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:

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.

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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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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.

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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.

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https://doi.org/10.1177/1526602819839044

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 

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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.

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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

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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.

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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

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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.

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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

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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

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https://doi.org/10.1007/BF01709560

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

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

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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

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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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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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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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.

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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.

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31.   Dansky H.M., Barlow C.B., Lominska C. et al. Adhesion of monocytes to arterial endothelium and initiation of atherosclerosis are critically dependent on vascular cell adhesion molecule-1 gene dosage. Arterioscler. Thromb. Vasc. Biol. 2001; 21(10):1662-1667.

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:

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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2.     Fern6ndez-Aguilar J., Santoyo J., Su6rezMuсoz M. et al. Biliary reconstruction in livertransplantation: is a biliary tutor necessary. Cir Esp. 2007; 82 (6): 338-340.

3.     Kasahara M., Egawa H., Takada Y. et al. Biliaryreconstruction in right lobe living-donor livertransplantation: Comparison of differenttechniques in 321 recipients. Annals of Surgery. 2006; 243 (4): 559-566.

4.     Alsharabi A., Zieniewicz K., Patkowski W. et al.Assessment of early biliary complications afterorthotopic liver transplantation and their relationship to the technique of biliary reconstruction. Transplantation proceedings. 2006; 38 (1): 244-246.

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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.

9.     Hatzidakis A., Tsetis D., Chrysou E. et al. Nitinol stents for palliative treatment of malignant obstructive jaundice: Should we stent the sphincter of oddi in every case? Cardiovasc. Intervent. Radiol. 2001; 24: 245-248.

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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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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

1.     Rutherford R.B., Durham J. Percutaneous balloon angioplasty for arteriosclerosis obliterans: Long-term results. In Pearce W.H. (eds). Technologies in Vascular Surgery. 1992; 32-345.

2.     Шиповский В.Н. Баллонная ангиопластика в лечении хронической ишемии нижних конечностей.Дис. д-ра мед. наук. 2002; 16-17.

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5.     Харазов А Ф. Диагностика и результаты лечения пациентов с критической ишемией нижних конечностей при атеросклеротическом и диабетическом поражении артерий ниже паховой связки. Дис. канд.мед. наук. 2002; 12.

Abstract:

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

Reference 

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

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

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

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

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

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

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

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

Abstract:

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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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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9.     Weaver W.D., Reisman M.A., Griffin J.J., et al., for the OPUS-1 Investigators. Optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial (OPUS-1): a randomised trial. Lancet. 2000; (355): 203-219.

10.   Schuhlen H., Kastrati A., Dirschinger J. Intracoronary Stenting and Risk for Major Adverse Cardiac Events During the First Month. Circulation. 1998; (98): 104-111.

Abstract:

The article gives account of coronary stenting impact on the dynamics of left ventricle index. The study covered 94 postinfarction patients, including 80 men and 14 women. Among them 52 patients with Q-forming myocardium infarction and 42 with non-Q myocardium infarction were observed. 1 3 patients that suffered Q-forming myocardium infarction didn't show any segment contractility disorders (group 1), while 39 showed contractility disorders (group 2). The analysis revealed that index improvement of the left ventricle is observed in the 1st group in 77% cases after stenting, while the 2nd group shows no improvements. Among the 2nd group of patients the full recovery is observed in 21% cases, the partial recovery - in 46% and 1 3% didn't overcome any dynamics.

The EchoCG study performed on 42 patients revealed that 31 men have no segmental activity disorders (group 3) and 1 1 suffered segmental activity disorder (group 4). Stenting procedure improved the myocardium function in the 3rd group in 65% cases. In the long prospect 1 0 patients of the 4th group fully recovered their myocardium function and only 1 man showed no dynamics in contractility improvement. Taking into consideration what has been said one can be sure that EchoCG proves to be an effective method of valuing the left ventricle function improvement before and after coronary stenting.

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Abstract:

This article presents a review of the literature on treatment of multifocal atherosclerosis of iliac arteries and arteries of lower extremities. Adequate correction of arterial inflow provides normal functioning of distal reconstructions. Combination of endovascular correction of arterial inflow with open surgical reconstructions of arterial outflow maximizes limb revascularization and this leads to less surgical trauma and less complications. Hybrid operations allow to achieve maximum results in terms of hemodynamics in patients with multi-segmental lesions. Immediate and long-term results of such operations are not worse than similarly isolated interventions in each segments. Hybrid operations show their worth and effectiveness in all lesions of aorto-iliac segment, including TASC C and D. Reduced operational trauma during hybrid operations, compared with one-stage surgical reconstruction, and the possibility to perform interventions under regional anesthesia, are particularly important in patients at high risk of comorbidity

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Abstract:

Background. Significant coronary artery disease (CAD), occurring in 7-10% of patients with obstructive hypertrophic cardiomyopathy (HCM), deteriorates the clinical course and survival rates. Until recently, such combination of abnormalities was an indication for coronary artery bypass graft (CABG) and septal myoseptecmy

Aim: was to investigate the efficacy, safety and technique of combined percutaneous intervention in patients with obstructive HCM and CAD. Materials and methods. We have performed 15 combined percutaneous interventions: alcohol septal ablation (ASA) and coronary revascularization. All patients had a marked asymmetric hypertrophy of LV with outflow tract obstruction at rest, as well as severe coronary lesions (75% - 95%). During the procedure, we performed consistently ASA of target zone in charge of obstruction and coronary stenting (10 stents in LAD, 8 stents in RCA, 4 stents in LCX).

Results. Among the effects of interventions were disappearance of angina pectoris and dyspnea, reduction of the pressure gradient in the LV outflow tract and a significant decrease in the thickness of septum. No serious complications (such as MI, complete av-block, ventricular tachiarrhythmias) occured

Conclusion. These results indicate efficacy and safety of ASA combined with coronary revascularization in patients with obstructive HCM who have concomitant CAD.

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Abstract:

Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. 

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Percutaneous coronary intervention in octogenarian patients with myocardial infarction (literature review)