Abstract: Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization. Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access. Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration. Medical consilium decided to perform staged endovascular revascularization of the myocardium. For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used. Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis. Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.
Abstract: Aim: was to evaluate the safety and efficacy of delayed endovascular treatment without stent implantation in ST-elevation myocardial infarction (STEMI) caused by massive thrombotic load and ectasia of infarct-related coronary artery. Material and methods: out of 4263 primary percutaneous coronary interventions (PCI) performed for STEMI for the period from January 2016 to September 2021, retrospective analysis included data of 21 patients with ectasia of infarct-related coronary artery and massive thrombotic load (TTG ? 3). Results: method of delayed endovascular treatment, without stent implantation, in STEMI caused by massive thrombotic load and ectasia of infarct-related coronary artery, allowed to significantly improve parameters of epicardial coronary blood flow according to TIMI and CFTC scales in 71% and 67% of examined patients (p <0,001, p=0,001); increase myocardial perfusion according to MBG in 62% of patients (p=0,001); reduce the severity of thrombotic load according to TTG scale in 71% of the subjects (p=0,001). Conclusion: in patients with ST-elevation myocardial infarction caused by massive thrombotic load and ectasia of infarct-related coronary artery, the strategy of delayed endovascular treatment with-out stent implantation is safe and effective at the hospital stage.
Abstract: Introduction: the main methods for diagnosing cardiac neoplasms, allowing to determine the localization, size, involvement of heart structures, to suggest the nature of the pathological process and to plan treatment tactics, are: echocardiography (EchoCG), contrast multispiral computed coronary angiography (MSCT CAG), magnetic resonance imaging (MRI) and positron emission computed tomography (PET CT). At the same time, any additional information about the pathological process can improve the quality of diagnosis and treatment. So, for example, selective coronary angiography (CAG), which in this case can be performed to clarify the coronary anatomy and exclude concomitant coronary atherosclerosis, in hands of attentive and experienced specialist of endovascular diagnostic and treatment methods can make a significant contribution to understanding the nature of blood supply of heart neoplasm, thereby bringing closer the formulation of the correct diagnosis and, ultimately, improving results of surgical treatment. Aim: was to study the nature of blood supply of heart myxoma based on results of a detailed analysis of data of selective coronary angiography in patients with this pathology. Material and methods: since 2005, 20 patients underwent surgery to remove heart myxoma. The average age of patients was 56,6 + 8,0 (43-74) years. According to data of ultrasound examination, sizes of myxomas ranged from 10 to 46 mm in width and from 15 to 71 mm in length (average size ? 25,6 ? 39,1 mm). In 2/3 of all cases (15 out of 20,75%), the fibrous part of the inter-atrial septum (fossa oval region) was the base of myxomas. In 8 of 20 (40%) cases, tumor prolapse into the left ventricle through structures of the mitral valve was noted in varying degrees. In order to exclude coronary pathology, CAG was performed in 14 cases, in the rest - MSCT CAG. Results: of 14 patients with myxoma who underwent selective coronary angiography, 12 (85,7%) patients had distinct angiographic signs of vascularization. In all 12 cases, the sinus branch participated in the blood supply of myxoma, begins from the right coronary artery (RCA) in 10 cases: in 7 case it begins from proximal segment of the RCA and, in 3 cases, from the posterior-lateral branch (PLB) of the RCA. In one case, the source of blood supply of neoplasm was the sinus branch extending from PLB of dominant (left type) circumflex artery of the left coronary artery (PLB CxA LCA). In one case, the blood supply to the neoplasm involved branches both from the RCA and CxA, mainly from the left atrial branch of CxA. Moreover, in all 12 cases, sinus branch formed two branches: branch of sinus node itself and left atrial branch. It was the left atrial branch that was the source of blood supply of myxoma. Analysis of angiograms in patients with myxoma of LA showed that left atrial branch in terminal section formed a pathological vascularization in the LA projection, accumulating contrast-agent in the capillary phase (MBG 3-4). In addition to newly formed