Abstract:

Introduction: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study.

Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies.

Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices.

Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%.

Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%).

Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.

Abstract:

Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods.

Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation.

Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients.

Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices.

The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing.

Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used.

Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.

Abstract:

Aim: was to study the efficacy and functionality of the Yukon Chrome PC stent in clinical practice.

Materials and methods: in 2021, a prospective, observational study of the safety, effectiveness of the Yukon Chrome PC stent, as well as its functionality during implantation in clinical practice, was launched on the basis of 25 domestic clinics. The study included 364 patients who underwent implantation of 495 Yukon Chrome PC stents. Mean age of patients was 62,8 years (from 33 to 89 years). Men were 263 (72,3%). The vast majority (82,4%) of patients were diagnosed with acute coronary syndrome (ACS): without ST segment elevation - 180 (49,45%) patients; with ST segment elevation - 120 (32,9%) patients. Unstable angina was verified in 22 (6%) patients. There were 42 (11,5%) patients with stable angina class 2-3.

Moderate tortuosity of vessels occurred in 27,7% of cases, while severe tortuosity of vessels occurred in 3,57% of cases. Moderate calcification was noted in 115 (31,5%) patients, severe/massive - in 23 (6,3%) cases. A complex lesion combining severe/moderate calcification and severe/moderate tortuosity of the target artery occurred in 79 (21,7%) patients.

Results: technical success of the procedure was achieved in 97,5% of cases. In one patient with severe calcification, the Yukon Chrome PC stent could not be inserted into the affected area. Attempts to implant another stent were also unsuccessful.

Depending on the number of implanted stents, the patients were distributed as follows: 3 stents were inplanted in 31 (8,5%) patients; 2 stents - 102 (28%) patients, 1 stent - 231 (63,5%) patients.

Bifurcation stenting using a two-stent technique was performed in 69 (19%) patients. Stenting of the left main was performed in 11 (3%) cases. Predilation was performed in 245 (67%) patients; postdilation - in 179 (49%) patients.

Conclusion: analysis of hospital results of implantation of Yukon Chrome PC stents indicates good flexibility and deliverability of stents even in patients with moderate and severe sheath calcification.

The overall assessment of the functional characteristics of the stent among endovascular surgeons who performed stenting is quite high.

Abstract:

Introduction: pseudo-aneurysm of subclavian artery is a rare pathology and most often develops due to trauma or iatrogenic causes. Despite the rarity of this pathology, it can be accompanied by the risk of lethal rupture or distal embolism. Article presents a case report of endovascular treatment of post-traumatic pseudo-aneurysm of right subclavian artery with a stent-graft.

Aim: was to demonstrate advantages of endovascular treatment of pseudo-aneurysms, based on case report of patient with post-traumatic pseudo-aneurysm of right subclavian artery.

Material and methods: a case report of a patient with post-traumatic pseudo-aneurysm of right subclavian artery, polytrauma and pulmonary embolism is presented.

Results: successful endovascular treatment of pseudo-aneurysm of right subclavian artery with the implantation of stent-graft was performed. Postoperative period was uneventful, and the patient was discharged with improved health.

Conclusions: endovascular treatment is the preferred method, due to its less invasiveness and lower complication frequency in comparison with open surgery.

Abstract:

Article presents a retrospective analysis of using the modified way experience in removing the occlusive substrate from cerebral vessels in the ischemic stroke acute phase after failed standard thrombectomy.

Aim: to study the efficacy and advantages of thrombectomy technique from intracranial arteries in patients with acute ischemic stroke combining a stent-retriever with reperfusion catheter in comparison with the standard stent retriever thromboextraction.

Methods: we analyzed 54 hospital charts of patients who had underwent endovascular recanalization of intracranial large vessel occlusion in acute ischemic stroke. Patients were divided into two equal groups, depending on thrombus removal method. Standard stent-retriever thrombectomy with a balloon guide-catheter was performed as the first stage in both groups. In 27 cases (1st group), after standard stent-retriever technique failed, we carried out combination of retriever extraction with distal aspiration and a guiding balloon-catheter. If we couldn’t safely insert stent-retriever into catheter of distal approach (during thrombectomy), we switched to vacuum aspiration from guiding balloon-catheter (vacuum-blocked) and removed stent-retriever, microcatheter and distal approach catheter simultaneously without reducing tension. In 27 patients (2nd group) after standard thrombectomy failed we repeated this technique several times.

Results: embolic complications relative risk was 2,249, 95% CI (1,126 - 4,492) and reperfusion mTICI 3 100% versus 74,07% rate was higher in the first group, in comparison with the second group. Other complications and hospital outcomes of disease did not differ between groups.

Conclusion: a stent retriever combined with distal aspiration and a simultaneous transition to vacuum-blocked extraction using after an unsuccessful standard thrombectomy increases the efficiency of complete reperfusion by 25%. Its use is 1,8 times safer than standard thrombectomy in terms of embolic complications.

Abstract:

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

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

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

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

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

References

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https://doi.org/10.4244/EIJY18M06_011

3.     Johnson TW, Raber L, di Mario C, et al. Clinical use of intracoronary imaging. Part 2: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2019; 15: 434-451.

https://doi.org/10.4244/EIJY19M06_02

4.     Van der Sijde JN, Guagliumi G, Sirbu V, et al. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography. EuroIntervention. 2016; 12: 855-860.

https://doi.org/10.4244/EIJV12I7A140

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https://doi.org/10.4244/EIJV10I10A190

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Abstract:

In interventional radiology department of clinical hospital № 27 (Moscow) since 2002 till 2009 TIPS was performed in 62 patients for hepatic cirrhosis with portal hypertension. One of the patients underwent orthotopic liver transplantation in Germany.
Material and methods. Mean age in the group was 5f ,6 y. o., 17 women, 45 men. Three types of stents were used: matrix stents, self-expanding and stent-grapfts. Patients were divided in 2 groups. In Group 1 (17 pts) we performed TIPS with stent-grafts (Gore Viatorr TIPS Endoprosthesis); in Group 2 (47 pts) bare metal stents were used (matrix stents Perico, Genesis, JoMed and self-expanding stents Za-stent, Zilver, Wallstent, sinus-SuperFlex Visual-Stent, SMART-control).
Results. During 18 months follow-up there were no thrombosis, significant stenosis in patients of Group 1, and primary patency rate was 100%. In Group 2 primary and secondary patency rates were 69,3% and 85,6% correspondingly. Freedom from recurr­ ent esophageal varices hemorrhage was 82,8% in Group 1 and 69,3% in Group 2, ascitis and hydrothorax regression - 93,9% and 80,0%, absence of hepatic cerebropathy progression - 93,9% and 80,0%, overall survival - 87,8% и 76,0% correspondingly.
Conclusions. Therefore use of stent-graft in TIPS procedure improve patency of intrahepatic shunt (p < 0,01), significantly reduce risk of recurrent variceal hemorrhage (0,1 < p < 0,5), and reduce volume of ascitis (0,1 < p < 0,5). It worth saying that cerebropathy progression was caused by non-compliance to diet, and was corrected with medicamental treatment. In long-term follow-up stent­ graft «Viatorr» deployment improves survival of patients (0,1 < p < 0,5). Introduction of stent-grafts marked a new stage of TIPS pro­ cedure improvement.

Abstract:

Aim: was to evaluate the effectiveness of endovascular interventions in patients with critical limb ischemia (CLI) with multilevel extended lesions of lower limb arteries of types C and D according to TASC II.

Materials and methods: a retrospective analysis of results of surgical treatment of patients with critical limb ischemia, who underwent 127 endovascular interventions on arteries of the femoral- popliteal-tibial segment for the period from 2007 to 2020, was carried out. 15 patients had ischemic limb pain at rest (11,8%) and 112 patients had trophic lesions (88,2%). Our study included patients with arterial lesions of type C (18 patients, 14,2%) and type D (109 patients, 85,8%) according to TASC II.

Results: technical success of performed endovascular interventions was 95,3%. Within a 30-day period, 2 patients (1,6%) had myocardial infarction, 3 patients (2,4%) underwent early «high» amputation. Perioperative mortality was 0,8% (1 patient). Primary patency of endovascular interventions was 87%, 58% and 36% after 1, 3 and 5 years, respectively, while secondary patency was 91%, 81% and 58% after 1, 3 and 5 years, respectively. Limb salvage rate was 93%, 89% and 79% after 1, 3 and 5 years, respectively. Patient survival rate was 95%, 84% and 78% after 1, 3 and 5 years, respectively.

Conclusions: endovascular interventions on femoral-popliteal-tibial arterial lesions of types C and D according to TASC II in patients with critical limb ischemia are effective, and modern method of treatment with good immediate and long-term results.

References

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https://doi.org/10.1016/j.jvs.2019.02.016

2.     Pokrovskij AV, Ivandeev AS. Sostojanie sosudistoj hirurgii v Rossii v 2016 godu. M.: Obshhestvo angiologov i sosudistyh hirurgov. Moskva. 2017; 76 [In Russ].

3.     Barriocanal АM, L?pez A, Monreal M, Montan? E. Quality assessment of peripheral artery disease clinical guidelines. J Vascular Surgery. 2016; 63(4): 1091-1097.

https://doi.org/10.1016/j.jvs.2015.12.040

4.     Farber A, Eberhardt RT. The Current State of Critical Limb Ischemia. A Systematic Review. JAMA Surg. 2016; 151(11): 1070-1077.

https://doi.org/10.1001/jamasurg.2016.2018

5.     Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003-2011. J Am Coll Cardiol. 2016; 67(16): 1901-1913.

https://doi.org/10.1016/j.jacc.2016.02.040

6.     Duff S, Mafilio MS, Bhounsul P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vascular Health and Risk Management. 2019; 15: 187-208.

https://doi.org/10.2147/VHRM.S209241

7.     Darling JD, McCallum JC, Soden PA, et al. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia. J Vasc Surg. 2017; 66(2): 466-475.

https://doi.org/10.1016/j.jvs.2017.01.024

8.     Antoniou GA, Georgiadis GS, Antoniou SA, et al. Bypass surgery for chronic lower limb ischemia (Review). Cochrane Database of Systematic Reviews. 2017; 3(4): CD002000.

