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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.



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.




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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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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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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.



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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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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.



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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Article exists only in Russian.



Article exists only in Russian.


Article exists only in Russian.



Article exists only in Russian.



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.



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10.   Droste D.W., Lakemeier S., Wichter T., Stypmann J., Dittrich R., Ritter M., Moeller M., Freund M., Ringelstein E.B. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke. 2002; 33 (9): 2211-2216.

11.   Hofer C.K., Furrer L., Matter-Ensner S., Maloigne M., Klaghofer R., Genoni M., Zollinger A. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br.J. Anaesth. 2005; 94 (6): 748-755.

12.   Augoustides J.G., Weiss S.J., Ochroch A.E., WeinerJ., Mancini J., Savino J.S., Cheung A.T. Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale. J. Cardiothorac. Vasc. Anesth. 2005; 19 (2): 146-149.

13.   Augoustides J.G., Weiss S.J., Weiner J., Mancini J., Savino J.S., Cheung A.T.Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography inadult cardiac surgical patients.J. Cardiothorac.Vasc. Anesth. 2004; 18 (6): 725-730.

14.   Carlson K.M., Justino H., O'Brien R.E.,Dimas V.V., Leonard G.T., Pignatelli R.H.,Mullins C.E., Smith E.O., Grifka R.G.Transcatheter atrial septal defect closure:modified balloon sizing technique to avoid     18.overstretching the defect and oversizing theAmplatzer septal occluder. Catheter.Cardiovasc. Interv. 2005; 66 (3): 390-396.

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.



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. 






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5.     Schild H.H., Kuhl C.K., Hubner-Steiner U.A., Bohm I.M. Adverse Events after Unenhanced and Monomeric and Dimeric Contrast-enhanced CT: A Prospective Randomized Controlled Trial. Radiology. 2006; 240: 56-64.

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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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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.

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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. 




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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. 





1.     Rutherford R.B., Durham J. Percutaneous balloon angioplasty for arteriosclerosis obliterans: Long-term results. In Pearce W.H. (eds). Technologies in Vascular Surgery. 1992; 32-345.



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Article exists only in Russian.



Article exists only in Russian.



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.



1.     Фуфаев Е.Н. К вопросу о методике клинико-социальных исследований по изучению потребности в кардиохирургической помощи. Качественная Клиническая Практика. 2003; (31) 2: 13-108.

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3.     Rogers С, Parikh S., Seifert P. Edelman E. Endogenous cell seeding. Remnant endothelium after stenting enhances vascular repair. Circulation. 1996; (94).2909-2914.

4.     Villegas B., Morice M.C., Hernandez S. et al. Triple Vessel Stenting for Triple Vessel Coronary Disease. The Journal of Invasive Cardiology. 2002; (14): 1-5.

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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.

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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.



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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.ETAXUS 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.

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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.ИМедико-биологические свойства биодеградирующих бактериальных полимеров полиоксиалканоатов для искусственных органов и клеточной трансплантологииДисс. канд. мед. наук 2003; 156.

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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:

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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: 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.



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.



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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).


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. 



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For quoting:
Kokov L.S. "". Journal Diagnostic & interventional radiology. 2012; 6(3); 5-10.


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. 



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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.

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13.   Semitko S.P. Metody rentgenjendovaskuljarnoj hirurgii v lechenii ostrogo infarkta miokarda u bol'nyh starshego


Literature report provides a critical analysis of the literature on the use of multislice computec tomography (MSCT) as an alternative to conventional autopsy in forensic examination in case of sudden death associated with target-organ damage in arterial hypertension (AH). The review was made using Internet resources: Scientific Electronic Library (elibrary), SciVerse (ScienceDirect), Scopus, PubMed, and Discover. The review includes only those articles that discuss both advantages and limitations of MSCT in the posthumous forensic sudden death of adults.

