc. (P < 0,001). Hence, the method of direct stenting of coronary arteries turned out to offer advantages over the conventional-stenting technique with predilatation in the clinical, angiographic and economic aspects, provided a careful selection of patients is performed.

Reference

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7.     La Manna A., Di Mario C. Therapeutic Strategies in Multiple Vessel Coronary Artery Disease. E-Journal of European Society of Cardiology. 2005; (29): 17-23.

8.     Triantis G.S., Tolis V.A., Michalis L.K. Direct Implantation of Intracoronary Stents. Hellenic J. Cardiol. 2002; (43): 156-160.

9.     Weaver W.D., Reisman M.A., Griffin J.J., et al., for the OPUS-1 Investigators. Optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial (OPUS-1): a randomised trial. Lancet. 2000; (355): 203-219.

10.   Schuhlen H., Kastrati A., Dirschinger J. Intracoronary Stenting and Risk for Major Adverse Cardiac Events During the First Month. Circulation. 1998; (98): 104-111.

Abstract:

Eighteen experimental animals (9 rabbits and 9 mongrel dogs) were used in a feasibility study of heparin and a polymer belonging to polyoxyalkanoates class - homopolymer of в-oxybutyric acid - polyoxybutyrate (POB) to be applied onto the surface of the nitinole self-expanding stent "Alex" ("Komed", Russia) in order to decrease responsiveness of the vascular wall. During a three-month chronic experiment at various terms following implantation, we examined the degree of biocompatibility of the coat-free stents, heparin-treated stents, and those coated with the above polymer. The studies were carried out by means of arteriography, binocular light microscopy, histological examination, electron microscopy; and the study of the ultrastructure of thestented segmentsof the vessels. The experiments carried out on animals showed that: 1. The coating of the stents may positively influence structural alterations in the vascular wall, which improve the conditions of the blood flow along the vessel; 2. Using POB-coated stents is accompanied by lesser intimal hyperplasia, relatively decreased leukocytic infiltration, and development of vasa vasorum; 3. POB may safely be considered the most favourable coating for stents because of minimal structural alterations in the vascular wall. The obtained findings would make it possible to plan future research on polyoxyalkanoatesas modifiers of the histological responseof the vascular wall tissues while implanting stents.

       References

1.     Holmes D.R. Jr., Leon M.B., Moses J.W., Popma J.J., Cutlip D., Fitzgerald P.J., Brown C., Fischell T., Wong S. C., Midei M., Snead D., Kuntz R.E.. Analysis of 1-Year Clinical Outcomes in the SIRIUS Trial. A Randomized Trial of a Sirolimus-Eluting Stent Versus a Standard Stent in Patients at High Risk for Coronary Restenosis. Circulation. 2004; 109: 634-640.

2.     Machan L. Drug eluting stents in the infrainguinal circulation. Tech. Vasc. Interv. Radiol. 2004; 7: 28-32.

3.     Tanabe K., Serruys P., Grube E., Smits P.C., Selbach G., van der Gissen W.J., Staberock M., de Feyter P., Muller R., Reger E., Degertekin M., Ligthart J.M.R., Disco C., Backx B., Russell M.E. TAXUS III Trial. In-Stent restenosis treated with stent-based delivery of paclitaxel incorporated in a slow-release polymer formation. Circulation. 2003; 107: 559-564.

4.     Grube E., Silber S., Hauptmann K.E., Mueller R., Buellesfeld L., Gerckens U., Russell M.E. TAXUS I. Six- and twelve-months results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation. 2003; 107: 38-42.

5.     Kerner A., Gruberg L., Kapeliovich L., Grenadier E. Late stent thrombosis after implantation of a sirolimus-eluting stent. Catheter Cardiovasc. Interv. 2003; 60: 505-508.

6.     Jeremias A., Sylvia B., Bridges J., Kirtane A.J, Bigelow B., Pinto D.S., Ho K.K., Cohen D.J., Garcia L.A., Cutlip D.E., Carrozza J.P. Jr. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation. 2004; 109: 1930-1932.

7.     Шишацкая Е.И. Медико-биологические свойства биодеградирующих бактериальных полимеров полиоксиалканоатов для искусственных органов и клеточной трансплантологии. Дисс. канд. мед. наук 2003; 156.

8.     Протопопов А.В. Разработка и клиническое внедрение метода эндопротезирования сосудов саморасширяющимся нитиноловым стентом (клинико-экспериментальное исследование). Дисс. док. мед. наук. 2002; 240.

9.     Peck P. Concerns About Subacute Thrombosis and the Sirolimus-Eluting Stents: Hype or Reality? Posted 12.10.2003. Available at:http//www.medscape.com/viewarticle/465210 - 50k.

