Abstract: Introduction: the problem of restenosis prevention and its early detection is very important in patients who underwent coronary intervention with bare-metal stent (BMS) implantation in acute coronary syndrome (ACS). But when is it necessary to perform elective coronary angiography in order not to miss possible restenosis development? This question needs to be answered. Aim: was to define the correct period to perform elective coronary angiography after bare-metal stent implantation in acute coronary syndrome. Material and methods: the study included 124 patients who underwent coronary intervention with BMS implantation in ACS, in period of 1-14 months before current admission. All patients included in this study had indications for repeating coronary angiography and were diagnosed hemodynamically relevant in-stent restenosis. No risk factors of restenosis were revealed at these patients. Results: average time of restenosis detection was 7,9±1,99 months. Average percent of restenosis among all included patients was 68,6±13,1%. We also revealed direct correlation of percent of restenosis with time of restenosis detection (r=0,5785, p <0,05). Correlation between time and percentage of restenosis and stent type or TIMI grade, was also estimated in this study. Conclusion: according to results of our study, there are good reasons to repeat coronary angiography in 7-9 month after BMS implantation in ACS, even if patients have no risk factors of restenosis. References 1. Bokerija LA, Alekjan BG, Anri M. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov. 3-e izd. Tom. 3. Rentgenojendovaskuljarnaja hirurgija ishemicheskoj bolezni serdca [Guide on endovascular surgery of heart and vessels. 3rd ed. Vol. 3. Endovascular surgery of ischemic heart disease]. Moscow: Bakulev Scientific Center of Cardiovascular Surgery. 2008. 648 pages [In Russ]. 2. Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis. 2016; 8(10): 1150-1162. 3. Ibanez B, James S, Agewall S, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2017; 39(2): 119-177. 4. Cortese B, Berti S, Biondi-Zoccai G, et al. Italian Society of Interventional Cardiology. Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. Catheter Cardiovasc Interv. 2014; 83(3): 427-35. 5. Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014; 63(24): 2659-73. 6. Agostoni P, Valgimigli M, Biondi-Zoccai GG, et al. Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J. 2006; 151(3): 682-9. 7. Goncharov AI, Kokov LS, Likharev AYu. Otsenka effektivnosti stentirovaniya koronarnyh arterij razlichnymi tipami stentov u bol'nyh IBS. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2009; 19: 23-24 [In Russ].
Abstract: Background: article presents a case of 11-month-old baby weighing 6,590, with phenomena of circulatory decompensation, and non-standard hybrid intervention using retroperitoneal open access to the infrarenal aorta - stent implantation with the potential for increasing its diameter as the child grows Materials and methods: the patient underwent examination - echocardiography (Echo-CG), multispiral computed tomography (MSCT), angiography Indication for the operation was the restenosis of the distal aortic anastomosis after the stage-by-stage surgical correction of hypoplastic left heart syndrome (Norwood procedure). This tactic was chosen taking into account the extremely high risk of re-surgery, as well as the impossibility of stent implantation with the potential for increasing the diameter through access to the femoral artery (body weight of the child is Results: good early postoperative period, against the background of disaggregant therapy (aspirin 5 mg/kg per day) and antibiotic therapy In control echocardiography (Echo-CG), the systolic pressure gradient in the stent implantation zone is Conclusion: stenting of restenosis in distal aortic anastomosis using retroperitoneal access can be considered as a surgery of choice in specialized centers. References 1. Sakurai T., 2. Pavlichev G.V., Podoksenov A.YU., Krivoshchekov E.V. Obstruction of the aortic artery after 3. Bartram U., Granenfelder J., Van Praagh R. Causes of death after the modified 4. Vitanova K., Cleuziou J., Pabst von Ohain J. et. al. Recoarctation After 5. Thomas P, Doyle M.D., William E. et al.Aortic obstructions in infants and children. Progress in Pediatric Cardiology. 1994; 3(1): 37-44. 6. Rothman A., Galindo A., Evans W.N. et. al. Effectiveness and safety of balloon dilation of native aortic coarctation in premature neonates weighing <or = 7. Atalay A., Pac A., Avci T.et. al. Histopathological evaluation of aortic coarctation after conventional balloon angioplasty in neonates. Cardiol. Young. 2018; 18:1-5. 8. Dijkema E.J., Sieswerda G.T., Takken T.et. al. Longterm results of balloon angioplasty for native coarctation of the aorta in childhood in comparison with surgery. Eur. Cardiothorac. Surg. 2018 1; 53(1): 262-268. 9. Fiore A.C., Ficher L.K., Schwartz T. et. al. Comparison of angioplasty and Surgery for Neonatal Aortic Coarctation. The society of the thoracic surgeons. 2005; 80:1659-65. 10. Shaddy R., Boucek M., Sturtevant J., et.al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation.1993; 87:793-9. 11. Attia I.M., Lababidi Z.A. Transumbilicalballon coarctation angioplasty. Am. Heart. 1988; 166:1623-4. 12. Redington A.N., Booth P, Shore D.F., Rigby M.L., Primary ballon dilatation of coarctation of aorta. A multi-institutional study. Thor. Cardiovasc. Surg. 1994;108:841-51. 13. Richard E.R., Gauvreau K., Moses H., et.al. Coarctation of the Aorta Stent Trial (COAST): Study design and rationale. Am. Heart. 2012; 164 (1): 7-13. 14. Coulson J.D.,Vricella L.A., Alekyan B.G. Аlternative arterial and venous access for catheterization in children and infants. Endovaskulyarnaya hirurgiya. 2016;4: 24-39 [In Russ]. 15. Pursanov M.G., Svobodov A.A., Levchenko E.G. et. al. New Approach for Hybrid Stenting of the Aortic Arch in Low Weight Children. Structural Heart Disease. 2017;(3)5:147-151. 16. Dorfer C., Standhardt H., Gruber A., et. al. Direct Percutaneous Puncture Approach versus Surgical Cutdiwon Technique for Intracranial Neuroendovascular Procedures: Technical Aspects. World Neurosur. 2012; 77(1): 192-200. 17. Chakrabati S., Kenny D., Morgan G. et. al. Balloon expandable stent implantation for native and recurrent coarctation of the aorta - prospective computed tomography assessment of stent integrity, aneurysm formation and stenosis relief. Heart. 2010; 96 (15): 1212-6. 18. 19. Sivanandam, S., Mackey-Bojack S.M., Moller J.H. Pathology of the aortic arch in hypoplastic left heart syndrome: surgical implications. PediatrCardiol. 2011; 32: 189-192. 20. Hammel J.M., Duncan K.F., Danford D.A. et.al. Two- stage biventricular rehabilitation for critical aortic stenosis with severe left ventricular dysfunction. Eur. Cardiothorac. Surg. 2012; 1-6. 21. Alekyan B.G. X-ray endovascular surgery. National Guidelines. M: Litterra. 2017; 1: 247-262 [In Russ]. 22. Feltes T.F., Bacha E., Beekman R.H. et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease. А scientific statement from the Am. Heart Association. Circulation. 2011: 7;123(22): 2607-52.