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9.     Uccioli L, Meloni M, Izzo V, et al. Critical limb ischemia: current challenges and future prospects. Vascular Health and Risk Management. 2018; 14: 63-74.

https://doi.org/10.2147/VHRM.S125065

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https://doi.org/10.1016/j.ejvs.2017.11.006

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https://doi.org/10.1016/j.ejvs.2017.01.008

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https://doi.org/10.1093/eurheartj/ehx095

14.   Brouillet J, Deloose K, Goueffic Y, et al. Primary stenting for TASC C and D femoropopliteal lesions: one-year results from a multicentric trial on 203 patients. The Journal of Cardiovascular Surgery. 2018; 59(3): 392-404.

https://doi.org/10.23736/S0021-9509.16.09282-X

15.   Schreuder SM, Hendrix Y, Reekers JA, Bipat S. Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review. Cardiovasc Intervent Radiol. 2018; 41(1): 1-20.

https://doi.org/10.1007/s00270-017-1796-9

16.   Norgren L, Patel MR, Hiatt WR, et al. Outcomes of Patients with Critical Limb Ischaemia in the EUCLID Trial. Eur J Vasc Endovasc Surg. 2018; 55: 109-117.

https://doi.org/10.1016/j.ejvs.2017.11.006

17.   Papojan SA, Shhegolev AA, Radchenko AN, et al. Otdalennye rezul'taty jendovaskuljarnogo lechenija porazhenij poverhnostnoj bedrennoj arterii tipov S i D po klassifikacii TASC II. Angiologija i sosudistaja hirurgija. 2018; 24(1): 73-78 [In Russ].

18.   Biagioni RB, Biagioni LC, Nasser F, et al. Infrapopliteal Angioplasty of One or More than One Artery for Critical Limb Ischaemia: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2018; 55: 518-527.

https://doi.org/10.1016/j.ejvs.2017.12.022

19.   Schneider PA, Laird JR, Tepe G, et al. Treatment effect of drug-coated balloons is durable to 3 years in the femoropopliteal arteries: long-term results of the IN.PACT SFA randomized trial. Circ Cardiovasc Interv. 2018; 11 (1): 885-891.

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20.   Reijnen MJ. Outcomes After Drug-Coated Balloon Treatment of Femoropopliteal Lesions in Patients With Critical Limb Ischemia: A Post Hoc Analysis From the IN.PACT Global Study. J Endovasc Ther. 2019; 26: 305-315.

https://doi.org/10.1177/1526602819839044

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:

Aim: was to determine the influence of blood plasma fibrinogen level on results of the left main coronary artery stenting.

Material and methods: clinical, laboratory and angiographic parameters of 819 patients after elective stenting of the unprotected left main coronary artery were used. The end-point was target lesion failure (TLF), including adverse events as repeated revascularization of the target lesion (TLR), myocardial infarction (MI) and death from cardiac causes.

Results: in 5 years follow-up period, end-point was achieved in 158 cases (19,3%). Independent predictors of TLF were: SyntaxScore > 32 (HR 1,089 95% CI 1,029-1,153, p = 0,003), creatinine level (HR 1,009 95% CI 1,004-1,013, p=0,001) and fibrinogen level (HR 1,4 95% CI 1,169-1698, p=0001). According to results of the Kaplan-Meier analysis, the cumulative probability of the TLF was higher in patients with fibrinogen values greater than 3,48 g/L (log-rank 0,001).

Conclusion: blood plasma fibrinogen level was an independent predictor of the TLF after left main coronary artery stenting. Increase in the level of blood fibrinogen for each 1 g/L led to an increase in the risk of TLF by 1,4 times per month.

References 

1.     G?n?reux P, Stone GW, Harrington RA, et al. Impact of intraprocedural stent thrombosis during percutaneous coronary intervention: insights from the CHAMPION PHOENIX Trial (Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention). J Am Coll Cardiol. 2014; 63: 619.

2.     Kurtul A, Yarlioglues M, Murat SN, et al.The associationof plasmafibrinogen with the extent andcomplexity of coronary lesions in patients with acute coronary syndrome. Kardiol Pol. 2016; 74: 338-345.

3.     Jiang P, Gao Z, Zhao W, et al. Relationship between fibrinogen levels and cardiovascular events in patients receiving percutaneous coronary intervention: a large single-center study. Chinese Medical Journal. 2019; 132(8).

4.     Ang L, Behnamfar O, Palakodeti S, et al. Elevated Baseline Serum Fibrinogen: Effect on 2-Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention. JAHA. 2017; 117.

5.     Gershlick A, Kandzar D, Banning A, et al. Outcomes After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting According to Lesion Site. Results From the EXCEL Trial. JACC. 2018; 11(13).

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7.     Rahel BM, Visseren FLJ, Suttorp M, et al. Preprocedural serum levels of acute-phase reactants and prognosis after percutaneous coronary intervention. Cardiovasc Res. 2003; 60: 136-140.

8.     Ou Baiqing, Yang Yulian, Chen Zhimin, et al. The Effect of Lumbrokinase on the Fibrinogen Increase Following Percutaneous Coronary Intervention. Chinese Journal of new Drugs. 2004; 13(12): 1158-60.

9.     Shi Y, Wu Y, Bian C, et al. Predictive value of plasma fibrinogen levels in patients admitted for acute coronary syndrome. Tex Heart Inst J. 2010; 37: 178-183.

10.   Corrado E, Novo S. Role of inflammation and infection in vascular disease. Acta Chir Belg. 2005; 105: 567-579.

11.   Ehtisham M, Mattheus R, Enright K, et al. Effect of Serum Fibrinogen, Total Stent Length, and Type of Acute Coronary Syndrome on 6-Month Major Adverse Cardiovascular Events and Bleeding Following Percutaneous Coronary Intervention. The American Journal of Cardiology. 2016; 117(10): 1575-1581.

12.   Otsuka M, Hayashi Y, Ueda H, et al. Predictive value of preprocedural fibrinogen concerning coronary stenting. Atherosclerosis. 2002; 164: 371-378.

13.   Kavitha S, Sridhar M, Satheesh S. Periprocedural plasma fibrinogen levels and coronary stent outcome. Indian heart journal. 2015; 67: 440-443.

Abstract:

Introduction: every year in the world, more than 13 millions strokes are recorded, most often (up to 80%) - acute cerebrovascular accidents of ischemic type, in which the cause of cerebral infarction is acute embolic occlusion of intracranial artery. Restoration of cerebral perfusion as early as possible from the onset of the disease can lead to a decrease of infarction zone and an improvement in clinical outcomes of the disease.

Case report: a 78-year-old patient was admitted with a clinical picture of acute stroke 90 minutes after onset; after computed tomography was performed, according to generally accepted method, systemic thrombolytic therapy was started. Angiography (occlusion of left middle cerebral artery (MCA) in the M1 segment followed by aspiration and then mechanical thrombectomy showed an «early» bifurcation of middle cerebral artery with a large lateral branch. Occluding thrombus was localized precisely in the area of MCA bifurcation, in branches of equal diameter. After unsuccessful attempts at thrombus extraction using the standard thrombus extraction and aspiration technique, patient underwent thrombus extraction using the original method (we called R-Culotte): simultaneous use of two retrievers positioned in the Culotte style (Culotte - «pants», French, R -retriever, English) in lumen of the bifurcation of middle cerebral artery. Blood flow in MCA was restored to mTICI-3 without complications. After the intervention, there was a rapid positive trend. Patient was discharged on 12th day with minimal neurological deficit.

Conclusions: this technique allowed to remove the thrombus and restore antegrade blood flow without complications after a series of unsuccessful attempts using the standard approach. Endovascular treatment of ischemic stroke has opened a new era in the treatment of this formidable disease. The search for new techniques for using existing devices contributes to the development of this promising technique.

References

1.     Ciccone A, del Zoppo GJ. Evolving Role of Endovascular Treatment of Acute Ischemic Stroke. Curr Neurol Neurosci Rep. 2014 Jan; 14(1): 416.

2.     Sardar P, Chatterjee S, Giri J, et al. Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials. Eur Heart J. 2015; 36 (35): 2373-2380.

3.     Novakovic RL, Toth G, Narayanan S, Zaidat OO. Retrievable stents, «stentrievers», for endovascular acute ischemic stroke therapy. Neurology. 2012; 79 (13 Suppl 1): 148–157.

4.     Arnaout OM, Rahme RJ, El Ahmadieh TY, et al. Past, present, and future perspectives on the endovascular treatment of acute ischemic stroke. Tech Vasc Interv Radiol. 2012; 15: 87-92.

5.     Koh JS, Lee SJ, Ryu CW, Kim HS. Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: A systematic review. J Neurointervention. 2012; 7: 1-9.

6.     Singh P, Kaur R, Kaur A. Endovascular treatment of acute ischemic stroke. J Neurosci Rural Pract. 2013 Jul-Sep; 4(3): 298-303.

7.     Goyal M, Yu AY, Menon BK, et al. Endovascular Therapy in Acute Ischemic Stroke. J Stroke. 2016; 47: 548-553.

8.     GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5): 439-458.

https://doi.org/10.1016/S1474-4422(19)30034-1

Abstract:

Aim: was to estimate results of endovascular treatment of subclavian arteries lesions.

Materials and methods: study analyzes results of endovascular treatment of patients with occlusive-stenotic lesions of subclavian arteries. For the period 2014-2018, 87 endovascular interventions were performed on subclavian arteries. Indication for surgery was occlusion of subclavian artery or stenosis of more than 70% with the development of steal-syndrome. Before surgery, all patients underwent duplex scanning of brachiocephalic vessels and CT angiography of branches of the aortic arch with cerebral phase. There was no difference in severity of symptoms and comorbidity between patients with stenosis or occlusions (р>0,05). In case of stenosis, direct stenting of subclavian artery was performed. For occlusions, mechanical recanalization was performed using hydrophilic wires, balloon angioplasty followed by stenting. In all cases, we used a balloon-expandable stent.

Results: technical success was achieved in 98,8% of interventions. There were no lethal outcomes, myocardial infarction, or stroke. In one patient, brachial artery thrombosis occurred in early postoperative period; thrombectomy from the brachial artery was performed with restoration of blood flow. Patency of subclavian artery after 1 and 3 years was 100% and 94%, respectively.

