Abstract:

Introduction: about 200 million people in the world suffer from ischemia of lower limbs. This pathology occupies a large part in the structure of all lesions of the vascular bed. Most patients with lesions of lower limb arteries have critical lower limb ischemia (CLLI), which is characterized by pain at rest and/or trophic lesions of foot. CLLI is the final stage of lower limb vascular bed lesion and is always accompanied by a deterioration in the quality of life, high morbidity and mortality. The only effective way to treat this pathology is revascularization, however, the current lack of clinical data does not allow us to determine the optimal strategy in treatment of this pathology.

Aim: was to determine advantages and disadvantages of using various methods of lower limb revascularization.

Material and methods: literature data from information aggregators Cyberleninka, Pubmed and MEDLINE on this topic, published in Russian and English for the period from 2010 to 2021, were selected for analysis. Articles written in German and French were included in the study in case of available translation to English. Termins as an inclusion criteria: critical limb ischaemia, ischaemic pain, tissue loss, gangrene, hybrid intervention, open surgical recanalization, endovascular revascularization, claudication, stenosis.

Results: it is determined that revascularization by open surgery showed better long-term results, however, it cannot be recommended for patients with severe comorbid diseases and defeat of lower limb and foot arteries, while endovascular revascularization techniques allow the procedure to be performed in almost all patients, regardless of the severity of their somatic status, however, extended multilevel lesions are poorly amenable to this method of treatment, and also have a relatively lower patency in the long-term period. Hybrid interventions combine advantages of both methods, however, they have high requirements for the equipment of the medical institution and the qualifications of the staff. In addition, hybrid methods are also more dangerous for the patient in comparison with revascularization by endovascular methods.

Abstract:

Patients with suspected peripheral artery disease (PAD) with critical limb ischemia (CLI) require intervention for limb salvage. Successful revascularization depends on quality and accurate visualization of vascular bed of lower limbs. Recent advances in imaging technology have significantly impacted the preoperative assessment of patients with PAD. The following is a description of main invasive techniques of obtaining high-quality images of arteries of lower limbs.

Aim: was to summarize data of modern literature sources, on the effectiveness of modern instrumental diagnostic methods for early and effective invasive assessment of blood flow and perfusion of lower limbs for planning revascularization interventions and assessing its effectiveness.

Material and methods: we analyzed sources of Russian and foreign literature over the past 5 years on the issue of modern possibilities of invasive diagnosis of critical lower limb ischemia. When choosing sources, we relied on the information content of described methods, the relevance of research, results of which are being applied today, and outlined prospects for their application in the future.

Conclusions: over the years, digital subtraction angiography has been traditionally the «gold standard» for intravascular imaging of lower limbs. Over time, this method has been improved because technological advances have created high-quality alternatives for preoperative (computed tomography [CT] angiography and magnetic resonance angiography [MRA]) and intraoperative imaging (Vascular Flow Reserve [VFR], intravascular ultrasound [IVUS], optical coherence tomography [OCT] and angiography CO₂).

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

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Abstract:

Background and aim: in Russian Federation, more than 10 million people suffer from peripheral artery disease (PAD), and from chronic limb-threatening ischemia (CLTI) as one of it’s complications. According to Russian guidelines on treatment of patients with CLTI, the initial diagnosis should include measurement of ankle-brachial and finger-brachial indices (ABI, ТВ I), as well as ultrasound duplex scanning (USDS) - however, the sensitivity and diagnostic accuracy of these methods are often insufficient. In this review, we have summarized the entire range of modern instrumental methods for early and effective diagnosis of critical lower limb-threatening ischemia and for the evaluation of limb perfusion.

Materials and methods: 31 sources of domestic and foreign literature published in last 5 years on the issue of modern possibilities for early precision diagnosis of critical limb-threatening ischemia were examined.

Results and conclusions: AHA Experts recommend some experimental technologies for evaluating lower limb perfusion, including angiography with indigocarmine, perfusion computed tomography (CT perfusion), magnetic resonance imaging (MRI), contrast echography, and hyperspectral imaging. Among other things, implantable bio-sensors can be identified: for example, oxygen-platform LuMee, which works in real time and provides continuous monitoring of oxygen levels in tissues. New technologies allow us to improve the accuracy of diagnosis and quality of treatment of patients with CLTI. It is worth considering switching from traditional methods to more modern ones, which can significantly reduce the frequency of amputations and the risk of disability and improve the quality of life of our patients.