10.   FDA Public Health Web Notification: Information for Physicians on Sub-acute Thromboses (SAT) and Hypersensitivity Reactions with Use of the Cordis CYPHER™ Coronary Stent. Issuing Date: October 28, 2003. Available at:http: //www.fda.gov/cdrh/safety/cypher.html.

11.   FDA Public Health Web Notification: Updated information for physicians on sub-acute thromboses (SAT) and hypersensitivity reactions with use of the Cordis CYPHER™ sirolimus-eluting coronary stent. Issuing Date: November 25, 2003. Available at: http://www.fda.gov/cdrh/safety/cypher2.pdf.

12.   Babinska A., Markell M.S., Salifu M.O. Enhancement of human platelet aggregation and secretion induced by rapamycin. Nephrol. Dial. Transplant. 1998; 13: 1353-1359.

13.   U.S. Food and Drug Administration, Center for devices and radiological health, Cypher sirolimus-eluting coronary stent on RAPTOR over-the-wire delivery system. Available at:http://www.fda.gov/cdrh/ pdf3/p020026.html.

14.   Lau W.C., Waskell L.A., Watkins P.B. Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction. Circulation. 2003; 107: 32-37.

15.   van der Giessen W.J., van Beusekom H.M., van Hoeten C.D., van Woerens L.J., Verdouw P.D., Serruys P.W. Coronary stenting with polymer-coating and uncoated self-expanding endoprostheses in pigs. Coronary artery disease. 1992; 3: 631-640.

16.   van der Giessen W.J., Slager C.J., van Beusekom H.M., van Ingen Schenau D.S., Huuts R.A., Schuurbiers J.C., de Klein W.J., Serruys P.W Development of a polymer Endovascular prosthesis and its implantation in porcine arteries. J. Interven. Cardiol. 1992; 5: 175-185.

17.   Unverdorben M., Spielberger A., Schywaisky M., Labahn D., Hartwig S., Schneider M., Lootz D., Behrend D., Schmitz K., Degenhardt R., Schaldach M., Vallbracht C. A polyhydroxybutyrate biodegradable stent: preliminary experience in the rabbit. CVIR.2002; 25: 127-132.

18.   Tamai H., Igaki K., Kyo E., Kosuga K., Kawashima A., Matsui S., Komori H.,TsujiT., Motohara S., Uehata H.. Initial and 6-month results of biodegradable poly-L- lactic acid coronary stents in human. Circulation. 2000; 102: 399-404.

Abstract:

A group of patients, including 88 diabetics and 93 non-diabetics (patients were diagnosed according to A. Bollinger system) was studied in terms of occlusive-stentic lesions. The occlusive-stentic affection of low-extremities combined with diabetes is characterized by a number of distinctive features. The majority of diabetics are suffering the distal type of arterial lesion, while atherosclerotics suffer the proximal type. Diabetes functions as a complicating factor, forcing the development of occlusive-stentic process largely in distal segments of low extremities, meaning popliteal and crural arteries. This process eventually leads to the ischemia of low extremities.

References

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6.     Покровский А.В., Дан В.Н., Чупин А.В.. Ишемическая диабетическая стопа. Синдром диабетической стопы. Клиника, диагностика, лечение и профилактика. Москва. 1998; 18 - 35.

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8.     Атанов Ю.П., Шамычкова А.А.. Диабетическая ангиопатия нижних конечностей. Российский медицинский журнал. 2001;5: 14- 15.

9.     Donnelly R. Vascular complications of diabetes. B.M.J. 2000; 320:1062- 1066.

10.   Faglia E. et al. Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. Journal of Internal Medicine. 2002; 252: 225 - 232

11.   Awad S., Karkos CD., Serrachino-Inglott E, Cooper N.J., Butterfield J.S., Ashleigh R., Nasim A. The impact of diabetes on current revascularisation practice and clinical outcome in patients with critical lower limb ischaemia. European journal of vascular and endovascular surgery. 2006; 32 (1): 51-59.

12.   Bosiers M, Hart J.P, Deloose K., Verbist J., Peeters P. Endovascular therapy as the primary approach for limb salvage in patients with critical limb ischemia: experience with 443 infrapopliteal procedures. Vascular. 2006; 14 (2):63 - 69.

Article exists only in Russian.

Abstract:

Article is devoted to the analysis of life, scientific and practical activities of professor Leonid Semenovich Zingerman - one of pioneers in diagnostic and interventional radiology in Russia, the founder of scientific and practical school in the sphere of diagnostic and interventional radiology in urgent situations. The article shows the role of professor Zingerman in development of radiological and diagnostic interventions in cardiac surgery neurosurgery, abdominal surgery and gynecology on the base of Bakoulev Scientific Center for Cardiovascular Surgery (1958-1977) and Scientific and Research Institute of emergency medicine (1977-1992).

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 

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To the 110th anniversary of the birth of Pavel Nikolaevich Mazaev