Abstract: The aim of the study was to define the factors, having influence to results of repeated percutaneous coronary interventions (PCI) such as isolated balloon angioplasty (BA) and BA in combination with rotational atherectomy (RA), used for treatment of stenosis inside stented segments of coronary arteries. 133 patients, submitted to repeated PCI due to development of stenosis in the stented coronary segments, were included in the study. Clinical and angiographic data were registered three times: at time of initial stenting, during repeated PCI and after 18 monthes of follow-up. Repeated PCI were done together with intracoronary ultrasonography. Decrease of neointimal volume and degree of balloon hyperinflation had not any influence on clinical end-points. Cross-luminal area of the vessel was the only significant prognostic facor for success of repeated PCI. Borderline value of the area was 4,7 sq.mm. Combined technique of PCI (BA + RA) had advantages over isolated BA only in those cases, when large cross-sectional lumen area must be achieved. Good clinical results of patients with cross-sectional lumen area >4,7 sq.mm, obtained after repeated PCI, give possoibility not to use additional interventions. If sufficient increase of the vessel lumen area can not be achieved, an active approach to therapy of such patients should be used after PCI. The only significant beneficial prognostic factor for success of repeated PCA of the stenosed stented coronary segments was area of the vessels's lumen. It did not depend on technique of revascularisation. Such factors, as decrease of neointimal volume and degree of balloon hyperinflation, had not influence on frequency of restenosis and clinical end-points. References 1. Bauters С, Banos J.L., Van BelleE., McFadden E., Lablanche J.M., Bertrand M. Six months outcome after successful repeat percutaneous intervention for in stent restenosis. Circulation.1998; 97: 318-321. 2. Elchaninof H., Koning R., Tron C, Gupta V, Cribier A. Balloon angioplasty for the treatment of coronary in stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate. J. Am. Coll. Cardiology .1998; 32:980-984. 3. Reimers В., Moussa I., Akiyama T. et al. long term clinical follow-up after successful repeat percutaneous intervention for stent restenosis. J. Am. Coll. Cardiology.1997; 30: 186-192. 4. Sharma S., Kini A., Garapati A. et al. Randomized trial of rotational atherectomy vs balloon angioplasty for in stent restenosis (Abstr.). Circulation.1998; 98 (1): 511. 5. Yokoi H., Kimura Т., Nakagawa Y, Nosaka H., Nouyoshi M. Long term clinical and quantitative angiographic follow-up after the Palmaz-Schatz stent restenosis. / Am. Coll. Cardiology.1993; 76: 618-622. 6. Mehran R., Dangas G., Mintz G. et al. In stent restenosis: «the great equalizer». Disappointing clinical outcomes with all interventional strategies (Abstr.). J. Am. Coll. Cardiology. 1999; 33: 1129-1191. 7. Mehran R., Mintz G.S., Popma JJ. et al. Mechanisms and results of balloon angioplasty for the treatment of in stent restenosis. Am. J. Cardiology. 1996; 78; 618-622. 8. Schiele E, Vuillemenot A., Meneveau N., Pales-Espinosa D., Gupta S., Bassand J.P. Effects of increasing balloon pressure on mechanism and results of balloon an gioplasty for treatment of restenosis after Palmaz-Schatz stent implantation. An angiographic and intra vascular ultrasound study. Cathet. Cardiovasc. Diagn. 1999; 46 (4): 3321. 9. Goldberg S.L., Berger P.B., Cohen DJ. et al. balloon angioplasty versus rotational atherectomy for in stent restenosis (abstr.). Circulation. 1998; 98 (1): 363. 10. Mehran R., Mintz G., Satler L. et al. Treatment of in stent restenosis with eximer laser coronary angioplasty. Mechanism and results compared to PTCA alone. Cir culation. 1997; 96: 2183-2189. 11. Dauerman H., Bairn D., Cutlip E. et al Mechanical debulking versus balloon angioplasty for the treatment of diffuse in stent restenosis. Am.]. Cardiol. 1998; 82: 277-284. 12. Lee S., Whan C, Cheong S. et al. Immediate and long term outcomes of rotational atherectomy versus balloon angioplasty alone for treatment of diffuse in stent restenosis. Am. J. Cardiology.1998; 82: 140-143. 13. Mahdi N.A., Pathan A.Z., Harrel L. et al. Directional atherectomy for the treatment of Palmaz-Schatz in stent restenosis. Am.]. Cardiology. 1998; 82: 1345-1351. 14. Kini A., Sharma S.K., Dangas G., Vidhun R., Duvvuri S. Marmur J. Predictors of restenosis after rotational at herectomy for in-stent restenosis (abstr.). Circulation.1998; 98 {!): 111. 15. Vom Dahl J., Radke P., Haage P. et al. Clinical and an giographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in stent restenosis. Am. J. Cardiology.1999; 833: 862-867. 16. Schiele E, Meneveau N., Vuillemenot A. et al. Impact of intravascular ultrasound guidance in stent deployment on 6 month restenosis rate. J. Am. Coll. Cardiology. 1998; 32: 320-328.
