Abstract:

Introduction: coronavirus (COVID) pandemic has caused temporary changes in work algorithms of different hospitals, that have not previously provided care for infectious patients. However, the consequences of COVID go beyond infectious pathology. Widespread use of therapeutic doses of anticoagulants as a necessary treatment option and resistant to treatment, cough as a typical symptom, led to an increase in spontaneous ruptures of epigastric arteries with hematomas of abdominal wall, which was an undesirable complication of the main disease.

Aim: was to demonstrate possibilities of endovascular methods in treatment of patients with spontaneous rupture of epigastric arteries on the background of COVID-19 and anticoagulant therapy.

Material and methods: at joinant infectious hospital, inpatient care was provided to 421 patients with coronavirus infection. At the same time, during treatment 9 patients had hematomas of abdominal wall and two of them had spontaneous rupture of rectus abdominis muscle and branches of inferior epigastric artery were damaged. In this article, we present both observations demonstrating the potential of endovascular surgery in treatment of such lesions in patients with COVID-19. Both patients, on the 6 and 10th day of inpatient treatment (severity of lung involvement was Grade 1 and Grade 2) during intense coughing, noted pain and swelling of anterior abdominal wall, accompanied by clinical and laboratory signs of blood loss. Computed tomography angiography (CT-A) revealed extravasation from small branches of inferior epigastric artery with an extensive hematoma that spread into the retroperitoneal space. In a hybrid operating room, a selective embolization of inferior (in one case, due to the high localization of the hematoma, inferior and superior) epigastric artery with an adhesive composition (N-butyl cyanoacrylate with iodolipol) was performed with successful angiographic and clinical results. Patients were discharged without complications on the 7th and 9th days of the postoperative period.

Conclusion: timely CT-diagnostic of severe bleeding, even in cases with atypical localization, and its management by selective embolization of damaged artery is the basis in treatment of spontaneous (cough-associated) ruptures of rectus abdominis muscle in patients with new coronavirus infection.

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:

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

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

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

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

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

Abstract:

Introduction: it is well known that magnetic resonance imaging (MRI) has superiority above computed tomography (CT) in identification of epileptogenic substrates due to higher resolution of images and the best differentiation between white and gray matter. But in some peculiar cases, CT can be the method of choice.

Aim: was to illustrate the role of CT in presurgical examination in children with drug-resistant focal epilepsy.

Materials and methods: results of CT of 65 patients with focal epilepsy had been analyzed. All patients underwent multimodal presurgical examination with followed antiepileptic surgical operation and morphological analysis.  CT was performed on GE Lightspeed and Philips Ingenity Elite scanners.

Results: in presurgical period, native CT was performed in 11 (16,9%) patients and in 6 patients, structural brain changes responsible for epilepsy were identified. In 13 patients (20%) we’ve used CT angiography for estimation of angio-architectonic environment in the area of potential surgical intervention and in case of suspicion on arteriovenous malformation (AVM). CT on the 1st day of post-operative period was made in 48 (73,8%) of patients, and in 2 cases CT revealed structural changes that influenced further treatment tactics. At the background of exacerbation in 3 patients, repeated CT revealed sings of acute disorders of cerebrospinal fluid cirdulation.

Conclusion: computed tomography can be an effective diagnostic method in examination of patients with epilepsy, especially when verifying bone and vascular (CT-angiography) changes, is used for neuronavigation to control the position of invasive electrodes and exclude post-implantation hemorrhages, and also helps to identify early postoperative complications, thus influencing tactics and outcomes of surgical treatment of epilepsy. In children with focal epilepsy undergoing surgical treatment, computed tomography and magnetic resonance imaging are complementary studies that provide adequate neuroradiological support.

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Abstract:

Chemodectomas are rare, in most cases, benign neoplasms. They originate from the chemoreceptor cells of the carotid glomus in the bifurcation of the carotid artery. Chemodectoma treatment is surgical. Classical removal of the tumor carries a high risk of damage of arteries and nerves. We present a case report of high localization (C1) carotid chemodectoma removal in a hybrid operating room. Tumor was successfully removed after selective embolization of chemodectoma with protection of distal flow of the internal carotid artery. This approach helped to minimize intraoperative blood loss, as well as to shorten time of intervention.

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Abstract:

This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease.

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Abstract:

Introduction: the problem of restenosis prevention and its early detection is very important in patients who underwent coronary intervention with bare-metal stent (BMS) implantation in acute coronary syndrome (ACS). But when is it necessary to perform elective coronary angiography in order not to miss possible restenosis development? This question needs to be answered.

Aim: was to define the correct period to perform elective coronary angiography after bare-metal stent implantation in acute coronary syndrome.

Material and methods: the study included 124 patients who underwent coronary intervention with BMS implantation in ACS, in period of 1-14 months before current admission. All patients included in this study had indications for repeating coronary angiography and were diagnosed hemodynamically relevant in-stent restenosis. No risk factors of restenosis were revealed at these patients.

Results: average time of restenosis detection was 7,9±1,99 months. Average percent of restenosis among all included patients was 68,6±13,1%. We also revealed direct correlation of percent of restenosis with time of restenosis detection (r=0,5785, p <0,05). Correlation between time and percentage of restenosis and stent type or TIMI grade, was also estimated in this study.

Conclusion: according to results of our study, there are good reasons to repeat coronary angiography in 7-9 month after BMS implantation in ACS, even if patients have no risk factors of restenosis.

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Abstract:

Introduction: сarotid chemodectoma is a benign, slowly growing, vascularized tumor that is one of the most common paragangliomas of head and neck. It is localized in the area of anterior surface of neck - in the area of carotid artery bifurcation. Despite the relative knowledge of the disease, surgical treatment of patients with these newgroth is difficult due to development of intraoperative hemorrhagic complications.

Aim: was to assess possibilities of primary embolization in the complex treatment of patients with chemodectoma.

Materials and methods: 70-year-old female patient was examined and treated. She was admitted with complaints on painless, pulsating, gradually progressive newgrowth of neck. After examination, carotid chemodectoma was diagnosed. The first stage was selective embolization of branches of the external carotid artery (ECA) feeding the tumor. Open chemodectomectomy was performed three days after embolization.

Results: analysis of literature sources and our case report showed that the volume of blood loss during an open operation for removal of chemodectoma using previous embolization is insignificant. This aspect also leads to a reduction of time of the intervention.

Conclusions: preoperative chemodectoma embolization significantly reduces the volume of blood loss and reduces the risk of developing other complications.

References

1.     Qaqish N, Gaillard F. Carotid body tumor. 2020.

https://radiopaedia.org/articles/carotid-body-tumour

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Abstract:

Introduction: basilar artery thrombosis (BAT) is the cause of about 1% of ischemic strokes (IS). About 27% of strokes in posterior circulation are associated with BAT. Mortality in BAT without recanalization reaches 85-95%. In 80.7% of patients with BAT at the onset of disease a decrease in level of consciousness is observed, in 34% of them – coma.

Aim: was to show the possibility of performing thrombectomy (TE) in patients with BAT and reduced level of consciousness as the only effective way to prevent death in this pathology.

Materials and methods: two case reports of successful TE from basilar artery in patients with IS and decrease in level of wakefulness to coma, are presented.

Results: article describes two successful cases of TE in patients with angiographically confirmed BAT and decrease in the level of consciousness to moderate coma at the onset of disease. In two presented patients, TE made a complete restoration of BA blood flow. Good clinical outcomes were noted in both patients by 90th day of disease (modified Rankin scale 0-2 points). The Rivermead mobility index at discharge from hospital was 14 points, and the Bartel index by 90th day – complete independence from others in everyday life (from 90 to 100 points), and that once again indicates that TE in BAT is not only a life-saving procedure, but significantly improves functional and clinical outcomes of disease.

Conclusions: basilar artery thrombosis is a life-threatening condition that requires urgent reperfusion therapy as the only effective method of treatment. Endovascular treatment for basilar artery thrombosis should be considered in all patients, regardless the decrease in the level of consciousness at the onset of disease, because thrombectomy is a life-saving procedure.

References 

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https://www.ncbi.nlm.nih.gov/books/NBK532241/

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https://doi.org/10.1016/S1474-4422(18)30233-3

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https://doi.org/10.1159/000486690

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https://doi.org/10.1001/jamaneurol.2020.0156

6.     Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; 15(11): 1138-1147.

https://doi.org/10.1016/S1474-4422(16)30177-6

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https://doi.org/10.1055/s-0040-1722638

8.     Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): 344-418.

https://doi.org/10.1161/STR.0000000000000211

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https://doi.org/10.1148/radiol.2019181924

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https://doi.org/10.1161/JAHA.118.009419

12.   Liu X, Dai Q, Ye R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol. 2020; 19(2): 115-122.

https://doi.org/10.1016/S1474-4422(19)30395-3

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https://doi.org/10.1016/j.ajem.2020.11.055

Abstract:

Introduction: left atrial (LA) volumes measured during different phases of the cardiac cycle can be used for the evaluation of the LA functional properties before and after catheter ablation (CA). Increase of LA ejection fraction (EF) supposed to be early and more sensitive marker of LA reverse remodeling process, than LA volume and can be important for assessing the effectiveness of CA.

