Abstract: Introduction: pathological tortuosity of internal carotid arteries (ICA) is widespread; its frequency in population varies within 18-34%. Currently, there are several approaches for the determination of indications for surgical intervention in pathological ICA tortuosity. The main criteria are hemodynamic changes in the arterial flow and the presence of neurological symptoms, so an informative preoperative examination is an integral part in treatment strategy determination in patients' subsequent treatment. Aim: was to estimate the condition of carotid arteries and substance of the brain in isolated pathological tortuosity and in combination with stenotic lesions, based on results of CT angiography. Materials and methods: we analyzed results of examination and treatment of 70 patients. Ultrasound and CT angiography of brachiocephalic arteries were performed on a Philips iCT 256-slice multislice computed tomograph. During CT angiography, a non-contrast study, arterial and venous phases of contrast enhancement were performed with an intravenous bolus injection of 50.0 ml of isoosmolar iodinated contrast-agent at 4-5 ml/sec. Patients were divided into two groups: patients with isolated pathological carotid tortuosity (28 pts) and patients with a combination of carotid tortuosity and stenotic lesions (42 pts). We assessed the effect of carotid tortuosity on the severity of the brain tissue alterations using statistical analysis. Results: a lesser severity of changes in the substance of the brain was noted in patients in the group with isolated pathological tortuosity of ICA. In 9 cases, we did not detect focal lesions; in 15 cases, small foci of microangiopathy and individual cerebrospinal fluid cysts were noted, in 4 patients, we noted areas and zones of cystic-glial changes. S- and C-shaped deformation became the most frequent variants of tortuosity; the formation of 3 saccular aneurysms (two true and one false) was revealed. Manifestations of ischemic damage of the brain substance in the group of patients with a combination of ICA tortuosity and stenotic lesion were more pronounced. Thus, in 11 cases, zones and areas of cystic-glial changes were determined within the framework of past cerebrovascular accidents; in 20 patients, foci of microangiopathy expressed in varying degrees, as well as individual cerebrospinal fluid cysts, were noted. In 11 cases, no focal lesions were detected in the brain. Statistical processing showed a correlation between the condition of carotid arteries and the presence of focal brain damage - in the group with combination of pathological tortuosity and stenosis of ICA, more pronounced chronic ischemic brain damage was detected (p=0,012). Conclusion: CT-angiography was noted to be highly informative in assessment of condition of carotid arteries and brain substance in patients with isolated pathological tortuosity, as well as in combination with a stenotic lesion of internal carotid arteries. With a combination of pathological tortuosity and a stenosis in internal carotid arteries, data were obtained on a more pronounced damage of the brain substance. According to computed tomography, clinical manifestations of chronic cerebrovascular insufficiency were generally more pronounced compared to changes in the brain substance. However, there was a correlation between the increase in the degree of chronic cerebrovascular insufficiency and the aggravation of the state of the brain substance.
Abstract: Introduction: currently, chemoradiation therapy is widely used as the main method of specific treatment for locally advanced head and neck cancer. Previously it was believed that radiation damage of carotid arteries occurs only several years after treatment. Material and methods: article presents two case reports of internal carotid artery stenosis which arose directly during the course of chemoradiation of head and neck malignant tumors. In the first case, patient K., 54 years old, had laryngeal cancer (stage III: T3N1M0), in the second case, patient M., 40 years old, had tongue cancer (stage I: T1N0M0). Conlusion: article presents angiographically confirmed carotid artery stenosis arisen directly during chemoradiation and in early stages after its completion. The discussion presents data on the incidence of stenosing lesions of carotid arteries, cerebrovascular events among patients undergoing radiation therapy. It is necessary to draw attention of specialists to the problem of early stenosis of carotid arteries during radiation and chemoradiation therapy of head and neck tumors.
Abstract: Introduction: about 200 million people in the world suffer from ischemia of lower limbs. This pathology occupies a large part in the structure of all lesions of the vascular bed. Most patients with lesions of lower limb arteries have critical lower limb ischemia (CLLI), which is characterized by pain at rest and/or trophic lesions of foot. CLLI is the final stage of lower limb vascular bed lesion and is always accompanied by a deterioration in the quality of life, high morbidity and mortality. The only effective way to treat this pathology is revascularization, however, the current lack of clinical data does not allow us to determine the optimal strategy in treatment of this pathology. Aim: was to determine advantages and disadvantages of using various methods of lower limb revascularization. Material and methods: literature data from information aggregators Cyberleninka, Pubmed and MEDLINE on this topic, published in Russian and English for the period from 2010 to 2021, were selected for analysis. Articles written in German and French were included in the study in case of available translation to English. Termins as an inclusion criteria: critical limb ischaemia, ischaemic pain, tissue loss, gangrene, hybrid intervention, open surgical recanalization, endovascular revascularization, claudication, stenosis. Results: it is determined that revascularization by open surgery showed better long-term results, however, it cannot be recommended for patients with severe comorbid diseases and defeat of lower limb and foot arteries, while endovascular revascularization techniques allow the procedure to be performed in almost all patients, regardless of the severity of their somatic status, however, extended multilevel lesions are poorly amenable to this method of treatment, and also have a relatively lower patency in the long-term period. Hybrid interventions combine advantages of both methods, however, they have high requirements for the equipment of the medical institution and the qualifications of the staff. In addition, hybrid methods are also more dangerous for the patient in comparison with revascularization by endovascular methods.