During analysis of the available literature, authors discuss the problem of posthumous use of MSCT imaging in arterial hypertension complications: myocardial infarction, brain stroke, aneurysm rupture and separation of the aortic wall. Authors tried to answer the question about possibilities of posthumous MSCT as an alternative to the traditional autopsy

Conclusion: native MSCT is suitable for imaging of intracranial hemorrhage and differential diagnosis of traumatic brain injury Method is suitable with restrictions for diagnosis of ischemic strokes, aneurysms and aortic dissection. Possibilities of native MSCT in the diagnosis of sudden death associated with the pathology of coronary artery disease, myocardial infarction and pulmonary embolism is significantly limited. Using postmortem CTA, extends method in the diagnosis of lesions of the coronary arteries, aorta and pulmonary artery.

The main advantage of MSCT in the posthumous sudden death - the possibility of visualizing hidden mechanical damage in case of failure of the autopsy relatives. 



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12.  Takahashi N., Satou C., Higuchi T., Shiotani M., Maeda H., Hirose Y Quantitative analysis of brain edema and swelling on early postmortem computed tomography: comparison with antemortem computed tomography. Jpn. J. Radiol. 2010 Jun;28(5):349-54.

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16.  Takahiro Z., Teruhiko T., Miyamoto M., Yamaguchi S., Endo T., Inaba H. Intravascular gas in multipleorgans detected by postmortem computed tomography: effect of prolonged cardiopulmonary resuscitation on organ damage in patient swith cardiopulmonary arrest. Jpn. J. Radiol. 2011; 29(2):148-51.

17.  Shiotani S., Kohno M., Ohashi N., Atake S., Yamazaki K., Nakayama H. Cardiovascular gas on non-traumatic post-mortem computed tomography (PMCT): thein- fluence of cardiopulmonaryre suscitation. Radiat. Med. 2005 Jun;23(4):225-9.

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Purpose. Was to investigate ability of videodensitometry for assessment the effect of renal artery stenosis on parenchymal perfusion.

Materials and methods. Аngiographic data of 97 patients with and 55 patients without renal artery stenosis were analyzed by means of videodensitometry, using «Multivox» software. All patients underwent renal arteries duplex ultrasound and kidneys ultrasound examination.

Levels of blood pressure and kidney function as a clinical signs of renovascular hypertension were assessed. Risk factors of kidney parenchymal injury such as diabetes mellitus, chronic kidney diseases were monitored.

Results. Videodensitometric analysis allows to detect statistically significant differences in parenchymal perfusion between kidneys with and without renal artery stenosis. A grade of changes in parenchymal perfusion correlates with angiographicaly measured degree of renal artery stenosis and renal artery blood flow velocity.

Conclusion. Videodensitometric perfusion parameters can be used to assess the effect of renal artery stenosis on parenchymal blood flow.

Thus, videodensitometry extends diagnostic capability of angiographic study. 




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To 70-th anniversary of David Georgievich Ioseliani

For quoting:
Kokov L.S. "To 70-th anniversary of David Georgievich Ioseliani". Journal Diagnostic & interventional radiology. 2013; 7(2); 11-13.


Article exists only in Russian.


Aneurism of the splenic artery is a rare, but potentially life-threatening condition. In the majority of patients with an aneurism of unpaired visceral arteries the endovascular procedure is a treatment of choice. Of them stent graft implantation is considered as the most promising method. However, until recent only balloon-dilated stent grafts were used. Due to a rigid delivering system this type of grafts cannot be implanted in distal branches of visceral arteries, that is significant limitation of this technique. Technological advances and developing of low-profile soft self-expanding grafts allow overcoming this limitation. New type of grafts opens the possibility to exclude aneurisms even in conditions of marked vessel tortuosity and complex vascular anatomy

Conclusion: stent-graft implantation is an effective and safe method of treatment of splenic artery false aneurisms. This method allows to reliably exclude an aneurism from the circulation and is not associated with increased risk of thrombotic complications. Modern low-profile soft self-expanding grafts open new possibility in treatment of visceral arteries aneurisms even in conditions of marked vessel tortuosity and complex vascular anatomy.