Aim: was to estimate volumetric parameters and function of LV before and after cryo- and radiofrequency catheter ablation of pulmonary veins in patients with paroxysmal atrial fibrillation.

Materials and methods: 21 patients with paroxysmal atrial fibrillation (AF) were included in study. All patients underwent multidetector computed tomography (MDCT) of pulmonary veins (PV) and LA before CA and 12±2 months after CA. 3-dimensional images at phases 0%, 40%, 75% of the cardiac cycle were used to assess LA functional properties.

Results: LA maximal volume before CA was increased insignificantly in patients with AF recurrence (124,52±38,22 ml vs. 117,89±23,94 ml, p>0,05). In patients without recurrence after CA, LA volumes decreased slightly (LA max 115,31±20,13 ml, p>0,05, LA min 73,43±14,91 ml, p>0,05), while in patients with recurrence increased (LA max 130,88±25,20 ml, p<0,05, LA min to 94,92±31,75 ml, p<0,05). Global LA ejection fraction was less in patients without recurrence before CA (22,37%±4,69 vs. 31,31%±9,89, p=0,013), but increased significantly after CA, while in patients with recurrence global LA EF was without relevant changes (36,54%±3,27 vs. 28,89%±9,41, p=0,011).

Conclusion: improved left atrial mechanical function was demonstrated in patients without any recurrence after ablation. The anatomic and functional reverse remodeling was not significant in patients with atrial fibrillation recurrence.

References

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6.     Murray MI, Arnold A, Younis M, et al. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clin Res Cardiol. 2018; 107(8): 658-669.

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https://doi.org/10.1046/j.1540-8167.2004.03538.x

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https://doi.org/10.1016/j.amjcard.2013.05.034

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https://doi.org/10.1016/j.hrthm.2004.07.020

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https://doi.org/10.1016/j.ijcard.2011.02.053

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https://doi.org/10.1111/j.1540-8167.2007.01086.x 

Abstract:

Background: prolonged vasospasm of coronary arteries (CA) is quite often cause of myocardial infarction (MI) in young patients. As a rule, it is associated to drug-using, as an example, cocaine that among other things has systemic vasoconstrictive effect.

Material and methods: article describes the development of acute large myocardial infarction with ST elevation in a 50-year-old patient with no risk factors for cardiovascular complications (RF CVC), except for obesity 1 grade. Previously, she was observed with mild bronchial asthma and chronic allergic rhinitis, for which she used a nasal spray with xylometazoline at doses many times higher than the therapeutic ones for a long time. These conditions we consider to be a cause of her persistent coronary spasm, which led to acute coronary insufficiency and myocardial infarction.

Results: coronary angiography revealed multiple subtotal lesions in the basin of left coronary artery (LCA) and acute occlusion of right coronary artery (RCA), which was the source of MI. Patient underwent recanalization of occlusion and balloon angioplasty with partial restoration of blood flow. Intracoronary injection of isosorbide dinitrate led to recovery of arterial lumen in all segment except distal third where stenosis was ment to be atherosclerotic plaque and the the initial trigger of complete RCA obstruction. After stent implantation in the zone of stenosis and several intra-arterial injections of isosorbide dinitrate, RCA lumen was fully restored. During control angiography of left coronary artery basin, spasm was totally treated with full recovery of lumen of all previously defeated arteries.

During hospitalization period, pain did not recur; prolongedrelease oral nitrates (isosorbide mononitr 40 mg) were prescribed to prevent vasospasm. However, less than a 1,5 month, acute coronary syndrome recurred: the cause was a pronounced spasm of circumflex artery (Cx), that was treated by intracoronary injection of nitrates. Subsequently, therapy was changed: instead of nitrates, calcium channels blocking agents were recommended (CCB - felodipine 5 mg per day). During 9 months of observation, the pain did not recur.

Conclusion: this is the first case report of developed myocardial infarction due to an overdose of xylometazoline, described in the literature. It should be kept in mind, that in case of spastic lesions detected with coronary angiography, especially in young patients without risk factors for cardiovascular diseases, carefully obtaining of anamnesis  should be done, and nobody should neglect the intracoronary injection of low doses of nitrates even if blood pressure is low.

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Abstract:

Introduction: carboxyangiography does not come into extensive use nowadays, due to two fundamental reasons: the impossibility of getting an equitable to Iodinated Contrast Agents (ICA) quality of angiographic image without special angiography system software. Besides, labour intensity, continuance, and potential risks of the methodology of «hand-operated» injection of carbon dioxide. Carboxyangiography made by automatic injector CO₂ appears a fundamentally new technique, free from pointed limitations.

Aim: was to inform possibilities and safety of carboxyangiography with automatic injector in different vascular basins.

Materials and methods: article presents data on possibilities and safety of performing carboxyangiography of various vascular basins, based on the analysis of world literature data. Data on indications and contraindications, on  features of this technique are presented. Article also provides clinical examples of such interventions as: revascularization of various peripheral basins (renal arteries, arteries of lower limbs, veins of upper limbs), primary and secondary interventions for abdominal aortic aneurysms (EVAR, diagnostics of endoleaks), formation and disconnection of various fistulas and shunts (TIPS, correction of fistulas and AVMs), interventions for gastrointestinal bleedings, implantation of cava filters, as well as a number of diagnostic procedures.

Conclusions: carboxyangiography with the use of the automatic injector can be performed for diagnostic and treatment endovascular interventions, as well in high operation risk patients with contrast-induced nephropathy (CIN) or/and ICA allergy. In case of use of automatic injector and special angiographic software, image quality is highly competitive with ICA contrast-enhanced imaging.

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Abstract:

Introduction: up to the present day, there were no published multicenter randomized researches, that could compare combined concept of thrombectomy, including different methods of stent-retrievers traction with elements of aspiration and thrombolysis. There is no data on the effect of embolic complications after extraction of thrombus from cerebral arteries on outcomes of treatment.

Aim: was to increase the effectiveness of treatment of patients with ischemic stroke basing on a comparison of results of various methods of endovascular thrombectomy from cerebral vessels and intravenous thrombolysis, and on the base of assessment of effect of distal embolism on treatment outcomes in acute period of ischemic stroke.

Materials and methods: we carried out statistical analysis of results of different methods of thrombectomy in 75 patients and intravenous thrombolysis in 75 patients in acute phase of ischemic stroke. Effect of embolic complications after thrombectomy on outcomes of treatment of ischemic stroke was determined.

Results: groups of patients were comparable in age, neurological deficit, sex, localization and stroke subtype. The first group is burdened by the proportion of documented cerebral artery occlusion, diabetes mellitus and ischemic stroke in anamnesis. Differences in deaths and disability rates were not reliable. Thrombectomy demonstrated neurological deficit regression at all evaluation intervals, as well as the superiority of 2 times at achievement of functionally independent outcome in comparison with intravenous thrombolysis group.

Conclusions: a concept to thrombectomy, that supposes different methods of use of stent-retrievers and aspiration demonstrates better functional outcomes in treatment of ischemic stroke in the acute phase compared with intravenous thrombolysis. Embolic complications of reperfusion treatment adversely affect ischemic stroke outcomes and should be considered as a factor requiring minimization.

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https://doi.org/10.1016/S1474-4422(16)30177-6

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https://doi.org/10.1056/NEJMoa1503780

13.   Muir K, Ford G, Messow C et al. Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. Journal of Neurology, Neurosurgery & Psychiatry. 2016;88(1):38-44.

https://doi.org/10.1136/jnnp-2016-314117

14.   Saver J, Goyal M, Bonafe A et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. New England Journal of Medicine. 2015;372(24):2285-2295.

https://doi.org/10.1056/NEJMoa1415061

15.   McCarthy D, Diaz A, Sheinberg D et al. Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis. The Scientific World Journal. 2019; 2019:1-9.

https://doi.org/10.1155/2019/7403104

16.   Logvinenko RL, Domashenko MA, Frantsevich AM et al. Choice of reperfusion strategy in acute period of ischemic stroke. Journal Diagnostic & interventional radiology. 2018;12(2):77-84 [In Russ].

