Abstract:

Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization.

Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access.

Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration.

Medical consilium decided to perform staged endovascular revascularization of the myocardium.

For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used.

Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis.

Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.

Abstract:

Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research.

Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method.

Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. 

Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research.

Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table.

References

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https://doi.org/10.4244/EIJY18M06_011

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https://doi.org/10.4244/EIJY19M06_02

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https://doi.org/10.4244/EIJV12I7A140

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https://doi.org/10.21688/1681-3472-2019-3-47-56

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https://doi.org/10.4244/EIJV11SVA15

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https://doi.org/10.4244/EIJV8I2A34

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https://doi.org/10.4244/EIJV5I5A89

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https://doi.org/10.4244/EIJY14M07_18

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https://doi.org/10.4244/EIJV11I3A59

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https://doi.org/10.4244/EIJV10I10A190

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https://doi.org/10.15829/1560-4071-2016-9-19-24

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https://doi.org/10.4244/EIJV8I7A118

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https://doi.org/10.4244/EIJV3I5A104

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https://doi.org/10.4244/EIJV7I3A60

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https://doi.org/10.24884/1682-6655-2019-18-1-77-85

20.   Demin VV, Galin PYu, Demin DV, et al. The comparison of intravascular ultrasound guided and angiography guided implantation of drug-eluting stents: The randomized trial ORENBURG. Part 1: Study design, direct clinical results. Diagnostic & Interventional Radiology. 2015; 9(3): 31-43 [In Russ].

21.   Demin VV, Murzajkina MM, Galin PYu, et al. Comparison between implantation of drug-eluting stents under control of intravascular ultrasound and angiography: The randomized trial ORENBURG. Part 2: The data of angiography and intravascular methods of visualization. Diagnostic & Interventional Radiology. 2016; 10(2): 31-47 [In Russ].

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Abstract:

Technological advance in multislice computed tomography (MSCT) set the radiologists all over the world thinking of its application in patients with ischemic heart disease. Proved diagnostic efficiency of 64-slice MSCT coronary angiography nominates the technique to be a first-line screening method for coronary atherosclerosis: it allows quick, accurate, and non-invasive imaging and quantitative assessment of coronary lesions. Though the indications for MSCT has already defined, there still are contro-versies about its place in diagnostic strategy. The aim of our study was to picture the state-of-the-art MSCT capabilities, focusing on MSCT coronary angiography and its place in contemporary clinical medicine.

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Abstract:

Diseases of the circulatory system in a few decades are one of the major causes of death and disability in the population in many countries around the world. In Russian Federation, a number of newly diagnosed cases of coronary heart disease and mortality of the working population of this pathology is growing. In clinical practice at the present time, various radiological techniques assess the condition of the heart and coronary vessels, determine the location and volume of lesions. In the available literature, however, we found no data on methods of research that would reveal the correlation between the X-ray anatomy of coronary vessels and structural and functional state of the heart muscle. Thus, the need for comprehensive scientific research is obvious. Results of this study will, on the basis of survey data, using the methods of radiation diagnosis, objectively assess the level of metabolic and structural and functional state of the cardiomyocytes in cardiac patients. This will improve the accuracy and informativeness of diagnosis, as well as the increase of the control of effectiveness of therapy and quality of patients' life with cardiac diseases. 

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Abstract:

Aim: was to increase diagnostic value of cardiac CTA (CCTA) by estimation of the CCTA informative value in CA (Coronary arteries) diseases and optimization of OOTA procedure for reducing of radiation dose (RD).

Materials and methods: CCTA informative value in CA diseases was assessed on the base of data of 200 patients (average age of patients was 60,4 (from 35 to 80 years), men/women ratio: 1.94:1(132/68). Parameters of coronary stenosis severities: its localization, extension, degree and characteristics of coronary stenosis. The study was performed with GE Optima 660 128-slice scanner and Missouri Ulrich injector with bolus injecting 60-100 ml of nonionic contrast media (350 mg/ml) at 4-6 ml/sec injector rate. For data processing used: «Auto Coronary Analysis» and «Auto Ejection Fraction» programs at - AW5 workstation.

Results: discovered various severity degrees of atherosclerotic lesions based stenosis intensity up to 50% (46 /23,5%), 50-60% (65/33%), 60-70% (35/17,9%), 70-80% (26/13,5%), 80% and more (23/11,8%). CCTA data coincided with conventional coronary angiography in 89% cases. RD decreasment was achieved by: pitch change depending on heart rate, scan area optimization (reduction), kV and mAc with radiation exposure decline in CCTA to 7,0-8,0 mSv In pitch value increasing to 1,48 - RD decreased to 45% (20 mSv). In prospective synchronization with ECG, RD decreased to 65% (7-12 mSv) as X-Ray tube radiates the highest RD at 70% cardiac cycle phase (120kV/180-200mAc), in other phases (80kV/100 mAc) RD values were lower.

Conclusion: CCTA is a valid non-invasive method in CA pathology diagnostics enabling accurate identification of stenosis location, extent, degree and characteristics. Scanning protocol individualization in CCTA enables significant reduce of RD.

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