Abstract: A multicentered study based on retrospective data covered 2012 patients and aimed at ascertaining the eficiency of various methods of treating patients with coronary restenosis after stenting. The average percent of complications after restenosis was about 20% during the period of study (1 1+4 months). The metaregression data analysis showed the positive correlation between the stage of residual stenosis of the stentet segment and the probability of complications. As the residual stenosis decreased at 1%, the frequency of complications diminished at 0,9%. Another factors under analysis did not show any evident influence, although we have registered a tendency towards better outcomes of the recurring operations as the diameter of the vessel increased. The recurring balloon angioplasty in cases of short restenosis and intracoronar radiation in cases of diffused restenotic lesions have proved to be the most effective operations. The indications for implanting the additional stents must be given very carefully, especially in cases of diabetes. References 1. Fischman D.L., Leon M.D., Baim D.S., et al. A randomized comparison of coronary stent placement and balloon angioplasty in treatment of coronary artery disease. N. Engl. J. Med. 1994; 331: 496 - 501. 2. Serruys P.W, de Jaeger P., Kimeneij E, et al. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary heart disease. N. Engl]. Med. 1994; 331: 489 - 495. 3. Di Mario C, Marsico E, Adamian M. et al. New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima? Heart. 2000; 84: 471 - 475. 4. Hoffmann R., Mintz G. S. Coronary in-stent restenosis-predictors, treatment and prevention. Eur. Heart J. 2000; 21: 1739- 1749. 5. Leon M.B., Tierstein P.S., Moses J.W et al. Localized intracoronary gamma-radiation therapy to inhibit the occurrence of restenosis after stenting. N. Egl. J. Med. 2001; 344: 250-256. 6. Waksman R., White R.L., Chan R.C., et al. Intracoronary gamma-radiation therapy after angioplasty inhibits reccurence in patients with in-stent restenosis. Circulation. 2000; 101: 2165 - 2171. 7. Sousa J. E., Costa M.A., Abizaid A., et al. Lack of neoitimal proliferation after implantation of sirolimus-coated stents in human coronary arteries: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2001; 10: 192 - 195. 8. Kuntz R.E., Gibson СМ., Nobuyoshi M., et al. Generalized model of restenosis after conventional balloon angioplasty, stenting and directional atherectomy. J. Am. Coll. Cardiology. 1993; 21: 15 - 25.
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Abstract: The article presents case report of step-by-step treatment of patient with coronary arteries disease (CAD). Male, 47 yrs in 1996 underwent aorto-coronary bypass with making of 7 bypasses. Due to progression of atherosclerotic disease in postoperative perion patient underwent percutaneous transluminal coronary angioplastics (PTCA). Despite of all procedures new coronary arteries and bypasses defeat appeared and restenosis of previously implanted stents was pointed. Patient was treated in different countries (Israel, Germany Japan, Russia) with different methods, including: drug-eluting stents, angioplasty with the help of excimer laser and rotational atherectomy Application of physical and mechanical isolation of hyperplastic intima (excimer laser, rotational atherectomy) did not give significant decrease of restenosis repeat. Implantation of drug-eluting stents also had no effect. Stent-in-stent implantation in case of drug-eluting stent restenosis led to repeated restenosis in this patient. Thus, restenosis is a serious problem for interventional cardiologists. Any of available interventional methods provide optimum direct results, and the long-term results are even poorer. References 1. Andres, Vicente & Wessely,Rainer (2009, January 15). In-stent restenosis: Molecular mechanisms and therapeutic principles. SciTopics. Retrieved March 9, 2011, from http://www.scitopics.com/ In_stent_restenosis_Molecular_mechanisms_ and_therapeutic_principles.html. 2. Sigwart U., Puel J., Mirkovitch V. et al. Intravascular stents to prevent occlusion and restenosis after transluminal angio-plasty. N. Engl. J. Med. 1987; 316: 701-6. 3. Fischman D.L., Leon M.D., Baim D.S. et al. for the Stent Restenosis Study Investigators. A randomized comparison of coronary-stent placement and balloon angioplasty in treat-ment of coronary artery disease. N. Engl. J. Med. 1994; 331: 496-501. 4. Till F.V., Aliabadi D., Kinn J.W., Kaplan B.M., Benzuly K.H., Safian R.D. Real life stenting: a comparison of target vessel revascularization in Benestent-Stress lesions to non Benestent-Stress lesions. Circulation. 1996; 94: I-332. 5. Fenton S.H., Fischman D.L., Savage M.P. et al. Long-term angiographic and clinical outcome after implantation of balloon expandable stents in aortocoronary saphenous vein grafts. Am. J. Cardiol. 1994; 74: 1187-91. 6. Serruys P.W., de Jaeger P., Kiemeneij F. et al. for the Benestent Study Group. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary heart disease. N. Engl. J. Med. 1994; 331: 489-95. 7. Hoffmann R. and Mintz G. S. Coronary in-stent restenosis - predictors, treatment and prevention. European Heart Journal. 2000; 21: 1739-1749. 8. Vom Dahl J., Dietz U., Haager P.K. et al. Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the Angioplasty versus Rotational Atherectomy for Treatment of Diffuse In-Stent Restenosis Trial (ARTIST). Circulation. 2002; 105:583-588 9. Waksman R., Cheneau E., Ajani A.E. et al. Intracoronary radiation therapy improves the clinical and angiographic outcomes of diffuse in-stent restenotic lesions: results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies. Circulation. 2003; 107:1744-1749. 10. Radke P.W., Kobella S., Kaiser A. et al. Treatment of in-stent restenosis using a paclitaxel-eluting stent: acute results and long-term follow-up of a matched-pair comparison with intracoronary beta-radiation therapy. Eur. Heart J. 2004; 25:920-925. 11. Lemos P.A., Hoye A., Goedhart D. et al. Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex patients: an evaluation from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) study. Circulation. 2004; 109:1366-1370. 12. Scott N.A., Cipolla G.D., Ross C.E. et al. Identification of a potential role for the adventitia in vascular lesion formation after balloon overstretch injury of porcine coronary arteries. Circulation. 1996; 93: 2178-87. 13. Axel D.I., Kunert W., Goggelmann C. et al. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation. 1997; 96:636-645. 14. Scheller B., Speck U., Romeike B. et al. Contrast media as carriers for local drug delivery: successful inhibition of neointimal proliferation in the porcine coronary stent model. Eur. Heart J. 2003; 24:1462-1467 15. Scheller B., 16. Osiev A.G., Mironenko S.P., Krestyaninov O.V., Vereshagin M.A., Kretov E.I., Biryukov A.V., Grankin D.S., Prokopenko R.N. Clinical and angiographic efficacy of the coated balloon catheters in patients with restenosis of the coronary stents. Pathology of blood circulation and heart surgery. 2010; 4: 29-35 [In Russ].