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27.  Gandini R., Pipitone V., Konda D. et al. Endovascular treatment of a giant superior mesenteric artery pseudoaneurysm using a nitinol stent-graft. Cardiovasc. Interv. Radiol. 2005;1: 102-106.

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This report touches upon the pressing problem of endocardial leads removal. It is essential to free the leads safely and effectively of fibrous depositions on contact points of venous walls or cardiac structures. Main principles of retrieval are contratraction and contra0 pressure. Authors present a comprehensive review of all existing lead removal techniques, from simple traction to active extraction device application, discussing clinical efficiency, indications and possible complications of each method. Active extraction systems are declared to be most advantageous.



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Aim: was to identify relationship between risk factors (RF) and severity of coronary artery (CA) defeat in patients, hospitalized with acute coronary syndrome (ACS), without the presence of ishemic heart disease (IHD) earlier.

Materials and methods: the research includes 201 patients, who were hospitalized to N.V Sklifosovsky Research Institute of Emergency Medicine from february 2011 to apri 2012 with the diagnosis «ACS». Main criteria of patients selection was the absence of IHD clinics in past. All patients underwent coronarography, obtained data was fixed in data base. At the time of arrival to hospital - risk factors were determined. To identify relationship between RF and CA defeat - statistic analyzes were made: the number of defeated CA (1,2 or 3); severity of CA defeat was measured with Syntax Score (SS) Scale (<22 and >22 points); praesence or absence of acute occlusion of CA of infarction zone.

Results: research consisted of 149 male (74,1%) and 52(25,9%) female, mean age of all patients was 56,6±10,6 yrs. ACS with elevation of ST-segment was diagnosed in 136 (67,7%) of patients. Haemodynamic significant stenosis (HSS) of 1, 2 or 3 CA were found in 56 (27,9%), 61 (30,4%) and 64 (30,8%) respectively In 20 (10%) patients - there was no HSS. Acute thrombotic occlusion (ATO) in myocardial infarction related(MI-related) CA was revealed in 146 (72,6%) of patients. It was noted, tht such RF as arterial hypertention (AH), smoking, low physical activity (LPA), was more spread with increasing numer of defeated CA. Patients with lot of defeated CA, were older, had higher figures of systolic arterial pressure (SAP). After examination and primary analysis, only age and number of RF had independent relation with prevalence of CA defeat. Patients with SS >22 points in comparison with patients <22 points, had higher AP, obesity, diabetes mellitus (DM), and more ofted had lack of fruits and vegetables. Also they were older had higher SAP, more RF. Analysis showed that only AH, DM, and age had independent relation with savere CA defeat (Syntax Score >22 points). Patients with ATO of CA, had higher such RF as smoking, LPA, DM. They also had more RF. After analysis - smoking and LPA were independently connected with ATO.

Conclution: such RF as age, AH, DM, LPA and number of combined RF in patient can have independent relation with volume and prevalence of CA defeat. Smoking and LPA can have relation with ATO, with clinics of ST-elevated ACS and macrofocal MI. Obtained data show necessity of inlarged reseach for a broad understanding og RF in connection with coronary atherosclerosis and thrombosis. All that can increase effectiveness of treatment and prophylaxis of cardiovascular morbidity and mortality.



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Article exists only in Russian.



Aim: was to estimate possibilities of the clinically developed method of diagnostic phlebography among patients with newly diagnosed and recurrent varicocele.

Materials and methods: phlebography was performed on 44 patients with left-sided varicocele . 24 of them have newly diagnosed varicocele and other 20 patients have recurrent varicocele. The age of patients varies from 12 to 48 years. During phlebographic studies the clinically developed method of diagnostic phlebography was applied to all patients. This method is based on the application of obturating balloon catheter installed in left internal spermatic vein.