References

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Abstract

Introduction: article presents the first experience and long-term results of using domestic coronary balloon-expandable stents with a bioinert carbon coating, «Nanomed».

Aim: was to evaluate long-term results of using domestic coronary balloon-expandable stents with bioinert linear chain carbon coating (BLCCC), «Nanomed».

Materials and methods: the study included 387 patients, suffering from coronary heart disease, who underwent endovascular myocardial revascularization from 2016 to 2018, with implantation of coronary balloon-expandable stents with BLCCC by the Nanomed company, Penza. The control group included 320 patients who underwent endovascular myocardial revascularization with implantation of coronary balloon-expandable cobalt-chromium stents «MSure Cr» of the company «Multimedics», during the same period. A comparative estimation of long-term results was carried out on the basis of a study of the overall frequency of repeated myocardial revascularization; repeated interventions on the target vessel; the frequency of interventions on other coronary arteries with the progression of atherosclerosis; long-term survival rates.

Results: in the long-term period, the overall probability of absence of repeated revascularization in 47 months after PCI was 78,3 ± 2.1% and 72,1 ± 2.4% in the «Nanomed» BLCCC and «MSure Cr» groups, respectively. There was no statistically significant difference between groups (Log. Rank=0,77). However, the incidence of restenosis in the stent was statistically significantly higher in the «MSureCr» group. (p = 0,027). The overall probability of survival in 47 months after surgery was 98,2±2,4% and 98,1±2.6% in groups 1 and 2, respectively. No statistically significant difference between groups was found (Log. Rank=0,4).

Conclusions: 1. The use of a coronary balloon-expandable stent with a BLCCC, Nanomed for endovascular myocardial revascularization is an effective treatment in patients with coronary heart disease.

2. Long-term results of using bioinert carbon-coated stents, Nanomed and MSureCr stents were comparable in terms of absence of myocardial re-revascularization procedures due to relapse of the angina pectoris and survival time of up to 47 months. However, the incidence of restenosis in a stent with a bioinert carbon coating, Nanomed was statistically significantly lower.

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Abstract

Aim: was to compare annual results of the use of stents with drug eluting - «NanoMed» and Orsiro.

Material and methods: in a randomized prospective study, an analysis of clinical and angiographic data of 1040 patients after stenting of coronary arteries with the observation period of 12 months was performed. The study and control groups randomly included 520 patients with implanted stents «NanoMed» and Orsiro.

Results: main initial clinical demographic and angiographic indicators did not statistically significantly differ. The primary endpoint (TLF - target lesion failure) was achieved in 6.5 and 5.9% in «NanoMed» and Orsiro groups, respectively (p = 0.7). Target lesion revascularization (TLR) was performed in study and control groups, respectively, in 1.7 versus 1.2% of cases (p = 0.4).

Conclusion: thus, in a comparative analysis of the use of stents «NanoMed» and Orsiro for a period of 12 months - no statistically significant difference was revealed.

References

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2.     Joner M, Finn A, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J. Am. Coll. Cardiol. 2006; 48: 193-202.

3.     Sarno G, Lagerqvist B, Fmbert O, et al. Lower risk of stent thrombosis and restenosis with unrestricted use of 'newgeneration' drug-eluting stents: a report from the nation wide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur. Heart J. 2012; 33(5): 606-613.

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Abstract:

Persistent sciatic artery (SA) is recognized as a minority variant of embryogenesis of lower limb artery. Article describes a clinical case of complex treatment of a patient with persistent SA, critical ischemia of lower limb and with diabetic foot. The patient underwent diagnostics of lesion, that helped to find out possible ways of disease progression, endovascular revascularization and step-by-step surgery treatment that allowed to keep support function of the limb.

References

1.      Patel S.N., Reilly J.P Persistent sciatic artery - a curious vascular anomaly. Catheter Cardiovasc. Interv. 2007; 70(2): 252-5

2.      Sultan S.A. et al. Endovascular management of rare sciatic artery aneurysm. J. Endovasc. Ther. 2000; 7(5): 415-22.

3.      van Hooft I.M. et al. The persistent sciatic artery. Eur. J. Vasc. Endovasc. Surg. 2009; 37, 585-591.

