Abstract:

Endovascular methods of treatment for coronary heart disease are of considerable current use. Stenting of coronary arteries is the most widely used intervention in management of coronary heart disease. Present-day models of coronary stents make it possible to selectively perform direct stenting in certain roentgenomorphology of the lesion concerned. The authors analysed the outcomes of direct and conventional stenting of coronary arteries in 74 patients presenting with coronary heart disease. No differences as to the mortality rate were observed between the groups. The group of direct stenting demonstrated lower percentage of ischemic events: myocardial infarction on the background of acute or subacute thrombosis of the stent (1 - in the direct-stenting group, 3 - in the conventional-stenting group), transitory myocardial ischaemia (1 case in the direct-stenting group, 3 cases in the conventional-stenting group). Of the angiographic peculiarities, dissection complicated a total of three procedures of traditional stenting, and did not occur in the direct-stenting group. The no-reflow syndrome was noted to have developed in one case in the stenting group with predilatation. Of the technical peculiarities in the direct-stenting group, we observed a statistically reliable decrease in the average duration of the intervention by 11,76 minutes (P = 0,039), that of roentgenoscopy by 5,91 minutes (P = 0,027), a decrease in the average consumption of the radiopaque medium by 68,36 ml (P < 0,01), and a decrease in the average expenditure of coronary balloon catheters by 0,59 pc. (P < 0,001). Hence, the method of direct stenting of coronary arteries turned out to offer advantages over the conventional-stenting technique with predilatation in the clinical, angiographic and economic aspects, provided a careful selection of patients is performed.

Reference

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Abstract:

Aim. Was to analyze atherosclerotic disease dynamics and long-term results (up to 5 years) after implantation of bare-metal stents (BMS) and sirolimus-eluting stents (SES) in patients with multivascular coronary disease

Methods and results. We have analyzed clinicaland angiographic results data of percutaneous coronary interventions (PCI) of 585 patients with multivascular coronary disease during 5-years of follow-up period. 264 patients were treated with BMS, 321 - with SES We used Cypher drug-eluting stents (sirolimus-eluting stents) in the first group and BX Velocity bare-metal stents in the second group of patients

During first year of follow-up the incidence of symptoms reoccurrence in BMS and SES groups was 22,3% and 11,8% (р < 0,05) repeated PCI was performed in 15,6% and 3,9% (р < 0,05), CABG - 2,8% and 0,3% (р < 0,05), the incidence of myocardial infarction (MI) was 1,4% and 0,9%. The restenosis rate in BMS and SES groups was 19,7% and 2,3% (р < 0,05), late thrombosis (LT) - 0,3% and 1,4% The survival without MACE was higher in SES group

During 5 years of follow-up the cumulative incidence of symptoms reoccurrence in BMS and DES groups was 30,7% and 22,7% repeated PCI was performed in 23,9% and 18,1% (р < 0,05), CABG - 6,4% and 4,7%, the incidence of myocardial infarction (MI) was 6,5% and 7,8%. The progression of atherosclerosis in early stented segments in BMS and SES groups was 6,6% and 10,1%, late thrombosis (LT) - 0,4% and 2,1%. There was no difference in survival without MACE between groups

Conclusions. By the end of the first year of follow-up the incidence of angina reoccurrence and repeat revascularization in patients with multivascular coronary disease was higher in BMS group compared with SES group. The survival without MACE was also higher in SES group. By the end of the fifth year of follow-up there was no difference in angina reoccurrence, repeated revascularization and surviva without MACE because the late thrombosis and atherosclerosis progression in early stented segments was more common in DES group. 

References 

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Abstract:

Purpose. To assess safety and efficiency of simultaneous RCA and major branches of LCA stenting in patients with myocardial infarction (MI).

Material and methods. Authors analyzed data of 237 patients. Coronary angiography (CAG) revealed triple vessel stenotic and/or occlusive disease. Pre-procedure systemic thrombolysis (streptokinase) used in 54 patients. Endovascular interventions (PTCA and stenting of the infarct related artery) performed in all the cases; in 24 patients, simultaneous complete anatomical coronary revascularization (CACR) attempted. In 30 cases, after PTCA of the infarct related artery (PTCA IRA) patients were transferred to other hospitals for bypass surgery as a second stage.

Results. Systemic thrombolysis efficiency was 40 %(22 patients) according to echocardiography and 26% (14 patients) by CAG. TIMI III flow restored in 100%, immediate clinical success rate was 97,5%. There were no procedural complications. Six patients died early after the PTCA for cerebral hemorrhage, acute LV failure, and LV rupture. Absence of myocardial ischemia in CACR subgroup was confirmed clinically and in treadmill test. Patients of PTCA IRA subgroup presented with angina of various functional class.