Results: as a result of the study, structural features of left internal spermatic vein were revealed among patients with newly diagnosed and recurrent varicocele. Also, angioarchitecture variants of external spermatic vein and its hemodynamic features were defined. The pelvic venous basin angiographic characters of hemodynamic disorders were marked.

Conclusions: the phlebotesticulography through left internal spermatic vein balloon obturation gives the opportunity to get full information about left testis' venous circulation architecture and hemodynamics. The obtained information allows to choose both traditional methods of surgical treatment and inter-venous anastomosis microsurgery.



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4.     Kim V.V., Kazimirov V.G. Anatomo-funkcional'noe obosnovanie operativnogo lechenija varikocele[Anatomic-functional justifications of operative treatment of varicocele]. M: Medpraktika. 2008; 112S [In Russ].

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and treatment of varicocele]. M: 2001; 3-206 [In Russ].

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Article exists only in Russian.




An important clinical challenge the management of patients with pulmonary embolism is to determine prognosis of the treatment generally, and thrombolytic reperfusion therapy as the main component of a specific pathogenetic treatment in particular. This knowledge is necessary to adjust the plan of remedial measures, the intensification of concomitant pharmacotherapy and provide a personalized approach to patients with thromboembolic lesions of the pulmonary circulation

Aim: was to identify reliable predictors of the onset of reperfusion in patients with pulmonary thromboembolism based on methods of radiographic diagnosis.

Materials and Methods: 138 patients (73 women and 65 men) underwent examination. Age of patients ranged from 20 to 80 years (mean age 55±25 years). The first group includes observation of 102 patients admitted to hospital in early stages of disease ( 1 month after onset of symptoms). The second group consisted of 36 patients admitted to the hospital at a later date (from 1.5 to 12 months). In groups we studied predictors of pulmonary reperfusion channel on the basis of direct angiography and multislice computed tomography As a control, a diagnostic method used direct angiography, which has a high sensitivity and specificity in identifying symptoms of pulmonary embolism. Using the method of multiple logistic regression odds ratios were prepared to achieve reperfusion in patients with certain diagnostic symptoms compared with patients who have no signs data in angiography

Results: diagnostic criteria, in presence of which on angio-pulmonography significantly increased the likelihood of reperfusion are «amputation» of segmental branches of the pulmonary artery ( p<0.05, 16,55(6,50-42,09 ) ), intraluminal defects of contrast staining (p < 0.05, 30.56 (8,66-107,84)) and the absence of distal blood flow (p<0,05; 6,16(2,47-15,40)). Signs, significantly reducing chances of achieving reperfusion are tortuosity of segmental branches of the pulmonary artery (p<0,05; 0,03(0,01-0,08)), slowing of contrast branches of the pulmonary artery (p<0,05; 0,11( 0.05-0.25)), and the presence of defects in the near-wall staining (p<0,05; 73,182 (9,606-557,542)).

Conclusions: basing on results of modern beam-diagnostics may reliably predict the likelihood of reperfusion in patients with pulmonary embolism.


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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.



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Article exists only in Russian.




Aim: was to evaluate efficiency of stents-grafts in treatment of cerebral aneurysms.

Materials and methods: for the period of 2001-2012 implantation of stent-grafts was performedm 10 patients with cerebral aneurysms. Indications for implantation: huge or giant aneurysms; wide«neck» of aneurysm; difficult localization for neurosurgical techniques; absence of significant tortuosity of artery that could interfere successful stent delivery All patients underwent examination:

MSCT-angiography, MRI, cerebral angiography To predict possible stent thrombosis we performed angiographic tests with pinching of pathological artery and contrasting of opposite artery Then we assessed blood-flow of anterior and posterior communicating arteries and also changes in neurological status. Unsatisfactory condition of collateral blood-flow - was not a contraindication for stenting. In 8 patient, aneurysms were localized in internal carotid artery, and in 2 patients in the vertebrobasilar artery In 3 cases implantation of stent-graft was proceeded in acute period of hemorrhage; that caused late disaggregant therapy (immediately after implantation, drugs were injected through nasogastric tube instead of 4-5 days of preoperative treatment).

