Abstract:

In recent years, with the growth of number of patients with multifocal atherosclerosis, revascularization of the brain and myocardium through hybrid intervention is gaining popularity. Although, in the world literature there are practically no results of significant randomized researches concerning percutaneous coronary intervention and carotid endarterectomy in hybrid mode, this technique is becoming more and more preferable and promising in comparison with other methods of treatment.

Aim: was to demonstrate results of revascularization of the brain and myocardium with staged and hybrid strategies, on the base of evaluation of advantages and disadvantages of these strategies on the example of case reports.

Materialsand methods: article presents two case reports, demonstrating different approaches to surgical treatment in patients with combined lesions of arteries of the brain and myocardium. Both patients were over 65 years age, at the time of treatment, had a history of acute cerebral circulation disorders, coronary heart disease and arterial hypertension. At the outpatient stage, they received antiplatelet, hypotensive, and hypolipidemic therapy. During further examination, both patients were found to have unilateral hemodynamically significant stenoses of internal carotid arteries and isolated stenoses of coronary arteries. In first case, patient was selected for hybrid surgical tactics in the volume of carotid endarterectomy and stenting of coronary artery, which was performed with a further favorable prognosis. In the second case, tactics was determined in favor of a staged procedure: first performing carotid endarterectomy, then stenting the affected coronary artery. However, taking into account subjective and objective factors, none of planned interventions were performed.

Results: hybrid revascularization allows to perform correction in two arterial of different regions in a short period of time using surgical and endovascular techniques. An important advantage of this method is the one-time performance, that means correction of MFA manifestations for one hospitalization, or even one anesthesia, with increasing in the availability of revascularization. In the first case report, the successful implementation of a hybrid approach in the treatment of combined vascular pathology in an elderly patient with a burdened anamnesis and significant comorbidities was demonstrated. Within one day, we managed to complete the planned volume of myocardial and brain revascularization and avoid the development of adverse events both in the early postoperative and long-term follow-up periods. The second clinical example clearly shows disadvantages of staged strategy, when the patient is at risk of developing adverse cardiovascular events while waiting for staged interventions, or for subjective reasons may refuse to be hospitalized in a clinic for performimg a particular operation, that as a result, led to negative dynamics and fatal outcome due to acute stroke.

Conclusions: thus, demonstrated case reports show significant potential and effectiveness of hybrid myocardial and brain revascularization using percutaneous coronary intervention and carotid endarteectomy in treatment of patients with combined lesions of two vascular regions. This method of treatment is especially promising in patients with burdened anamnesis and additional risk factors. It not only prevents adverse cardiovascular events in brain and myocardium, but also has greatest availability and implementation of the planned volume of treatment, completely excluding the influence of subjective factors (change of tactics, failure of patient to attend the next stage of treatment, etc.).

References

1.     Bajkov VYu. Combined atherosclerotic lesion of coronary and brachiocephalic arteries - choice of surgical tactics. Bulletin o f Pirogov National Medical & Surgical Center. 2013; 8 (4): 108-111 [In Russ].

2.     Shevchenko YuL, Popov LV, Batrashev VA, Bajkov VYu. Results of surgical treatment of patients with combined atherosclerotic lesions of coronary and brachiocephalic arteries. Bulletin o f Pirogov National Medical & Surgical Center. 2014; 9 (1): 14-17 [In Russ].

3.     Tarasov RS, Kazantsev AN, Ivanov SV et al. Personalized choice of the optimal revascularization strategy in patients with combined lesions of coronary and brachiocephalic arteries: results of testing an automated decision support system in clinical practice. Russian Cardiology Bulletin. 2018; 13 (1): 30-39 [In Russ].

4.     Kazanchyan PO, Sotnikov PG, Kozorin MG, Lar'kov RN. Surgical treatment of multifocal lesions in impaired blood circulation of several arterial territories. Russian Journal of Thoracic and Cardiovascular Surgery. 2013; (4): 31-38 [In Russ].