4.      Shutze W., Garrett W., Smith B. Persistent sciatic artery: collective review and management. Ann. Vasc. Surg. 1993; 7: 303-10

5.      Yang S. et al. Bilateral persistent sciatic artery with aneurysm formation and review of the literature. Ann. Vasc. Surg. 2014; 28: 264, 1-7

6.      Pillet, J. et al. The sciaticopopliteal arterial trunk: Persistent axial artery. Bull. de l'Association des Anatomiste. 1980; 64: 97-110.

7.      Gauffre S., Lasjaunias P, Zerah M. Sciatic artery: a case, review of literature and attempt of systemization. Surg. Radiol. Anat. 1994; 16: 105-9.

8.      Ikezawa T. et al. Aneurysm of bilateral persistent sciatic arteries with ischemic complications: case report and review of the world literature. J. Vasc. Sur. 1994; 20: 96 -103.

9.      Bower E.B., Smullens S.N., Parke W.W. Clinical aspects of persistent sciatic artery: report of two cases and review of the literature. Surgery. 1977; 81: 588-595.

10.    Ahnc S. et al. Treatment Strategy for Persistent Sciatic Artery and Novel Classification Reflecting Anatomic Status. Eur. J. Vasc. Endovasc. Surg. 2016; 52: 360-369.

11.    Rezayat C. et al. Ruptured persistent sciatic artery aneurysm managed by endovascular embolization. Ann. Vasc. Surg. 2010; 24: 115.e5-9.

12.    Modugno P et al. Endovascular treatment of persistent sciatic artery aneurysm with the multilayer stent. J. Endovasc. Ther. 2014; 21:410-3. 

Abstract:

Authors present results of simultaneous transluminal coronary interventions (TCI) (stenting) in coronary patients with triple vessel disease. Stenting of right coronary artery (RCA) and major branches of left coronary artery (LCA) was performed in 44 patients with coronary artery disease, having angina of III—IV functional classes. In total 1 83 coronary stents were implanted (1 66 «Cypher» and 17 «BxVelocity»). Stents «Bx Velocity» were used only coronary arteries with diameter > 3,5 mm. 3 stents were implanted in 22 cases, 4 — in 9, 5 — in 4, 6 — in 4 and 7 — in 7. TCI were successful in all patients, with restoration of coronary blood flow up to TIMI III through stented segments. Clinical effectiveneness of TCI during long-term follow-up (up to 32 months) was 100%, patient's survival — 90,9%. In 3 patients (6,8%) restenosis developed inside drug-coated stents (4,8%). Repeated stenting was performed with satisfactory clinical and angiographic results. Complete transluminal coronary revascularization is an effective method for treatment of patients with multiple coronary lesions. It provides return to high level of life quality.

Reference 

1.     Бокерия Л. А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2004. Болезни и врожденные аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН. 2005; 118.

2.     Daemen S., Serruys P.W. Optimal revascularization strategies for multivessel coronary artery disease. Curr. Opin. Cardiol. 2006; 21(6): 595-601.

3.     Vaina S., Touchida K., Serruys P.W Treatment options for multivessel coronary artery desease. Expert Rev. Cardiovasc. Ther. 2006; 4(2): 143-147.

4.     Serruys P.W, Unger E, Sousa J.E. et al. Sirolimus eluting stent implantation for patients with multivessel disease: rationale for the Arterial Revascularization Therapies study part II (ARTS II). Heart. 2004; 90(9): 995-998.

5.     Legrand VH., Serruys P.W, Unger E et al. Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease. Circulation. 2004; 109(9): 1079-1081.

6.     Алекян Б.Г., Бузиашвили Ю.И., Стаферов А.В. Ангиопластика при множественном поражении коронарных артерий. М.: НЦССХ им. А.Н. Бакулева РАМН. 2002; 146-178.

7.     Меркулов Е.В., Ширяев А.А., Самко А.Н. и др. Сравнительная оценка результатов ангиопластики и коронарного шунтирования у больных ИБС с многососудистым поражением коронарного русла. Материалы 1-й межрегиональной конференции по проблемам кардиологии. Ханты-Мансийск. 2003; 65. 

8.     Babunashvili A.M., Iudin I.E., Dundua D.P., Kartashov D.S., Kavteladze Z.A. Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries. Cardiology. 2006; 46 (11): 21- 29.

Abstract:

Purpose. To assess the effectiveness of palliative endovascular interventions in patients with CTO anatomy infavorable for recanalisation.