Abstract: Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. References 1. Wheatley K., Phil D., Ives N. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med. 2009; 36: 1953 - 62. 2. Textor S. Despite results from ASTRAL, jury still out on stenting for atherosclerotic renal artery stenosis. Nephrology. Times .2010; 3: 2-7. 3. Kapoor N., Fahsah I., Karim R et al. Physiological assessment of renal artery stenosis: comparisons of resting with hyperemic renal pressure measurements. Catheter. Cardiovasc. Interv. 2010; 76(5): 726-32. 4. Rundback J.H., Sacks D., Kent K.C., et al. Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation. 2002; 106: 1572-1585. 5. Jones N., Bates E., Chetcuti S. Usefulness of tran- slesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease. Catheter. Cardiovasc. Interv. 2006; 68(3): 429-34. 6. Mitchell J., Subramanian R., White C. et al. Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: renal fractional flow reserve. Catheter. Cardiovasc. Interv. 2007; 69(5):685-9. 7. Kadziela J., Witkowski A., Januszewicz A. Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography. BloodPress. 2011; 20(4): 211-7. 8. Drieghe B., Madaric J., Sarno G. et al. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. European. Heart. Journal. 2007; 29 (4): 517-24. 9. Subramanian R., White C.J., Rosenfield K. et al. Renal fractional flow reserve: a hemodynamic evaluation of moderate renal artery stenoses. Catheter. Cardiovasc. Interv. 2005; 64: 480-486. 10. Leesar M., Varma J., Shapira A. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J. Am. Coll. Cardiol. 2009; 53(25): 2363-71. 11. Radermacher J., Chavan A., Bleck J. et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N. Engl. J. Med. 2001; 344: 410-417. 12. Doi Y., Iwashima Y., Yoshihara F. Et al. Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension. 2012; Jul 23. Epub ahead of print. 13. Zeller T., Ulrich F., Mflller C., Bbrgelin K., Sinn L. Angioplasty of severe atherosclerotic ostial renal artery stenosis: predictors of improved renal function after percutaneous stent-supported intervention. Circulation 2003; 108: 2244-2249. 14. Liew Y., Bartholomew J. Atheromatous embolization. hsc. Med. 2005; 10: 309-326. 15. Holden A. Is there an indication for embolic protection in renal artery intervention? Tech. Vasc. Interv. Radiol. 2011; 14(2): 95-100. 16. Rocha-Singh K., Eisenhauer A.,Textor S. Atherosclerotic peripheral vascular disease symposium II: intervention for renal artery disease. Circulation. 2008; 118: 2873-2878. 17. Feldman R., Wargovich T., Bittl J. No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter. Cardiovasc. Interv. 1999; 46(2): 245-8. 18. Kolluri R., Goldstein J., Rocha-Singh K. Percutaneous vascular interventions in renal artery diseases. Minerva. Cardioangiol. 2006; 54: 95-107. 19. Hiramoto J., Hansen K., Pan X. Atheroemboli during renal artery angioplasty: an ex vivo study. J. Vhsc. Surg. 2005; 41(6): 1026-30. 20. Holden A., Hill A. Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience. Journal Vascular. Surgery. 2003; 38: 962-968. 21. Perkovic V., Thomson K., Mitchell P. et al. Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Austral. Radiol. 2001; 45: 438-43. 22. Paulsen D., Klow N., Rogstad B. et al. Preservation of renal function by percutaneous transluminal angioplasty in ischaemic renal disease. Nephrol. Dial Transplant. 1999; 14: 1454-61. 23. Leertouwer T., Gussenhoven E., Bosch J. et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000; 216: 78-85. 24. Vignali C., Bargellini I., Lazzereschi M. et al. Predictive factors of in-stent restenosis in renal artery stenting: a retrospective analysis. Cardiovasc. Intervent. Radiol. 2005; 28: 296-302. 25. Corriere M., Edwards M., Pearce J. et al. Restenosis after renal artery angioplasty and stenting: incidence and risk factors. J. Vasc. Surg. 2009; 50(4): 813-819. 26. Leertouwer T., Gussenhoven E., van Overhagen H. et al. Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound. J. Vasc. Interv. Radiol. 1998; 9: 945-952. 27. Zeller T., Rastan A., Rothenpieler U. et al. Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents? Catheter. Cardiovasc. Interv. 2006; 68(1): 125-30. 28. Sapoval M., Zghringer M., Pattynama P. et al. Low- profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial. J. Vasc. Intern Radiol. 2005; 16(9): 1195-202.
The first experience of «cross-stenting» bifurcation technique
DOI: https://doi.org/10.25512/DIR.2013.07.2.12
For quoting:
Markasyan A.V. "The first experience of «cross-stenting» bifurcation technique". Journal Diagnostic & interventional radiology. 2013; 7(2); 103-108.
Abstract: In 2010, Kawasaki T et al. presented a modification of the bifurcation technique named «culotte» - «cross-stenting» technique. The purpose of this technique - minimization of metal overlap in the proximal part of the main branch and, thus, reducing the risk of stent thrombosis and restenosis. In this article, we have present a case report of successful application of «cross-stenting» technique. Also we have described technical features of this technique and principles of choice stent for the side branch. References 1. Erglis A., Kumsars I., Niemela M., Kervinen K., Maeng M. et al. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: The Nordic Stent Technique Study. Circ. Cardiovasc. Intervent. 2009; 2: 27-34. 2. Chevalier B., Glatt B., Royer T., Guyon P. Placement of coronary stents in bifurcation lesions by the «culotte» technique. Am J. Cardiol. 1998; 82: 943-949. 3. Hildick-Smith D., Lassen J.F., Albiero R., Lefevre Th., Darremont O., Pan M., Ferenc M., Stankovic G., Louvard Y. Consensus from the 5th European Bifurcation Club meeting. Eurolntervention. 2010; 6: 34-38. 4. Iakovou I., Ge L, Colombo A. Contemporary stent treatment of coronary bifurcations. J. Am. Coll. Cardiol. 2008; 46: 1446-1455. 5. Kawasaki T., Koga H., Serikawa T. Modified culotte stenting technique for bifurcation lesions: the cross-stenting technique. J. Invasive Cardiol. 2010; 22: 243-246. 6. Examination of stent deformation and gap formation after complex stenting of left main coronary artery bifurcations using microfocus computed tomography. J.Interv. Cardiol. 2009; 22: 135-144.