Conclusions. Endovascular interventions are highly efficient as a component of complex IM treatment. Primary CACR is proved to decrease symptoms of myocardial ischemia. 

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Abstract:

Aim: was to analyze long-term results of coronary artery stenting with drug-eluting stents «Zotarolimus» and bare metal stents in patients with a concomitant diabetes mellitus type II.

Materials and methods: 37 patients with ischemic heart disease and concomitant diabetes mellitus type II were selected for analysis; they underwent implantation of stents without drug coverage («Intergrity» «Medtronic») or stents with drug-eluting «Zotarolimus» («Resolute Integrity» «Medtronic»). All patients were divided into 2 groups: first group consisted of 11 patients, who underwent implantation of bare metal stents, second group - 26 patients who underwent implantation of drug-eluting stents, «Zotarolimus». Follow-up period was 26±4 months. Criteria of stenting efficiency were: angiographic assessment of coronary arteries anatomy in control angiography after stent implantation, reccurence of angina or functional class increase, the survival rate in the nearest postoperative period, before discharge, but not more than 30 days, and in the early post-operative period up to 6 months. In the medium-distant post-operative period - 12 months, and in the late postoperative period - 24 months.

Results: all patients underwent successfully performed endovascular revascularization. The optimal angiographic result was achieved in all patients. Regression of ischemic changes on ECG data and increase myocardial contractility by echocardiography data also were marked in all patients. In long-term follow-up period, in 5 (45%) patients with bare metal stents we noted the appearence of hemodynamically significant restenosis, that needed performance of secondary angioplasty with stenting.

Conclusion: the use of antiproliferative drug-eluting stents «Zotarolimus» is possible in treatment of patients with coronary artery disease and comorbid diagnosis of diabetes mellitus type II. Bare metal stents in coronary stenting in patients with concomitant diagnosis of diabetes mellitus type II is impractical due to developing in-stent restenosis (45% of patients). 

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11.   Park K.W., Lee J.M., Kang S.H., Ahn H.S., Kang H.J., Koo B.K., Rhew J.Y, Hwang S.H., Lee S.Y, Kang T.S., Kwak C.H., Hong B.K., Yu C.W., Seong I.W., Ahn T., Lee H.C., Lim S.W., Kim H.S. Everolimus-eluting xience v/promus versus zotarolimus-eluting resolute stents in patients with diabetes mellitus. JACC. Cardiovasc. Interv. 2014 May;7(5):471-81. doi: 10.1016/j.jcin.2013.12.201. 

Abstract:

Aim: was to provide data of examination of patients of single-center randomized clinical trial ORENBURG (results of angiography, intravascular ultrasound (IVUS), optical coherence tomography (OCT), which were made at different stages of primary operations).

Materials and methods: 1032 patients were enrolled into this trial and uniformly distributed into 6 subgroups, representing 6 different types of drug-eluted stents implanted. Patients in this study were also divided into IVUS guidance and angiography guidance subgroups in 2 to 1 ratio. All patients underwent the OCT examination at the final stage of the procedure, and according to OCT results, no additional interventions were performed. Data of instrumental studies was analyzed with use of modern statistical methods and programs.

Results: according to angiographic data, in-segment lesion length and lumen volume before the operation were higher in IVUS group. After intervention, lumen volume was still higher, and % diameter stenosis and % area stenosis were lower in IVUS group in comparison with angiography group. Comparison of IVUS and angiography data after predilatation showed that IVUS was associated with bigger absolute values of minimum lumen diameter (MLD) and minimum lumen area (MLA), while % diameter stenosis and % area stenosis were similar between two groups. At control IVUS and OCT studies the region of the maximum residual stenosis did not usually match with the site of the baseline maximum stenosis. Quantitative data in these segments significantly differed. According to control IVUS data, additional angioplasty in stent was needed in 10,1 % of patients. Additional procedure allowed to improve all quantitative indicators. Implantations of different types of stents were performed using similar interventional technic but randomized by selection of stent eluting. Nevertheless, initial technical parameters of endoprosthesis affected quantitative results of the implantation. Nobori stent showed biggest differences in quantitative results of implantation in comparison with other types of stents and to the whole group.

Conclusion: ORENBURG is second large trial in terms of volume, and second large trial that was initiated, and which was dedicated to the comparison of interventional strategies using drug-eluting stents under intravascular visualization or angiography guidance. The minimal incidence of MACE was registered during the period of in-hospital stay Only one case of cardiac death was registered, and it was not associated with the region of the treated artery. Results of ORENBURG trial confirm the tendency to absolute measures recieved by intravascular methods of visualization, and used for characterization of defeated vessel excess absolute measures received by angiography.

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