Material and methods. The authors analyzed the results of interventions in 60 patients (50 male (83,3%), 10 female (16,7%)) aged 38 – 75 years (mean age 53,9±3,2), with occlusive coronary disease. Palliative revascularizations were performed in 30 patients, and CTO recanalization was done in 30 cases. The LV function was assessed echocardiographically in both groups before and after the intervention.

Results. 12 month follow-up showed significant improvement or normalization of LV function in both groups. Results of palliative interventions were shown to be as effective as recanalization of CTO.

Conclusions. Endovascular palliation is effective in treatment of patients with coronary CTO. It results in myocardial function improvement comparable to that in patients with complete coronary revascularization.   

References

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2.        Meier B. Chronic total coronary acclusion angioplasty. Cathet Cardiovasc. Diagn, 2006; 25: 1–11.

3.        Ганюков В.И., Осиев А.Г. Частные вопросы коронарной ангиопластики. Новосибирск. 2002; 4–23.

4.        Лопотовский П.Ю., Яницкая М.В. Клинический эффект эндоваскулярной реперфузии миокарда в бассейне длительно окклюзированной коронарной артерии. Между народный журнал интервенционной кардиоангиологии. 2006; 10: 22–26.

5.        Султан М.В. Реваскуляризация миокарда при остром коронарном синдроме. Авто-реф. дис. канд. мед. наук. М. 2006: 15–20.  

6.        Иоселиани Д.Г., Громов Д.Г., Сухоруков О.Е., Хоткевич Е.Ю., Семитко С.П., Исаева И.В., Верне Ж.-Ш., Арабаджян И.С., Овесян З.Р., Алигишева З.А. Хирургическая и эндоваскулярная реваскуляризация миокарда у больных с многососудистым поражением венечного русла: сравнительный анализ ближайших и среднеотдаленных результатов. Международный журнал интервенционной кардиоангиологии. 2008; 15: 22–31.

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8.        Ott R.A., Tobis J.M., Mills T.C., Allen B.J., Dwyer M.L. ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. Department of Cardiothoracic Surgery, University of California. Irvine Medical Center. 2006.  

9.        Gaudino M., Santarelli P., Bruno P., Piancone F.L., Possati G. Palliative coronary artery surgery in patients with severe noncardiac diseases. Department of Cardiac Surgery, Catholic University. Rome. Italy. 2006.  

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11.      Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12 (16): 41–46.

12.      Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17–37.

13.      Rahimtoola S.H. The hibernating myocardium. Ibid. 1989; 117: 211–221.

Abstract:

The author presents the endovascular technique for treatment of the Alzheimer disease. 40 patients aged 34–78 years were included into the study 4 of them were at risk, 13 had early and moderate stage, 16 – full-scaled stage, and 7 had preterminal stage of the disease.

The survey design included computed tomography with temporal lobes volume calculation, brain scintigraphy, rheoencephalography, and digital cerebral angiography.

Temporal lobes atrophy and capillary flow reduction in fronto-parietal and temporal regions are shown to be the characteristic radiomorphological features of the Alzheimer disease. Indications and contrindications for the treatment are presented.

Interventions were pefformed in terms of 1 to 12 years after the disease manifestation. The aim of treatment was percutaneous revascularization and capillary bed restoration by means of transluminal low-energy laser.

Clinical improvement was seen in all the cases; however, it differed in each group of patients. Thus, it is possible not only suspend the advancement of the Alzheimer disease, but to achieve its regression, with regeneration of the brain tissues and to return the people into the active life.  

References 

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10.      Жариков Г.А., Рощина И.Ф. Диагностика деменции альцгеймеровского типа на ранних этапах ее развития. Психиатрия и психофармакотерапия. 2001; 2 (2): 3–27.

11.      Гаврилова С.И. Фармакотерапия болезни Альцгеймера. М.: Пульс. 2003; 337.  

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15.      Masse I., Bordet R., Deplanque D. et al. Lipid lowering agents are associated with a slower cognitive decline in Alzheimer’s disease. J. of Neurol., Neurosurg. and Psych. 2005; 76: 1624–1629.  

Abstract:

Aim. Was to investigate the efficiency of transluminal laser revascularization of brain in treatment of vascular dementia.

