Abstract:

Article presents a clinical case of 83-year old woman with successful aspiration thrombectomy from the superior mesenteric artery due to its thromboembolism with the help of endovascular reperfusion catheter ACE68. Due to the satisfactory angiographic and clinical results - additional manipulations (artery stenting, selective thrombolysis) were not performed. Time from the onset of the disease to the restoration of blood mesenteric flow in the basin of the superior mesenteric artery was 24 hours, laparotomy or laparoscopy in post-operative period were not necessary. This article also discusses indications for endovascular treatment of acute occlusion of the superior mesenteric artery.

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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.

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Abstract:

Aim: was to assess dynamics of angiographic parameters of coronary artery rehabilitation, spasm throughout, below chronic coronary occlusion (CCO), after recanalization and balloon angioplasty, with survey of 8-10 weeks, basing on dynamics of anatomical and morphological characteristics of the artery with a major idea to optimize conditions for stenting.

Materials and methods: research analyzes results of two-stage treatment of 26 patients with CCO, complicated by a spasm, by which result after a recanalization of occlusion, was a contrasted artery with diameter less than 1 mm.

In these cases angioplasty with balloons with a diameter up to 3 mm doesn’t yield desirable results and diameter of an artery below a place of occlusion averaged 1,5 mm, and the difference of diameters of proximal and distally department averages 1,78 mm that is an adverse factor for stenting as is followed by high level of restenosis and thrombosis.

Results: within 4-8 weeks (on average 68 days) all arteries remained passable with equal contours, without angiographic signs of dissection, which took place right after balloon angioplasty Diameter of an artery increased with 1,5 mm to 2,64 mm; a difference of diameters of proximal and distally departments of an artery at the level of CCO decreased from 1,78 mm to 0,45 mm that was a favorable condition for stenting.

Conclusion: within 4-8 weeks after recanalization under normal pressure and blood flow occurs a readaptation of artery, expressed in a significant increase in the diameter of the artery below the CCO, which contributes to the optimization of stenting.

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Abstract:

The world data devoted to endovascular treatment of acute thrombotic or thromboembolic occlusion of the superior mesenteric artery are provided in article. Various methods of intra vascular interventions are described at acute mesenteric ischemia: mechanical and rheolytic thrombectomy, retrograde stenting, thrombolytic therapy and some others. Endovascular intervention, according to different authors, may consider as choice option in treatment of patients in a stage of intestine ischemia.

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Abstract:

Article presents data of modern literature concerning diagnostic efficiency of computed tomography and CT-angiography in diagnostics of acute disorders of mesenterial blood circulation. Article describes various groups of instrumental diagnostic signs indicating directly or indirectly on acute thrombotic and thromboembolic occlusion of mesenterial.

According to huge ammount of authors, CT-angiography can be considered as the first step in instrumental diagnostics of acute disorder of mesenterial blood circulation, due to demonstrated sensitivity and specificity, comparable in comparison with a standard angiography. 

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Abstract:

Aim: was to estimate parameters of left ventricle (LV) perfusion and kinetics at ischemic chronic heart failure (CHF), which initial values are predictors of increased myocardial functional reserve and patients clinical status improvement as a result of revascularization.

Materials and methods: examined 157 patients (146 men and 11 women; age from 33 to 72 years) before and in 2 - 3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III-IV echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion and function disorders were estimated with use of ECG-gated single photon emission computed tomography (SPECT).

Results: in 48% of cases 6-minute walk test increased more than 150%; NYHA class decreased by 2 classes (group 1). In 52% cases 6-minute walk test increased less than 50% and the NYHA class decreased on 1 class or did not change (group 2). Comparison of initial LV condition and clinical effect revealed following conformities. The revascularization effect is limited not to extent of coronary blood flow recovery, but first of all a cardiac muscle condition, the quantitative relation of the functioning myocardium and a focal cardiosclerosis. Thus, critical size to define the favorable forecast of revascularization is perfusion disorder more than a half of LV and kinetics disorder more than a third of cardiac muscle volume. Prevalence of a cardiosclerosis over the functioning myocardium limits clinical effect of a revascularization and growth of a functional reserve.

Conclusion: degree of initial LV myocardium perfusion and movement disorders at patients with severe ischemic heart failure is the key indicator, influencing clinical efficiency of coronary intervention

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