5.     Zaharov PI, Tobohov AV. Tactics of surgical treatment of generalized atherosclerosis with combined hemodynamically significant defeat of coronary and carotid arteries. Yakut medical journal. 2013; 2 (42): 52-55 [In Russ].

6.     Charchyan ER, Stepanenko AB, BelovYuV, et al. One-Stage Carotid and Coronary Artery Surgeries in Treatment of Multifocal Atherosclerosis. Cardiology. 2014; 54 (9): 46-51 [In Russ].

7.     2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal o f Cardiology. 2019; 24 (8): 151-226 [In Russ].

8.     ESC/ESVS Recommendations for the diagnosis and treatment of peripheral arterial disease 2017. Rossijskij kardiologicheskij zhurnal 2018; 23 (8), 218-221 [In Russ].

9.     Tarasov RS, Kazantsev AN, Ivanov SV, et al. Surgical treatment of multifocal atherosclerosis: coronary and brachiocephalic pathology and predictors of early adverse events development. Cardiovascular Therapy and Prevention. 2017; 16 (4): 37-44 [In Russ].

10.   Tarasov RS, Ivanov SV, Kazantsev AN etal. Hospital results of different strategies of surgical treatment of patients with concomitant coronary disease and internal carotid arteries stenoses. Complex Issues o f Cardiovascular Diseases. 2016; 5 (4): 15-24 [In Russ].

11.   Shilov AA, Kochergin NA, Ganyukov VI. Hybrid myocardial revascularization in multivessel coronary disease. Current state of the issue. Interventional cardiology. 2015; (41): 22-29 [In Russ].

12.   Alekyan BG, Karapetyan NG. Hybrid surgery in treatment of coronary heart disease. Russian journal of Endovascular surgery. 2017; 4 (1): 5-17 [In Russ].

13. Khubulava GG, Kozlov KL, Sedova EV et al. Importance and role of endovascular techniques in the diagnosis and treatment of generalized atherosclerosis in patients of elderly and senile age. Clinical gerontology. 2014; 20 (5-6): 35-40 [In Russ].

14.   Tarasov RS, Kazantsev AN, Ivanov SV et al. Choosing a strategy for brain and myocardial revascularization in patients with atherosclerosis of internal carotid and coronary arteries: a place for personified medicine. Russian journal of Endovascular surgery. 2018; 5 (2): 241-249 [In Russ].

15.   Frota dos Reis PF, Linhares PV, Pitta FG, Lima EG. Approach to concurrent coronary and carotid artery disease: Epidemiology, screening and treatment. Rev Assoc Med Bras. 2017; 63(11): 1012-1016.

16.   Tomai F, Pesarini G, Castriota F et al. Early and Long-Term Outcomes After Combined Percutaneous Revascularization in Patients With Carotid and Coronary Artery Stenoses. Cardiovascular interventios. 2011: 560-8.

17.   Zhang J, Dong Z, Liu P et al. Different Strategies in Simultaneous Coronary and Carotid Artery Revascularization - A Single Center Experience. Arch Iran Med. 2019; 22 (3): 132-136.

18.   Drakopoulou M, Oikonomou G, Soulaidopoulos S et al. Management of patients with concomitant coronary and carotid artery disease. Expert Review o f Cardiovascular Therapy. 2019: 1-32.

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:

Aim: was to carry out a comparative evaluation of results of stenting of bifurcation lesions in the segment of coronary chronic total occlusions (CTO) using different methods of percutaneous coronary intervention (PCI).

Materials and methods: present study is based on results of treatment of 146 patients (2010-2013) with coronary artery disease (CAD), who underwent CTO recanalization and had bifurcation with side-branch diameter more than 2mm. After successful recanalization of CTO, patients were randomized into two groups with respect to the used method of stenting: a group with stenting of major vessel and side branch with technique «Mini Crush», and a group with Provisional «Т-stenting» technique. The primary composite endpoint - incidence of major adverse cardiac and cerebrovascular events (MACCE), which includes thrombosis, restenosis, repeated intervention in the target vessel, acute myocardial infarction, stroke and cardiovascular death.