vascularization, lacunae of irregular shape were distinguished, the size of which varied from 2 to 8 mm along the long axis. In 8 cases, hypervascular areas with areas of lacunar accumulation of contrast-agent showed signs of paradoxical mobility and accelerated onset of venous phase. In two cases, there were distinct angiographic signs of arteriovenous shunt. In 2 cases (when the size of the myxoma did not exceed 15-20 mm according to EchoCG and CT), angiographic signs allowing to determine the presence of LA myxoma were not so convincing: there was no lacunar accumulation of contrast-agent; small (up to 10 mm) hypervascular areas were noticed, the capillary network of which stood out against the general background of uniform contrasting impregnation and corresponded to MBG grade 1-2. Conclusion: according to our data, angiographic signs of vascularization of myxomas are detected in most cases with this pathology (85,7%). The source of blood supply, in the overwhelming majority of cases, is branch of coronary artery, which normally supplies the structure of the heart, on which the basement of the pathological neoplasm is located. The aforementioned angiographic signs characteristic of myxomas deserve the attention of specialists in the field of endovascular diagnosis and treatment and should be described in details in protocols of invasive coronary angiography. References 1. Петровский Б.В., Константинов Б.А., Нечаенко М.А. Первичные опухоли сердца. М.: Медицина, 1997; 152. Petrovskiy BV, Konstantinov BA, Nechaenko MA. Primary heart tumors. M.: Medicina, 1997 [In Russ]. 2. Balci AY, Sargin M, Akansel S, et al. The importance of mass diameter in decision-making for preoperative coronary angiography in myxoma patients. Interact Cardiovasc Thorac Surg. 2019; 28(1): 52-57. https://doi.org/10.1093/icvts/ivy217 3. Omar HR. The value of coronary angiography in the work-up of atrial myxomas. Herz. 2015; 40(3): 442-446. 4. Gupta PN, Sagar N, Ramachandran R, Rajeshekharan VR. How does knowledge of the blood supply to an intracardiac tumour help? BMJ Case Rep. 2019; 12(2): 225900. https://doi.org/10.1136/bcr-2018-225900 5. Marshall WHJr., Steiner RM, Wexler L. Tumor vascularity in left atrial myxoma demonstrated by selective coronary arteriography. Radiology. 1969; 93(4): 815-816. 6. Lee SY, Lee SH, Jung SM, et al. Value of Coronary Angiography in the Cardiac Myxoma. Clin Anat. 2020; 33(6): 833-838.
Abstract: Background: atrial septal defect (ASD) is characterized by a progressive increase in pulmonary vascular resistance and, accordingly, pressure in small circulation circle. It is noteworthy that these hemodynamic changes go in parallel with morphofunctional changes in small vessels of pulmonary artery system. At the same time, changes in hemodynamics of small circulatory circulation after endovascular closure in this category of patients and reversibility of pulmonary hypertension are not fully studied. Aim: was to assess clinical course, indicators of cardiac chamber geometry and hemodynamics of small circulation circle after transcatheter closure of secondary ASD in adult patients with moderate and significant pulmonary hypertension in immediate and long-term periods. Material and methods: from 2009 to 2020, 103 patients (mean age 48,3 ± 15,3 years) with secondary ASD underwent endovascular transcatheter closure of the defect. 60 (58,3%) patients had pulmonary hypertension. Depending on systolic pulmonary arterial pressure (SPAP), patients were divided into 3 groups: the first group consisted of 41 (68,3%) patients with mild PH (from 40 to 49 mm Hg); the second group included 10 (16,6%) patients with moderate PH (50 to 59 Hg); and the third group consisted of 9 (15%) patients with high SPAP (? 60 mm Hg). Average pulmonary artery systolic pressure in groups was: 43,6 ± 2,9 mm Hg; 52,1 ± 2,5 mm Hg; 64,4 ± 5,2 mm Hg, respectively. Average sizes of ASD (according to Pre-TEE data) were 18,7 + 6,1 mm; 22,1 ± 7,5 mm and 21,3 ± 5,3 mm, respectively. In all cases, echocardiographic signs of the right heart volume overload were detected. Follow-up was performed on an outpatient basis with an assessment of the clinical status and TTE in the long-term period. Results: technical success of endovascular defect closure was 100%. Average size of the occluder was 26,3 + 6,96 (from 12 to 40) mm. Immediately after implantation of device, complete closure of ASD was observed in 55 (91,7%) cases. Residual flow (<3 mm) was observed in 5 cases (2 cases in the first group, 1 case in second group, and 2 cases in third group, (p >0,05)). In the vast majority of cases - 54 (90%) hospital period proceeded smoothly. All patients were examined in the long-term period (on average 12,5 + 6,5 months). The survival rate in groups was 100%. In the long- term follow-up