Abstract: Introduction: improving the technique of radiofrequency denervation of renal arteries seems to be extremely important for optimizing the effectiveness of lowering blood pressure in patients with resistant arterial hypertension. Our study presents an assessment of the comparison of long-term results of renal artery denervation (RAD) using various techniques and instruments. Aim: was to compare the use of various techniques for renal artery denervation and to evaluate longterm results in patients with resistant arterial hypertension using various radio frequency catheters. Materials and methods: in a prospective study, three groups of patients (n = 58) aged 18-85 years with resistant systolic-diastolic arterial hypertension of 1-2 stages were studied: patients underwent denervation of renal arteries by various methods, against background of standardized antihypertensive therapy. In group I (n = 21), denervation was performed only in the proximal segment of the renal artery (before the first bifurcation). In group II (n = 19), ablation was performed both in proximal segment and in branches of the second and third order, as well as in the accessory renal arteries with a diameter of more than 3 mm. The third control group included 18 patients who received only standardized drug antihypertensive therapy. Results: technical success of the operation was achieved in 100% of cases. According to the 24-hours ambulatory blood pressure monitoring (ABPM) data, the decrease in blood pressure (BP) in group I by the second year of observation was 6,7 mm Hg, p <0,05 for systolic BP (SBP) and ? 2,7 mm Hg, p> 0,05 for diastolic BP (DBP). In the second group, a greater decrease in mean SBP and DBP was recorded: ? 9,2 mm Hg, p <0,05 and ? 4,3 mm Hg, p <0,05, respectively. In the control group of drug treatment, the weakest antihypertensive effect of treatment was revealed. The average indicators of SBP and DBP decreased by - 4,9/1,9 mm Hg, p> 0,05. Conclusion: results of the use of prolonged radiofrequency denervation of the main, segmental and accessory renal arteries with a large number of ablation points demonstrate a similar safety and greater efficacy in treatment of patients with resistant arterial hypertension, in comparison with denervation of only main trunk of renal artery. References 1. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: 49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98 2. Group SR, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373: 2103-2116. https://doi.org/10.1056/NEJMoa1511939 3. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013; 34: 2940-2948. https://doi.org/10.1093/eurheartj/eht295 4. Fengler K, Ewen S, Hцllriegel R, et al. Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients with Resistant Hypertension. J Am Heart Assoc. 2017; 6(8): 006196. https://doi.org/10.1161/JAHA.117.006196 5. Reshetnik A, Gohlisch C, Scheurig-M?nkler C, et al. Predictors for success in renal denervation-a single centre retrospective analysis. Sci Rep. 2018; 8(1): 15505. https://doi.org/10.1038/s41598-018-33783-3 6. Wang A. 2019 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on Renal Denervation for the Management of Arterial Hypertension. Acta Cardiologica Sinica. 2019; 35(3): 199-230. https://doi.org/10.6515/ACS.201905_35(3).20190415A 7. Steigerwald K, Titova A, Malle C, et al. Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model J Hypertens. 2012; 30(11). https://doi.org/10.1097/HJH.0b013e32835821e5 8. Пекарский С.Е., Баев А.Е., Фальковская А.Ю. и др. Анатомически оптимизированная дистальная ренальная денервация — стойкий гипотензивный эффект в течение 3 лет после вмешательства. Патология кровообращения и кардиохирургия. 2020; 24(3S): 98-107. Pekarskij SE, Baev AE, Fal'kovskaya AYU, et al. Anatomically optimized distal renal denervation – permanent hypotensive effect for 3 years after intervention. Patologiya krovoobrashcheniya i kardiohirurgiya, 2020; 24(3S): 98-107 [In Russ]. http://dx.doi.org/10.21688/1681-3472-2020-3S-98-107 9. Mahfoud F, Tunev S, Ewen S,et al. Impact of Lesion Placement on Efficacy and Safety of Catheter-Based Radiofrequency Renal Denervation. Journal of the American College of Cardiology. 2015; 66: 1766-1775. https://doi.org/10.1016/j.jacc.2015.08.018 10. Bertog S, Fischel T, Vega F, et al. Randomised, blinded and controlled comparative study of chemical and radiofrequency-based renal denervation in a porcine model. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017; 12: 1898-1906. https://doi.org/10.4244/EIJ-D-16-00206 11. Mahfoud F, Pipenhagen C, Moon L, et al. Comparison of branch and distally focused main renal artery denervation using two different radio-frequency systems in a porcine model. International journal of cardiology. 