Abstract:

Aim: was to analyze long-term resuts of true lumen reconstruction in complicated aortic dissections type В with help of balloon-expandable stents under intravascular ultrasonic (IVUS) guidance as a preoperative evaluation of anatomy and morphology of lesion.

Materials and methods: 47 patients witn type В aortiс dissections underwent endovascular treatment in our departmert n 20 cases - IVUS was used for irtraoperative anatomy and morphology verification. Complications developed n 16 patients, and true lumen was reconstructed by stent-graft implantation (to cover proximal fenestration) followed by balloon-expandable stents implantation at the level of visceral arteries under IVUS control at every stage. 87,5% of patents were man, mean ago 51 8—16,2 years.

Results: Technical success was 100% True lumen total reconstruction was reached in every case under precise IVUS control. Visceral arteries malperfusion was not observed at hospital period or follow-up. З0-day mortality rate was 6,25% (1 case due to aortic rupture in uncovered part of aorta - 7 days after procedure). All 15 discharged patients survived for 1st year. Mean follow-up period is 3,3±1,6 years. One patient died due to aortobronchial fistula, 1 due to repeated stroke and 1 due to cancer. At CT-scan 2 years after implantation (10 cases) fractures of balloon-expandable stents were observed, without аnу influence on intraluminal size or stenotic lesion. True lumen size stayed stable for 1 year.

Conclusion: true lumen reconstruction under IVUS control seems to be feasible and effective in complicated Type B dissections, even with the use of balloon-expandable stents. The usage of additional intraoperative visualization - intraaortic IVUS is the key point in the development of advanced endovascular methods.

References

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23.    Mossop P.J., McLachlan C.S., Amukotuwa S.A., Nixon I.K. Staged endovascular treatment for complicated type B aortic dissection. Nat Clin Pract Cardiovasc Med. 2005; 2: 316e22.

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Abstract:

The aim of the study was to define the factors, having influence to results of repeated percutaneous coronary interventions (PCI) such as isolated balloon angioplasty (BA) and BA in combination with rotational atherectomy (RA), used for treatment of stenosis inside stented segments of coronary arteries. 133 patients, submitted to repeated PCI due to development of stenosis in the stented coronary segments, were included in the study. Clinical and angiographic data were registered three times: at time of initial stenting, during repeated PCI and after 18 monthes of follow-up. Repeated PCI were done together with intracoronary ultrasonography. Decrease of neointimal volume and degree of balloon hyperinflation had not any influence on clinical end-points. Cross-luminal area of the vessel was the only significant prognostic facor for success of repeated PCI. Borderline value of the area was 4,7 sq.mm. Combined technique of PCI (BA + RA) had advantages over isolated BA only in those cases, when large cross-sectional lumen area must be achieved. Good clinical results of patients with cross-sectional lumen area >4,7 sq.mm, obtained after repeated PCI, give possoibility not to use additional interventions. If sufficient increase of the vessel lumen area can not be achieved, an active approach to therapy of such patients should be used after PCI.

The only significant beneficial prognostic factor for success of repeated PCA of the stenosed stented coronary segments was area of the vessels's lumen. It did not depend on technique of revascularisation. Such factors, as decrease of neointimal volume and degree of balloon hyperinflation, had not influence on frequency of restenosis and clinical end-points. 

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Abstract:

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

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Abstract:

A multicentered study based on retrospective data covered 2012 patients and aimed at ascertaining the eficiency of various methods of treating patients with coronary restenosis after stenting. The average percent of complications after restenosis was about 20% during the period of study (1 1+4 months). The metaregression data analysis showed the positive correlation between the stage of residual stenosis of the stentet segment and the probability of complications. As the residual stenosis decreased at 1%, the frequency of complications diminished at 0,9%. Another factors under analysis did not show any evident influence, although we have registered a tendency towards better outcomes of the recurring operations as the diameter of the vessel increased. The recurring balloon angioplasty in cases of short restenosis and intracoronar radiation in cases of diffused restenotic lesions have proved to be the most effective operations. The indications for implanting the additional stents must be given very carefully, especially in cases of diabetes.

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Abstract:

Current indications for transcatheter aortic valve replacement (TAVR) are limited for inoperable and high risk patients only. Meanwhile, TAVR may be successfully performed in young patients with low risk and with high technical and functional results according to short- and long-term follow-up.

54 patients underwent TAVR, 7 (12,9%) of them were younger than 65. Cause for endovascular procedure was the presence of oncological process in liver/autoimmune hepatitis/liver cirrhosis/severe bronchial asthma/atherosclerotic lesion of major vessels/severe diabetes mellitus. In 3 cases additional visualization method (intracardiac ultrasound examination) was necessary. All patients underwent implantation of CoreValve.

Technical success was 100%. Function of valves was satisfactory. Light near-valve regurgitation was found in 6 cases, valve regurgitation class II was found in 1 case with decrease to class I after treatment.

Intracardiac ultrasound examination is useful to attend successful results in this group of patients. 

References

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Abstract:

Background: There are no randomized trials describing outcomes of multivessel percutaneous coronary interventions (PCI) (in primary anc staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715)

Materials and methods: Six-month outcomes of 89 consecutive patients with STEMI and multivessel coronary artery disease (CAD) (SYNTAX 18.6±7.9 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity; Medtronic) were studied. We used two strategies of multivessel stenting: in primary PCI (MS primary) and multivessel stenting in staged revascularisation (MS staged) (8.5±4.2 days).