remodeling of the right heart was observed in all patients. In the first group the size of RA decreased from 6,0 ± 0,5 cm to 3,3 ± 0,4 cm, RV size decreased from 4,7 ± 0,5 to 3,1 ± 0,4 cm; in the second group RA from 5,7 ± 0,7 cm to 3,8 ± 0,5 cm, RV - from 4,7 ± 0,9 to 3,8 ± 0,6 cm; in the third group RA - from 5,5 ± 0,6 cm and 4,2 ± 0,5 cm, the size of RV decreased from 4,5 ± 0,6 4,0 ± 0,5 cm, respectively. In all patients, significant decrease in SPAP was observed, in some cases up to normalization. In the first group, SPAP decreased from 43,7 ± 2,9 to 32,1 ± 2,6 mmHg, in the second group - from 52,1 ± 2,5 to 34,3 ± 2,6 mmHg; in the third group - from 64,4 ± 5,2 to 50,3 ± 4,8 mmHg. The most expressed decrease of pressure occurred in the second group of patients. At the same time, in the third group, dynamics of pressure reduction was significantly less expressed in comparison with the other two groups. At the same time in two patients of third group high PH remained in the long-term period, despite the successful closure of the defect. Conclusion: results show that in case of left-right shunt in the absence of hypoxemia, transcatheter closure of ASD in adult patients with moderate and significant pulmonary hypertension is a pathophysiologically and clinically justified, is a highly effective treatment method that allows achieving significant improvement of both clinical manifestations and intracardiac and systemic hemodynamics. In patients with a significant degree of pulmonary hypertension and a high probability of the latter, the following tactical approaches may be considered: 1. primary closure of defect with further drug therapy; 2. primary drug therapy aimed on regulating of the anatomic-functional state of the arterial bed of the small circulation and hence reducing pulmonary vascular resistance followed by endovascular ASD-closure; 3. closure of the defect with a fenestrated occluder (in case of a negative test for temporary balloon occlusion), followed by drug therapy. This assumption can be considered in future research. References 1. Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis. 2018; 10(24): 2890-2898. 2. Fraisse, et al. Atrial Septal Defect Closure: Indications and Contra-Indications. J Thorac Dis. 2018; 10(24): 2874-2881. 3. Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol. 2015; 65(1): 17-25. 4. Kefer J. Percutaneous Transcatheter Closure of Interatrial Septal Defect in Adults: Procedural Outcome and Long-Term Results. Catheter Cardiovasc Interv. 2012; 79(2): 322-30. 5. Gruner C, Akkaya E, Kretschmar O, et al. Pharmacologic preconditioning therapy prior to atrial septal defect closure in patients at high risk for acute pulmonary edema. J Interv Cardiol. 2012; 25: 505-12. 6. Abaci A, Unlu S, Alsancak Y, et al. Short- and long-term complications of device closure of atrial septal defect and patent foramen ovale: metaanalysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv. 2013; 82(7): 1123-1138. 7. Humenberger M, Rosenhek R, Gabriel H, et al. Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J. 2011; 32: 553-560. 8. Ioseliani DG, Kovalchuk IA, Rafaeli TR, et al. Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults. Kardiologia. 2019; 59(2): 56-60 [In Russ]. 9. Correction to: 2018 AHA/ACC Guideline for the Management of Adults with Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139(14): 833-834. 10. Gali? N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37(1): 67-119. 11. Haas NA, Soetemann DB, Ates I, et al. Closure of secundum atrial septal defects by using the occlutech occluder devices in more than 1300 patients: the IRFACODE project: a retrospective case series. Catheter Cardiovasc Interv. 2016; 88: 71-81. 12. Nakahawa K, Akagi T, Taniguchi M, et al. Transcatheter closure of atrial septal defect in a geriatric population. Catheter Cardiovasc Interv. 2012. 13. Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr. 2015; 28(7): 727-754. 14. Galderisi M, Cosyns B, Edvardsen T, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017; 18(12): 1301-1310. 15. Bossone E, D'Andrea A, D'Alto M, et al. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr. 2013; 26(1): 1-14. 16. Miranda WR, Hagler DJ, Reeder GS, et al. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv. 2019; 93(6): 1069-1075. 17. Shin C, Kim J, Kim J-Y, et al. Determinants of serial left ventricular diastolic functional change after device closure of atrial septal defect. JACC. 2020; 75(11). 18. Martin-Garcia AC, Dimopoulos K, Boutsikou M, et al. Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement. Heart. 2020; 106(6): 455-461. 19. Zwijnenburg RD, Baggen VJM, Witsenburg M, et al. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol. 2019; 123(8): 1336-1342.
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.
