Abstract:

The research covered the results of the endovascular surgical operations in 81 patients with CHD aged 36-76 with bifurcational stenoses of coronary arteries. The peculiarity of the method was the primary delivery of the guides for balloon catheters behind the stenosis area in the "main" and side branches of the left coronary artery. This was prophylaxis of the side artery occlusion after implantation of the "Cypher select" stent into the "main" branch. During the post-operational period (after 6-8 months) 69 patients have passed the examination including coronaroventriculography. The results of the endovascular surgical treatment were successful, no deaths or myocardial infarctions were registered. According to coronarography data, hemodynamically significant stenosis in the stent lumen was observed in 1,2 % cases.

References

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2.      Serruys P.W, De Jaegere P.P.T., Kiemeneij E et al. Comparison of Balloon-expandabie stent implantation with balloon angioplasty in patients with coronary artery disease. N. Engl. J. Med., 1994; 331, 489 - 495.

3.      Kastrati A., Dirschinger J., Boekstegers P. et al. Influens of stent design on 1 year outcome after coronary stent placement: A randomized comparisone of five stent types in 1147 unselected patients. Caih. Cardiovasc. Interv., 2000; July, 50(03): 290 - 297.

4.      Reimers В., Colombo A., Tobis J. Bifurcation lesions. In: Colombo A, Tobis J, eds. Techniques in Coronary Artery Stenting. London, Martin Dunitz Ltd, 2000; 171 -204.

5.      Schofer J., Schluter M., Gershlick A.H. et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomized controlled trial (E-SIRIUS). Lancet, 2003; 362: 1093 - 1099.

6.      Colombo A., Moses J.W, Morice M.C. et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation, 2004; 109: 1244- 1249.

7.      Ge L., Tsagalou E., Iakovou I. et al. In-Hospital and Nine- Month Outcome of Treatment of Coronary Bifurcational Lesions With Sirolimus-Eluting Stent. Am. ]. CardwL, 2005; 95: 757 - 760.

Abstract:

Aim. Was to assess the safety and efficiency of ulnar artery catheterization for diagnostic coronarography and endovascular treatment in patients with coronary arteries diseases.

Materials and methods. The study includes 150 patients with coronary arteries disease middle aged 57±9 yrs, underwent diagnostic coronarography and ballon angioplasty with stenting from ulnar artery port (UAPo). Comparative group consisted of 150 patients middle age 58±9 with radial artery port (RAPo).

Results. Technical success of procedure was 96,7 % (145 pts) in group with UAPo and 95,3% (143 pts) in RAPo group. Ulnar artery puncture failed in 5 cases (3,3%): in 3 (2%) cases due to ulnar artery spasm; in 1 case due to impossibility of guide insertion; in 1 case due to failure of ulnar artery puncture. In RAPo group puncture failed in 7 cases (4,7%): in 4 cases due to artery spasm; in 2 cases of guide insertion impossibility and in 2 cases of ulnar artery puncture failure. Time of puncture in UAPo group was 2,6±1,1 min, in RAPo - 2,6±1,2. Time of radiation was 5,5±5,2 min against 6,0±4,6 min in RAPo group. Time of procedure was 29,5±18,4 min in UAPo group against 32,9±16,8 min. The difference of indicators was doubtful in all cases

Complications: thrombosis of ulnar artery appeared in 1 patients at the 2nd day after procedure, thrombosis of radial artery - in 4 cases (2,7%). Spasm of ulnar artery appeared more rarely, than radial artery: 6 cases (4%) against 25 cases (16,7%). In 1 case in RAPo group during puncture we noticed appearance of bradycardia and hypotonia. Local neurological complications were not noticed.

Conclusion: the use of ulnar artery catheterization for diagnostics and treatment is safe and effective. The quantity of complication is lover than in RAPo group. 

References 

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2.      Бойцов С.А., Руда М.Я. Национальный регистр острого коронарного синдрома: положение дел и перспективы. Кардиоваскул. тер. и профилак. 2007; 4: 115-20.

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5.      Pierfrancesco Agostoni, Giuseppe G. L. et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and metaanalysis of randomized trials. J. Am. Coll. Cardiol. 2004; 44: 349-356.