17.   Semitko SP, Analeev AI, Azarov AV et al. Results of primary endovascular treatment of patients with acute ischemic stroke and high risk or contraindication for thrombolytic therapy. Journal Diagnostic & interventional radiology. 2018;12(4):52-58. [In Russ]

18.   Kang D, Kim B, Heo J et al. Effect of balloon guide catheter utilization on contact aspiration thrombectomy. Journal of Neurosurgery. 2018;1-7.

https://doi.org/10.3171/2018.6.JNS181045

19.   Maegerlein C, Monch S, Boeckh-Behrens T et al. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment. Journal of NeuroInterventional Surgery. 2017;10(8):751-755.

https://doi.org/10.1136/neurintsurg-2017-013558

20.   Goto S, Ohshima T, Ishikawa K et al. A Stent-Retrieving into an Aspiration Catheter with Proximal Balloon (ASAP) Technique: A Technique of Mechanical Thrombectomy. World Neurosurgery. 2018;109:e468-e475.

https://doi.org/10.1016/j.wneu.2017.10.004

21.   Lee D, Sung J, Kim S et al. Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization. Acta Neurochirurgica. 2017;159(9):1671-1677.

https://doi.org/10.1007/s00701-017-3256-3

22.   Stampfl S, Pfaff J, Herweh C et al. Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy. Journal of NeuroInterventional Surgery. 2016;9(4):346-351.

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23.   Maus V, Behme D, Kabbasch C et al. Maximizing First-Pass Complete Reperfusion with SAVE. Clinical Neu-roradiology. 2017;28(3):327-338.

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24.   Jadhav A, Aghaebrahim A, Horev A et al. Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke. Interventional Neurology. 2016;6(1-2):16-24.

https://doi.org/10.1159/000449321

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28.   Volodukhin M.U. Roentengen-endovascular method of cerebral flow restoration in acute tandem occlusion of the internal carotid artery with embolism development in middle cerebral artery. Kazan medical journal. 2016;97(3): 457-460 [In Russ].

https://doi.org/10.17750/KMJ2016-457

29.   Geroulakos G, Ramaswami G, Nicolaides A et al. Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography. British Journal of Surgery. 1993;80(10): 1274-1277.

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30.   Adams H, Bendixen B, Kappelle L et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.

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31.   Logvinenko RL, Kokov LS, Shabunin AV, Arablinskiy AlV, Tsurkan VA. Analysis of a modified method for combined removal of throbus from blood vessels of the brain in the treatment of acute ischemic stroke. REJR. 2020; 10 (1):159-177 [In Russ].

https://doi.org/10.21569/2222-7415-2020-10-1-159-177

32.   Chen C, Parsons M, Levi C, Spratt N, Miteff F, Lin L et al. Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis. Neurology. 2019;93(3):e283-e292.

https://doi.org/10.1212/WNL.0000000000007768

33.   Southerland A, Johnston K. Considering hyperglycemia and thrombolysis in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial. Annals of the New York Academy of Sciences. 2012;1268(1):72-78.

https://doi.org/10.1111/j.1749-6632.2012.06731.x

34.   Lansberg M, Thijs V, Bammer R, Kemp S, Wijman C, Marks M et al. Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke. Stroke. 2007;38(8):2275-2278.

https://doi.org/10.1161/STROKEAHA.106.480475

Abstract:

In recent years, with the growth of number of patients with multifocal atherosclerosis, revascularization of the brain and myocardium through hybrid intervention is gaining popularity. Although, in the world literature there are practically no results of significant randomized researches concerning percutaneous coronary intervention and carotid endarterectomy in hybrid mode, this technique is becoming more and more preferable and promising in comparison with other methods of treatment.

Aim: was to demonstrate results of revascularization of the brain and myocardium with staged and hybrid strategies, on the base of evaluation of advantages and disadvantages of these strategies on the example of case reports.

Materialsand methods: article presents two case reports, demonstrating different approaches to surgical treatment in patients with combined lesions of arteries of the brain and myocardium. Both patients were over 65 years age, at the time of treatment, had a history of acute cerebral circulation disorders, coronary heart disease and arterial hypertension. At the outpatient stage, they received antiplatelet, hypotensive, and hypolipidemic therapy. During further examination, both patients were found to have unilateral hemodynamically significant stenoses of internal carotid arteries and isolated stenoses of coronary arteries. In first case, patient was selected for hybrid surgical tactics in the volume of carotid endarterectomy and stenting of coronary artery, which was performed with a further favorable prognosis. In the second case, tactics was determined in favor of a staged procedure: first performing carotid endarterectomy, then stenting the affected coronary artery. However, taking into account subjective and objective factors, none of planned interventions were performed.

Results: hybrid revascularization allows to perform correction in two arterial of different regions in a short period of time using surgical and endovascular techniques. An important advantage of this method is the one-time performance, that means correction of MFA manifestations for one hospitalization, or even one anesthesia, with increasing in the availability of revascularization. In the first case report, the successful implementation of a hybrid approach in the treatment of combined vascular pathology in an elderly patient with a burdened anamnesis and significant comorbidities was demonstrated. Within one day, we managed to complete the planned volume of myocardial and brain revascularization and avoid the development of adverse events both in the early postoperative and long-term follow-up periods. The second clinical example clearly shows disadvantages of staged strategy, when the patient is at risk of developing adverse cardiovascular events while waiting for staged interventions, or for subjective reasons may refuse to be hospitalized in a clinic for performimg a particular operation, that as a result, led to negative dynamics and fatal outcome due to acute stroke.

Conclusions: thus, demonstrated case reports show significant potential and effectiveness of hybrid myocardial and brain revascularization using percutaneous coronary intervention and carotid endarteectomy in treatment of patients with combined lesions of two vascular regions. This method of treatment is especially promising in patients with burdened anamnesis and additional risk factors. It not only prevents adverse cardiovascular events in brain and myocardium, but also has greatest availability and implementation of the planned volume of treatment, completely excluding the influence of subjective factors (change of tactics, failure of patient to attend the next stage of treatment, etc.).

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Abstract:

Article presents a case report of a 38-year-old patient who was admitted to our hospital with symptoms of acute appendicitis, she was examined and then urgently operated.

Postoperative period was complicated by clinical picture of colonic bleeding. During 1 st day of postoperative period, patient underwent a diagnostic search of bleeding source, conservative hemostatic therapy, transfusion of blood components, however, taking into consideration negative dynamics of patient's condition, laboratory test indicators, the next day, she was urgently operated: lower midline laparotomy, suturing of cecum hematoma, drainage of the abdominal cavity. Eight hours after repeated surgical treatment, against the background of transfusion of blood components, further negative dynamics of patient's condition, laboratory test indicators also worsened, medical concilium decided to perform angiography, followed by a decision on the amount of treatment intraoperatively. Selective angiography of branches of the mesenteric artery was performed, the source of bleeding was diagnosed, and a successful temporary pharmacologic endovascular hemostasis of the branch of the superior mesenteric artery was performed. Post-hemorrhagic anemia in the patient was corrected on the 3rd day after endovascular intervention, 10 days after, patient was discharged in a satisfactory condition.

The choice of the method of endovascular intervention was carried out taking into consideration the ineffective of reoperation, patient's condition, as well as peculiarities of the blood supply to the area of the alleged source of bleeding.

The study also discusses indications and methods of endovascular treatment of colonic bleeding.

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http://doi.org/10.1016/i.gtc.2014.08.013

Abstract:

Aim: was to elucidate factors of poor prognosis for chronic brain ischemia in «asymptomatic» patients with atherosclerotic stenosis of vertebral arteries, who regularly take optimal medical therapy.

Methods: in 1st group (n = 44), secondary prevention of cerebrovascular accidents was carried out in a combined strategy - stenting of vertebral arteries in combination with medication therapy, and in 2nd group (n = 56) - only medication therapy. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: «asymptomatic» patients with stenosis of vertebral arteries 50-95%; diameter of vertebral arteries is not less than 3.0 and not more than 5 mm; presence of cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of chronic brain ischemia (according to E.V. Schmidt). Primary endpoint: total frequency of cardiovascular complications (death, transient ischemic attack or stroke, myocardial infarction).

Results: the total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (? ²=15.101; p<0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to 1st and 2nd groups (? ²=14.784; p<0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of stents was observed in general, in 38.67% of patients from group I. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (? ²=0.1643; p=0.735). Most significant poor prognosis factors of chronic brain ischemia in «asymptomatic» patients with vertebral artery stenosis, who regularly take optimal medical therapy are: arrhythmia, total cholesterol more than 6.0 mmol/l, incomplete circle of Willis, arterial hypertension, bilateral defeat of vertebral arteries, (low-density lipoprotein) LDL levels of more than 3.5 mmol/I, combined lesion of vertebral and carotid arteries, calcification of vertebral arteries, coronary heart disease in anamnesis.

Conclusion: endovascular intervention in combination with medical therapy could help to avoid the development of major brain complications arising from the instability of atherosclerotic plaque in «asymptomatic» patients with vertebral artery stenosis, and in the presence of poor prognosis factors identified can be regarded as a method of secondary prevention of cerebral circulatory disorders.

