Abstract:

Background: the use of vascular closure devices (VCD) reduces the time of hemostasis, accelerates activation and discharge of the patient. Suture-mediated closure devices are closest in it's structure to the traditional surgical method of hemostasis. Advantages and disadvantages of these devices are mainly associated with design features. Stenoses, atherosclerosis, calcification and scars at the site of access are predictors of complications in the use of suturing devices. Although the effectiveness of these devices has been proven in several foreign studies, their data are not sufficient to draw clear conclusions.

Aim: was to evaluate advantages and disadvantages of using the suture-mediated closure devices after PCI.

Material and methods: study enrolled 208 adult patients, who underwent PCI in City Clinical Hospital named after M.P Konchalovsky, Moscow; FSBI «3 Central clinical military hospital n.a. A. A. Vishnevsky» Defense Ministry RF and SMRC preventive medicine of Department of Healthcare. Study group, where hemostasis after PCI was achieved by means of suture-mediated closure devices Perclose Pro Glide (Abbott Vascular), consisted of 90 patients, control group - 118 patients with manual hemostasis. Subjective feelings (pain, numbness, etc.) were assessed using a rating scale. The incidence of complications in the study group was 5.56%, in the control group - 6.78%. The comfort level of patients was higher in the study group

Results of the study: showed that the use of the Perclose device to achieve hemostasis after PC does not increase the frequency of regional vascular complications in compatison with manual hemostasis. But, at the same time, the use of VCD is an effective way to reduce the time of hemostasis, reduces the period of immobilization of the patient, which increases the patient's comfort and reduces patient's hospital stay.

References

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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 

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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:

Percutaneous coronary intervention is a method of choice in patients with recurrence of angina after aorto-coronary bypass. Endovascular interventions after aorto-coronary bypass are associated with a high risk of distal embolism and technical difficulties. On the other hand, revascularization of native coronary arteries in patients after aorto-coronary bypass, leads to worse results than PCI in patients without prior cardiac operations.

Aim: was to compare results of stenting of coronary bypass graft and native artery stenting in patients with recurrence of angina after aorto-coronary bypass, with use of proposed algorithm.

Materials and methods: for the period 2010-2014, in 3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence, 168 patients with coronary bypass defeat underwent operation: in 80 patients native artery reconstruction and in 88 - aorto-coronary bypass graft stenting were performed.

Due to impossible endovascular revascularization, 14 patients underwent repeated aorto-coronary bypass; after that they were excluded from research.

Included into research patietns were treated by different stents: drug-eluting stents (DES), bare metal stents (BMS) and combination BMS+DES. In first group the rate of DES implantation was higher (60% vs 37,5%); in the second group stent placement was comparable (DES 46,6% vs BMS 50%).

The results of this study show that the choice of revascularization strategy according to the presented algorithm, the short-term outcomes of both tactics are comparable.  

References 

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6.    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.

7.    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.

8.    Nguyen T.T., O'Neill W.W., Grines C.L., et al. One-year survival in patients with acute myocardial infarction and a saphenous vein graft culprit treated with primary angioplasty. Am. J. Cardiol. 2003;91:1250-4

9.    Serruys P.W., Stoll H.P., Macours N. et al. Multivessel coronary revascularization in patients with and without diabetes mellitus 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J. Am. Coll. Cardiol. 2008; 52(24): 1957-1967.

10.  Rodriguez A., Baldi J., Pereira C.F. et al. for the ERACI II Investigators: Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II). J. Am. Coll. Cardiol. 2005; 46: 582-588.

11.  Serruys P.W., Donohoe D.J., Wittebols K. et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II). Eur. Heart J. 2007; 28(4): 433-442.

12.  Iakovou I., Schmidt T., Bonizzoni E. et al. Incidence, predictors and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293: 2126-2130.

13.  Banning A.P, Westaby S., Morice M.C. et al. Diabetic and Nondiabetic Patients With Left Main and/or 3- Vessel Coronary Artery Disease: Comparison of Outcomes With Cardiac Surgery and Paclitaxel-Eluting Stents. J. Am. Coll. Cardiol. 2010; 55: 1067-1075.

14.  Kappetein A.P, Dawkins K.D., Mohr F.W. et al. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.: Insights from the SYNTAX run-in phase. Eur. J. Cardiothorac. Surg. 2006; 29: 486-491.

15.  Serruys P.W., Morice M.C., Kappetein A.P et al. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N. Engl. J. Med. 2009; 360: 961-972.

16.  Serruys P.W., Ong A.T., Piek J.J. et al. A randomized comparison of a durable polymer everolimus-eluting stent with a bare metal coronary stent: The SPIRIT fist trial. Eurointervention. 2005; 1: 58-65.

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Abstract:

In present time coronary angiography remains the "gold standart" in ischemic heart disease diagnostics. The correlation between angiographic or intravascular ultrasound (IVUS) variables and fractional flow reserve (FFR) in patients with intermittent lesion remain unclear. The aim of this article is to demonstrate complimentary use of fractional flow reserve evaluation and intravascular ultrasound for achieving optimal results during PCI.

Abstract:

The article is devoted to one of the most modern methods of treatment of benign prostatic hyperplasia (BPH) - endovascular prostatic artery embolization (PAE). This kind of intervention is performed, usually, with approach through the common femoral artery Transradial vascular approach has many advantages over the femoral approach, but its use in this type of intervention is currently limited.

Aim: was to conduct a comparative analysis of the use of transradial and transfemoral vascular approach when performing PAE.

Materials and methods: in a group of transradial approach included 24 patients, and in the femoral approach group - 23 patients

Results: success rate of the procedure and the frequency of complications of vascular approach were comparable between groups. The total duration of the procedure, the time spent on catheterization of internal iliac and prostatic arteries, radiation exposure dose were significantly lower in the group of transradial approach. Using the transradial approach is associated with a significant reduction in the incidence and severity of the discomfort associated with the procedure.

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16.   Sherev D.A., Shaw R.E., Brent B.N. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005;65(2):196-202.