Abstract: Aim. Was to study long-term results of drug eluting stents implantation: angiographic frequency of prolong stenosis, frequency of restenosis, endotelization dynamics, and other morphological indicators on the base of intravascular ultrasound (IV-US) Materials and methods. The research consisted of 220 patients with angina pectoris or/and myocardial ischemic indexes: all of them were after drug eluting stents implantation. 174 patients on the first year and 82 on the second were underwent coronaroventriculography Double antiaggregant theraphy was given on the first year to 198(90%) patients, on the second - 21(9,5%) Results. The whole angiographic success was 89,5%. 44% patients were underwent of lateral arterial branches defense. Unsuccessfu stenting was due to technical impossibility of movement threw variated coronar arteries segment in 5%; 1,8% was due to incomplete disclosing of stent; 2,7% - occlusion of lateral arterial branch Conclusions. On the base of IV-US, at the end of the 1st year, 40% stents had full endotelization, at the end of the 2nd - 91%. Double antiaggregant theraphy was given to 99,1% patients on the first year. All coronary situations (morbidity, heart stroke, restenosis) was much more ess, than on the 2nd years, on which drug therapy was given only to 9,6% patients. References 1. G. Ertaio et al. Late stent thrombosis, endothelialisation and drug-eluting stents. Neth. Heart. J. 2009l; 17 (4): 177-180. 2. Ako J. et al. Late incomplete stent apposition after sirolimus-eluting stent implantation. A serial intravascular ultrasound analysis. J. Am. Coll. Cardiol. 2005; 46 (6): 1002-1005. 3. Virmani R. et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent. Should we be cautious? Circulation. 2004; 109 (6): 701-705. 4. Lee S.H., Chae J.K., Ko J.K. Consecutively developed late stent malappositions following the implantation of two different kinds of drug-eluting stents associated with spontaneous healing. Int. J. Cardiol. 2009; 134 (1): 7-10. 5. Yamen E. et al. Late incomplete apposition and coronary artery aneurysm formation following paclitaxel-eluting stent deployment. Does size matter? J. Invasive. Cardiol. 2007; 19 (10): 449-450. 6. Yasumi U. and Yasuto U. Angioscopic evaluation of neointimal coverage of coronary stents. Curr. Cardiovasc. Imaging. Rep. 2010; 3 (5): 317-323. 7. Mayraj A. et al. Comparison of one year clinical outcomes with paclitaxel-eluting stents versus bare metal stents in everyday practice. Can. J. Cardiol. 2008; 24 (10): 771-775. 8. Kim J.S. et al. Comparison of neointimal coverage of sirolimus-eluting stents and paclitaxel-eluting stents using optical coherence tomography at 9 months after implantation. Circ. J. 2010; 74: 320-326. 9. Suwaidi J.A. et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000; 101: 948-954. 10. Hofma S.H. et al. Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur. Heart. J. 2006; 27: 166-170. 11. Togni M. et al. Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J. Am. Col. Cardiol. 2005; 46: 231-236. 12. Shin D.I. et al. Drugeluting stent implantation could be associated with long-term coronary endothelial dysfunction. Comparison between sirolimus-eluting stent and paclitaxel-eluting stent. Int. Heart. J. 2007; 48: 553-567. 13. Takano M. et al. Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare-metal stents after 6-month implantation. Eur. Heart. J. 2006; 27: 2189-2195. 14. Moore P. et al. A randomized optical coherence tomography study of coronary stent strut coverage and luminal protrusion with rapamycin-eluting stents. JACC Cardiovasc. Interv. 2009. 15. Oyabu J. et al. Angioscopic evaluation of neointimal coverage. Sirolimus drug-eluting stent versus bare metal stent. Am. Heart. J. 2006; 52: 1168-1174. 16. Kotani J. et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J. Am. Col. Cardiol. 2006; 47: 2108. 17. Wilson G.J. et al. Comparison of inflammatory response after implantation of sirolimus- and paclitaxel-eluting stents in porcine coronary arteries. Circulation. 2009; 120: 141-149. 18. Higo T. et al. Atherosclerotic and thrombogenic neointima formed over SES. JACC Cardiovasc. Imaging. 2009; 2: 616-624 19. Latchumanadhas K. et al. Early coronary aneurysm with paclitaxel-eluting stent. Indian. Heart. J. 2006; 58 (1): 57-60. 20. Levisay J.P., Roth R.M., Schatz R.A. Coronary artery aneurysm formation after drug-eluting stent implantation. Cardiovasc. Revasc. Med. 2008; 9 (4): 284-287. 21. Chen D. et al. Spontaneous resolution of coronary artery pseudoaneurysm consequent to percutaneous intervention with paclitaxel-eluting stent. Tex. Heart. Inst. J. 2008; 35 (2): 189-192. 22. Lee S.E. et al. Very late stent thrombosis associated with multiple stent fractures and peri-stent aneurysm formation after sirolimus-eluting stent implantation. Circ. J. 2008; 72 (7): 1201-1204. 23. Kim J.S. et al. Delayed stent fracture after successful sirolimus-eluting stent (Cypher®) implantation. Korea
Abstract: Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE) Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible. Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression. References 1. Покровский А.В. Клиническая ангиология. Руководство. В двух томах. Т.2. М.: Медицина. 2004; 888. 2. Савельев В.С., Кошкин В.М. Критическая ишемия нижних конечностей. М.: Медицина. 1997; 160. 3. Jeans W.D. et al. Fate of patients undergoing transluminal angioplasty for lover-limb ischemia. Radiology. 1990; 177: 559-564. 4. Hunink M.G. et al. Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Med. Decis. Making. 1994; 14: 71-81. 5. Stokes K.R. et al. Five-year results of iliac end femoropopliteal angioplasty in diabetic patients. Radiology. 1990; 174: 977-982. 6. Минкин С., Рабкин Д. Экспериментально-морфологическое исследование динамики «вживления» рентгеноэндоваскулярных протезов в сосудистую стенку. Материалы 8-го симпозиума по рентгеноэндоваскуляр-ной хирургии. Москва - Ереван. 1987; 12. 7. Maas D. et al. Radiological follow-ap of transluminalli inserted vascular endoprothes-es. An experimental study using expanding spirals. Radiology. 1984; 152: 659-663. 8. Blum U. et al. Percutaneous recanalization of iliac occlusions. Resultsof a prosrective study. Radiology. 1993; 189: 536-540. 9. Henry M. et al. Stenting of femoral and popliteal arteries. Tenth international book of peripheral vascular intervention. 1995; 199: 368-369. 10. Henry M. et al. Palmaz stent placement in iliac and femoropopliteal arteries. Primary and secondary patency in 310 patients 2-4 year follow-up. Radiology. 1995; 197: 167-174. 11. Коков Л.С., Покровский А.В., Балан А.Н. и др. Отдаленные результаты клинического применения отечественного нитинолово-го стента для лечения стенозирующих поражений артерий. Ангиология и сосудистая хирургия. 2002; 8 (1): 41-46. 12. Scheinert D. et al. Stent supported recanaliza-tion of chronic iliac artery occlusions. Tenth international book of peripheral vascular intervention. Edited by M. Hanry. M. Fmor.Paris. 1999; 303-313. 13. Zeller T. Long-term results after recanalisation of thrombotic occlusions of native and stented arteries using a rotationals thrombectomy device. The Paris Course on Revascularization. Paris. 2002; 435-441. 14. White C.J. Peripheral аtherectomi with the рullback аtherectomy сatheter. Procedural safety and efficacy in a multicenter trail. J. of Endovascular. Surgery. 1998; 5: 9-17. 15. Yoffe B. et al. Preliminary experience with the Xtrak debulking device the treatment of peripheral occlusions. J. Endovasc. Ther. 2002; 9: 234-240. 16. Zeller T. et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the silverhawk device. J. Intervent. Radiol. 2004; 15: 1391-1397. 17. Ramaiah V. et al. Midterm outcomes from the TALON registry. Treating peripherals with «Silverhawk». Outcomes collection.J. Endovasc. Ther. 2006; 13 (5): 592-602.