Results: We evaluated results in the overall cohort of patients, including two study groups (MS primary and MS staged). During follow-up of 6 months there was no cardiac death in overall group. We observed 3 (3.4%) non-fatal myocardial infarction (MI) due to definite stent thromboses (ST) (1.3% on the number of stents). Target vessel revascularization (TVR) was performed in 2 cases (2.2%). Major adverse cardiac event (MACE) (cardiac death, MI, TVR) was diagnosed in 4.5%.

Conclusions: Resolute Integrity stents in STEMI patients with multivessel CAD are satisfactory safely and effectively as part of the strategy of multivessel stenting in primary PCI and multivessel staged PCI (8.5±4.2 days).

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18.   Тарасов Р. С., Ганюков В. И., Шушпанников П. А. Исходы различных стратегий реваскуляризации у больных инфарктом миокарда с элевацией сегмента ST при многососудистом поражении в зависимости от тяжести поражения коронарного русла по шкале «- SYNTAX». Российский кардиологический журнал. 2013; 100(2):31-32. 

Abstract:

An important clinical challenge the management of patients with pulmonary embolism is to determine prognosis of the treatment generally, and thrombolytic reperfusion therapy as the main component of a specific pathogenetic treatment in particular. This knowledge is necessary to adjust the plan of remedial measures, the intensification of concomitant pharmacotherapy and provide a personalized approach to patients with thromboembolic lesions of the pulmonary circulation

Aim: was to identify reliable predictors of the onset of reperfusion in patients with pulmonary thromboembolism based on methods of radiographic diagnosis.

Materials and Methods: 138 patients (73 women and 65 men) underwent examination. Age of patients ranged from 20 to 80 years (mean age 55±25 years). The first group includes observation of 102 patients admitted to hospital in early stages of disease ( 1 month after onset of symptoms). The second group consisted of 36 patients admitted to the hospital at a later date (from 1.5 to 12 months). In groups we studied predictors of pulmonary reperfusion channel on the basis of direct angiography and multislice computed tomography As a control, a diagnostic method used direct angiography, which has a high sensitivity and specificity in identifying symptoms of pulmonary embolism. Using the method of multiple logistic regression odds ratios were prepared to achieve reperfusion in patients with certain diagnostic symptoms compared with patients who have no signs data in angiography

Results: diagnostic criteria, in presence of which on angio-pulmonography significantly increased the likelihood of reperfusion are «amputation» of segmental branches of the pulmonary artery ( p<0.05, 16,55(6,50-42,09 ) ), intraluminal defects of contrast staining (p < 0.05, 30.56 (8,66-107,84)) and the absence of distal blood flow (p<0,05; 6,16(2,47-15,40)). Signs, significantly reducing chances of achieving reperfusion are tortuosity of segmental branches of the pulmonary artery (p<0,05; 0,03(0,01-0,08)), slowing of contrast branches of the pulmonary artery (p<0,05; 0,11( 0.05-0.25)), and the presence of defects in the near-wall staining (p<0,05; 73,182 (9,606-557,542)).

Conclusions: basing on results of modern beam-diagnostics may reliably predict the likelihood of reperfusion in patients with pulmonary embolism.

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Abstract:

Ventricular septal defect after myocardial infarction (post-MI VSD) is one of the most rare and lethal complication.

We present a case report of patient with recurrent VSD, 7 months after coronary artery bypass graft with cardiosurgical correction of post-MI VSD. Due to the high risk of re-operation, it was decided to perform endovascular closure of VSD.

Despite acceptable stability test, after delivery system disconnection - migration of occluder to left ventricular occurred. All efforts to retrieve device were not successful, due to strong fixation of the device in anterior leaflet chordal tendons of mitral valve (MV). The presence of 12 mm occluder didn't influence on existed MV insufficiency, so the decision to leave this device in place and to implant the bigger one to VSD was made. 14 mm occluder was successfully implanted, with immediate reduction of left-right shunt and normalization of pulmonary artery pressure. Follow-up period is 3 years - patient doesn't have any complaints. Ejection fraction 55%, mitral insufficiency 30% by volume, device is fully endothelialyzed.

Endovascular VSD occlusion can be effectively used in case of post-surgery re-occurence. In cases of migration of endovascular devices, thorough functional analysis should be performed for choosing the best strategy of further actions. In this clinical case the decision to leave the device in LV didn't cause any negative outcomes for the patient.

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Abstract:

Endovascular aortic repair (EVAR) proved to be safe and effective alternative to surgical treatment of abdominal aortic aneurism (AAA). Type II endoleaks development is the most frequent complication after EVAR that increases the rate of reinterventions and it is need to be treated in the case of aneurysm sac growth for rupture prevention. We present long-term results of the first case in our hospital of endovascular type II endoleak treatment. One month after EVAR of big AAA in high-risk patient type II endoleak on computer tomography (CT) was seen. 16 month after patient complained on lumbar and abdominal pain, expansion of endoleak size was seen on CT To prevent aneurysm sac rupture we performed endoleak' embolization with coil and micro-particles with good result during follow up period more than 3 years. Total follow-up period is more than 5 years, all elements of endograft are stable, aneurysm cavity decreased in diameter on 23 mm. Endovascular techniques for AAA treatment and for the treatment of it's possible life-threating complications are effective and safe during long-term follow-up period. 

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