Conclusions: endovascular interventions for occlusive-stenotic lesions of subclavian arteries is an effective and safe method of treatment of vertebrobasilar insufficiency.

References

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5.     Perren F. Vertebral artery hypoplasia: a predisposing factor for posterior circulation stroke. Neurology. 2007; 2: 6

6.     Sigala F, Galyfos G, Coutelle AG, et al. Open reconstructions for symptomatic atheroscherotic lesions of the supra-aortic vessels: thirty years results from two university hospitals. Ann Vasc Surg. 2015 (29): 404.

7.     Towne JB, Hollier LH. Complications in vascular surgery. New York, Marcel. Dekken. 2005; 457-466.

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9.     Eisenhauer AC. Subclavian and innominate revascularization: surgical therapy versus catheter-based intervention. Curr. Interv. Cardiol. 2000; 2: 101-110.

10.   Mousa AY, Abu Rahma AF, Bozzay J, et al. Anatomic and clinical predictors of reintervention after subclavian artery stenting. J. Vasc. Surg. 2015; 15.

11.   Tomoi Y, Soga Y, Fujihara M, et al. Outcomes of endovascular therapy for upper extremity peripheral artery disease with critical hand ischemia. J Endovasc Ther. 2016; 23: 717-22

12.   Endovascular surgery. National guideline: In 4 books. Vol.3. (ed.by acad. BG Alekyan). М: Litterra, 2017 [In Russ].

13.   National guidelines by treatment of patients whith brachiocephalic arteries deseases. Angiology and vascular surgery (Suppl.). 2013; 19(2) [In Russ].

14.   Usai MV, Bosiers M, Bisdas T, et al. Surgical versus endovascular revascularization of subclavian artery arteriosclerotic disease. The Journal of Cardiovascular Surgery. 2018.

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16.   Benhammamia M, Mazzaccaro D, Ben Mrad M, et al. Endovascular And Surgical Management Of Subclavian Artery Occlusive Disease: Early And Long Term Outcomes. Annals of Vascular Surgery. 2020.

17.   Alekyan BG, Zakaryan NV, Shumilina MV, et al. Low term and long term outcomes of stenting by subclavian artery deseases. Thoracic and cardiovascular surgery. 2011; 1: 24-31 [In Russ].

18.   De Vries JP, Jager LC, van den Berg JC. Durability of Percutaneous trans- luminal angioplasty for obstructive lesions of proximal subclavian artery: long term results. J. Vasc. Surg. 2005; 41: 19-23.

19.   Linni K, Ugurluoglu A, Mader N, et al. Endovascular management versus surgery for proximal subclavian artery lesions. Ann. Vasc. Surg. 2008; 22(6): 769-67.

Abstract:

Introduction: pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance that leads to the development of right ventricular heart failure and premature death of patients. Today, there are several ways to create an atrial communication: balloon dilatation, Park procedure, balloon knife atrial septostomy, atrial septum stenting and implantation of fenestrated occluder.

The main problem with positioning of the device is that the atrial septum is not visible on fluoroscopy, where the stent is visible throughout. And the stent is not visible throughout on echocardiography, where the septum is visible. Exactly for this operation, the combination of echo- and fluoroscopic image in real time is very useful in order to accurately place in the middle at the level of stent in the septum and to avoid its dislocation with embolization of right or left heart chambers, or vessels of pulmonary and systemic circuit.

Material and methods: we present a case report of atrial septostomy with stent implantation into the atrial septum using the EchoNavigator® hybrid imaging system in a patient with pulmonary arterial hypertension.Surgical intervention was performed on a patient with PAH: atrial septostomy with intubation anesthesia under the control of fluoroscopy and transesophageal echocardiography (TEE) using the EchoNavigator® system. The procedure was performed using a Palmaz stent, that was implanted without additional fixation.

Results: patient with pulmonary hypertension underwent an atrial septostomy using the EchoNavigator® hybrid imaging system, which was used for positioning and implantation of stent into the atrial septum as quickly and accurately as possible. This surgical intervention significantly improved patient's clinical condition, cardiac hemodynamics and, accordingly, increased the quality of life.

Conclusion: atrial septostomy is a surgical method for patients with severe pulmonary arterial hypertension. Carrying out this operation under the control of the EchoNavigator® system with the function of hybrid imaging in real time greatly facilitated the procedure for positioning and implanting of stent, facilitated the safe implementation.

References

1.     Gali? N, Rubin L. Pulmonary arterial hypertension. Epidemiology, pathobiology, assessment and therapy. Journal of the American College of Cardiology. 2004; 43:1–90.

2.     Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest. 2007; 131:1918–28.

http://doi.org/10.1378/chest.06-2674

3.     Reichenberger F, Pepke-Zaba J, McNeil K, et al. Atrial seprostomy in the treatment of severe pulmonary arterial hypertension. Thorax. 2003; 58:797–800.

http://doi.org/10.1136/thorax.58.9.797

4.     Law M, Grifka RG, Mullins CE, et al. Atrial septostomy improves survival in select patients with pulmonary hypertension. Am Heart J. 2007; 153:779–84.

http://doi.org/10.1016/j.ahj.2007.02.019

5.     Kurzyna M, Dabrowski M, Bielecki D, et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest. 2007; 131:977–83.

http://doi.org/10.1378/chest.06-1227

6.     Gorbachevsky SV, Belkina MV, Pursanov MG, et al. Atrial septostomy as a long bridge to lung transplantation in patients with idiopathic pulmonary arterial hypertension. J. Cardiovasc. Surg. 2012; 53:11.

7.     Alekyan BG, Gorbachevsky SV, Pursanov MG, et al. Atrial septal stenting in idiopathic pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2016; 58(5): 258-314 [In Russ].

8.     Schmaltz АА, Nishonov NА. Atrioseptostomy in patients with pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2015; 57(5): 18-25 [In Russ].

9.     Sandoval J, Gaspar J, Pena H, et al. Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension. Eur. Respir. J. 2011; 38: 1343–8.

http://doi.org/10.1183/09031936.00072210

10.   Chiu S, Zuckerman WA, Turner ME, et al. Balloon atrial septostomy in pulmonary arterial hypertension: Effect on survival and associated outcomes. J. Heart Transplant. 2015;34(3):376-80.

http://doi.org/10.1016/j.healun.2015.01.004

11.   Fraisse A, Chetaille P, Amin Z, et al. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr. Cardiol. 2006; 27: 759–62.

12.   O’loughlin AJ, Keogh A, Muller DW. Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ. 2006; 15: 275–7.

http://doi.org/10.1016/j.hlc.2006.02.002

13.   Prieto LR, Latson LA, Jennings C. Atrial septostomy using a butterfly stent in a patient with severe pulmonary arterial hypertension. Cathet. Cardiovasc. Interv. 2006; 68: 642–7.

http://doi.org/10.1002/ccd.20745

14.   Althoff TF, Knebel F, Panda A, et al. Longterm follow-up of a fenestrated Amplatzer atrial septal occlude in pulmonary arterial hypertension. Chest. 2008; 133; 283–5.

http://doi.org/10.1378/chest.07-1222

15.   Troost E, Delcroix M, Gewillig M, et al. A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension. Cathet. Cardiovasc. Interv. 2008; 73: 173–9.

https://doi.org/10.1002/ccd.21760

16.   Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ. 2013; 22(8):668–71.

https://doi.org/10.1016/j.hlc.2013.01.005

17.   Alekyan BG, Pursanov MG. Atrial septal stenting. Guide to endovascular surgery of the heart and blood vessels. 2008; 2:57–65 [In Russ].

18.   Sager JS, Ahya VN. Surgical therapies for pulmonary arterial hypertension. Clin. Chest Med. 2007; 28: 187–202.

https://doi.org/10.1016/j.ccm.2006.11.003

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https://doi.org/10.1007/BF01709560

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https://doi.org/10.1002/ccd.1810240318

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https://doi.org/10.1002/ccd.1116

22.   Sorajja P, Cabalka AK, Hagler DJ, et al. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011; 58:2218–2224.

https://doi.org/10.1016/j.jacc.2011.07.041

23.   Zorinas A, Janusauskas V, Davidavicius G, et al. Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure. Advances in Interventional Cardiology. 2017; 13(3):263-268.

https://doi.org/10.5114/aic.2017.70200

24.   Corti R, Biaggi P, Gaemperli O, et al. Integrated x-ray and echocardiography imaging for structural heart interventions. EuroIntervention. 2013; 9:863-869.

https://doi.org/10.4244/EIJV9I7A140

25.   S?ndermann SH, Biaggi P, Gr?nenfelder J, et al. Safety and feasibility of novel technology fusing echocardiography and fluoroscopy images during MitraClip interventions. EuroIntervention. 2014; 9:1210-1216.

https://doi.org/10.4244/EIJV9I10A203

Abstract:

Aim: was to estimate long-term results of vertebral artery (VA) stenting in patients with vertebrobasilar insufficiency (VBI).

Material and methods: study included 194 patients with VBI caused by lesion of V1 segment of VA. All patients received the best course of drug therapy before admission to the clinic. In all these patients, atherosclerotic stenosis of 70% or more of VA was revealed in V1 sergment. All patients underwent surgical correction of V1 segment of VA. Open surgery was performed in «A» group – with a tortuosity of VA – 129(66,5%), in group «B» – without tortuosity of a VA – 65(33,5%) performed stenting of V1 segment of PA.

Bare-metal stents were implanted in 44 patients, drug-eluted stents - 14, renal stents – 7. Distal protection was used in 14 patients. In remaining patients, stenting was performed without embolic protection devices.

Main criteria for evaluating of results were: patency of the reconstruction zone and clinical improvement in the patient after surgery. Statistical processing of results was carried out by calculating ?2, the exact Fisher test (EFT) and constructing of Kaplan-Meier survival curves.

Results: it was determined that in «hopeless» patients, from the point of view of drug treatment, it is possible to achieve a significant clinical effect by surgical methods. Of 194 patients, clinical improvement in the early postoperative period was achieved in 189(97,4%) patients, after 1 year in 177 (91,2%) patients, and after 3 years in 156(80.2%) patients.