Abstract Aim: was to explore clinical efficacy and safety of two distal radial approach (DRA) types in primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) patients. Materials and methods: 113 ACS patients with endovascular procedure that had been performed through DRA - met entry criteria. Standard DRA was performed within anatomic snuffbox in 82 patients (72,6%) and modified - on the dorsal surface of the palm (dorsopalmar type) in 31 patients (27,4%). Approach conversion was performed in 7 patients (6,2%). PCI on syndrome- related artery was performed in 94 patients (83,2%). On completion of PCI and final approach angiography, hemostasis was performed with bandage application for 6 hours. Hemostasis comfort was determined by 10 point verbal descriptor Gaston-Johansson scale. On the 5th-7th day after PCI, all patients underwent visual check, palpation and ultrasound duplex scan (UDS). Results: procedure and fluoroscopy time, X-ray load, hemostasis comfort - didn't depend on DRA type. Examination, palpation, UDS performed on the 5th-7th day after PCI didn't reveal cases of forearm radial artery occlusion (RAO). Subcutaneous forearm hematoma (EASY III - IV) was registered in 3 cases (2,7%). RAO was registered in standard DRA group only in 4 cases (3,5%). There were no cases of access side RAO in dorsopalmar DRA group. Conclusion: DRA modifications for PCI in ACS patients are valuable addition to classic radial approach. Dorsopalmar DRA can be considered as basic approach. References 1. Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989; 16:3-7. 2. Kiemeneij F, Laarmann Gj, de Melker E. Transradial coronary artery angioplasty (Abstr). Circulation. 1993; 88: I-251. 3. Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39 (2): 119-77. 4. Neumann F.J., Sousa-Uva M., Ahlsson A. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2018; Aug. 25. 5. Valgimigli M, Gagnor A, Calabro P. et al. MATRIX Investigators. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: A randomised multicentre trial. Lancet. 2015; 385:2465-2476. 6. Bazemore E, Tift Man J, Problems and Complications of the Transradial Approach for Coronary Interventions: A Review Issue Number J Invasive Cardiol. 2005 Mar;17(3):156-9. 7. Stawin J, Kubler P, Szczepanski A. et al. (2013). Radial artery occlusion after percutaneous coronary interventions - an underestimated issue. Postepy Kardiol Interwencyjnej. 2013 18; 9(4):353-61. Epub 2013 Nov 18. 8. Avdikos G, Karatasakis A, Tsoumeleas A. et al. Radial artery occlusion after transradial coronary catheterization. Cardiovasc Diagn Ther. 2017; 7(3):305-316. 9. Kotowycz MA, DГlavнk V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv. 2012; 5:127-33. 10. Karpov YA, Samko AN, Buza VV. Coronary angioplasty and stenting. Moscow, 2010; 235 [In Russ]. 11. Babunashvili A, Dundua D. Recanalization and reuse of early occluded radial artery within 6 days after previous transradial diagnostic procedure. Catheter. Cardiovasc. Interv. 2011; 77 (4): 530-6. 12. Kaledin AL, Kochanov IN, Seletskiy SS. et al. Peculiarities of arterial access in endovascular surgery in elderly patients. Uspekhi Gerontologii. 2014; 27 (1): 115-9 [In Russ]. 13. Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017; 13 (7): 851-7. 14. Al-Azizi KM, Lotfi AS. The distal left radial artery access for coronary angiography and intervention: a new era. Cardiovasc. Revasc. Med. 2018; Dec 26; 19(8S): 35-40. 15. Valsecchi O, Vassileva A, Cereda AF. et al. Early clinical experience with right and left distal transradial access in the anatomical snuffbox in 52 consecutive patients. J. Invasive Cardiol. 2018; 30(6): 218-23. 16. Soydan E, Akin M. Coronary angiography using the left distal radial approach - an alternative site to conventional radial coronary angiography. Anatol. J. Cardiol. 2018; 19: 243-248. Mar. 21. 17. Manchurov VN, Orlov OS, Anisimov KV. et al. Distal transradial access for percutaneous coronary interventions in patients with acute coronary syndrome and ischemic heart disease. Endovasculyarnaya. khirurgiya. 2018; 5 (4): 438-44 [In Russ]. 18. Kaledin AL, Kochanov IN, Podmetin PS., et al. Distal part of the radial artery for endovascular interventions. Endоskulyarnaya khirurgiya. 2017; 4(2): 125-133 [In Russ]. 19. Amsterdam EA, Wenger NK, Brindis et al. (23 September 2014). "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 130 (25): e344-e426. 20. Gaston-Johansson F, Albert M, Fagan et al. Similarities in pain descriptions of four different ethnic-culture groups. J Pain Symptom Manage. 1990; 5: 94-100. 21. Bertrand OF. Acute forearm muscle swelling post transradial catheterization and compartment syndrome: prevention is better than treatment! Catheter Cardio Interv. 2010; 75:366-8. 22. Radial access for percutaneous coronary procedure: relationship between operator expertise and complications. Clin Exp Emerg Med. 2018 Jun; 5(2): 95-99. 23. Rafael J Ruiz-Salmeryna, Ramyn Moraa, Manuel Velez-Gimyna et al. Radial Artery Spasm in Transradial Cardiac Catheterization. Assessment of Factors Related to Its Occurrence, and of Its Consequences During Follow-Up. Revista Espanola de cardiologia. 2005; 58(5): 465610.
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: 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., 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 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.