Results: absence of MACCE in the remote period of observation was significantly higher when using and amounted to 87,7% against 63,1% at 12 months after surgery

Conclusions: the use of technique «Mini crush» stenting is more effective (to reduce frequency of post-operative complications, risk of restenosis and repeat intervention in long term) in patients with bifurcation lesions in chronic total occlusion of coronary artery in comparison with using «T-provisional» stenting. 

References 

1.    Popma J., Mauri L., O’Shaughnessy C., et al. Frequency and clinical consequences associated with side branch occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary stents. Circ. Cardiovasc. Interv. 2009; 2:133-9.

2.    Colombo A., Moses J., Morice M., et al. The randomized study to evaluate sirolimus-eluting stents implanted in coronary bifurcation lesions. Circ. 2004; 109:1244-9.

3.    Garot P, Lefevre T., Savage M., et al. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) Trial. J. Am. Coll. Cardiol. 2005; 46:606-612.

4.    Nakamura S., Muthusamy T., Bae J., et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions: multicenter registry in Asia. J. Am. Coll. Cardiol. 2004; 43:35A.

5.    Werner G., Krack A., Schwarz G., et al. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

6.    Hoye A., Tanabe K., Lemos P, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J. Am. Coll. Cardiol. 2004; 43: 1954-1958.

7.    Kini A., Lee P, Marmur J., et al. Correlation of post-percutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am. J. Cardiol. 2004; 93:18-23.

8.    Osiev A.G., Baystrukov V.I., Biryukov A.V. Taktika endovaskulyarnogo lecheniya pri bifurkacionnom porazhenii posle rekanalizacii khronicheskoy okklyuzii koronarnyh arteriy.[ Endovascular treatment tactics in patients with bifurcation lesions after recanalization of chronic coronary arteries occlusions]. Diagnosticheskaya i intervencionnaya radiologiya. 2013; 7(1): 27-31[In Russ].

9.    Albiero R., Boldi E. Provisional Stenting Technique for Non-Left Main Coronary Bifurcation Lesions: Patient Selection and Technique. Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions, 1st ed. By Issam D. Moussa and Antonio Colombo. London: Informa Healthcare. 2010; 48.

10.  Galassi A., Colombo A., Buchbinder M., et al. Long term outcome of bifurcation lesions after implantation of drug-eluting stents with the «Mini-Crush technique». Catheter. Cardiovasc. Interv. 2007; 69:976-83.

11.  Galassi A., Tomasello S., Capodanno D., et al. «Mini Crush» versus «T-provisional» techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. J. Am. Coll. Cardiol. Intv. 2009; 2: 185-94.

Abstract:

This article presents a clinical case of successful prevention of distal embolization in patient with acute ST-elevation myocardial infarction with a combination of manual thromboaspiration and distal protection. We have presented own and literature data about possible additional sourse of distal embolization (contents of cavity plaque rupture) after successful thromboaspiration during stent implantation, which was the basis of a strategy combination of manual thromboaspiration and distal protection. As a device for distal protection we used the system «Emboshield NAV6» (Abbott Vascular, USA). We have described design features of the device, knowledge of which will help to make better use of it in native coronary arteries in such situations.

Reference 

1.    Mehta R.H., Harjai K.J., Boura J. et al., for the Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am. J. Cardiol. 2003; 92: 1445-1447.

2.    Niccoli G., Burzotta F., Galiuto L. et al. Myocardial no-reflow in humans. J. Am Coll. Cardiol. 2009: 21: 281-292.

3.    Piana R.N., Paik G.Y., Moscucci M. et al. Incidence and treatment of «no-reflow» after percutaneous coronary intervention. Circulation. 1994; 89: 2514-2518.