In case of stenting of V1 segment of VA – we received excellent immediate results – 100% of technical and clinical success. However, in the long term, results of open operations were better than results of stenting. 3 years after operation, a higher clinical efficacy of open methods was determined – 79,8%, in contrast to stenting – 73,8%. Although, differences were not statistically significant (p> 0,05). 3 years after operation, in case of open operations, a significantly smaller number of restenosis of the reconstruction zone was 1.6%, than with stenting – 15,4% (p <0.05). However, in patients with open operations, more thrombosis of the reconstruction zone were revealed – 5,5% than in patients with stenting – 1.5% (p>0,05). When performing open operations on V1 segment of VA, strokes were fewer – 2.3%, than in group of V1 stenting segment of VA – 3.1% (p> 0.05). When comparing Kaplan-Meyer curves, the median during open surgeries on VA is not achieved after 18 years, and in group of stenting of VA, it occurs after 7 years.

Conclusion: stenting of V1 segment of vertebral arteries in patients with VBI is not the operation of choice in terms of long-term results. However, this operation can be considered as the first stage of brain revascularization in the presence of significant stenosis of V1 segment of vertebral artery and low brain tolerance to ischemia in patients with multiple lesions of brachiocephalic arteries.

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8.     2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1; 39(9): 763-816.

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15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240.

16.   Markus HS, Harshfield EL, Compter A. et al. Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis. Lancet Neurol. 2019 Jul; 18(7): 666-673.

https://doi.org/10.1016/S1474-4422(19)30149-8

17.   Markus HS, Larsson SC, Dennis J et al. Vertebral artery stenting to prevent recurrent stroke in symptomatic vertebral artery stenosis: the VIST RCT. Health Technol Assess. 2019 Aug; 23(41): 1-30.

Abstract

Aim: was to evaluate the effectiveness of carotid arterial revascularization by stenting of internal carotid arteries (ICA) in patients with a previous ischemic stroke.

Materials and methods: in FSBI «Treatment and rehabilitation center» of the Ministry of Health of Russia,104 patients on treatment and rehabilitation after previous ischemic stroke, underwent stenting of symptomatic atherosclerotic stenosis of the ICA. The average time since stroke was 67 days (from 28 to 273 days). ICA stenting was performed according to generally accepted standards with the mandatory use of intravascular protective devices against cerebral embolism. In most patients we used a filter protection system (77 observations), and for stenosis of more than 95% and in the presence of an unstable atherosclerotic plaque, a proximal defense system was used (27 patients). In some cases, if the situation required it, a combination of protective devices was used (5 observations). A few days before upcoming operation, all patients were evaluated for microcirculation and perfusion in brain tissue using single photon emission computed tomography (SPECT), followed by analysis of results and comparison with SPECT data in the postoperative period.

Results: when analyzing 30 days after stenting, there were no fatal outcomes. In one case (0.96%) after stenting of the subtotal stenosis of the ICA, a hemorrhagic stroke on the ipsilateral side developed on the fifth day. In another case, intraoperative embolism of the ophthalmic artery occurred on the side of the operation with partial loss of vision field.

In the long-term period (4 years and 7 months), the number of undesirable events was 2%. In one case (0.96%), the patient died of ischemic stroke on the ipsilateral side after 3 years and 2 months after stenting. In another case, patient after 1 year and 2 months had an ischemic stroke on the side of the operation. Thus, the total number of complications associated with ICA stenting (30-day period + long-term period) was 3.8%.

When evaluating results of stenting by the SPECT method, the state of cerebral perfusion was assessed using perfusion maps in two modes and by axial perfusion sections.

In all observations after stenting, improvement of cerebral perfusion was noticed, regardless of the side and severity of ICA stenosis and the presence of focal postischemic changes. Visually, perfusion sections show a general increase in cerebral blood perfusion (CBP), a decrease in one-sided focal deficiency of CBP . Same results were obtained for relative cortex perfusion (relCP) in four regions and in vascular basins.

Comparing results, obtained by the number of undesirable events (strokes, restenosis and death) with the four-year data of the analysis of the international CREST study, the complication rate in our group is significantly lower (3.8% versus 8.6% in the CREST stenting group and 8.4% in carotid endarterectomy group CREST).

Conclusion: carotid stenting is an effective method of treatment of atherosclerotic lesions of main cerebral arteries in patients with previous stroke. The effectiveness of this type of treatment is confirmed by a positive clinical result and with the help of modern diagnostic methods, in particular SPECT.

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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.

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Abstract

Background: pancreatic cancer (PC) - oncologic disease with nonsignificant clinics on early stages and tendention of spreadind in population, as a result - late diagnosis and low rate of radical treatment (10-25%). Carried radical treatment, such as pancreaticoduodenectomy (PDE) - has a high risk of postoperative complications (30-70%) due to its difficulty Most often and dangerous complications are: bleeding, anastomotic leakage, postoperative pancreatitis, purulent complications. Bleeding occurs in 5-10% of cases, mortality varries between 30,7% and 58,5% according to moderd literature. "Sentinel bleeding" - term that meand non-fatal bleeding through drainage or gastrointestinal bleeding (GIB) that follows PDE, and is a predictor of further massive fatal bleeding. Material and methods: article presents data of patient (male, 64y) who underwent gastropancreaticoduodenectomy (GPDE) through bilateral hypochondriacal access as treatment of moderate differentiated (MD) ductal adenocarcinoma of pancreatic head. On 21st day after surgery - massive GIB with source of bleeding as pseudoaneurysm of right hepatic artery Taking into consideration "adverse anatomy", impossibility of stent-graft implantation and failure of primary embolization with "front-to-back-door" technique - against the background of reccurent bleeding, patient undewent coiling of pseudoaneurysm and subseqent coil implantation into right hepatic artery anc common hepatic artery Against the background of second reccurency of GIB - patient underwent successful "front-to-back-door" embolization with combinaton of coils and Onyx.

Results: technique of «front-to-back-door» embolization led to stable hemostasis and patient's discharge in satisfactory condition without recurrence of bleeding.

Conclusions: surgical hospital, carrying on resections of pancreas as a routine, should have a CathLab unit, equipped with wide specter of angiografic instruments and 24/7 surgical team with experience of hemostatic interventions. Bleeding after PDE should be considered as «sentinel bleeding». In case of side-injury of large vessels - stent-graft implantation is preferable, if it is impossible - "front-to-back-door" embolization should be used. 

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Abstract

This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.

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24.   Deloose K, Callaert J. Less is more: the "As Less As Reasonably Achievable Stenting" (ALARAS) strategy in the femoropopliteal area. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):495-503.

25.   Chalmers n Walker PT, Belly AM et al. A randomized study of a smart stent versus balloon angioplasty for long superficial lesions of the femoral artery: a super-study. Cardiovascular and Interventional Radiology. 2013; 36 (2): 353-361

26.   Dake MD. et al. Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal ArteryCLINICAL PERSPECTIVE. Circulation. Ovid Technologies (Wolters Kluwer Health), 2016;133(15): 1472-1483.

27.   Muradin GSR, Bosch Denpasar, Stainen T, Hunink MGM. Balloon dilatation and stent implantation for the treatment of arterial disease of the femur: Meta-analysis. Radiology. 2001; 221 (1): 137-145.

28.   Acin F, de Haro J, Bleda S,et al Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther. 2012 Oct;19(5):585-95. doi: 10.1583/JEVT-12-3898R.1.

29.   Zatevahin         I.I., SHipovskij V.N., Tursunov S.B. i dr. Longterm results of angioplasty using drug-coated balloons for lesions of the femoral-popliteal segment. Angiologiya i sosudistaya hirurgiya. 2014; 20(4): 64-68. [In Russ.]

30.   Katsanos to Karnabatidis D. Kitrou P Spiliopoulos with Christeas H Siablis D. Paclitaxel-coated balloon angioplasty and a conventional dilatation balloon for treatment of non-dialysis access: 6-month interim results from a prospective randomized controlled trial. Journal of Endovascular Therapy. 2012; 19 (2): 263-272.

31.   Werk M, Albrecht T, Dirk-Roelfs Meyer D-R, et al. Paklitaxel-Coated Balloons Reduse Restenosis After Femoropopliteal Angioplasty. Circ. Cardivasc. Interv. 2012; 5:831-840.

32.   Fanelli F, Cannavale A, Boatta E, et al. Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19: 571-580.

33.   Diamantopoulos A, Gupta Y, Zayed H. et al Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; epub ahead of print.

34.   Pastromas G, Katsanos K, Krokidis M, et al Emerging stent and balloon technologies in the femoropopliteal arteries. Scientific World Journal. 2014; 2014:695402.

35.   Schmidt A, Piorkowski M, Werner M, et al: First experience with drug-eluting balloons in infrapopliteal arteries: restenosis rate and clinical outcome. J Am Coll Cardiol. 2011; 58 (11): 1105-1109. 10.1016/j.jacc. 2011.05.034.

36.   Fanelli F, Cannavale A, Boatta E, et al: Lower limb multilevel treatment with drug-eluting balloons: 6-month results from the DEBELLUM randomized trial. J Endovasc Ther. 2012; 19 (5): 571-580. 10.1583/JEVT-12-3926MR.1.

37.   Liistro F, Porto I, Angioli P, et al: Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation. 2013.

38.   Bays S. The use of scoring balloons in the superficial femoral artery. J Cardiovasc Surg (Torino). 2018 Aug; 59(4):504-511.

39.   Saxon rubles. Heparin bonded stent grafts in SFA: VIPER annual results. The report is presented at the International Symposium on Endovascular Therapy; January 18, 2012; Miami, Fla, USA.

40.   Ansel G. 3-year vivid results. The document is available at: Vascular InterVentional Advances; October 2011; Las Vegas, Nev, USA.

41.   Vermassen F. Bouckenooghe I, Morel N Goverde P. Schroe N. The role of biodegradable stents in the superficial femoral artery. Journal of Cardiovascular Surgery. 2013; 54 (2): 225-234.

Abstract:

Aim: was to identify risk factors of early adverse cerebral events after carotid artery stenting anc endarterectomy

Materials and methods: 908 patients who underwent isolated carotid stenting (N = 522) and carotid endarterectomy (N = 386) were included in this retrospective analysis. Patients with simultaneous cardiac surgery and patients with symptomic stenosis of CA were excluded from research. The primary end point was ipsilateral perioperative ischemic stroke, proved by neurologist and CT/MRI data. To identify predictors, multivariate regression was used, with factors that could influence endovascular and surgical methods of treatment.