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 1. Bokerija LA, Alekjan BG, Anri M. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov. 3-e izd. Tom. 3. Rentgenojendovaskuljarnaja hirurgija ishemicheskoj bolezni serdca [Guide on endovascular surgery of heart and vessels. 3rd ed. Vol. 3. Endovascular surgery of ischemic heart disease]. Moscow: Bakulev Scientific Center of Cardiovascular Surgery. 2008. 648 pages [In Russ]. 2. Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis. 2016; 8(10): 1150-1162. 3. Ibanez B, James S, Agewall S, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2017; 39(2): 119-177. 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. 5. Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014; 63(24): 2659-73. 6. Agostoni P, Valgimigli M, Biondi-Zoccai GG, et al. Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J. 2006; 151(3): 682-9. 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. References 1. Britov AN, Pozdnyakov YuM, Volkova EG, et al. National guidelines on cardiovascular prevention. Kardio-vaskulyarnaya terapiya i profilaktika. 2011;10(6)2: 1-64 [In Russ]. 2. Suslina ZA, Guglevskaja TS, Maksimova MJu, Morgunov VA. Cerebrovascular accidents: diagnosis, treatment, prevention. Moscow: MEDpress-inform, 2016, 440 [In Russ]. 3. Shchukin IA, Lebedeva AV, Burd GS, et al. Chronic cerebral ischemia: syndromological approaches to therapy. Nevrologiya irevmatologiya. 2015;1:17-24 [In Russ]. 4. Zakharov W, Voznesenskaya TG. Neuropsychiatric Disorders: Diagnostic Tests; podobshch. red. N.N.Yakhno. M.: MEDpress-inform, 2015: 320 [In Russ]. 5. Chechetkin AO, Skrylev SI, Koshheev AJu, et al. Clinical and instrumental assessment of the effectiveness of stenting of the vertebral arteries in the near and remote postoperative periods. Annaly klinicheskoj i jeksperimental'noj nevrologii. 2018;12(3): 13-22 [In Russ]. http://doi.org/10.25692/ACEN.2018.3.2 6. Sermagambetova ZhN, Maksimova MJu, Skrylev SI, et al. Interventional technologies for the prevention of stroke in the vertebral-basilar system. Consilium Medicum. 2017;19(2): 96-103 [In Russ]. 7. Migunova SG. Clinical and epidemiological study of cerebrovascular diseases and a comparative analysis of the effectiveness of treatment of patients with cerebral atherosclerosis: Diss. kand. med. Ekaterinburg, 2018: 145 [In Russ]. 8. Aboyans V, Ricco JB, Bartelink MEL et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vase Endovasc Surg. 2017 Aug 26. http://doi.org/10.1093/eurhearti/ehx095 9. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal. 2020;41:255-323. http://doi.org/10.1093/eurhearti/ehz486 10. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2020;41: 111-188. http://doi.org/10.1093/eurhearti/ehz455 11. Kamchatnov PR, Umarova HJa, Kabanov AA, Abieva NA. The problem of diagnosis and treatment of patients with vertebrobasilar insufficiency. Lechebnoedelo. 2017;3: 68-75 [In Russ]. 12. Kocak B, Korkmazer B, Islak C, et al. Endovascular treatment of extracranial vertebral artery stenosis. World J. 2012;4:391-400. http://doi.org/10.4329/wir.v4.i9.391 13. Markus HS, Larsson SC, Kuker W, et al. VIST Investigators. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischemia Stenting Trial. Neurology. 2017;89(12):1229-1236. http://doi.org/10.1212/WNL.00000000000Q4385 14. Babayan GB, Zorin RA, Pshennikov AS, et al. Predictors of neurological deficiency in hemodynamically significant stenoses of the carotid and vertebral arteries. Nauka molodykh (Eruditio Juvenium). 2019;7(4): 533-540 [In Russ]. http://doi.org/10.23888/HMJ201974533-540 15. Rakhmonov RA, Todzhiddinov ТВ, Isoeva MB, Zuurbekova DP. Total Cardiovascular Risk - A New Approach to Stroke Prediction. Vestnik Avitsenny. 2017;19(4): 471-475. [In Russ]. http://doi.org/10.25005/2074-0581-2017-19-4-471-475 16. Shao JX, Ling YA, Du HP, et al. Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis. M edicine(Baltimore). 2019;98( 13): e14899.