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Abstract: Aim. To compare safety and efficiency of drug-eluting stents (DES) and bare metal stents (BMS) implantation for coronary artery disease (CAD). Materials and methods. 230 patients with CAD were divided in 2 groups: patients in group 1 received DES; in group 2 we performed BMS implantation. Results. Long-term results (over 12 months follow-up) of DES primary implantation reduces risk of the angiographic restenosis by 15% compared to BMS (р < 0,001). Conclusions. Notwithstanding low basic risk of restenosis, DES demonstrate no statistically significant advantages in MACE rate. It is also shown that DES implantation is associated with higher mortality and greater risk of non-cardiac complications, related to prolonged antiplatelet therapy. Thus, decision of DES implantation should be made in consideration of the patients' tolerance for double antiplatelet therapy, risk of bleeding, possible elective surgery, as well as any pre-procedure immune system disturbances. References 1. Sigwart U., Puel J., Mirkovitch V., Joffre F. et al. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.New. Engl. Med. 1987; 316: 701-706. 2. Van der Giessen W.J., Lincoff A.M., Schwartz R.S. et al. Marked inflammatory sequel to implantation of biodegradable and nonbiode-gradable polymers in porcine coronary arteries. Circulation. 1996; 94: 1690-1697. 3. Бокерия Л.А., Алекян Б.Г., Голухова Е.З. и др. Применение стентов с лекарственным антипролиферативным покрытием в лечении больных ишемической болезнью сердца. Креативная кардиология. 2007; 1:193-198. 4. Befeyter PJ. Percutaneous coronary intervention for unstable coronary artery disease. Text-book of interventional cardiology, 4th ed. by Topol E. Philadelphia. W.B. Saunders Company. 2003: 183-199. 5. Bauters C., Lablanche J.M., McFadden E.P. et al. Clinical characteristics and angiographic follow-up of patients undergoing early or late repeat dilation for a first restenosis. J. Am. Coll. Cardiol. 1992; 20: 845-848. 6. Бабунашвили А.М., Юдин И.Е., Дундуа Д.П. и др. Стенты с лекарственным покрытием при лечении диффузных атеросклеротиче-ских поражений коронарных артерий. Актуальные вопросы болезней сердца и сосудов. 2007; 4: 57-63. 7. Waters R.E. 3 cases following DES for in-stent-restenosis (at 16, 20, 43 mo) - shortly after interruption of antiplatelet Tx. Catheter. Car-diovasc. Interv. 2005; 4: 107-115. 8. PeterJ., Fitzgerald S. etal. Is angiographic late loss still a worthwhile surrogate endpoint in DES trials? Circulation. 2006; 54: 237-291.
Role of duplex ultrasound in the assessment of early follow-up period outcomes, after endovascular procedures in patients with critical limb ischemia and diabetes melitus
DOI: https://doi.org/10.25512/DIR.2014.08.3.02
For quoting:
Bondarenko O.N., Galstyan G.R., Ayubova N.L., Egorova D.N., Dedov I.I. "Role of duplex ultrasound in the assessment of early follow-up period outcomes, after endovascular procedures in patients with critical limb ischemia and diabetes melitus". Journal Diagnostic & interventional radiology. 2014; 8(3); 15-28.