Results: patients from two groups were similar in main clinical and demographic characteristics. There were no deaths and cerebral hemorrhagic complications. The stroke rate in the endovascular and surgical groups was 1.7% and 1.04% respectively (p = 0.5). The total rate of strokes and transitory ischemic attack (TIA) using two methods was 1.4%. The TIA rate was higher in the endovascular group without statistically difference (1.3% vs. 0.3%, p = 0.1). The regression analysis showed that predictor of the adverse cerebral events was the degree of carotid artery stenosis in endovascular group (OR 1.318, 95% CI: 1.131-1.535, p <0.001). There were no any predictive factors of TIA or stroke in the surgical group.

Conclusions: the independent predictor of early TIA and stroke in endovascular group, unlike endarterectomy, was the degree of carotid stenosis.

References

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3.      Jhang K, Huang J, NforIs O et al. Is Extended Duration of Dual Antiplatelet Therapy After Carotid Stenting Beneficial? Medicine 2015; 94:40.

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Abstract:

A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. 

References

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2.      Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N. Engl. J. Med. 2010; 362 (25): 2370-2379.

3.      Bacalbasa N, Balescu I, Brasoveanu V. Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction - A Case Report and Literature Review. In Vivo. 2018; 32 (3): 699-702.

4.      Degheili J., Chediak A., Dergham M, et al. Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Hindawi. Case reports in radiology. Volume 2017, Article ID 6989673,7 pages.

5.      Uchida H, Sakamoto S, Matsunami M., et al. Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr. Transplant. 2014; 18 (7): 232-235.

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11.    Tien Y-W, Kao H-L, Wang H-P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. Journal of Gastroenterology. 2004; 39 (1): 81-85.

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Abstract:

Aim: was to perform a retrospective comparative analysis of clinical and angiographic results of primary endovascular treatment of ischemic stroke in patients who had contraindications for adjuvant thrombolytic therapy, and results of applying standard pharmaco-invasive (thrombolysis and thrombus extraction) treatment.

Material and methods: angiography was performed in 61 patients. The main criterion for the selection of patients for cerebral angiography according to MSCT-angiography, was a confirmed occlusion of a large intracranial vessel (the internal carotid artery or the middle cerebral artery at M1-2 segment). After MSCT-angiography, in the absence of contraindications, (STT) systemic throbolytic therapy (Alteplaza in the standard dose) was started and patients were sent to an endovascular operation, where selective angiography of the syndrome-responsive artery was performed, followed by an endovascular procedure, according to standard procedure. For endovascular treatment, Penumbra Reperfusion catheters - ACE 68 , were used in combination with 3MAX catheters, or stent-retrievers (Trevo, PRESET, ERIC). In a number of cases, the use of retrievers was supplemented with an assisting thrombus aspiration («Solumbra» method). The criterion for the effectiveness of endovascular treatment was the achievement of blood flow in the syndrome-responsible artery TICI 2b - 3. 6 patients with lesion of distal segments of middle cerebral artery (M3-4) or with no occlusion of large intracranial occlusion were excluded from the study.

Results: all 55 patients who received endovascular treatment, retrospectively were divided into two groups depending on the performance of adjuvant STT Group of combined treatment (STT and endovascular procedure (EVP)) included 24 patients; 31 patients were included in the primary EVP group.

Conclusions: basing on results of the study it can be supposed that primary endovascular treatment of ischemic stroke without thrombolysis can provide comparable efficacy and safety of treatment.

References

1.      Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010; 41:2254-2258.

2.      Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Dбvalos A. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemicstroke: a pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017;74:268-274.

3.      Broeg-Morvay A, Mordasini P, Bernasconi C, Bьhlmann M, Pult F, Arnold M. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis. Stroke. 2016; 47:1037-1044.

4.      Bellwald S, Weber R, Dobrocky T, Nordmeyer H, et al Direct Mechanical Intervention Versus Bridging Therapy in Stroke Patients Eligible for Intravenous Thrombolysis: A Pooled Analysis of 2 Registries. Stroke. 2017 Nov 7.

5.      Merlino, G., Sponza, M., Petralia, B. et al. Short and long-term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy: a prospective single-center study. J Thromb Thrombolysis. 2017; 44: 203.

6.      Guedin P, Larcher A, Decroix JP, Labreuche J, Dreyfus JF, Evrard S. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015; 24:952-957.

7.      Behme D, Kabbasch C, Kowoll A, Dorn F, Liebig T, Weber W, Mpotsaris A. Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions. J Stroke Cerebrovasc Dis. 2016; 25:954-959.

8.      Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke. 2015; 46:3241-3248.

9.      Kass-Hout T, Kass-Hout O, Mokin M, Thesier DM, Yashar P, Orion D. Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke? WorldNeurosurg. 2014; 82:e453-458.

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 6.6 kg). The patient underwent stenting of restenosis of the distal aortic anastomosis through retroperitoneal open access to the infrarenal aorta.

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 22 mm hg. The patient was discharged to an outpatient stage, followed by examination after 6 months and possible re-intervention (stent dilatation with a larger diameter balloon) as the pressure gradient rises as the child grows. Proposed hybrid approach in a child 11 months with a body weight of 6,590 kg allowed to avoid the risk of re-surgery in conditions of circulatory arrest and demonstrated a satisfactory angiographic and clinical result.

Conclusion: stenting of restenosis in distal aortic anastomosis using retroperitoneal access can be considered as a surgery of choice in specialized centers.

References

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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 = 2,500 grams. Am. Cardiol. 2010; 105:1176- 80.

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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.

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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.    Davenport J.J., Lam L., Whalen-Glass R., et. al. The successful use of alternative routes of vascular access for performing pediatric interventional cardiac catheterization. Cathet. Cardiovasc. Interv. 2008; 72 (3): 392-8.

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Abstract:

Aim: was to assess efficiency of mechanical thrombectomy using stent-retriever pREset in patients with acute ischemic stroke (AIS).

Materials and methods: study included 27 patients with AIS. The average age of patients was 66 years, female - 12(44,4%). The average NIHSS was 20. Occlusion of middle cerebral artery (MCA) was observed in 21(77,8%) patients, internal carotid artery (ICA) - 4 patients, basilar artery - 2 patients.

Results: effective recovery of cerebral blood flow (TICI2b-3) was achieved in 22 patients (81,5%). The frequency of distal embolisms was 11,1%. The frequency of symptom hemorrhagic transformation was 7,4%. A favorable neurological outcome (mRs 0-2) was observed in 29,6% of patients, mortality was 25,9%.

Conclusions: the use of stent-retriever pREset allows to efficiently restore blood flow during occlusion of large cerebral arteries.

References

1.      Powers W., Rabinstein A., Ackerson T., et al. 2018 Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018; (49): DOI 10.1161/ STR.0000000000000158.

2.      Savello A.V., Voznyuk I.A., Svistov D.V. Vnutrisosudistoe lechenie ishemicheskogo insul'ta v ostrejshem periode (klinicheskie rekomendacii) [Intravascular treatment of ischemic stroke in the acute period (clinical recommendations)]. Sankt-Peterburg. 2015; [In Russ].

3.      Volodyuhin M.YU., Hasanova D.R., Dyomin T.V., i dr. Vnutriarterial'naya reperfuzionnaya terapiya u pacientov s ostrym ishemicheskim insul'tom [Intraarterial reperfusion therapy in patients with acute ischemic stroke.]. Medicinskij sovet. 2015; (10): 6-11 [In Russ].

4.      Krylov V.V., Savello A.V., Volodyuhin M.YU. Rentgenehdovaskulyarnoe lechenie ostrogo ishemicheskogo insul'ta [Endovascular treatment of acute ischemic stroke.]. Rukovodstvo. Moskva. 2017; 120 s [In Russ].

5.      Schwaiger B., Kober F., Gersing A., et al. The pREset stent retriever for endovascular treatment of stroke caused by MCA occlusion: safety and clinical outcome. Clin Neuroradiol. 2016; (26): 47-55.

6.      Machi P., Jourdan F., Ambard D., et. al. Experimental evaluation of stent retrievers mechanical properties and effectiveness. J. Neurolntervent. Surg. 2016; (0): 1-7.

7.      Prothmann S., Schwaiger B., Gersing A., et al. Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J. Neuro. Intervent. Surg. 2017; (9): 817-822.

8.      Shams T., Zaidat O., Yavagal D., et al. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) criteria: A 7M management approach to developing a stroke interventional laboratory in the era of stroke thrombectomy for large vessel occlusions. Intervent. Neurol. 2016; (5): 1-28.

9.      Seker F., Pfaff J., Wolf M., et al. Correlation of thrombectomy maneuver count with recanalization success and clinical outcome in patients with ischemic stroke. Am. J. Neuroradiol. 2017; (38): 1368-1371.

10.    Mokin M., Nagesh S., Ionita C., et al. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. Am. J. Neuroradiol. 2016; (36): 547-551.

11.    Raymond J., Ghostine J., Khoury N., et al. Endovascular interventions for acute stroke: past practice and current research. J. Neurolntervent.Surg. 2017; (9): 1-4.

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:

This article spotlights problems of diagnostic and treatment of rare vascular complication: false aneurysm of transplanted kidney artery We describe a case of successful treatment using stent-assisted aneurysm embolization. Our case is illustrated with ultrasound, computed tomography and angiographic images and 30-day follow-up data.

References

1.      Tomilina N., Bikbov B. Sostojanie zamestitel'noj terpapii pri hronicheskoj pochechnoj nedostatochnosti v Rossii v 1998-2011 gg. (po dannym registra Rossijskogo dializnogo obshhestva) [The status of substitutive therapy in chronic renal insufficiency in Russia in 1998-2011. (according to the register of the Russian Dialysis Society).]. Vestnik transplantologii i iskusstvennyh organov. 2015; 17(1):35-58 [In Russ].

2.      Streeter E.H., Little D.M., Cranston D.W. and Morris P.J. The urological complications of renal transplantation: a series of 1535 patients. BJU International. 2002; 90: 627634.