Materials and methods. We have examined and treated 665 patients aged 29 to 81 (average age 75) suffering from various kinds of atherosclerotic lesions of cerebral vessels accompanied by developed vascular dementia. The research included: CT, MRI, scintigraphy, rheoencephalography, poliprojectional angiography To perform endovascular treatment we selected 639 patients: Group 1 (CDR-1) - 352, Group 2 (CDR-2) - 184, Group 3 (CDR-3) - 103 patients. To conduct revascularization of main intracranial arteries high-energy laser systems were used; for revascularization of distal intracranial branches low-energy laser systems were used.

Results. The clinical outcome depended on the severity of dementia and timing of the intervention. A good clinical outcome in Group 1 was obtained in 281 (79.82%) cases, in Group 2 in 81 (44.02%) cases, in Group 3 in 9 (8.73%) cases. A satisfactory clinical outcome in Group 1 was obtained in 53 (15.34%) cases, in Group 2 in 62 (33.70%) cases, in Group 3 in 31 (30.09%) cases. A relatively satisfactory clinical outcome in Group 1 was obtained in 17 (4.83%) cases, in Group 2 in 41 (22.28%) cases, in Group 3 in 63 (61.16%) cases. No negative effects were observed after the interventions.

Conclusions. Evaluating the data obtained it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of atherosclerotic lesions of the brain accompanied by dementia.  

Reference 

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20.  Amb

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. 

References 

1.    Бокерия Л.А., Гудкова Р.Г. Тенденции развития кардиохирургии в 2007 году. Бюллетень НЦССХим. А.Н. Бакулева РАМН. 2008; 3-4.

2.    Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2007. Болезни и врожденные    аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН.  2007; 144.

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4.    Carver A. et al. Longer-term follow-up of patients recruited to the REACT (Rescue Angioplasty Versus Conservative Treatment or Repeat Thrombolysis) trial. J. Am. Coll. Cardiol. 2009; 54:1 18-126.

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Abstract:

Contemporary methods of myocardial revascularization allow improving survival and quality of life in patients with multivessel disease. At the same time, there is still no satisfactory answer where and when one should perform complete myocardial revascularization. The latter is often a difficult task, and we consider well-reasoned incomplete adequate revascularization to be a valid alternative.

This study presents several methods of coronary flow assessment where regional ischemic deficiency is calculated in a mathematical model, evaluating thereby hemodynamic significance of coronary stenoses. Decision of complete or adequate incomplete revascularization can be rooted in these data. 

References

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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

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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.

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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. 

Abstract:

Aim: was to determine indications for use of the technique of retrograde recanalization of the occluded portion of the artery through tibial collateral branches.

Materials and methods: 71 years old patient, was admitted with complaints of pain at rest in the right foot, cold, lack of sensitivity of fingers of both feet, blackening of hallux of the right foot with ischemic gangrene of 1 toe of right foot. Multislice computed tomography angiography of lower limbs revealed shin artery occlusion on both sides. Regional systolic pressure (RSP) on the right anterior tibial artery (ATA) - 80 mm Hg., (ancle-brachial index (ABI) = 0.55) for posterior tibial artery (PTA) - 50 mm Hg., (ABI = 0.33). Diagnostic angiography: fibular artery and PTA occlusion throughout, occlusion of proximal and middle parts of ATA. We performed retrograde recanalization of the occluded artery of the transcollateral approach

Results: ATA patency restored all the way to the foot. RSP to ATA 140 mm Hg., (ABI = 0.9) for PTA RSP was 100 mm Hg., (ABI = 0.6).

Conclusions: transcollateral approach is an additional method of revascularization, which increases the rate of technical success after a failed antegrade revascularization, and this method can be an alternative to the retrograde approach.

References

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Abstract:

The research investigates the possibility of restoring the blood supply in patients with atherosclerosis of the brain, as well as the treatment of chronic cerebrovascular insufficiency, both not burdened and the burdened development of small strokes, with use for this method of transcatheter laser revascularization.

The research involves 946 patients aged 29-81 (average age 74) suffering from various types of cerebral atherosclerosis. 568(60,04%) patients underwent transcatheter treatment - Test Group. 378 (39,96%) patients underwent conservative treatment - Control Group. The examination plan included laboratory diagnostics, assessment CDR, MMSE, IB, cerebral SG, REG, CT, MRI, MRA, MUGA. To restore the blood supply, the method of transcatheter laser revascularization was applied; high-energy pulsed lasers were used for major intracranial arteries treatment, and low-energy CW lasers - for distal intracranial branches treatment.