Abstract: Aim: was to evaluate morphological features of lesions in lower limb arteries before percutaneous transluminal angioplasty (PTA) and its arterial complications in patients with critical lower limb ischemia (CLI) combined with diabetes mellitus(DM). Materials and methods: for the period from September 2010 to June 2013, a prospective single-center study was conducted involving 171 patients with CLI and DM (80(47%) men, mean age 64,1[54-68] years, mean HbA1c 8,3[7,4-9,6]%, mean duration of diabetes 16,5[8-23] years, diabetes type 1/2-18/153) who underwent PTA in 193 lower limbs. Myocardial infarction and brain stroke in anamnesis had 53(31%) and 19(11%) patients, respectively Chronic kidney disease (CKD) 3-4 stages had 40 patients(24%), end-stage renal disease - 16 cases (10%). Diagnosis of CLI was based on recommendation of TASC II. Patency of arteries of lower limbs was evaluated by duplex ultrasound (DU) before PTA and during early follow-up period (30 days). PTA in all patients was considered technically successful in restoring continuous arterial flow to the foot of at least one crural artery without residual stenosis >50%. Results: stenosis>50% and occlusions of tibial arteries were found in all patients. Peripheral arterial disease 4-6 classes according Graziani L. classification was marked in 180(93%) cases. Extensive tibial arterial calcification was found in 123(64%) cases, in patients with residual stenosis (> 50% remaining diameter) -113 (89%). The mean value of transcutaneous oxygen pressure (tcpO2) before PTA was 14,7(8-25) mmHg, after PTA - 35,2 (31-38) mmHg. After PTA , residual stenosis (>50%) in treated arteries was in 125(79,1%) cases, thrombosis in treated arteries - 9(5,7%), intimal dissection - 18(11,4%), incomplete stent disclosure - 3(1,9%), incomplete capture stent area stenosis - 2(1,3%), dislocation of the stent - 1(0,6%). Repeat PTA in the early follow-up period was performed in 15 patients with clinically significant complications (6%). Conclusion: CLI in diabetic patients is characterized by having severe morphological lesions of lower limb arteries, infrapopliteal arterial calcification. DU plays important role in evaluation of arterial patency and PTA complications in early follow-up period. The high level of residual stenosis of tibial arteries after PTA is associated with chronic complications of diabetes mellitus, including renal insufficiency Timely reintervention in diabetic patients with clinical significant PTA complications promotes optimal arterial patency and permission of CLI in theese cases. Reference 1. Ajubova N.L., Bondarenko O.N., Galstjan G.R., Manchenko O.V., Dedov 1.1. Osobennosti porazhenija arterij nizhnih konechnostej i klinicheskie ishody jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom s kriticheskoj ishemiej nizhnih konechnostej i hronicheskoj pochechnoj nedostatochnost'ju [Peculiarities of arteries' lesions of lower limb, and clinical outcomes of PCI in patients with critical ishemia of lower limbs with diabetes mellitus and chronic renal insufficiency]. Saharnyj diabet. 2013; 4:85-94 [In Russ]. 2. TASC. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J.Vasc Surg., 2000;31(1 part2):S1-287. 3. Lumley J.S. Vascular management of the diabetic foot- a British view. Journal Annals of the Academy of Medicine, Singapore. 1993, Vol 22, N 6, P 912-6 4. M.Doherty T., Lorraine A.F., Inoue D., Jian-Hua Qiao, M.C.Fishbein, R.C.Detrano, PK.Shan, T.B. Rajavashisth. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocrine Reviews. 2004, 25 (4):629-672 5. Bublik E.V., Galstjan G.R., Mel'nichenko G.A., Safonov V.V., Shutov E.V., Filipcev P.Ja. Porazhenija nizhnih konechnostej u bol'nyh saharnym diabetom s terminal'noj stadiej hronicheskoj pochechnoj nedostatochnosti, poluchajushhih zamestitel'nuju pochechnuju terapiju [Lower limbs’ lesions in patients with diabetesmellitus with end-stage chronic renal insufficiency, receiving replacement therapy]. Saharnyj diabet. 2008; 2: 17-23 [In Russ]. 6. Jager K.A., Phillips D.J., Martin R.L., Hanson C., Roederer G.O., Langlois YE. et al. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med. Biol. 1985;11: 515-21. 7. Ciaverella A., Silletti A., &Mustacchio A., et al. Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischemia. Diabet. Metab. 1993;19:586-589. 8. Jude E.B., Oyibo S.O. & Chalmers N., et al. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433-1437. 9. Bandyk D.F. Surveillance after lower extremity arterial bypass. perspect vasc surg endovasc ther. Eur Heart J. 2007;19:376-83. 10. Faglia E., Mantero M. & Caminiti M. et al. Extensive use of peripheral angioplasty, especially infrapopliteal, in the treatment of ischemic foot ulcer: clinical results of a multicentric study of 221 consecutive diabetic subjects. J. Intern. Med. 2002; 252:225-232. 11. Adam D.J., Beard J.D., Cleveland T., Bell J., Bradbury A.W., Forbes J.F. et al.; BASIL Trial Participants. Bypass versus Angioplasty in Severelschaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366:1925-34. 12. Norgen L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes FGR. Inter-society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 45(Suppl S):S5-67. 13. Hirsch A.T., Haskal Z.J., Hertzer N.R., Bakal C.W., Creager M.A., Halperin J. et al; American Association for Vascular Surgery/Society for Vascular Surgery;Society for Cardiovascular Angiography and Interventions;Society for Vascular Medicine and Biology; Society for Inerventional Radiology; ACC/AHA TASC Force on Practice Guidelines. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower exteremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA TASC Forc on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. Circulation. 2006 113: e463-654, 14. Dick F., Ricco J.B., Davies A.H.: Chapter VI: Follow-up after Revascularisation. Eur. J. Vasc. Endovasc. Surg. 2011; 42: S75-S90. 15. Bondarenko O.N., Ajubova N.L., Galstjan G.R., Dedov 1.1. Dooperacionnaja vizualizacija perifericheskih arterij s primeneniem ul'trazvukovogo dupleksnogo skanirovanja u pacientov s saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej [Preoperative visualization of peripheral arteries with the help of ultrasonic duplex scanning in patients with critical ischemia of lower limbs and diabetes mellitus]. Saharnyj diabet. 2013; 2: 52-61 [In Russ]. 16. Arvela E., Dick F: Surveillance after Distal Revascularization for Critical Limb Ischemia. Scandinavian Journal of Surgery. 2012; 101:119-124. 17. Diehm N., Baumgartner I., Jaff M., Do D.D., Minar E., Schmidli J. et al. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischemia of lower limb arteries. Eur. Heart J. 2007; 28: 798-805.