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Abstract:

Introduction: among patients with ischemic stroke (IS), more than 17% has atrial fibrillation (AF). The active application of aspiration thrombectomy (AT), in addition to thrombolytic therapy (TLT), can significantly improve functional outcome, prognosis and survival of patients with IS. The main method of preventing of IS in patients with nonvalvular AF today is still an anticoagulant therapy, but percutaneous transcatheter occlusion of the left atrium appendage (LAA) can be an alternative method, especially if anticoagulant therapy is contraindicated or ineffective.

Aim: was to demonstrate results of a complex staged treatment of an age-related patient with nonvalvular atrial fibrillation, complicated by the development of cardioembolic ischemic stroke while taking anticoagulants.

Material and methods: a clinical observation of a 81-year-old patient delivered to the hospital with a clinical manifestation of ischemic stroke in the “therapeutic window”, with a history of persistent AF and taking anticoagulants, is presented. After conservative therapy - a regression of neurological symptoms was achieved. Three days after - negative dynamics in the clinical picture with development of aphasia and right-sided hemiplegia. Multispiral computed tomography with contrast (MSCT-A): occlusion of M2 segment of the left middle cerebral artery (MCA). Patient underwent aspiration thrombectomy with complete restoration of blood flow and regression of neurological symptoms. After 2 months from the episode of IS, patient underwent implantation of occlude in the left atrial appendage as a prophylaxis of re-embolism, followed by the abolition of warfarin.

Results: a senile patient returned to normal life and self-care (assessed using the modified Rankin scale 1). During next 13 months patient had no major adverse cardiac events (MACE) or significant bleeding and all that shows that occlusion of LAA is effective.

Conclusions: in the early period of ischemic stroke, isolated aspiration thrombectomy is the operation of choice in patients with atrial fibrillation and contraindication for thrombolytic therapy, and endovascular occlusion of the left atrial appendage can be the method of choice for secondary prevention of ischemic stroke. Further studies are required to assess applicability and reproducibility of the approach we have described in routine clinical practice.

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https://doi.org/10.1016/j.rec.2016.11.033 

Abstract

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

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

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

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Abstract

Aim: was to determine characteristic signs of instability and threatening rupture of abdominal aortic aneurysms, detected by computed tomography (CT) according to analysis of modern literature.

Materials: international clinical recommendations and studies of 36 domestic and foreign authors on the diagnosis of abdominal aortic aneurysms (AAA) using computed tomography (CT) were studied. We studied publications that describe the pathogenetic mechanisms of AAA rupture, structural changes in the aortic wall and surrounding tissues, which can be regarded as signs of the formation of aneurysm rupture.

Conclusion: according to literature, specific CT signs of aortic wall instability and data on the high diagnostic value of some of them are presented. Methodological aspects of the analysis of CT data are described for large aneurysms and complex configurations.

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Abstract:

Aim: was to develop a compleх ultrasound assessment of atherosclerotic plaque instability in correlation with morphological evaluation.

Material and methods: research included 121 patients with stenosis of left/right internal carotic artery (ICA) of 50% and more (due to NASCET scale): 80 men and 41 women, mean age 56,0 years. All patients underwent standart and contrast-enhanced ultrasonic scanning (CEUS), bilateral duplex monitoring of cerebral blood flow with registration of microembolic signals (MES). All patients in period up to 3 days after hospitalization - underwent carotid endarterectomy with histological examination of atheroscleroitc plaque.

Results: analysis of relationship between ultrasound and histological characteristics showed a moderate association between the intensity of contrast agent accumulation and the degree of plaque vascularization (Cramer's V 0,529; p<<0,000;) number of lipofages (Cramer's V 0,569; p<<0,001). There were no significant differences between the degree of plaque vascularization and the degree of plaque stenosis (p<0,05). We revealed significant differences between the number of MES and the intensity of atherosclerotic plaque blood supply (<<0,001).

Discussions: intensive accumulation of contrast agent in a plaque is associated with the process of angiogenesis and inflammation, and contrast-enhanced ultrasound examination of the plaque is promising for assessing its instability and the possible risk of developing cerebral vascular complications. Neovascularization intensity detected by contrast-enhanced ultrasound is associated with the number of detected microparticles in the cerebral blood flow, and does not depend on the degree of stenosis.

Conclusions: method of comprehensive assessment using CEUS and Doppler detection of microembolic particles can be effective in stratifying the risk of possible ischemic stroke in asymptomatic patients, for optimizing indications for surgical treatment of atherosclerotic plaque, and evaluating the effectiveness of lipid-lowering and statin therapy.

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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.

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15.    Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke 2010; 41: 757-64.

16.    Mathur A, Roubin GS, Iyer SS, et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998; 97: 1239-1245.

17.    Nicolaides AN, Kakkos SK, Kyriacou E, Griffi n M, Sabetai M, Thomas DJ, et al. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J Vasc Surg 2010;52:1486-1496.

18.    Obeid T, Arnaoutakis DJ, Arhuidese I, et al. Poststent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting. J Vasc Surg 2015; 62: 616-623.

19.    Aronow HD, Gray WA, Ramee SR, et al. Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients. Circ Cardiovasc Interv 2010; 3: 577-584.

Abstract:

Aim: was to study motor-evacuation and reservoir functions after gastrectomy followed by jejuno- gastroplasty by x-ray method in late-postoperative period.

Material and methods: for the period from 2011 to 2017 inA.VVishnevskyNationalResearchScientificSurgicalCenter, stomach was totally replaced with a segment of the intestine in 154 patients, after gastrectomy - 144, after extirpation of the stomach stump - 8, after resection of the esophagus - in 2 cases. Indications for surgery were gastric cancer in 142 (92.2%) patients, stump cancer and cancer recurrence in esophagojejunoanastomosis - in 8(5,2%), diseases of the operated stomach - in 4(2,6%). There were 94(61,1%) men and 60(38,9%) women. The follow-up period ranged from 6 months up to 5 years, the average value was 17±2.5 months. In different terms of the long-term period, the evaluation of the evacuation (motor) and reservoir (depositing) function of the intestinal graft was carried out by means of a standard x-ray contrast study with per oral barium suspension on an empty stomach. After that, the patient took the whole portion of barium suspension (200 ml) and was examined after 20 minutes, 45, and 2 hours.

Results: evaluation of reservoir capability of the reconstructed upper digestive tract was made according to rate of complete emptying of the jejunal segment and the duodenum.The speed of emptying remained within normal limits at 133(86,3%), did not exceed 20 min. and was considered to be fast - in 21(13,7%) patients. None of patients had a slow evacuation. To assess the motor function of the small intestine in new conditions of digestion, the time of passage of barium suspension through its loops was studied in 56(36,3%) patients in the long-term period, and 13(23,6%) patients revealed accelerated evacuation, and 43(76,4%) evacuation time approached the physiological norm.

Conclusion: X-ray examination carried out in the remote period after gastrectomy, shows that the EGP (esophagogastro plastic) restores the normal anatomical and physiological pathway of fooc promotion in the gastrointestinal tract, and the interpolated segment of the jejunum in combination with the duodenum compensates for the reservoir function of the stomach, creating conditions for portion evacuation of food to the underlying intestine. Thus, motor-evacuation function of the gastrointestinal tract in patients with EGP in the long term is approaching the physiological norm.

References

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2.     Henley FA., Hudson RV. Gastrectomy with replacement. A preliminary communication with an introduction. British Journal of Surgery. 1952; 40(160): 118-128.

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12.   Yang YS. Chen LQ., Yan XX., Liu YL. Preservation versus Non-preservation of the Duodenal Passage Following Total Gastrectomy: A Systematic Review. Journal of Gastrointestinal Surgery. 2013; 17(5): 877-886. DOI: 10.1007/s11605-013-2174-9.

Abstract:

Aim: was to analyze long-term results of carotid endarterectomy (CEA) in patients with unilateral lesion of the internal carotid artery (ICA), the lack of/or insignificant lesion on the contralateral side on statin therapy.

Materials and methods: for the period January 2009-December 2010, 262 CEA performed in 262 patients. Evaluated results of survival rate, stroke and myocardial infarction, condition of carotid arteries, effect of various factors on features of atherosclerotic lesions and effect of statin therapy on these processes.

Results: in late follow-up period - 245(93,5%) survivors. Patients were divided into groups: simvastatin - 60(24,5%) patients, atorvastatin - 134(54,7%) observations, rosuvastatin - 51(20,8%) cases. 14 patients died, data were obtained on the 13, average loss of 6.06%. The frequency of cardiovascular events leading to death is seven cases. Non-fatal stroke of any location - 5(1,9%) observations. The influence of hypertension (p=0,019), smoking (p=0,004), type 2 diabetes (p=0,03), dyslipidemia: hypercholesterolemia (p=0,05), hypertriglyceridemia (p=0,02), low-density lipoprotein (LDL) level is higher than normal (p=0,015), high-density lipoprotein (HDL) is below normal (p = 0,03) and other factors. Lowering cholesterol by 5,9% is marked in the atorvastatin group, maintaining at recommended values throughout the period from the initial selection in the rosuvastatin group (p = 0,0001). LDL cholesterol decreased by 19,1% in the mean value in the atorvastatin group (p = 0,0001), the increase of HDL level of 3,4% in the rosuvastatin group (p=0,02). Achievement of recommended levels of cholesterol was more often observed in the rosuvastatin group at 64,7% compared with simvastatin (p = 0,03). Risk factors influenced the incidence of restenosis ipsilateral side in 3 patients (1,2%). The greatest influence of risk factors was determined in the atorvastatin group (4,1%, p=0,001). Atorvastatin therapy stabilized the wall of the ICA 17,6% more often (p=0,05) and contralateral common carotid artery, leaving it intact at 84,6% (p=0,002) compared with other groups of statins.

Conclusion: the purpose of statin therapy depends on the severity of the atherosclerotic process the characteristics of the lipid profile and the need correction of risk factors. The most effect is provided by the group of synthetic statin above semisynthetic. Atorvastatin therapy is effective with moderate hypercholesterolemia; rosuvastatin prescribed with severe dyslipidemia.

References

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2.      AbuRahma A.F., Srivastava M., Stone P.A. Effects of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis. J Am Coll Surg. 2015;220:481-488.

3.      Sillesen H., Amarenco P., Hennerici M.G., Callahan A., Goldstein L.B., Zivin J. et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008; 39: 3297-3302.

4.      O'Regan C., Wu P., Arora P., Perri D., and Mills E.J. Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am J Med. 2008; 21: 24-33.

5.      Perler B.A. The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007; 20: 252-258.

6.      McGirt M.J., Perler B.A., Brooke B.S., Woodworth G.F., Coon A., Jain S. et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J. Vasc Surg. 2005; 42: 829-836.

7.      Paraskevas K.I., Athyros V.G., Briana D.D., Kakafika A.I., Karagiannis A., and Mikhailidis, D.P. Statins exert multiple beneficial effects on patients undergoing percutaneous revascularization procedures. Curr Drug Targets. 2007; 8: 942-951.

8.      Koh K.K. Effects of statins on vascular wall (vasomotor function, inflammation, and plaque stability). Cardiovasc Res. 2000; 47: 648-657.

9.      Amarenco P., Labreuche J., Lavallee P., and Touboul, P.J. Statins in stroke prevention and carotid atherosclerosis (systematic review and up-to-date meta-analysis). Stroke. 2004; 35: 2902-2909.

10.    Amarenco P. and Labreuche J. Lipid management in the prevention of stroke: review and updated metaanalysis of statins for stroke prevention. Lancet Neurol. 2009; 8: 453-463.

11.    Pokrovsky A.V., Beloyartsev D. F., Talibli O. L. Analysis of long-term results of eversion carotid endarterectomy. Angiology and vascular surgery. 2014; 20 (4): 100-108 [In Russ].

12.    Efthymios D. Avgerinos Rabih A., Abdallah Naddaf, Omar M. El-Shazly, Luke Marone, Michel S. Makaroun. Primary closure after carotid endarterectomy is not inferior to other closure techniques. Presented at the Vascular and Endovascular Surgery Society 2015 Summer Meeting, Chicago, Ill, June 17-20, 2015.

13.    Taylor A.J., Kent S.M., Flaherty P.J., Coyle L.C., Markwood T.T., and Vernalis, M.N. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002; 106: 2055-2060.

14.    Taylor A.J., Sullenberger L.E., and Lee H.Y ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation. 2005; 112: II-179.

15.    Jones P., Davidson M., Stein E. et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR  Trial). Am. J. Cardiol. 2003; 92(2): 152-160.

16.    Crouse J.R. III, Raichlen J.S., Riley W.A. et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007;297:1344-1353.

17.    Radak D., Tanaskovic S., Matic P., et al. Eversion Carotid Endarterectomy - Our Experience After 20 Years of Carotid Surgery and 9897 Carotid Endarterectomy Procedures. Ann. Vasc. Surg. 2012; 26(7): 924-928.

18.    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273: 1421-1428.

19.    Sever P.S., Poulter N.R., Dahlof B. et al. Different Time Course for Prevention of Coronary and Stroke Events by Atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Am J Cardiol. 2005; 96: 39-44.

20.    Paraskevas K.I., Hamilton G., Mikhailidis D.P. Statins: an essential component in the management of carotid artery disease. J Vasc Surg. 2007; 46: 373-386.

Abstract:

The article presents an analysis of the choice of strategy for the treatment of ischemic stroke in the acute period, based on literature review.

Aim: was to develop the concept of effective thromboextraction (TE), based on the evaluation of factors influencing results of reperfusion treatment of ischemic stroke (IS), methods of endovascular restoration of cerebral blood flow

Materials and methods: meta-analysis of 44 sources of domestic and foreign literature is performed. The analysis of factors limiting the effectiveness of various reperfusion approaches and the analysis of modern methods of thrombectomy are performed.

Results: it is established, that SMAT (Solumbra) and PROTECT techniques have an advantage in comparison with aspiration approaches to thrombectomy in reducing the period to full reperfusion; methods with temporary occlusion of the source vessel (BGC) SAVE and PROTECT significantly reduce the risk of stroke spread to new vascular areas of the brain and increase the frequency of successful recanalization.

Conclusion: at present time, the PROTECT is the most effective technique in the frequency of successful recanalization, the degree and speed of achieved reperfusion, as well as in the prevention of distal embolization. Extrapolation of experience and principles from other sections of interventional radiology, development of new methods and strategies of brain reperfusion, depending on the morphology of thromboembolism, its size, localization and extent may contribute to improving results of endovascular treatment of ischemic stroke.

References

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3.      Furlan A., Higashida R., Wechsler L. et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999 Dec; 282(21): 2003-11.

4.      Domashenko M.A., Maksimova M.Yu., GafarovaM.E. i dr. Personifikatsiya podkhodov k reperfuzionnoj terapii ishemicheskogo insul'ta [Personification of approaches to reperfusion therapy of ischemic stroke.] Annaly klinicheskojI experimental'noj nevrologii. 2017; 11(1): 7-13.

5.      Domashenko M.A., Panova K.V., Murtazalieva D.M. i dr. Personifikatsiya tromboliticheskoj terapii patsientov s ishemicheskim insulom [Personification of thrombolytic therapy in patients with ischemic stroke.] Medica mente. 2017; 3(1): 45-48.

6.      Emberson J. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. - 2014; 384(9958): 1929-1935.

7.      Fransen P.S., Berkhemer O.A., Lingsma H.F. et al. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2016 Feb; 73(2): 190-196.

8.      Seet R.C., Rabinstein A.A. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions. Cerebrovasc Dis. 2012; 34: 106-114.

9.      Yaghi S., Eisenberger A., Willey J.Z. Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment. JAMA Neurol. 2014; 71(9): 1181-1185.

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12.    Nikoubashman O., Reich A., Pjontek R. et al. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers. Neuroradiology. 2014; Dec; 56(12): 1087-1096.

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14.    Urbach H. et al. Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type? Neuroradiology 2002; 44: 695-699.

15.    Riedel C.H., Zimmermann P., Jensen-Kondering U. et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011;Jun; 42(6):1775-1777.

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17.    Mori E. et al. Intravenous recombinant tissue plasminogen activator in acute carotid territory stroke. Neurology, 1992; 42: 976-982.

18.    Shamalov N.A. Optimizatsiya reperfusionnoj terapii u patsientov s ishemicheskim insultom. Diss. dokt. med. nauk [Optimization of reperfusion therapy in patients with ischemic stroke. Dr. med. sci. diss.]. Moscow. 2012: 47 [In Russ].

19.    Lansberg M.G. et al. Risk factors of symptomatic intracerebral hemorrhage after tPA therapy for acute stroke. Stroke. - 2007; 38: 2275-2278.

20.    Bracard S., Ducrocq X., Mas J.L., et. al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; Oct; 15(11): 1138-1147.

21.    Powers W.J., Rabinstein A.A., Ackerson T. et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2018 Mar; 49(3): 46 - 99.

22.    Eva A. Mistry, Akshitkumar M. Mistry, Mohammad Obadah Nakawah, Mechanical Thrombectomy Outcomes with and without Intravenous Thrombolysis in Stroke Patients. Stroke. 2017 Sept; 48(9): 2450-2456.

23.    Kaesmacher J., Boeckh-Behrens T., Simon S. et al. Risk of Thrombus Fragmentation during Endovascular Stroke Treatment. AJNR Am J Neuroradiol. 2017 May; 38(5): 991-998.

24.    Nikoubashman O., Reich A., Pjontek R. et al. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers. Neuroradiology. 2014 Dec; 56(12): 1087-1096.

25.    Kang D.H., Park J. Endovascular Stroke Therapy Focused on Stent Retriever Thrombectomy and Direct Clot Aspiration: Historical Review and Modern Application J Korean Neurosurgical Society 2017 May; 60(3): 335-347.

26.    Kang D.H., Hwang YH., Kim YS. et al. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol. 2011 Feb; 32(2): 283 - 287.

27.    Hwang YH., Kang D.H., Kim YW. et al. Outcome of forced-suction thrombectomy in acute intracranial internal carotid occlusion. J Neurointervent Surg. 2013; 5 (Suppl 1): 81-84.

28.    Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointervent Surg. 2014 Apr; 6(3): 231-237.

29.    Lee D.H., Sung J.H., Kim S.U. et al. Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization. Acta Neurochirurgica 2017 Sept; 159(9): 1671-1677.

30.    Kang D.H., Kim YW., Hwang YH. et al. Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation. Stroke. 2013; Dec; 44(12): 3577-3579.

31.    Deshaies EM. Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci. 2013; 20(9): 1303-1305.

32.    Humphries W., Hoit D., Doss V.T. et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 2015; 7(2): 90-94.

33.    Lee J.S., Hong J.M., Lee S.J. et al. The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochir (Wien) 2013; 155(4): 635 - 641.

34.    Jadhav A.P, Aghaebrahim A., Horev A. et. al. Jovina, Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke. Interv Neurol. 2017 Mar; 6(1-2): 16 - 24.

35.    Maegerlein C., Mцnch S., Boeckh-Behrens T. et al. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy - evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg. 2017; 0: 1 - 5.

36.    Maus V., Behme D., Kabbasch C. et al. Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol. 2017 Feb 13. doi: 10.1007/s00062-017-0566-z.

37.    Wiesmann M., Brockmann M.A., Heringer S. et al. Active push deployment technique improves stent/vesselwall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointerv Surg. 2017 Mar; 9(3): 253 - 256.

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39.   Volodyukhin M.U., Novozhilova A.A. Sposob vosstanovleniya krovotoka pri sochetannom tromboze vnutrennej sonnoj I srednej mozgovoj arterij [A method for restoring of blood flow in a combined thrombosis of the internal carotid and middle cerebral artery]. Patent RF №2629046, 2016.

40.    Volodyukhin M.U. Rentgenendovaskulyarnyj metod vosstanovleniya cerebral'nogo krovotoka pri ostroy tandemnoj okklyuzii vnutrennej sonnoj arterii s razvitiem embolii v srednyuyu mozgovuyu arteriyu. [Endovascular method of cerebral blood flow restoration in acute tandem occlusion of the internal carotid artery with embolism development in the middle cerebral artery.] Kazanskij meditsinskijzhurnal. 2016; 97(3): 457-460.

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Abstract:

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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

Abstract:

Aim: was to optimize treatment of patients with acute myocardial infarction without significant stenotic lesions of coronary arteries.

Materials and methods: authors present a clinical case of treatment of patient, who was admitted in few hours from onset of myocardial infarction. At first-stage, patient underwent manual vacuum thrombectomy, and it revealed the absence of significant stenotic lesions of coronary arteries. Patient underwent coronary angiography, left ventriculography, optical-coherence tomography of the infarct-dependent artery

Results: in this clinical case the cause of myocardial infarction in patient without significant stenotic coronary lesions was the presence of intramural fibrecalcific plaque without signs of instability

Conclusions: according to authors, in order to reduce the incidence of re-thrombosis of coronary arteries in patients with myocardial infarction without stenotic lesions of coronary arteries, it is recommended to perform optical-coherence tomography to reveal unstable atherosclerotic plaque; in such cases it may be warranted stenting of coronary artery.

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Abstract:

By authors it is resulted results of application of system for Angojet rheolytic trombectomy in treatment of acute thromboses of the main veins and pulmonary embolism. On the basis of the data received with use rheolytic trombectomy in system vena cava superior and vena cava inferior and pulmonaty artery thrombosis? Authors conclude, that system Jet-9000 is a modern and highly effective method of treatment of venous tromboses of varios localisation and their complications. Authors specify? That tactic of the use of this method can provide as its isolated, and conjaction application with trombolytic therapy, ballon angyoplasty, stenting and others endovascular techniques. Besides rheolytic trombectomy is an alternative at existence contraindications for standard methods of treatment acute venouse thromboses. At the same time, authors emphasize, that in some cases rheolytic thrombectomy can be main method of treatment of patients with venous patology, before considered incurable (a thrombosis vena cava inferior after cavafilter-implantation, massive pulmonary artery thrombosis).

Reference 

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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:

The article presents case report of step-by-step treatment of patient with coronary arteries disease (CAD). Male, 47 yrs in 1996 underwent aorto-coronary bypass with making of 7 bypasses. Due to progression of atherosclerotic disease in postoperative perion patient underwent percutaneous transluminal coronary angioplastics (PTCA). Despite of all procedures new coronary arteries and bypasses defeat appeared and restenosis of previously implanted stents was pointed. Patient was treated in different countries (Israel, Germany Japan, Russia) with different methods, including: drug-eluting stents, angioplasty with the help of excimer laser and rotational atherectomy Application of physical and mechanical isolation of hyperplastic intima (excimer laser, rotational atherectomy) did not give significant decrease of restenosis repeat. Implantation of drug-eluting stents also had no effect. Stent-in-stent implantation in case of drug-eluting stent restenosis led to repeated restenosis in this patient.

Thus, restenosis is a serious problem for interventional cardiologists. Any of available interventional methods provide optimum direct results, and the long-term results are even poorer.

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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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57.   Parshin PJu. Odnomomentnye rentgenjendovaskuljarnye i rekonstruktivnye operacii pri jetazhnyh porazhenijah arterij aorto-podvzdoshnogo i bedrenno-podkolennogo segmentov: Avtoreferat. Dis. kand. med. nauk. [One-stage endovascular and reconstructive surgery for multi leveled arterial disease aorto-iliac and femoral-popliteal segments. PhD sci. diss.]. Moscow. 2004; 105 [In Russ]. 

Abstract:

Arm. In order to improve the quality of severe pelvis fractures' diagnostics, detection of pelvic organs' lesion, preoperative examination and monitoring of treatment, we have made a retrospective analysis of radiological data of 70 patients (46 males, 24 females) aged between 24 and 54 years who were treated in emergency departments of hospital.

Results. The diagnostic efficiency of X-rays for injuries of the pelvis in case of lesions of the acetabulum is less than MDCT (specificity - 70.4%, accuracy - 61.3%, sensitivity - 56.3%). At the same time, traditional X-rays should only be used to diagnose fractures without displacement and for the control of metal after the surgery It is established that multidetector CT is the method of choice and the first stage in the diagnosis of associated injuries and hidden pelvic fractures, and has the best indicators of diagnostic value (specificity - 69% accuracy - 95% predictive of a positive result - 90%).

Conclusion. It was established that radiography is a method of screening and monitoring of treatment in patients with injuries of the pelvic ring and acetabulum, and in the first place during the provision of urgent specialist care. However, existing X-ray examination methods are not sufficiently informative, particularly in the diagnosis of posterior half-ring damage and hip; early and complete radiodiagnostics of pelvic and intrapelvic organs' injures is the leader in terms of examination of patients. A differentiated approach to the assessment of individual semiotic signs of pelvic fractures with MSCT improves informative value not only from the standpoint of initial diagnostics, but also helps to predict possible complications.

References 

1.     Gumanenko E.K., Shapovalov V. M., Dulaev A.K., Dudykin A.V. Sovremennye podhody k lecheniju postradavshih s nestabil'nymi povrezhdenijami tazovogo kol'ca. [Current approaches to the treatment of patients with unstable pelvic ring injuries] Voenno-med. zhurnal. 2003; 4: 17. [In Russ].

2.     Ratnikov V.A. SYNGO-MR-tehnologija: metodika i vozmozhnosti vizualizacii organov brjushnoj polo- sti i taza na vysokopol'nom (1,5 T) magnitnom tomografe «MAGNETOM SYMPHONY» [SYNGO- MR-Technology: methodology and visualization of the abdomen and pelvis in the 1.5 T magnetic tomography «MAGNETOM SYMPHONY»]. ( V.A. Ratnikov, G.E. Trufanov, S.V. Serebrjakova). Materialy Nevskogo radiologicheskogo foruma «Iz buduwego v nastojawee». SPb, 2003; 343 [In Russ].

3.     Balogh Z., Voros E., Suveges G. Stent graft treatment of an external iliac artery injury associated with pelvic fracture. A case report. J. Borne Joint Surg. Am. 2003; 5: 919-922.