3.      Verstova A.I., Kokov L.S., Parhomenko M.V., Pinchuk A.V. Klinicheskij sluchaj jembolizacii lozhnoj anevrizmy arterii pochechnogo transplantata Materialy VII nauch.-obr. foruma 2015 g [Clinical case of embolization of a false aneurysm of an artery of a transplanted kidney.]. Rossijskij Jelektronnyj Zhurnal Luchevoj Diagnostiki = Russian Electronic Journal of Radiology (REJR). 2015; 5(2) Pril.:231-232[ In Russ].

4.      Matas A.J., Payne W.D., Sutherland DER, et al. 2,500 Living Donor Kidney Transplants: A Single-Center Experience. Annals of Surgery. 2001; 234(2):149-164.

5.      Orlic P., Vukas D., Curuvija D., Markic D., Merlak-Prodan Z., Maleta I., Zivcic-Cosic S., Orlic L., Blecich G., Valencic M., Spanjol J., Budiselic B. Pseudoaneurysm after renal transplantation. Acta Med Croatica. 2008; 62(1):86-9.

6.      Fujikata S., Tanji N., Iseda T., Ohoka H., Yokoyama M. Mycotic aneurysm of the renal transplant artery. Int J Urol. 2006;13: 820e3.

7.      Al-Wahaibi K.N., Aquil S., Al-Sukaiti R., Al-Riyami D., Al-Busaidi Q. Transplant Renal Artery False Aneurysm: Case Report and Literature Review. Oman Medical Journal. 2010; 25(4):306-310.

8.      Bracale U.M., Santangelo M., Carbone F., Del Guercio L., Maurea S., Porcellini M., Bracale G. Anastomotic pseudoaneurysm complicating renal transplantation:treatment options. Eur J Vasc Endovasc Surg. 2010 May; 39(5):565-8.

9.      Dimitroulis D., Bokos J., Zavos G., Nikiteas N.Karidis P., Katsaronis P., et al. Vascular complications in renal transplantation: a single-center experience in 1367 renal transplantations and review of the literature. Transplant Proc. 2009; 41:1609e14.

10.    Burkey S.H., Vazquez M.A., Valentine R.J. De novo renal artery aneurysm presenting 6 years after transplantation: a complication of recurrent arterial stenosis? J Vasc Surg. 2000; Aug;32(2):388-391 10.1067/mva.2000. 106943.

11.    McIntosh B.C., Bakhos C.T., Sweeney T.F., DeNa- tale R.W., Ferneini A.M. Endovascular repair of transplant nephrectomy external iliac artery pseudoaneurysm. Conn Med. 2005; Sep;69(8):465-466.

12.    Bracale U.M., Carbone F., del Guercio L., Viola D., D’Armiento F.P., Maurea S. et al. External iliac artery pseudoaneurysm complicating renal transplantation. Interact Cardiovasc Thorac Surg. 2009. Jun; 8(6):654-660 10.1510/icvts.2008.200386.

13.    Asztalos L., Olvaszto' S., Fedor R., Szabo' L., Bala 'zs G., Luka' cs G. Renal artery aneurysm at the anastomosis after kidney transplantation. Transplant Proc. 2006; 38:2915e8.

Abstract:

Article describes a case report of successful treatment of coronary artery perforation using handmade stent-graft, ex tempore made of coronary balloon and two bare-metal stents. Article also reports results of follow-up, including control angiography and optical coherence tomography 3 months later. 

References

1.     Ellis S.G., Ajluni S., Arnold A.Z., Popma J.J., Bittl J.A., Eigler N.L. et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994; 90(6):2725-30.

2.     Shirakabe A., Takano H., Nakamura S., Kikuchi A., Sasaki A., Yamamoto E. et al. Coronary perforation during percutaneous coronary intervention. Int Heart J. 2007; 48(1):1-9.

3.     Lansky A.J., Yang YM., Khan Y, Costa R.A., Pietras C., Tsuchiya Y et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006; 98(3): 370-4.

4.     Sarli B., Baktir A.O., Saglam H., Kurtul S., Dogan Y., Aring H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J. 2013; 35(3):164-6 • DOI: 10.5152/etd.2013.20.

5.     Copeland K.A., Hopkins J.T., Weintraub W.S., Rahman E. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv. 2012; 80(1):53-7.

Abstract:

Open surgery is a basis of treatment of major vascular injuries, although some of injuries can be treated by means of endovascular surgery

Aim: was to investigate the possibility of endovascular treatment of full transection of major arteries. Material and methods: а retrospective analysis of patients histories of 52 patients with limbs' vascular injuries was performed. Opinions of physicians of different surgical specialties about practicability of endovascular technologies use in trauma surgery were investigated. Using a created stand-desk, consisted with container filled with gelatin mass, simulating a hematoma in a zone of vascular rupture, plunged into gelatin ends of silicone tubes 6 mm in internal diameter, and a web-camera fixed above the stand, comparative analysis of efficacy of 6 different methods of vessel recanalization was done.

Results: еndovascular methods of treatment can be performed in 42,3% of patients with major arterial injuries. Of those, 13,5% of patients may need to undergo recanalization of full vascular transection followed by stent-graft implantation. Our study demonstrated the possibility of through-and-through recanalization of the full major vascular transection, and most effective methods of recanalization - methods with use of a special endovascular loop, a retrieval device, and a standard folded guidewire. Preliminary balloon inflation inside a proximal part of the artery should be considered in case of unstable hemodynamics of a patient.

The questionnaire showed that integration of endovascular surgical methods is perspective for the future of trauma surgery; however, there are some retaining obstacles such as organizational and fiscal issues. It is likely that training of general surgeons in basic endovascular skills is practical. 

References

1.     Soroka V.V. Neotlozhnye serdechno-sosudistye operatsii v praktike obshhego khirurga [Emergency cardiovascular operations in practice of a general surgeon]. Volgograd: Izd-vo VolGU. 2001; 204 [In Russ].

2.    Samokhvalov I.M. Boevye povrezhdeniya magistral'nykh sosudov: diagnostika i lechenie na etapakh meditsinskoj evakuatsii. Diss. doct. med. nauk [Wartime major vascular injuries: diagnosis and treatment on echelons of care. Doct. med. sci. diss.]. St.Petersburg. 1994; 389 [In Russ].

3.     White J.M., Stannard A., Burkhardt G.E. et al. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann. Surg. 2011; 263(6):1184-1189. 

4.     Eastridge B.J., Mabry R.L., Seguin P et al. Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J. Trauma Acute Care Surg. 2012; 73(6):431-437.

5.     Holcomb J.B., Fox E.E., Scalea T.M. et al. Current opinion on catheter-based hemorrhage control in trauma patients. J. Trauma Acute Care Surg. 2013; 76(3): 888-893.

6.     Lumsden A.B. Commentary on «Endovascular management of vascular trauma». Perspect. Vasc. Surg. Endovasc. Ther. 2006; 18(2):130-131.

7.     Rasmussen T.E., Woodson J., Rich N.M. et al. Vascular trauma at a crossroads. J. Trauma. 2011; 70(5): 1291-1293.

8.     Reva V.A., Samokhvalov I.M. Endovaskulyarnaya khirurgiya na vojne. [Endovascular surgery in the war]. Angiologiya i sosudistaya khirurgiya. 2015; 21(2):166-175 [In Russ].

9.     Reva V.A., Semenov E.A., Petrov A.N. et al. Endovaskulyarnaya ballonnaya okklyuziya aorty: primenenie na statsionarnom i dogospital'nom ehtapakh skoroj meditsinskoj pomoshhi. [Endovascular balloon occlusion of the aorta: the use at in-hospital and pre-hospital stages of emergency medical care]. Skoraya meditsinskayapomoshh,'. 2016; 3:30-38.

10.   Reva V.A., Kiselev M.A., Platonov S.A. et al. Selektivnaja embolizacija vetvej glubokoj arterii bedra pri koloto-rezanom ranenii. [Selective angioembolization of the branches of the deep femoral artery in its stab injury]. Vestn. chir. irn. Grekova. 2015; 174(3):67-69 [In Russ].

11.   Bocharov S.M. Angiograficheskaya diagnostika i endovaskulyarnoe lechenie pri travme arterij. Diss. kand. med. nauk [Angiographic diagnosis and endovascular treatment in arterial trauma. Cand. med. sci. diss.]. Moscow. 2008: 103 [In Russ].

12.   Chernaya N.R., Muslimov R.Sh., Selina I.E. et al. Endovaskulyarnoe i khirurgicheskoe lechenie bol'nogo s travmaticheskim razryvom aorty i pechenochnoj arterii. [Endovascular and surgical treatment of a patient with traumatic rupture of the aorta and the hepatic artery]. Angiologiya i sosudistaya khirurgiya. 2016; 22(1):176-181 [In Russ].

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14.   Villamaria C.Y, Eliason J.L., Napolitano L.M. et al. Endovascular Skills for Trauma and Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J. Trauma Acute Care Surg. 2014; 76(4):929-935.

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Abstract:

Aim: was to study immediate and medium-term results of using of stent Calypso in patients with acute coronary syndrome (ACS).

Materials and methods: 274 patients with ACS were included in study and were divided into 2 groups. The first group consisted of 140 patients, who underwent implantation of Calypso (Angioline, Russia). The other group consisted of 134 patients who underwent revascularization with further implantation of Xience (Abbot Vascular, USA). During first 24 hours after admission to the hospital all patients underwent percutaneous coronarography intervention (PCI). Their health state was monitored by phone during the 6, 9-12 months period. The majority of patients underwent coronary angiography during 9-12 months period.

Results: immediate results of the first group: incomplete stent apposition - in 0,6% cases, difficulties of delivery - in 3 cases, artery dissection - 2, occlusion of the side branch - 2 cases, acute thrombosis - 0,6% cases. Immediate results of the second group: incomplete stent apposition - in 0,5% cases, difficulties of delivery - in 2 cases, artery dissection - 2, occlusion of the side branch - 1 case, acute thrombosis - none. Confirmatory angiography in 9-12 months was done in 89 patients from the first group and 94 patients from the second group. The frequency of MACE in first group was 4,3%, in second group was 3,7%.

Conclusions: taking into consideration immediate and medium-term results it can be concludec that domestic stents can be successfully used in different clinical situations in different severity of lesions of coronary arteries. Calypso could be used in urgent PCI and they have minor percentage of complications in medium-term results.