4.    Klonner R.A., Ganote C.E., Jennings R.B. The «no-reflow» phenomenon after temporary coronary occusion in the dog. J. Clin. Invest. 1974: 54: 1496-1508.

5.    Al'biero R. Oslozhnenija pri chreskozhnyh koronarnyh vmeshatel'stvah: ot prognoza k preduprezhdeniju i lecheniju. Rentgenojendovaskuljarnaja hirurgija ishemicheskoj bolezni serdca: Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov: V 3 t. (Pod red. L.A. Bokerija, B.G. Alekjana). M.: NCSSH im. A.N. Bakuleva RAMN. 2008; 3: 157-174 [In Russ].

6.    Burzotta F., Trani C., Romagnoli E. et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J. Am Coll. Cardiol. 2005; 46: 371-376.

7.    The Thrombolysis in Myocardial Infarction (TIMI) trial, phase I findings: TIMI Study Group. N. Engl. J. Med. 1985; 312: 932-936.

8.    Kirma C., Izgi A., Dundar C. et al. Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions. Experience at a Single Center. Circ. J. 2008; 72: 716-721.

9.    Zalewski J., Bogaerts K., Desmet W. et al. Intraluminal thrombus in facilitated versus primary percutaneous coronary intervention: an angiographic substudy of the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy With Percutaneous Coronary Intervention) trial. J. Am. Coll. Cardiol. 2011; 57: 1867-1873.

10.  Svilaas T., Vlaar P.J., van der Horst I. et al. Thrombus aspiration during primary percutaneous coronary intervention. N. Engl. J. Med. 2008; 358: 557-567.

11.  Vlaar P.J., Svilaas G., van der Horst. et al. Cardiac death and reinfarction after 1 year in the Thrombus aspiration during primary percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1 - year follow - up study. Lancet. 2008; 371: 1915-1920.

12.  Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2010; 31: 2501-2555.

13.  Lee S.Y., Mintz G.S., Kim S.Y. et al. Attenuated plaque detected by intravascular ultrasound: clinical, angiographic, and morphologic features and post-percutaneous coronary intervention complication in patients with acute coronary syndromes. J. Am. Coll. Cardiol. 2009; 2(1): 65-72.

14.  Okura H., Taguchi H., Kubo T. et al. Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study. CircJ.2007; 71: 648-653.

15.  Isshiki T., Kozuma K., Kyono H. et al. Initial clinical experience with distal embolic protection using «Filtrap’», a novel filter device with a self-expandable spiral basket in patients undergoing percutaneous coronary intervention. Cardiovasc. Intern and Ther. 2011; 26: 12-17.

16.  Markas'jan A.V., Petrushenko A.E., Val'ko A.S. i dr. Uspeshnaja aspiracija vnutrikoronarnyh trombov cherez provodnikovyj kateter HEARTRAIL II pri ostrom infarkte miokarda s pod#emom segmenta ST: tri klinicheskih sluchaja. Vest. rentgen. i radiol. 2012; 1: 38-44 [In Russ].

17.  Hadi H.M., Fraser D.G., Mamas M.A. Novel use of the Heartrail catheter as a thrombectomy Device. J. Invas. Cardiol. 2011; 23 (1): 35 - 40.

18.  Porto I., Choudhury R.P., Pillay P. et al. Filter no reflow during percutaneous coronary interventions using the Filterwire distal protection device. Int. J. Cardiol. 2006; 109: 53-58.

19.  Wu X., Mintz G.S., Xu K. et al. The Relationship Between Attenuated Plaque Identified by Intravascular Ultrasound and No-Reflow After Stenting in Acute Myocardial Infarction The HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial. J. Am. Coll. Cardiol. Intv. 2011; 4: 495-502.

20.  Endo M., Hibi K., Shimizu T. et al. Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction. J. Am. Coll. Cardiol. Intv. 2010; 3: 540-549.