Results: exclusion of the aneurysm from the blood-flow was reached 100% of cases. In one case, implantation of micro-coils was necessary due to inability to cover the whole neck of the aneurysm because of tortuosity of artery In 1 case we had thrombosis of stent in vertebral artery with spreading of thrombosis on basilar artery with development of ischemic stroke and further death.

Conclusion: use of stent-grafts for exclusion of huge and giant aneurysms from cerebral blood- flow is a highly effective method.



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4.     Hirurgija anevrizm golovnogo mozga. V 3 tomah. T. 1. Pod red. V.V. Krylova [Brain aneurysms surgery. In three volumes. Vol. 1. Edited by V.V. Krylov]. Moscow. 2012; 432S [In Russ].

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Aim: was to estimate changes in architectonic and hemodynamics of left common iliac vein (lCIV), caused by its crossing with right common iliac artery (rCIA), in patients with varicocele according to data of computed tomography angiography (CTA) and contrast venography.

Materials and methods: we analyzed results of CTA and contrast venography in the area of arte-riovenous crossing: 37 patients with newly diagnosed and 45 with recurrent varicocele. Analysis of topical changes was made on data of axial tomography, multiplanar and 3D reconstructions. Hemodynamic changes in lCIV, were determined by dynamic venogram and results of mesurement of pressure gradient between lCIV and vena cava inferior (VCI).

Results: it was found that CTA is the most informative for visualizing of lCIV narrowing caused by its compression by rCIA. This is due to the possibility of obtaining a same contrasting imaging of vessels involved in arteriovenous «conflict». Multiple view scanning reconstruction revealed a correlation between size of the lumbosacral angle and the degree of compression of lCIV caused by arteriovenous conflict. CT angiography with the use of utility model, allowed to change the state of the arteriovenous crossing, showed compression instability Dynamic contrast venography showed angiographic features typical for lCIV compression, and also visualized venous collaterals that compensate blood-flow disorders. Conducting direct measurement of venous pressure gradient in compression area allowed us to estimate the degree of hemodynamic changes in lCIV and explore the mechanism of compression generated by pulsating blood flow of rCIA.

Conclusions: severity of compression of lCIV at arteriovenous «conflict» is affected by constitutionally-static angle between L5-S1 vertebral bodies. Compression degree of lCIV is not constant and may vary depending on the patient's body position. Compression of lCIV promotes collateral blood flow through veins of sacral and external lumbar drainage. The more expressed compression of lCIV the more developed collateral blood flow in both drainage systems. Developed collaterals compensate hypertension caused by compression of lCIV Estimation of venous blood flow disorders, in case of varicocele, and choice of method of surgical treatment should be based on data from X-ray contrast studies and results of tensometry conducted at the area of arteriovenous «conflict» of lCIV.  



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Article presents a case of successful re-stenting of the left subclavian artery with good medium-term outcome in 59 years patient with a return of symptoms of vertebrobasilar insufficiency due to proximal fracture of previously implanted stent. The leading cause of stents destruction in the aortic arch branches are excessive mechanical load due to constant compression and/or vessel displacement, its compression due closeness of beating heart and movements of the shoulder girdle, which is likely had happened in our case - fracture of proximal segment. After analyzing the movement of vessels during the cardiac cycle, we found that stents in proximal aortic arch branches had been influenced mainly by bending, tension/compression. As a consequence - metal fatigue, which led it to the progressive destruction. Most stent fractures are asymptomatic, but in case of return of previous clinic - reintervention should be done. In this case, endovascular treatment is considered to be the method of first choice.


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Article exists only in Russian. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы