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: 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.

References

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4.     Cortese B, Berti S, Biondi-Zoccai G, et al. Italian Society of Interventional Cardiology. Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. Catheter Cardiovasc Interv. 2014; 83(3): 427-35.

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7.     Goncharov AI, Kokov LS, Likharev AYu. Otsenka effektivnosti stentirovaniya koronarnyh arterij razlichnymi tipami stentov u bol'nyh IBS. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2009; 19: 23-24 [In Russ].

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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http://doi.org/10.25692/ACEN.2018.3.2

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http://doi.org/10.1093/eurhearti/ehz455

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http://doi.org/10.1097/md.0000000000014899

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.

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Abstract:

Aim: was to identify relationship between risk factors (RF) and severity of coronary artery (CA) defeat in patients, hospitalized with acute coronary syndrome (ACS), without the presence of ishemic heart disease (IHD) earlier.

Materials and methods: the research includes 201 patients, who were hospitalized to N.V Sklifosovsky Research Institute of Emergency Medicine from february 2011 to apri 2012 with the diagnosis «ACS». Main criteria of patients selection was the absence of IHD clinics in past. All patients underwent coronarography, obtained data was fixed in data base. At the time of arrival to hospital - risk factors were determined. To identify relationship between RF and CA defeat - statistic analyzes were made: the number of defeated CA (1,2 or 3); severity of CA defeat was measured with Syntax Score (SS) Scale (<22 and >22 points); praesence or absence of acute occlusion of CA of infarction zone.

Results: research consisted of 149 male (74,1%) and 52(25,9%) female, mean age of all patients was 56,6±10,6 yrs. ACS with elevation of ST-segment was diagnosed in 136 (67,7%) of patients. Haemodynamic significant stenosis (HSS) of 1, 2 or 3 CA were found in 56 (27,9%), 61 (30,4%) and 64 (30,8%) respectively In 20 (10%) patients - there was no HSS. Acute thrombotic occlusion (ATO) in myocardial infarction related(MI-related) CA was revealed in 146 (72,6%) of patients. It was noted, tht such RF as arterial hypertention (AH), smoking, low physical activity (LPA), was more spread with increasing numer of defeated CA. Patients with lot of defeated CA, were older, had higher figures of systolic arterial pressure (SAP). After examination and primary analysis, only age and number of RF had independent relation with prevalence of CA defeat. Patients with SS >22 points in comparison with patients <22 points, had higher AP, obesity, diabetes mellitus (DM), and more ofted had lack of fruits and vegetables. Also they were older had higher SAP, more RF. Analysis showed that only AH, DM, and age had independent relation with savere CA defeat (Syntax Score >22 points). Patients with ATO of CA, had higher such RF as smoking, LPA, DM. They also had more RF. After analysis - smoking and LPA were independently connected with ATO.

Conclution: such RF as age, AH, DM, LPA and number of combined RF in patient can have independent relation with volume and prevalence of CA defeat. Smoking and LPA can have relation with ATO, with clinics of ST-elevated ACS and macrofocal MI. Obtained data show necessity of inlarged reseach for a broad understanding og RF in connection with coronary atherosclerosis and thrombosis. All that can increase effectiveness of treatment and prophylaxis of cardiovascular morbidity and mortality.

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