21.  Hara H., Tsunoda T., Moroi M. et al. Ultrasound attenuation behind coronary atheroma without calcication: mechanism revealed by autopsy. Acute Cardiac Care. 2006: 8: 110-112.

22.  Johnstone E., Friedl S.E., Maheshwari A. et al. Distinguishing characteristics of erythrocyte-rich and platelet-rich thrombus by intravascular ultrasound catheter system. J. Thromb. Thrombolysis. 2007; 24: 233-239.

23.  Ohshima K., Ikeda Sh., Kadota H. et al.

Abstract:

Aim: was to determine indications for various methods of stenting on the base of conducted earlier interventions on bifurcation lesions after previously coronary artery occlusion.

Methods. In NRICP we studied a group of patients who underwent PCI for occluded arteries since 2009 to 2011. The study included patients with chronic total occlusion and bifurcation lesion with a diameter of side brunch more than 2 mm and stenosis >50%. Patients were divided into two groups (proximal and distal lesions) with respect of the proximal cap occlusion to the bifurcation. The primary end point was the emergence of MACE during the hospital period, including death, myocardial infarction, or repeat revascularization of the target vessel. Immediate angiographic success was considered in the case of blood flow TIMI II-III after stenting and residual stenosis of less than 50%.

Results. For the period of 2009-2011 PCI was performed. 307 patients were included in the study. The group of proximal lesions included 148 cases. The group of distal lesions consisted of 159 patients. Immediate angiographic success was observed in 98.3% of cases. Deaths, myocardial infarction, cerebrovascular accident, re-PCI, CABG during the hospital period were not noted.

Conclusion. Bifurcation lesions occure in 57,9% of cases after recanalization of chronic occlusions. In both groups one stent technique dominated, but in a group of proximal lesions two stents technique was used 5,8 times more often than in the distal lesions group. In both groups, MACE in hospital period were not noted.

References 

1.    Nakamura S., Muthusamy T.S., Bae J.H., Cahyadi Y.H., Udayachalerm W., Tresukosol D. Impact of sirolimus-eluting stent on the outcome of patients6. with chronic total occlusions. Am. J. Cardiol. 2005; 95: 161-166.

2.    Werner G.S., Krack A., Schwarz G., Prochnau D., Betge S., Figulla HR. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

3.    Valent R.I., Migliorini A., Signorini U., Vergara R., Parodi G., Carrabba N., et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur. Heart. J.2008; 29: 2336-2342.

4.    Kahn J.K. Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting. Am. Heart J. 1993; 126: 561-4.

5.    Christofferson R.D., Lehmann K.G., Martin G.V. et al. Effect of chronic total coronary occlusions on treatment strategy. Am. J. Cardiol. 2005; 95: 1088-91.

6.    Garot P., Lefevre T., Savage M., Louvard Y., Bamlet W.R., Willerson J.T., Morice M.C., Holmes D.R. Jr. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes(PRESTO) trial. J. Am Coll. Cardiol. 2005; 46: 606-12.

7.    Colombo A., Moses J.W., Morice M.C., Ludwig J., Holmes D.R. Jr., Spanos V., Louvard Y., Desmedt B., Di Mario C., Leon M.B. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004; 109:1244-9.

8.    Sharma SK., Sweeny J., Kini A.S. Coronary bifurcation lesions: a current update. Cardiol. Clin. 2010;28:.55-70

9.    Alfredo R. Galassi. Galassi’s Tips & Tricks. Second edition published in Republic of San Marino by Alpha s.r.l. 2010;.275

Abstract:

Background: There are no randomized trials describing outcomes of multivessel percutaneous coronary interventions (PCI) (in primary anc staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715)

Materials and methods: Six-month outcomes of 89 consecutive patients with STEMI and multivessel coronary artery disease (CAD) (SYNTAX 18.6±7.9 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity; Medtronic) were studied. We used two strategies of multivessel stenting: in primary PCI (MS primary) and multivessel stenting in staged revascularisation (MS staged) (8.5±4.2 days).