 Reference 

1.     Chernjaev M.V., Koledinskij A.G. i dr. Koronarnye stenty: proshloe, nastojashhee, budushhee. Otechestvennye razrabotki v jendovaskuljarnoj hirurgii (obzor literatury). [Coronary stents: past, present, future. Domestic elaborations in endovascular surgery (literature review)]. Diagnosticheskaja i intervencionnaja radiologija. 2016; 10(4):51-56 [In Russ].

2.     Kudrjashov A.N., Lopotovskij P.Ju. Sravnitel'naja ocenka mehanicheskih svojstv koronarnogo stenta «Sinus». [Comparative estimation of mechanical properties of coronary stent «Sinus»]. Diagnosticheskaja i intervencionnaja radiologija.. 2014; 8(1)1:70-77 [In Russ].

3.     Lopotovskij P.Ju., Parhomenko M.V., Kokov L.S. Predvaritel'nye rezul'taty Registra retrospektivnogo issledovanija praktiki primenenija rossijskih stentov «Sinus» i «Kalipso». [Preliminary results of a retrospective study register for the use of Russian stents «Sinus» and «Calypso»]. Vestnik Roszdravnadzora. 2015; 5:44-49 [In Russ].

Abstract:

Aim: was to assess dynamics of markers of endothelial dysfunction after open reconstructive and endovascular operations on the aortoiliac segment.

Material and methods: the study included 36 patients, who were divided into two groups depending on the method of performed operations. Patients of the first group (n = 20) underwent open surgery - aortofemoral bypass, the second group (n = 16) underwent endovascular stenting and angioplasty of iliac arteries. We examined the level of the endothelial dysfunction markers: homocysteine, oxidized low density lipoprotein, adhesion molecules of vascular endothelium type 1 (sVCAM-1) Annexin V the inhibitor (PAI-1) and tissue plasminogen activator (t-PA) in the systemic circulation and in operated limb before the operation and in the early postoperative period.

Results: an expression of endothelial dysfunction after reconstructive surgery on the aortoiliac segment was established in both, systemic and local blood flow. Carrying of X-ray-endovascular operations was accompanied by endothelial dysfunction, which was comparable with open repair. Increased concentration of sVCAM-1 after surgery was revealed in all groups with greater dynamics in the operated limb. Annexin V content in the local blood flow in patients of the second group is significantly lower than of the first (at 42,66%, p <0.05).The most significant changes were found in the fibrinolytic activity in the performance of X-ray-endovascular interventions. A significant increase in systemic and local concentrations of PAI-1 was marked in the second group. The level of PAI-1 in the operated limb after stenting was 1,93 times higher than that in an open procedure. In contrast, post-operative changes in t-PA in patients undergoing endovascular surgery, showed an increase in t-PA compared to open surgery group.

Conclusion: in the complex examination of patients with atherosclerosis obliterans before anc after reconstructive surgery is necessary to monitor markers of endothelial dysfunction with the aim of personalized correction.

References

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32.   Maksimov A.V., Feyshanov A.K., Plotnikov M.V. Ob'ektivnyie kriterii invazivnosti minidostupa pri aortobedrennyih rekonstruktsiyah. Prospektivnoe issledovanie. [Objective criteria of invasiveness in aortofemoral reconstructions. A prospective study.]. Angiologiya i sosudistaya hirurgiya. 2011; 17:1:127-130 [In Russ].  

 Abstract:

Aim: was to compare endothelialization of stents with permanent and biodegradable coatings at an early stage with help of optical coherence tomography (OCT).

Materials and methods: this study is a prospective, randomized trial that includes a comparative analysis of OCT data in patients after implantation of coronary stents with biodegradable (study group) and permanent coatings (control group). 98 patients were randomized 1:1 into 2 groups. After 3 months, 10 patients from each group - were randomized to conduct OCT.

Results: we analyzed OCT data of 10 studies in the biodegradable group (1,776 struts and 247 sections) and 10 studies in the permanent coating group (1562 struts and 226 sections). There were no differences in proportion of uncovered (8,9% vs. 8,5%, p=0,49) and non-exposed struts (1,6% vs. 1,3%, p=0,2). Thus, 98,4% of struts in study group and 98.7% in control group were endothelialized.

Conclusions: according to OCT data, similar results were obtained in both groups. After 3 months of observation in two groups, the overwhelming number of struts were endothelialized. At the early stage of observation, none of groups, achievement of endpoints was detected. 

References

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4.     Izumi D., Miyahara M., Sakai M., Fukuoka S. OCT- based comparison of early strut coverage between zotarolimus- and everolimus-eluting stents with second stent designs. Eurointervention. 2014;5;20.

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Abstract:

Company Endogene Pty. Ltd. designd an endoluminal stapler. The purpose of the study was to report the use of device in a living canine model and appraise the technology in a living canine model, and to assess reliability of the delivery system and deployment process, security of the rings discharge and fixation, as well as maintenance of the vessel patency and abcence of thrombotic complications.

Reference:

1.     Slonim S.M., Nyman U., Semba C.P., Miller D.C., Mitchell R.S., Dake M.D. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration. J. Vasc. Surg. 1996; 23:241-253.

2.     Leurs L.J., Buth J., Laheij R.J.F. Long-term results  of endovascular  abdominal  aortic aneurysm treatment with the first generation of commercially available stent grafts. Arch. Surg. 2007; 142: 33-41.

3.     Brewster D.C.,Jones J.E., Chung T.K., Lamuraglia G.M., Kwolek C.J., Watkins M.T., Hodgman T.M., Cambria R.P. Long-term outcomes after endovascular abdominal aortic aneurysm repair. Ann. Surg. 2006; 244 (3): 426-438

Abstract:

From January 2003 till January 2008 transhepatic endobiliar stenting was performed in 62 patients with obstructive jaundice due to high post-operative malignant strictures of hepaticocholedochus duct. In 49 cases (79 %) two-step intervention performed (biliary drainage followed by endobiliary stenting), 13 patients (21 %) underwent single-stage intervention. In 60 patients (96,8%) balloon dilatation was done prior to stent implantation. In 59 cases (95,2%) the procedure was completed by control drainage placement. Hospital stay for the endobiliary stenting procedure was 12,7-22,3 days (average hospital stay 17,5 days). Mortality was as high as 12,9% (8 cases). Average post-implantation life span appeared to be 9,7 months. In 5 patients (8,1%) mechanical jaundice relapse occurred, so they needed hospitalization for reintervention. Direct dependence found between the effectiveness of endobiliary stenting and the technical characteristics of stents, anatomy of biliary strictures, as well as the methods and techniques of the intervention. Single-stage endobiliary stenting, without prior drainage, decreases the complication rate, improves the quality of life during the hospital stay, and prolongs the post-implantation life expectancy. Single-stege interventions are also shown to decrease the hospital stay and reduce the costs. Balloon dilatation is the required stage of the intervention, especially if self-expandable stents are used in torturous biliary ducts. Post-implantation drainage placement can be skipped if the wall of the hepatico-choledochus duct is not edematous, there are no signs of tumor prolapse into the lumen, if the stent is completely expanded, and the contrast media evacuates easily into the intestine.

Reference

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7.     Maire E, Hammel P., Ponsot P. et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006; 101 (4):735-742.

8.     Katsinelos P., Paikos D., Kountouras J. et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. SurgicalEndoscopy. 2006; 20 (10): 1587-1593.

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Abstract:

19 males with unilateral symptomatic internal carotid artery stenosis were stented in 2007 using Mo.Ma cerebral protection device (Invatec, Italy). Angiographic success rate was 100%, average procedure time 53,7±9,9 min, ICA occlusion time 53,7±19,9 min. 2 patients presented transitory ischemic attack. Clinical improvement achieved in all cases. Our experience demonstrates that the Mo.Ma device effectively prevents intraprocedural cerebral embolism in carotid stenting, and the idea of proximal protection seems to be safe, user-friendly and very promising. 

Reference

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6.     Ahmadi R., Willfort A., Lang W. et al. Carotidartery stenting: effect of learning curve and intermediate-term morphological outcome./Endovasc. Ther. 2001; 8 (6): 539-546.

7.     Reimers B., Schluter M., Castriota F. et al.Routine use of cerebral protection duringcarotid artery stenting: results of a multicenterregistry of 753 patients. Am. J. Med. 2004;116 (4): 217-222.

8.     Cremonesi A., Manetti R., Setacci F. et al.Protected carotid stenting: clinical advantagesand complications of embolic protectiondevices in 442 consecutive patients. Stroke.2003; 34 (8): 1936-1941.

9.     Aronow Н., Yadav J. Embolic Protection forCarotid Artery Stenting. A 'No Brainer'.Actachir. belg. 2004; 104: 65-70.

Abstract:

Internal carotid artery (ICA) pathological kinking considered to be one of the main causes of stroke. Aim of our study was to assess endovascular possibilities to manage this condition. Carotid stenting performed in 15 non-fixed human corpses with ICA kinking (6 - L-shaped, 5 - S-shaped, 4 - looping) under hydrodynamic monitoring.

It is shown that endovascular correction (stenting) of kinked ICA straightens the artery, considerably reduces pressure gradient, and increases volume of flow. At the same time carotid stenting, performed for ICA kinking, does not distress the vessel wall, in particular, it causes no significant intimal trauma. 

Reference

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Abstract:

РТА and stenting of lower limb s arteries was performed in 28 diabetic patients with critical limb ischemia. Technical success rate of interventions was 96,3%. Clinical success rate after the procedure was 64,3%. Mean values of basal ТсРО2 on the foot after operation increased on 11 mm of mercury. At a favorable outcome of treatment ankle-brachial index values increased on 0,2-0,4. Ischemia recurrence rate was 25%. All recurrences of ischemia were observed in period of 3 to 9 months. Cumulative limb salvage rate in 6 months was 80 %, in 12 months - 75%.

In short period of observation PTA and stenting in diabetic patients is able to eliminate the necessity of amputation in majority of patients. Considering weight of the general condition of such patients, presence of accompanying diseases, risk of development of complications of surgical treatment, РТА can be considered as operation of the first choice. 