4.     Serebrjakova S.V. Spiral'naja komp'juternaja tomografija v diagnostike povrezhdenij vertluzhnoj vpadiny (S.V. Serebrjakova, V. M. Cheremisin, O. F. Pozdnjakova) [Spiral computed tomography in the diagnosis of acetabulum lesions]. Materialy Nevskogo radiologicheskogo foruma «Iz buduwego v nastojawee». SPb, 2003; 113-115 [In Russ].

5.     Djatlov M. M. Luchevaja diagnostika povrezhdenij tazovogo kol'ca v ostrom periode perelomov vert- luzhnoj vpadiny. [Radiological diagnosis of pelvic ring injuries in acute acetabular fractures]. Ortop., travm im Priorova 2003; 3: 72-74 [In Russ].

6.     Miller P. R, Moore P. S., Mansell E., Meredith J. W. С External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by. Clin. Imaging. 2003; 18(4): 533-536.

7.     Loberant N., Goldfeld M. A pitfall in triple contrast CT of penetrating trauma of the flank. Clin. Imaging. 2003; 27(5): 351-352.

8.     Tile M. Fracture of pelvis. The Rationale of operative Fracture Care. Spinger Verlag. 1987: 441.

Abstract:

Pancreatic transcutaneous necrosectomy from postnecrotic cavities can be a mini-invasive methods of treatment. Such method leads to fast sanation of lesions and is objectivelly a good monitoring method of control.

Aim: was to demonstrate possibilities of transcutaneous pancreatic necrosectomy after spread anc infected pancreatic necrosis.

Results: one of the most illustrative cases of successful mini-invasive treatment of spread infected pancreatic necrosis using transcutaneous necrosectomy under combined control (ultrasound, X- ray and endoscopy) is presented

Conclusion: the use of mini-invasive surgical techniques such as percutaneous drainage under combined control is possbile for panreatic necroectomy in patients with spread infected pancreatic necrosis (necrotic parapancreatitis).  

References 

1.    Rossiyskoe obschestvo hirurgov, Assotsiatsiya gepa- topankreatobiliarnyih hirurgov stran SNG, Rossiyskoe obschestvo skoroy meditsinskoy pomoschi. Diagnostika i lechenie ostrogo pankreatita. (Rossiyskie klinic- heskie rekomendatsii) g. Sankt-Peterburg, 2014. (ssyilka:http://xn—9sbdbejx7bdduahou3a5d.xn-- p1ai/stranica-pravlenija/unkr/urgentnaja-abdominalnaja- hirurgija/nacionalnye-klinicheskie-rekomendaci-po-ostromu-pankreatitu.html [In Russ].

2.    KuleznyovaYu. V., MorozO. V., IzrailovR. E., SmirnovE. A., EgorovV. PChreskozhnyievmeshatelstvaprignoyno-nekroticheskih oslozhneniyahpankreonekroza. Annalyi hirurgicheskoy gepatologii. 2015; 2: 90 (ssyilka http://vidar.ru/ Article.asp?an=ASH_2015_2_90) [In Russ].

3.    Ivshin V.G., Ivshin M.V., Malafeev I.V., Yakunin A.Yu., Kremyanskiy M. A., Romanova N. N., Nikitchenko V.V. Originalnyie instrumentyii metodiki chreskozhnogo lecheniya bolnyih pankreonekrozom i rasprostranennyim parapankreatitom. Annalyi hirurgicheskoy pankreatologii. 2014; 19(1): 30-39. [In Russ].

4.    Andreev A. V., Ivshin V. G., Goltsov V. R. Lechenie infitsirovannogo pankreonekroza s pomoschyu miniinvazivnyih vmeshatelstv. Annalyi hirurgicheskoy gepatologii. 2015; 3: 110 (ssyilka http://vidar.ru/Article.asp?an=ASH_2015_ 3_110) [In Russ].

5.    Rogal M.L., Novikov S.V., Gyulasaryan S.G., Kuzmin A.M., Shlyahovskiy I.A., Bayramov R.Sh. Optimizatsiya etapov minimalno invazivnogo chreskozhnogo hirurgicheskogo lecheniya ostrogo pankreatita. Tezisyi s'ezda ROH Rostov- na-Donu. 2015, 1161-1162 [InRuss].

Abstract:

Cardiovascular disease is a leading cause of mortality and morbidity in octogenarian patients. The number of such patients and the number of percutaneous coronary interventions are increasing.

Methods: literature report is based on data, searched in PubMed database, Elibrary, electronic catalog of the Russian State Library, published until January 2017.

Results: review showed reasons why this group of patients refers to high-risk patients. Also, we analyzed modern approaches to the treatment of such patients, significance of PCI, intraoperative factors affecting the outcome of treatment of patients with myocardial infarction.

Conclusion: worse results of PCI in elderly patients in comparison with younger group have multifactorial reasons. Different authors point on higher percent of comorbidity, and previous MI, worse cardiac function, higher iatrogenity Based on received data, we showed clinical problems in these patients, the solution of which would improve results of treatment of this group of challenging patients. 

References

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2.     Predpolozhitel'naja chislennost' naselenija Rossijskoj Federacii do 2030 goda. [Presumptive population of the Russian Federation until 2030]. Statisticheskij bjulleten'. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2016 [In Russ].

3.     Roth, Gregory A. et al. «Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality.» The  New England journal of medicine 372.14(2015):1333-1341. PMC. Web. 9 Jan. 2017.

4.     Zdravoohranenie v Rossii 2015. [Healthcare in Russia 2015]. Statisticheskij sbornik. Federal'naja sluzhba gosudarstvennoj statistiki. M., 2015 [In Russ].

5.     Bogomolov A.N. Retrospektivnyj analiz rezul'tatov koronarnogo stentirovanija u bol'nyh pozhilogo i starcheskogo vozrasta. Dis. kand. med. nauk. [Retrospective analysis of coronary stenting in elderly and very elderly patients. Cand. of Dr. med. sci. diss]. SPb. 2013 [In Russ].

6.     Bauer T., Mollmann H., Weidinger F., Zeymer U., SeabraGomes R., Eberli F., Serruys P, Vahanian A., Silber S., Wijns W., Hochadel M., Nef H.M., Hamm C.W., Marco J., Gitt A.K. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol. 2011; 151:164-169.

7.     Antonsen L., Jensen L.O., Terkelsen C.J., Tilsted H. H., Junker A., Maeng M., Hansen K.N., Lassen J.F., Thuesen L., Thayssen P Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with STsegment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013; 81:912-919.

8.     Daniel I. Bromage, Daniel A. Jones, Krishnaraj S. Rathod. Outcome of 1051 Octogenarian Patients With STSegment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. Journal of the American Heart Association. 2016;5:e003027.

9.     Caretta G., Passamonti E., Pedroni PN., Fadin B.M., Galeazzi G.L., Pirelli S. Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty. Clin Cardiol. 2014; 37:9:523-529.

10.   Spoon D.B., Psaltis PJ., Singh M., et al. Trends in cause of death after percutaneous coronary intervention. Circulation. 2014; 129:1286-1294.

11.   Goch A., Misiewicz P, Rysz J., Banach M. The clinical manifestation of myocardial infarction in elderly patients. Clin Cardiol. 2009; 32:E46-E51

12.   Dangas G.D., Singh H.S. Primary percutaneous coronary intervention in octogenarians: navigate with caution. Heart. 2010; 96:813-814.

13.   Semitko S.P. Metody rentgenjendovaskuljarnoj hirurgii v lechenii ostrogo infarkta miokarda u bol'nyh starshego

Abstract:

It has been described the experience of use of automatic injector Mark V Pro Vis (Medrad) for endovascular interventions in pediatry. The choice of optimal roentgen contrast media for angiography and endovascular interventions is considerated. It has been concluded that contrast enhancement by iopromide and automatic injector Mark V Pro Vis is effective and safety method of visualization of vessels, tumors and other pathology.  

References

1.      Поляев Ю.А., Мыльников А.А. Эндоваскулярная окклюзия в лечении гиперваскулярных образований головы. Практикующий врач. 2003; 1: 38–41.

2.      Поляев Ю.А., Щенев С.В. Опыт лечения некоторых форм ангиодисплазий периферической локализации у детей. Практикующий врач. 2003; 1: 42–45.

3.      Поляев Ю.А., Шимановский Н.Л., Лазарев В.В., Голенищев А.И. Десятилетний опыт использования неионного рентгеноконтрастного средства Ультравист в детской интервенционной радиологии. Детская больница. 2004; 1: 55–60.

4.      Сергеев П.В., Поляев Ю.А., Юдин А.Л., Шимановский Н.Л. Контрастные средства. М: Известия. 2007; 496.

5.      Liss P., Persson P.B., Hansell P., Lagerqvist B. Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int. 2006;. 70: 1811–1817.