Test Group: 459(80,81%) patients had good clinical outcome, 91(16,02%) - satisfactory clinical outcome, 18(3,17%) - relatively satisfactory clinical outcome; relatively positive clinical outcome was not obtained in any case. Control Group: good clinical outcome was not obtained in any case; 65(17,20%) patients had satisfactory clinical outcome, 121(23,26%) - relatively satisfactory clinical outcome; 192(50,79%) - relatively positive clinical outcome.

The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from atherosclerosis of the brain. Obtained results last up to 10 years and more; it causes regression of mental and motor disorders, promotes regression of dementia and largely improves patients' quality of life; it has virtually no alternative - which makes the proposed method significantly different from conservative treatment methods. 

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Abstract:

Revascularization strategy definition in acute coronary syndrome in patients with multivessel coronary artery disease is a significant problem of modern intervention cardiology Aim: was to evaluate effectiveness of special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» designed to the revascularization strategy definition ir acute coronary syndrome patients.

Materials and methods: revascularization strategy of 50 acute coronary syndrome patients was analyzed. In all cases the revascularization strategy was defined by the group of intervention cardiologists with the help of independent experts and special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance». Experts-, physicians-, and soft- based revascularization strategies were compared among themselves.

Results: complete coincidence between expert-based and soft-based revascularization strategies was registered in 66% patients and the incomplete coincidence - in 32% patients. Complete mismatch between expert-based and soft-based revascularization strategies was registered in 2% patients. The complete coincidence between physicians-based and soft-based revascularization strategies was registered in 42% patients and the incomplete coincidence - ir 52% patients. Complete mismatch between physicians-based and soft-based revascularization strategies was registered in 6% patients

Conclusion: as well as experts, special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» provide success in the revascularization strategy definition 1г acute coronary syndrome patients with multivessel coronary artery disease.

References

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2.     Sardella G., Lucisano L., Garbo R. et al. Singlestaged compared with multi-staged PCI in multivessel NSTEMI patients: The SMILE Trial. J. Am. Coll. Cardiol. 2016; 67(3): 264-272.

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5.     Kornowski R., Mehran R., Dangas G. et al. Prognostic impact of staged versus «one-time» multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J. Am. Coll. Cardiol. 2011; 58: 704-711.

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10.   El-Hayek G.E., Gershlick A.H., Hong M.K. et al. Metaanalysis of randomized controlled trials comparing multivessel versus culprit-only revascularization for patients with ST-segment elevation myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention. Am. J. Cardiol. 2015; 115(11): 1481-1486.

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13.   Bainey K.R., Mehta S.R., Lai T. et al. Complete versus culprit only revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a systematic review and meta-analysis. Am. Heart J. 2014; 167: 1-14.

Abstract:

Aim: was to evaluate results of endovascular treatment of patients with acute coronary syndrome (ACS) without ST-segment elevation, with multivessel coronary disease.

Materials and methods: 346 patients were enrolled in study and initially randomized into 3 groups. 1st group included 100 patients with complete myocardial revascularization which had been performed during initial PCI. 2nd group included 124 patients with complete myocardial revascularization, performed during initial hospitalization: 3rd group - 122 patients with complete revascularization, performed at different times after initial hospitalization. Inclusion criteria: ACS patients without ST-segment elevation; multivessel coronary disease (risk SYNTAX score = 23-32); high and medium risk for the GRACE scale; absence of previous myocardial revascularization.

Results: long-term results of treatment were evaluated in 192 patients. After 12 months, patients in 3rd group was significantly more likely to have greater cardiovascular complications and re-interventions on the target vessel. It was found that complete myocardial revascularization, performed after 30 days from the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease (r = 0,58, p <0,05). Risk factors adversely affecting the prognosis of ACS patients without ST-segment elevation and presence of multivessel disease include: subtotal stenosis in non-symptomatic arteries; circulation failure Killip class III; myocardial infarction in past; high risk on GRACE scale; lesion length in non-symptomatic arteries more than 20 mm diabetes mellitus; degree of risk on a SYNTAX scale-score> 25; overweight/obesity; high cholesterol 6.5 mmol/l.

Conclusions: when performing PCI in patients with ACS without ST-segment elevation with multivessel coronary disease, performing a complete myocardial revascularization 30 days after the date of diagnosed acute coronary syndrome, has a negative impact on the prognosis of the disease.

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