Reference

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Abstract:

The authors report 44 successful implantations of original retrieval Nitinol stent-filters, unique "closed" design of which comprehensively described in the article. All the devices placed for pulmonary embolism (PE) management in patients with lower extremity and pelvic deep vein (DV) thrombosis. Authors announce absolute efficiency of their stent-filters for PE prophylaxis, and the procedure itself declared to be safe and minimally invasive.

Stent-filter implantation into iliac veins compared to standard filter placement in inferior vena cava (IVC) excludes risks of total infrarenal IVC thrombosis - the major complication of such procedures. It is also associated with early DV recanalization, that in sum radically reduces disability rate. Moreover, in case of IVC abnormalities, kinking or external compression stent-filter into iliac position remains the only option for endovascular PE management. All the above can be mentioned as advantages of using stent-filters.

At the same time authors observe that stent-filters quick incorporation into vessel wall prevented endovascular retrieval of the device in quite a number of cases. Persistent PE threat, requiring prolonged antithrombotic therapy under endovascular protection, might also contribute for low retrievability of the device. 

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18.   Grams J., The S.H., Torres V.E.,. Andrews J.C. Nagor-ney D.M. Inferior vena cava-stenting: A safe and tffec-tive treatment for intractable ascites in patients with polycystic liver disease.J. Gastrointest. Surg. 2007; 11:985-990.

19.   Kishi K., SonomuraT., Fujimoto H., Kimura M., Yamada K., Sato M., Juri M. Physiologic tffect of stent therapy for Inferior vena cavajbstruction due to valignant liver tumor. Cardiovasc. Intervent. Radiol. 2006; 29: 75-83.

20.   Heijmen R., Bollen T., Duyndam D. et al. Endovascular venous stenting in May-Thurner syndrome.J. Cardiovasc. Surg. 2001; 42 (1): 83-87.

21.   Прокубовский В.И., Капранов С.А., МоскаленкоЕ.П. Анатомические и гемодинамические изменения нижней полой вены при профилактике тромбоэмболии легочной артерии. Ангиология и сосудистая хирургия. 2003; 2 (9): 51-60.

22.   Marcy P., Magne N., Frenay M. et al. Renal failure secondary to thrombotic complications of suprarenal inferior vena cava filter in cancer patients. Cardiovasc. Intervent. Radiol. 2001; 24: 257-259.

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

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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 

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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:

Lesions of the LCA stem are found in 2,5-4 % of patients with coronary heart disease who endured coronography, and are accompanied by more severe symptomatology, higher morbidity and mortality rates, and difficulty of radical correction. According to the generally accepted guidelines, the operation of coronary artery bypass has up to now been a method of choice in treatment of the LCA stem. Nevertheless, endovascular methods of treatment for LCA stem lesions have relatively long been used, while implementation into clinical practice of drug-eluding stents has considerably improved the remote outcomes, which made it possible to consider LCA stem stenting as a real alternative to ACB. Hence, the problem concerning indications for and contraindications to LCA stem stenting remains unsolved today. We retrospectively analysed a total of 75 endovascular interventions on the LCA stem in 67 patients, with an isolated lesion of the LCA stem being found only in 7,4 % of the patients. The remaining subjects had lesions of the LCA stem on the background of a multivascular lesion of the coronary bed, including occlusion of the RCA observed in 16,4 % of cases. Successive revascularization was performed in 98,64 % of cases, with no lethal outcomes. One patient required urgent ACB due to development of occluding dissection of the circumflex branch. Complications in the immediate postoperative period were observed in two patients and were represented by non-Q myocardial infarction and stroke. LCA stem stenting proved an efficient and safe method of treatment for coronary heart disease. A comparative analysis of the immediate results of LCA stem stenting and ACB revealed advantages of stenting, consisting in no lethal outcomes (in our series) and a lower short-term rate of postoperative complications.

Reference

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4.     Seung-Jung Park, MD, PHD, Young-Hak Kim, MD, Bong-Ki Lee, MD et al. Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis Comparison With Bare Metal Stent Implantation. Journal of the American College of Cardiology. 2005; 3 (45): 351-6.

5.     Seung-Jung Park, Young-Hak Kim, Bong-Ki Lee, Seung-Whan Lee, Cheol Whan Lee, Myeong-Ki Hong, Jae-Joong Kim, Gary S. Mintz, MD, Seong-Wook Park. Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis. J. Am. Coll. Cardiol. 2005; 45: 351-6.

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7.     Arampatzis CA, Hoye A, Saia F, et al. Elective sirolimus-eluting stent implantation for left main coronary artery disease: six-month angiographic follow-up and 1-year clinical outcome. Cathet. Cardiovasc. Interv. 2004; 62: 292 - 6.

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10.   Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994; 344: 563 - 570.

11.   Park S, Hong M, Lee CW, et al. Elective stenting of unprotected left main coronary artery stenosis: effect of debulking before stenting and intravascular ultrasound guidance. J. Am. Coll. Cardiol. 2001; 38: 1054 - 1060.

12.   TakagiT, Stankovic G, Finci L, Toutouzas K, Chieffo A, Spanos У Liis-tro F, Briguori C, Corvaja N, Albero R, Sivieri G, Paloschi R, Di Mario C, Colombo A. Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery. Circulation. 2002; 106: 698 - 702.

13.   Sorin J. Brener, MD; Bruce W Lytle, MD; Ivan P. Casserly, MD; Jakob P. Schneider, RN; Eric J. Topol, MD; Michael S. Lauer, MD. Propensity Analysis of Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease and High-Risk Features. Circulation. 2004; 109: 2290 -2295.

14.   Silvestri M, LefПvre T, Labrunie P, Khalife K, Bayet G, Morice MC, Bedossa M, Chmait A.. On behalf of the FLM registry investigators. The French registry of left main coronary artery treatment: Preliminary results. J. Am. Coll. Cardiol. 2003; 41: 45.

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16.   Бокерия Л. А., Алекян Б. Г., Бузиашвили Ю. И. и др

Abstract:

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

Reference

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

3.     Rogers С, Parikh S., Seifert P. Edelman E. Endogenous cell seeding. Remnant endothelium after stenting enhances vascular repair. Circulation. 1996; (94).2909-2914.

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Abstract:

The importance of using minimally invasive techniques in management of pancreatic pseudocysts is evident today. In order to evaluate the efficacy of puncture-draining interventions, analysed herein are therapeutic outcomes in 102 patients. The patients were subdivided depending on the causes of pathology, localization, forms and presence of complications. Diagnosis included an ultrasonographic study. Suspected for neoplastic cysts, 21 patients underwent computed tomography, 42 - duodenoscopy, 17 - endoscopic retrograde pancreatocholangiography. Taking into consideration a high risk of pancreatic fistulas formation, after external drainage, we isolated a high-risk group comprising 36 people, and a group of 66 subjects with no risk of this complication. The latter underwent ultrasonography-controlled external drainage. Of these, 49 patients were subjected to drainage by the Seldinger technique, 12 - large-calibre percutaneous external drainage. Complications were observed in 3 subjects. Patients at risk of a complication underwent ultrasonographically and endoscopically controlled internal drainage. Complications were noted in 4 cases. Of these, two, during transduodenal drainage, developed bed-sores of the superior mesenteric artery branches, and one patient developed abdominal haemorrhage. In this connection we refused carrying out transduodenal drainage. The long-term results in patients with cystoduodenal stents were followed-up in 19 subjects. By month six, the stent detached spontaneously in 6 patients, being removed endoscopically in 8 subjects. Fifteen patients with intrapancreatic hypertension were subjected to endoscopic papillosphincterotomy. The duration of the hospital stay amounted to 23-28 days. Hence, internal drainage of pancreatic pseudocysts, followed by cystoduodenal stenting in patients at risk of an external pancreatic fistula within the described therapeutic-and-diagnostic algorithm is an operation of choice.

References

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Abstract:

Eighteen experimental animals (9 rabbits and 9 mongrel dogs) were used in a feasibility study of heparin and a polymer belonging to polyoxyalkanoates class - homopolymer of в-oxybutyric acid - polyoxybutyrate (POB) to be applied onto the surface of the nitinole self-expanding stent "Alex" ("Komed", Russia) in order to decrease responsiveness of the vascular wall. During a three-month chronic experiment at various terms following implantation, we examined the degree of biocompatibility of the coat-free stents, heparin-treated stents, and those coated with the above polymer. The studies were carried out by means of arteriography, binocular light microscopy, histological examination, electron microscopy; and the study of the ultrastructure of thestented segmentsof the vessels. The experiments carried out on animals showed that: 1. The coating of the stents may positively influence structural alterations in the vascular wall, which improve the conditions of the blood flow along the vessel; 2. Using POB-coated stents is accompanied by lesser intimal hyperplasia, relatively decreased leukocytic infiltration, and development of vasa vasorum; 3. POB may safely be considered the most favourable coating for stents because of minimal structural alterations in the vascular wall. The obtained findings would make it possible to plan future research on polyoxyalkanoatesas modifiers of the histological responseof the vascular wall tissues while implanting stents.

       References

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2.     Machan L. Drug eluting stents in the infrainguinal circulation. Tech. Vasc. Interv. Radiol. 2004; 7: 28-32.

3.     Tanabe K., Serruys P., Grube E., Smits P.C., Selbach G., van der Gissen W.J., Staberock M., de Feyter P., Muller R., Reger E., Degertekin M., Ligthart J.M.R., Disco C., Backx B., Russell M.E. TAXUS III Trial. In-Stent restenosis treated with stent-based delivery of paclitaxel incorporated in a slow-release polymer formation. Circulation. 2003; 107: 559-564.

4.     Grube E., Silber S., Hauptmann K.E., Mueller R., Buellesfeld L., Gerckens U., Russell M.E. TAXUS I. Six- and twelve-months results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation. 2003; 107: 38-42.

5.     Kerner A., Gruberg L., Kapeliovich L., Grenadier E. Late stent thrombosis after implantation of a sirolimus-eluting stent. Catheter Cardiovasc. Interv. 2003; 60: 505-508.

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9.     Peck P. Concerns About Subacute Thrombosis and the Sirolimus-Eluting Stents: Hype or Reality? Posted 12.10.2003. Available at:http//www.medscape.com/viewarticle/465210 - 50k.