2017; 241: 373-378. https://doi.org/10.1016/j.ijcard.2017.04.057 12. Vink E, Goldschmeding R, Vink A, et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrology, dialysis, transplantation - European Renal Association. 2014; 29: 1608-1610. https://doi.org/10.1093/ndt/gfu192 13. Агаева Р.А., Данилов Н.М., Щелкова Г.В. и др. Радиочастотная денервация почечных артерий моно-электродным и мультиэлектродным устройствами у пациентов с неконтролируемой артериальной гипертонией: результаты 6-месячного наблюдения. Системные гипертензии. 2020; 17(1): 46-50. Agaeva RA, Danilov NM, Shchcelkova GV, et al. Radiofrequency renal denervation with mono-electrode and multielectrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up. Sistemnye gipertenzii. 2020; 17(1): 46-50 [In Russ]. https://doi.org/10.26442/2075082X.2020.1.200077 14. Mahfoud F, Tunev S, Ewen S, et al. Impact of lesion placement on efficacy and safety of catheter-based radiofrequency renal denervation. J Am Coll Cardiol. 2015; 66: 1766-1775. https://doi.org/10.1016/j.jacc.2015.08.018 15. Henegar JR, Zhang Y, Hata C, et al. Catheter-based radiofrequency renal denervation: location effects on renal norepinephrine. Am J Hypertens. 2015; 28: 909-914. https://doi.org/10.1093/ajh/hpu258 16. Konstantinos PT, Lida F, Kyriakos D. Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients. EuroIntervention. 2018; 14: 1334-1342.
Abstract: Choice of treatment strategy in patients with recurrent angina after coronary artery bypass graft surgery (CABG) is still an actual question. Repeat CABG is associated with an increased risk of mortality and large cardiovascular events, so percutaneous coronary intervention (PCI) is the main strategy in these patients. Criteria for choosing between the bypass and the native vessel stenting are not fully understood, as well as not resolved the question of the differentiated approach to the choice of defeat for stenting Aim: was to compare long-term results of stenting of bypass and native coronary arteries in patients with recurrent angina after CABG using the algorithm proposed in the study. Materials and methods: study was conducted in 2010-2014 years. in «3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence». A total of 168 patients with the defeat of coronary bypass graft were operated: revascularization of the native vessel - 80 patients, stenting of coronary bypass graft was performed in 88 patients. Treatment groups were comparable in all major clinical characteristics of patients, as well as on the number of affected arteries, the total number of bypasses, the number of working bypasses, and diffuse lesion of the native channel. The degree of stenosis of the native vessel was significantly higher in the second group, and the degree of stenosis of bypasses was significantly higher in the first group. Diffuse lesions of coronary bypasses were significantly more frequent in the first group. Long-term results of the study were followed up in patients in the observation period of 3 to 36 months (mean follow-up was 21(14-27) months). The average duration was not significantly different between treatment groups. Results: the incidence of myocardial infarction was comparable between groups. In group of coronary bypass graft stenting, revascularization procedures frequency was higher than in the native vessel revascularization (20,45% and 16,25%, respectively, p = 0,0045), and also had a higher incidence of target lesion revascularization (11.36% and 6.25%, respectively, p = 0,0045). The cumulative rate of major cardiovascular events did not differ significantly, but there was a certain tendency toward a lower incidence of major cardiovascular events in the group of revascularization of the native vessel. References 1. Goldman S., Zadina K., Moritz T., et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J. Am. Coll. Cardiol. 2004; 44:2149 -56. 2. Бокерия Л.А., Алекян Б.Г. Руководство по рентгеноэндоваскулярной хирургии сердца и сосудов. Москва. Издательство НЦССХ им. А.Н. Бакулева РАМН. 2008. том 3; 592с. Bokerija L.A., Alekjan B.G. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov [Guideline for endovascular surgery of vesels and heart]. Moskva. Izdatel'stvo NCSSH im. A.N. Bakuleva RAMN. 2008. tom 3; 592s [In Russ]. 3. Brilakis E.S., de Lemos J.A., Cannon C.P., et al. Outcomes of patients with acute coronary syndrome and previous coronary artery bypass grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] trials). Am.J. Cardiol. 2008;102:552-8. 4. Brilakis E.S., Wang T.Y, Rao S.V., et al. Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology National Cardiovascular Data CathPCI registry. JACC Cardiovasc Interv. 2010; 3:1068-73. 5. Brodie B.R., Wilson H., Stuckey T., et al. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv. 2009; 2:1105-12. 6. Brilakis E.S1, Rao S.V., Ba