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11.    Yokoyama N., Takeshita S., Ochiai M., et al. Anatomic variations of the radial artery in patients undergoing transradial coronary intervention. Catheter Cardiovasc Interv. 2000; 49: 357-362.

12.    Terashima M., Meguro T., Takeda H., et al. Percutaneous ulnar artery approach for coronary angiography: a preliminary report in nine patients. Cathet. Cardiovasc. Interv. 2001; 53:410-4.

13.    

Abstract:

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.

References

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4.     John G. Canto, Catarina I. Kiefe., William J. Rogers., Eric D. Peterson, et al. Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction JAMA, November 16, 2011: Vol 306, No.19.)

5.     Kappetein A.P, Feldman T.E., Mack M.J., et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur. Heart J. 2011;32: 2125-2134.

6.     Frederick G. Kushner, Mary Hand, Sidney C. Smith, Jr, Spencer B. King, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Am. Coll. Cardiol. 2009;54;2205-2241; originally published online Nov 18, 2009; doi: 10.1016/ j.jacc.2009.10.015.

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15.   Saleem T., Mohammad K.H., Abdel-Fattah M.M., Abbasi A.H. Association of glycosylated haemoglobin level and diabetes mellitus duration with the severity of coronary artery disease. Diab. Vasc. Dis. Res. 2008; 5(3): 184-189.

16.   Zornitzki T., Ayzenberg O., Gandelman G., et al. Diabetes, but not the metabolic syndrome, predicts the severity and extent of coronary artery disease in women. QJM. 2007; 100(9): 575-581.

17.   Mehta L., Devlin W., McCulloughPA., et al. Impact of body mass index on outcomes after percutaneous coronary intervention in patients with acute myocardial infarction. Am. J. Cardiol. 2007; 99(7): 906-910.

18.   Rubinshtein R., Halon D.A., Jaffe R., Shahla J., Lewis B.S. Relation between obesity and severity of coronary artery disease in patients undergoing coronary angiography. Am. J. Cardiol. 2006; 97(9): 1277-1280.

19.   Phillips S.D., Roberts W.C. Comparison of body mass index among patients with versus without angiographic coronary artery disease. Am. J. Cardiol. 2007; 100(1): 18-22.

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22.   O’Callaghan PA., Fitzgerald A., Fogarty J., et al. New and old cardiovascular risk factors: C-reactive protein, homocysteine, cysteine and von Willebrand factor increase risk, especially in smokers. Eur. J. Cardiovasc. Prev. Rehabil. 2005; 12(6): 542-547

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28.   El-Menyar A., Zubaid M., Shehab A., Bulbanat B., et al. Prevalence and Impact of Cardiovascular Risk Factors Among Patients Presenting With Acute Coronary Syndrome in the Middle East Clin. Cardiol. 2011; 34, 1, 51-58 

Abstract:

Aim: was to study possibilities of using thermographic equipment (TE) in coronary surgery (for evaluating coronary arteries' condition, quality of formed anastomosis and revascularization efficiency).

We examined 38 patients who underwent myocardial revascularization in condition of extracorporeal circulation.

Intraoperatively investigated 164 distal anastomosis of autotransplants with coronary artery (CA): 126 of which were vein autotransplant (great saphenous vein (GSV)), 38 - arterial autotransplant (left internal mammary artery (LIMA) - anterior interventricular branch (AIB)).

Absence of rough technical variations has been confirmed in all cases but one, when the leak as a thermal spot of extravasation was found.

In all 38 patients absence of thermal gradients on the surface of various myocardium area after reperfusion of myocardium was noted, which is perhaps (in our opinion) the sign of complete revascularization of myocardium.

Using of the TE was especially effective in detection of coronary arteries in cases when it was impossible by the conventional visual examination and epicardium palpation in patients with postinfarction adhesive process in pericardium (Dressler syndrome) or thick epicardium fat layer. In 2 patients with postinfarction in left ventricular aneurism the TE helped to distinguish viable myocardium from the scar.

Conclusion: the usage of the TE during a surgery is quite effective in examination of coronary arteries condition on a real-time basis, quality of distal anastomosis made, and adequacy of myocardial perfusion after its revascularization. 

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