Abstract: Aim: was to study properties of nanostructured carbon coating stents in coronary arteries with the help of intravascular ultrasonic visualization. Materials and Methods: experimental implantation of stents in coronary artery was performed on 8 yearling sheep. Estimation of bioinertness properties of stents was made by intravascular ultrasonic method on the 14, 28, 180 day. Bioinertness properties were estimated in comparison with analogical bare-metal stents. Results: The analysis of results showed that in early stages (up to 28 days) experimental samples of stents cause less formation of trombus than simple balloon-extendable stents. In the period of late outcomes, coronary nanostructured carbon coating stents have lower level of «in-stent stenosis». Conclusion: stent implantation with nanostructured carbon coating does not prevent the natural reparative processes taking place in the artery wall, does not cause the formation of thrombotic masses under standard doses of antiaggregants. Experimental stents significantly less affected in-stent stenosis, than stents without surface modification, indicating their higher bioinertness. References 1. Libby P., Ganz P. Restenosis revisited.- new tsrgets, new therapies. - N. Egl.S.Med. 1997; 37: 418-419. 2. Aref'eva T.I. et. al. Uvelichenie jekspressii monocitarnyh molekul adgezii i obrazovanija monocitotrombocitarnyh agregatov v krovi pri koronarnom restenoze [Increased expression of monocyte adhesion molecules and the formation of aggregates monotsitotrombotsitarnyh blood in coronary restenosis]. Terapevticheskijarhiv. 2002; 4:46-49 [In Russ]. 3. Morice M.C. A randomized comparison of sirolimus-eluting stent with a standard stent for coronary revesculazation. N. Engl. J. Med. 2002; 346:1773-1780. 4. Topol E.J. Artery size, neointima and remodeling time for some standards. J. Am. Coll Cardiol. 1998; 32:2087-2094. 5. Kremneva L.V. Vospalenie kak faktor riska restenoza i serdechno-sosudistyh oslozhnenij posle chreskozhnyh intrakoronarnyh vmeshatel'stv [Inflammation as a risk factor for restenosis and cardiovascular events after percutaneous intracoronary intervention]. Terapevticheskij arhiv. 2006; 3: 89-95 [In Russ]. 6. Lazarenko O.N. Vlijanie pokrytij stentov na tromboobrazovanie i razvitie restenozov [Tekst] [Influence of coatings on the stent thrombosis and restenosis. [Text]. Prakticheskaja angiologija. 2007; 2 (7): 10-13 [In Russ]. 7. Demin V.V. Klinicheskoe rukovodstvo po vnutrisosudistomu ul'trazvukovomu issledovaniju [Clinical guidelines for intravascular ultrasound]. O. IPK JuzhnyjUral. 2005; 400 s. [In Russ]. 8. Fedorchenko AN., Osiev A.G., Kochkina T.A., Protopopov A.V. Prognozirovanie klinicheskih rezul'tatov jendovaskuljarnogo vosstanovlenija prosveta stentirovannyh koronarnyh arterij. Diagnosticheskaja i intervencionnaja radiologija [Prediction of clinical results of endovascular stented recovery lumen of the coronary arteries. Diagnostic and intewentional Radiology. 2007; 3(1): 54-65 [In Russ]. 9. Vlodaver Z., French R., Van tassel R.A. et. al. Corellation of the atamortem coronary arteriogram and the postmortem specimen. Circulation. 1973; 47:162-9. 10. Grondin C.M., dyrda I., Pasternac A. et al. Discrepancies between cineangiographic and postmortem findings in partients with coronary artery disease and recent myocardial revascularheart diseases: comparison of ciuneangiographic and necropsy findings. Ann. Intern. Med. 1979; 91:350-6. 12. Isner J.M., Kishel J., Kent K.M. et. al. Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic - histologic correlative analisys in 28 patients. Circulation. 1981; 63: 1056-64. 13. Ivanov V.A., Movsesjanc M.Ju., Trunin I.V. Vnutrisosudistye metody issledovanija v intervencionnoj kardiologii [Intravascular methods of research in interventional cardiology]. Medpraktika. M. 2008; 112S. [In Russ]. 14. Nakamura S., Colombo A., Gaglione A. et al. Intracoronary ultrasound observations during stent implantations. Circulation. 1994; 89; 2026-34. 15. Colombo A., Hall P., Nakamura S. et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995; 91: 1676-88. 16. Goldberg S.L., Colombo A., Nakamura S. et al. Benefit of intracoronary ultrasound in the deployment of Palmaz - Schatz stents. J. Am. Coll. Cardiol. 1994; 24:996-1003.
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). References 1. Kereiakes D.J., Cutlip D.E., Applegate R.J., Wang J., Yaqub M., Sood P., Su X., Su G., Farhat N., Rizvi A., Simonton C.A., Sudhir K., Stone G.W. Outcomes in diabetic and nondiabetic patients treated with everolimus- or paclitaxel-eluting stents: results from the SPIRIT IV clinical trial (Clinical Evaluation of the XIENCE V Limus Eluting Coronary Stent System). J. Am. Coll. Cardiol. 2010 Dec 14; 56(25):2084-2089. 2. Petrova K.N., Kozlov S.G., Ljakishev A.A., Savchenko A.P. Vlijanie saharnogo diabeta 2 tipa na rezul'taty jendovaskuljarnogo lechenija IBS s pomoshhju stentov s lekarstvennym pokrytiem (dannye godichnogo nabljudenija) [Influence of diabetes mellitus type 2 on results of endovascular treatment of IHD with help of drug-eluting stents (data monitoring for one year)]. Kardiohgija. 2006; 12: 22-6 [In Russ]. 3. Abizaid A., Costa M.A., Blanchard D. et al. Sirolimus-Eluting Stents Inhibit Neointimal Hyperplasia in Diabetic Patients. Insights from the RAVEL Trial. Eur. Heart J. 2004; 25: 107-12. 4. Moussa I., Leon M.B., Baim D.S. et al. Impact of Sirolimus-Eluting Stents on Outcome in Diabetic Patients. Circulation .2004; 109: 2273-8. 5. Hermiller J.B., Raizner A., Cannon L. et al. TAXUS-IV Investigators. Outcomes With the Polymer-Based Paclitaxel-Eluting TAXUS Stent in Patients With Diabetes Mellitus: the TAXUS-IV trial. JACC. 2005; 45: 1172-9. 6. Sabate M., Jim Onez-Quevedo P., Angiolillo D.J. et al. Randomized Comparison of Limus-Eluting Stent Versus Standard Stent for Percutaneous Coronary Revascularization in Diabetic Patients. Circulation. 2005; 112: 2175-83. 7. Jensen J., Lagerqvist B., Aasa M., Sarev T., Nilsson T., Tornvall P. Clinical and angiographic follow-up after coronary drug-eluting and bare metal stent implantation. Do drug-eluting stents hold the promise? J. Intern. Med. 2006 Aug; 260(2):118-24. 8. Jain A.K., Lotan C., Meredith I.T., Feres F., Zambahari R., Sinha N., Rothman M.T. E-Five Registry Investigators. Twelve-month outcomes in patients with diabetes implanted with a zotarolimus-eluting stent: results from the E-Five Registry. Heart. 2010 Jun; 96(11):848-53. doi: 10.1136/hrt.2009.184150. 9. Stettler C., Allemann S., Egger M. et al. Efficacy of drug eluting stents in patients with and without diabetes mellitus: indirect comparison of controlled trials. Heart. 2006; 92: 650-7. 10. Scheen A.J., Warzee F. Diabetes Is Still a Risk Factor for Restenosis After Drug-Eluting Stent in Coronary Arteries. Diabetes Care. 2004; 27: 1840-1. 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.