6.      Ultravist. Monograph, Schering AG, Berlin, Second edition. 2005; 72.

7.      Misawa M., Sato Y., Hara M. et al. Use of non-ionic contrast medium, iopromide (Proscope-370), in pediatric cardiovascular angiography. Nihion Shoni Hoshasen Gakkai Zasshi. 2000; 2: 42–48.

8.      Liss P., Hansell P., Lagerkvist B. Higher Incidence of Renal Failure in 23 224 Patients Using Iso-osmolar Compared to Low-osmolar Contrast Media during Coronary Interventions in Swedish Hospitals. RSNA, 2008; SSG 08–01.

Abstract:

Purpose. To assess the effectiveness of palliative endovascular interventions in patients with CTO anatomy infavorable for recanalisation.

Material and methods. The authors analyzed the results of interventions in 60 patients (50 male (83,3%), 10 female (16,7%)) aged 38 – 75 years (mean age 53,9±3,2), with occlusive coronary disease. Palliative revascularizations were performed in 30 patients, and CTO recanalization was done in 30 cases. The LV function was assessed echocardiographically in both groups before and after the intervention.

Results. 12 month follow-up showed significant improvement or normalization of LV function in both groups. Results of palliative interventions were shown to be as effective as recanalization of CTO.

Conclusions. Endovascular palliation is effective in treatment of patients with coronary CTO. It results in myocardial function improvement comparable to that in patients with complete coronary revascularization.   

References

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3.        Ганюков В.И., Осиев А.Г. Частные вопросы коронарной ангиопластики. Новосибирск. 2002; 4–23.

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5.        Султан М.В. Реваскуляризация миокарда при остром коронарном синдроме. Авто-реф. дис. канд. мед. наук. М. 2006: 15–20.  

6.        Иоселиани Д.Г., Громов Д.Г., Сухоруков О.Е., Хоткевич Е.Ю., Семитко С.П., Исаева И.В., Верне Ж.-Ш., Арабаджян И.С., Овесян З.Р., Алигишева З.А. Хирургическая и эндоваскулярная реваскуляризация миокарда у больных с многососудистым поражением венечного русла: сравнительный анализ ближайших и среднеотдаленных результатов. Международный журнал интервенционной кардиоангиологии. 2008; 15: 22–31.

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8.        Ott R.A., Tobis J.M., Mills T.C., Allen B.J., Dwyer M.L. ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. Department of Cardiothoracic Surgery, University of California. Irvine Medical Center. 2006.  

9.        Gaudino M., Santarelli P., Bruno P., Piancone F.L., Possati G. Palliative coronary artery surgery in patients with severe noncardiac diseases. Department of Cardiac Surgery, Catholic University. Rome. Italy. 2006.  

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11.      Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12 (16): 41–46.

12.      Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17–37.

13.      Rahimtoola S.H. The hibernating myocardium. Ibid. 1989; 117: 211–221.

Abstract:

Aim: was to show possibilities of endovascular methods of treatment in patients with acute ischemic stroke in endovascular operation-room of cardiovascular surgical department.

Materials and methods: we present two case reports of treatment of patients with acute ischemic stroke, who were admitted to neurological department during first hours from onset.

Patients underwent CT perfusion, CT angiography of cerebral arteries. For blood-flow restoration, patients underwent thrombectomy

Results: thrombectomy from occluded artery was successful in both cases, that leaded to better recovery of neurological status.

Conclusions: wide application of endovascular techniques for restoration of cerebral blood flow in patients with ischemic stroke in the early hours of the onset of the disease, can lead to a more prosperous clinical outcomes, more rapid and complete recovery of the patient. Important is the presence of specialized personnel with appropriate skills and a wide spectrum of endovascular instruments.  

References 

1.    Feigin V.L., Lawes C.M.M., Bennet D.A., Anderson C.A. (Stroke epidemiology: a review of population-based studies of incidence, prevalence, and casefatality in the late 20th century. Lancet Neurol. 2003;2:43-53.

2.    Stulin I.D., Musin R.S., Belousov Ju.B. Insul't s tochki zrenija dokazatel'noj mediciny. [Stroke from viewpoint of evidence-based medicine]. Kachestvennaja klinicheskaja praktika. 2003; 4: 10-18 [In Russ].

3.    Varakin Ju.A. Jepidemiologicheskie aspekty profilaktiki narushenij mozgovogo krovoobrashhenija. [Epidemiological aspects of the stroke prevention]. Nervnye bolezni. 2005; 2: 4-9 [In Russ].

4.    Hripun A.V., Malevannyj M.V. i soavt. Pervyj opyt oblastnogo sosudistogo centra ROKB po jendovaskuljarnomu lecheniju ostorogo narushenija mozgovogo krovoobrashhenija po ishemicheskomu tipu [First Experience of Regional Vascular Center ROKB in Endovascular Treatment of ischemic stroke]. Mezhdunarodnyj zhurnal intentencionnoj kardiologii. 2010; 23: 32-42 [In Russ].

5.    Gusev E.I., Skvorcova V.I., Martynov M.Ju. Vedenie bol'nyh v ostrom periode mozgovogo insul'ta [The treatment of the acute phase of the stroke]. Vrach. 2003; 3: 8-24 [In Russ].

6.    Nakano S., Iseda T., Yoneyama T., et. Al. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombollysis. Stroke. 2002; 33: 2872-2876.

7.    White J., Cates Ch., Cowley M. et. al. Interventional stroke therapy: current state of the art and needs assessment. Catheterization and Cardiovascular Intervention. 2007; DOI 10.1002/ccd: 1-7.

8.    Suzuki S., et al. Access to intra-arterial therapies for acute ischemic stroke: an analysis of the US population. AJNR Am. J. Neuroradiol. 2004; 25: 1802-1806.

9.    Wholey M.H, et.al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167

Abstract:

In clinical practice, ischemic stroke still remains a difficult problem, being in most leading causes of death. Development of new treatments, founding of new therapeutic algorythmes and untiringly technical progress in sphere of instrumental support of operation-room allow to proceed endovascular intervention in group of patients with cardioembolic stroke.

Case report presents successful endovascular treatment of patient from cardio-surgical department of Belgorod Region Clinical Hospital named after St. loasaf, with cardioembolic stroke, onset in preoperative period (before aorto-coronary bypass).

Materials and methods: patient A., 59 years, diagnosis: «Ischemic heart disease. Exertional angina FC II. Post-infarction cardiosclerosis. (AMI in September 2014). Stenosis of coronary arteries according to coronary angiography (CAG), hemodynamically significant. Hypertensive heart disease III st., 2 degree, with the defeat of the heart and blood vessels of the brain, with the achievement of target blood pressure (BP). Diabetes mellitus type 2, the second insulin-depended, stage subcompensation. Risk factor 4. congestive heart failure 2a class, functional class III. Chronic gallstone disease. Chronic calculous cholecystitis without exacerbation». 05.02.15 - onset of ischemic stroke in left hemisphere of brain. Patient urgently underwent: multislice computed tomography (MSCT), MSCT-angiography of main brain arteries, direct angiography of main brain arteries. Survey showed: occlusion of proximal third of left common carotid artery (CCA) with TICI-0 blood flow; left middle cerebral artery (MCA) and anterior cerebral artery (ACA) were filled threw anterior communicating artery (ACoA) from right internal carotid artery (ICA). Patient underwent: recanalization of occlusion, thrombectomy from left CCA, stenting of CCA-ICA segment, selective thrombolythic therapy into left MCA.

Results: «Time-To-Treatment» was 4 hours 15 minutes. Made endovascular treatment leaded to regression of neurological deficit.

Conclusions: the use of endovascular methods in patients with cardioembolic stroke car decrease neurological deficit and increase quality of life of patients in this group.  

References 

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14.  Akhmedov A.D-O. Karotidnaya endarterektomiya u bol’nikh s visokim khirurgicheskim riskom. [Carotid endarterectomy in patients with high operation risk]. Diss. kand.med. Mos

Abstract:

Endovascular interventions became widespread for last decade. The directional atherectomy with a SilwerHawk device is one of such methods of possible vascular restoration. This method has some advantages than balloon angioplasty or stenting.

Aim: Was to evaluate the efficiency of directional atherectomy with a SilwerHawk device with iliac arteries disease and arteries of legs disease.

Materials and methods: We have included nine patients with peripheral arterial disease in our study the endovascular directional atherectomy with a SilwerHawk device (EV-3) was performed in all patients. We used different accesses to the artery and protocols of interventions. In all cases we used distal embolic protection device «Spider» (EV-3).

Results: The immediate results of intervention were evaluated. We developed operation algorithms in different cases of vessel disease. The article describes the technical aspects and nuances of work with SilwerHawk device. The perioperative tactics of treatment are also considered in it.

Conclusion: Endovascular atherectomy is a new and effective method in treatment of patients with different peripheral arteries disease. It provides allows considerably to expand the field of methodics application. 

References 

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