Results: We evaluated results in the overall cohort of patients, including two study groups (MS primary and MS staged). During follow-up of 6 months there was no cardiac death in overall group. We observed 3 (3.4%) non-fatal myocardial infarction (MI) due to definite stent thromboses (ST) (1.3% on the number of stents). Target vessel revascularization (TVR) was performed in 2 cases (2.2%). Major adverse cardiac event (MACE) (cardiac death, MI, TVR) was diagnosed in 4.5%.

Conclusions: Resolute Integrity stents in STEMI patients with multivessel CAD are satisfactory safely and effectively as part of the strategy of multivessel stenting in primary PCI and multivessel staged PCI (8.5±4.2 days).

References

1.     Sorjja P., Gersh B.J., Cox D.A. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur. Heart J. 2007; 28:1709-16.

2.     Jang H.L., Hun S.P., Shung Ch.Ch. Wee Hyun Park and Korea Acute Myocardial Infarction Registry Investigators. Predictors of six-month major adverse cardiac events in 30-day survivors after acute myocardial infarction (from the Korea Acute Myocardial Infarction Registry). Am. J. Cardiol. 2009;104:182-89.

3.     Rasoul S., Ottervanger J.P., de Boer M.J. Predictors of 30- day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron. Artery Dis. 2009; 20: 415-21.

4.     Webb J.G. Lowe A.M., Sanborn T.A. et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J.Am. Coll. Cardiol. 2003;42:138-86.

5.     Smith S.C., Jr., Feldman T.E., Hirshfeld J.W. Jr. et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Interventiondsummary article: a report of the AmericanCollege of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation. 2006;113:156-75.

6.     Ijsselmuiden A.J., Ezechiels J., Westendorp I.C., et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am.Heart.J. 2004;148:467-74.

7.     Politi L., Sgura F., Rossi R., et al. A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart. 2010; 96:662-67.

8.     Fox K., Garcia M.A., Ardissino D. Guidelines on the management of stable angina pectoris: executive summary. The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur. Heart J. 2006;27:1341-81.

9.     Gabriel S., Stefan K., James D.A. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal. 2012. doi:10.1093/eurheartj/ehs215.

10.   Roe M.T., Cura F.A., Joski PS. Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. Am. J. Cardiol. 2001; 88:170-173.

11.   Corpus R.A., House J.A., Marso S.P et al. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am. Heart. J. 2004; 148:493-500.

12.   Widimsky P., Holmes Jr. David R. How to treat patients with ST-elevation acute myocardial infarction and multivessel disease? European Heart Journal Advance Access published November 30, 2010. European Heart Journal doi:10.1093/eurheartj/ehq410.

13.   Politi L., Sgura F., Rossi R. et al. A randomised trial of target-vessel versus multi-vessel revascularization in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart.2010;96:662-667.

14.   Varani E., Balducelli M., Aquilina M. et al. Single or multivessel percutaneous coronary intervention in ST-elevation myocardial infarction patients. Catheter Cardiovasc. Interv. 2008;72:927-933.

15.   Roe M.T., Cura F.A., Joski PS. Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. Am. J.Cardiol. 2001;88:170-173.

16.   Hannan E.L., Samadashvili Z., Walford G. Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST- segment elevation myocardial infarction patients with multivessel disease. JACC Cardiovasc. Interv. 2010; 3:22-31.

17.   Goldstein J.A., Demetriou D., Grines C.L. Multiple complex coronary plaques in patients with acute myocardial infarction. N. Engl. J. Med. 2000;343:915-22.

18.   Тарасов Р. С., Ганюков В. И., Шушпанников П. А. Исходы различных стратегий реваскуляризации у больных инфарктом миокарда с элевацией сегмента ST при многососудистом поражении в зависимости от тяжести поражения коронарного русла по шкале «- SYNTAX». Российский кардиологический журнал. 2013; 100(2):31-32.