Abstract:

Aim: was to elucidate factors of poor prognosis for chronic brain ischemia in «asymptomatic» patients with atherosclerotic stenosis of vertebral arteries, who regularly take optimal medical therapy.

Methods: in 1st group (n = 44), secondary prevention of cerebrovascular accidents was carried out in a combined strategy - stenting of vertebral arteries in combination with medication therapy, and in 2nd group (n = 56) - only medication therapy. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: «asymptomatic» patients with stenosis of vertebral arteries 50-95%; diameter of vertebral arteries is not less than 3.0 and not more than 5 mm; presence of cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of chronic brain ischemia (according to E.V. Schmidt). Primary endpoint: total frequency of cardiovascular complications (death, transient ischemic attack or stroke, myocardial infarction).

Results: the total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (? ²=15.101; p<0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to 1st and 2nd groups (? ²=14.784; p<0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of stents was observed in general, in 38.67% of patients from group I. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (? ²=0.1643; p=0.735). Most significant poor prognosis factors of chronic brain ischemia in «asymptomatic» patients with vertebral artery stenosis, who regularly take optimal medical therapy are: arrhythmia, total cholesterol more than 6.0 mmol/l, incomplete circle of Willis, arterial hypertension, bilateral defeat of vertebral arteries, (low-density lipoprotein) LDL levels of more than 3.5 mmol/I, combined lesion of vertebral and carotid arteries, calcification of vertebral arteries, coronary heart disease in anamnesis.

Conclusion: endovascular intervention in combination with medical therapy could help to avoid the development of major brain complications arising from the instability of atherosclerotic plaque in «asymptomatic» patients with vertebral artery stenosis, and in the presence of poor prognosis factors identified can be regarded as a method of secondary prevention of cerebral circulatory disorders.

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Abstract:

The presented research on studying the efficiency and safety of various anticoagulants used in patients with acute coronary syndrome during percutaneous coronary interventions (PCI). High efficiency of a Bivalirudin is shown, in comparison with Unfractionated Heparin and Monofram on the amount of bleeding arising in the postoperative period and main adverse coronary events (MACE). 

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Abstract:

Aim: was to evaluate results of endovascular treatment of patients with acute coronary syndrome (ACS) without ST-segment elevation, with multivessel coronary disease.

Materials and methods: 346 patients were enrolled in study and initially randomized into 3 groups. 1st group included 100 patients with complete myocardial revascularization which had been performed during initial PCI. 2nd group included 124 patients with complete myocardial revascularization, performed during initial hospitalization: 3rd group - 122 patients with complete revascularization, performed at different times after initial hospitalization. Inclusion criteria: ACS patients without ST-segment elevation; multivessel coronary disease (risk SYNTAX score = 23-32); high and medium risk for the GRACE scale; absence of previous myocardial revascularization.

Results: long-term results of treatment were evaluated in 192 patients. After 12 months, patients in 3rd group was significantly more likely to have greater cardiovascular complications and re-interventions on the target vessel. It was found that complete myocardial revascularization, performed after 30 days from the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease (r = 0,58, p <0,05). Risk factors adversely affecting the prognosis of ACS patients without ST-segment elevation and presence of multivessel disease include: subtotal stenosis in non-symptomatic arteries; circulation failure Killip class III; myocardial infarction in past; high risk on GRACE scale; lesion length in non-symptomatic arteries more than 20 mm diabetes mellitus; degree of risk on a SYNTAX scale-score> 25; overweight/obesity; high cholesterol 6.5 mmol/l.

Conclusions: when performing PCI in patients with ACS without ST-segment elevation with multivessel coronary disease, performing a complete myocardial revascularization 30 days after the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease.

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