Abstract: We have analyzed long-term results of different revascularization strategies in 171 patients with multivessel coronary artery defeat. Duration of follow up observation ranged from 12 to 18 months. Complete revascularization of the myocardium was performed in 63 pts, culprit vessel revascularization - in 86 and incomplete revascularization - in 22 patients. All patients undervwent SYNTAX scoring analysis to find out possible risks of transcutaneus coronary interventions. Survival rate, incidence of myocardial infarction, repeat myocardial revascularization procedures and major adverse cardiac events were comparable among the patients with low and intermediate SYNTAX Score. Among the patients with high SYNTAX Score the incidence of myocardial infarction (8,82%, р = 0,002), repeat PCI procedure (32,35%, р = 0,001) and major adverse cardiac events (32,35%, р = 0,002) was reliably higher compared to patients with low and intermediate SYNTAX Score. The mpact of the SYNTAX Score rate on the long-term results in the different revascularization strategy groups was also analyzed. In the 1st group the incidence of major adverse cardiac events among the patients was comparable. In the 2nd group patients with the high SYNTAX Score rate had reliably higher rate of major adverse cardiac events (43,75%, р = 0,002). The rate of major adverse cardiac events were higher in the 3rd group of patients with the high SYNTAX Score rate compared in patients with low and intermediate SYNTAX Score rate, but this difference didn't reach statistically reliable difference. Use of the strategy of culprit vessel revascularization in the patients with high SYNTAX Score rate, leads to increased rate of major adverse cardiac events and repeat PCI procedures in the long-term follow up period. References 1. Silber S. et al. Guidelines for percutaneous coronary interventions. Eur. Heart. J.2005; 26: 804-847. 2. Bourassa M.G. et al. Strategy of complete revascularization in patients with multivessel coronary artery disease (a report from the 1985-1986 NHLBI PTCA Registry). 3. Am. J. Cardiol. 1992; 70: 174. Bourassa M.G. et al. Long-term outcome of 5 patients with incomplete vs complete revascularization after multivessel PTCA (a report from NHLBI PTCA Registry). Eur. Heart. J. 1998; 19: 103-111. 4. Hannan E.L. et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation. 2006; 113; 2406-2412. 5. Hannan E.L. et al. Incomplete revascularization in the era of drug-eluting stents. Impact on adverse outcomes. J. Am. Coll. Cardiol. Intv. 2009; 2: 17-25. 6. Ijsselmuiden A.J.J. et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease. A randomized comparison. Am. Heart. J.2004; 148: 467-474. 7. Martuscelli E. et al. Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded. Data from the CABRI trial. Eur. J. of Card.Thorac. Surg. 2008; 33: 4-8. 8. Van den Brand M.J.B.M. et al. The effect of completeness of revascularization on event-free survival at one year in the arts trial. J. Am. Col. Cardiol. 2002; 39; 559-564. 9. Беленков Ю.Н., Акчурин Р.С., Савченко А.П. и др. Результаты коронарного стентирования и хирургического лечения у больных ИБС с многососудистым поражением коронарного русла. Кардиология. 2002; 5: 42-45. 10. Ong A.T.L., Serruys P.W. Coronary artery bypass graft surgery versus percutaneous coronaryintervention. Circulation. 2006; 114: 249-255. 11. Patil C.V. et al. Multivessel coronary artery disease. Current revascularization strategies. Eur. Heart. J. 2001; 22: 1183-1197. 12. Buda A.J. et al. Long-term results following coronary bypass operation. Importance of preoperative factors and complete revascularization. J. Thorac. Cardiovasc. Surg. 1981; 82: 383-290. 13. Rodriguez A.E. et al. Revascularization strategies of coronary multiple vessel disease in drug eluting stent era. One year follow-up results of ERACI III trial. Eurointervention. 2006; 2: 53-60. 14. Rodriguez A.E. et al. Late loss of early benefit from drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery. 3 years follow-up of the ERACI III registry. Eur. Heart. J. 2007; 28: 2118-2125. 15. Serruys P.W. et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent. Insights from the Arteкial Revascularization Therapies Study Fart II (ARTS II). Eur. Heart. J. 2007; 28 (4): 433-442. 16. Serruys P.W. et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N. Engl. J. Med. 2009; 360: 961-972. 17. Serruys P.W. Sirolimus-eluting stents for the treatment of patients with multivessel de novocoronary artery lesions. EuroInterv. Arterial, Revascularis. Therap. Study PartII. 2005; 2: 147-156. 18. Serruys P.W. et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009; 5 (1): 50-56.