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. References 1. Liapis CD, Bell PR., Mikhailidis D., Sivenius J.et al. ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009 Apr; 37(4 Suppl):1-19. 2. Nicolaides AN, Kakkos SK, Kyriacou E, Griffin M, et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification.Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. J Vasc Surg. 2010 Dec; 52(6):1486-1496.e1-5. 3. Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease ACCF/AHA Pocket Guideline Based on the 2011ASA/ACCF/AHA/AANN/AANS/ACR/CNS/SAIP/SCAI/ SIR/SNIS/SVM/SVS. P 22-23. 4. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis.Circulation. 2002 Mar 5; 105(9):1135-43. 5. Redgrave JN, Lovett JK, Rothwell PM. Histological features of symptomatic carotid plaques in relation to age and smoking: the oxford plaque study. Stroke. 2010; 41:2288-94. 6. Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg. 1988;29:676-681. 7. Kwon HM, Sangiorgi GU, Ritman EL, et al.Enhanced coronary vasa vasorum neovascularization in experimental hypercholesterolemia. J Clin Invest 1998; 101: 15511556. 8. Cosgrove D. Angiogenesis imaging-ultrasound. Br J Radiol 2003; 76:S43-9. 9. Kumamoto M, Nakashima Y, Sueishi K. Intimal neovascularization in human coronary atherosclerosis: its origin and pathophysiological significance. Hum Pathol 1995; 26:450-6. 10. Balahonova T.V., Pogorelova O.A., Tripoten' M.I., Gerasimova V.V., Safiulina A.A., Rogoza A.N. Contrast enhancement during ultrasound examination of blood vessels: atherosclerosis, nonspecific aortoarteritis. Ul'trazvukovaya i funkcional'naya diagnostika 2015; 4: 33-45. [In Russ]. 11. Coli S, Magnoni M, Sangiorgi G, Marrocco-Trischitta M. et al.Contrast-Enhanced Ultrasound imaging of intraplaque neovascularisatopn in carotid arteries. J of the American College of Cardioilogy 2008; 52(3): 345-2. 12. Vicenzini E. Giannoni MF, Puccinelli F. et al. Detection of carotid adventitial vasa vasorum and plaque vascularisation with ultrasound cadence contrast pulsr sequencing technique and echo-contrast agents. Stroke 2007; 38:2841-3. 13. Shah F, Balah P, Weinber M, et al. Contrast-enhanced ultrasound imaging of atherosclerotic plaque neovascularization: a new surrogate marker of atherosclerosis? Vasc Med 2007; 12:291-7. 14. CHechetkin AO, Druina L.D., Possibilities of contrast ultrasound in angioneurology. Annaly klinicheskoj I eksperimental'noj nevrologii 2015; 9(2): 33-40. [In Russ]. 15. Silvestre-Roig C, de Winther MP Atherosclerotic plaque destabilization: mechanisms, models, and therapeutic strategies. Weber C, Daemen MJ, Lutgens E, Soehnlein O. Circ Res. 2014 Jan 3; 114(1):214-26. 16. Ross R. Atherosclerosis is an inflammatory disease. Am Heart J. 1999; 138:S419-20. doi: 10.1016/S0002-8703(99)70266-8. 17. Casadei M, Floreani R, Catalini C, Serra AP, Assanti and P Concif Sonographic characteristics of carotid artery plaques: Implications for follow-up planning? J Ultrasound. 2012 Sep; 15(3): 151-157. 18. Carmeliet P Angiogenesis in health and disease. Nat Med 2003;9;653-52. 19. Moulton K.,Vakili K., Zurakovski D., et al. Inhibition of plaque neovascularizatopn reduces macrophage accumulation and progression of anvanced atherosclerosis. Proc Natl Acad Sci U S A 2003; 100: 4736-41. 20. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation. 2003;108:1772-8. doi: 10.1161/01.CIR.0000087481.55887.C9. 21. Gutstein DE, Fuster V. Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res. 1999; 41:323-33. doi: 10.1016/S0008-6363(98) 00322-8. 22. Petrikov SS, Hamidova LT. About the conference «Emergency care for patients with acute cerebrovascular accident» ZHurnal im. N.V. Sklifosovskogo «Neotlozhnaya medicinskaya pomoshch'». 2015; 1:11-18. [In Russ]. 23. Krylov VV., Dash'yan VG., Lemenyov VL., Dalibaldyan VA., i dr. Surgical treatment of patients with bilateral occlusion-stenotic lesions of brachiocephalic arteries. Nejrohirurgiya.2014; 16-25. [In Russ]. 24. Novikov N.E. Contrast-enhanced ultrasound examinations. History of development and modern possibilities. Russian Electr. J. Radiol. (REJR). 2012; 2 (1): 20-28. [In Russ].
Abstract: A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. References 1. Unger L, Stork T, Bucsics T, et al. The role of TIPS in the management of liver transplant candidates. United Eur. Gastroenterol. J. 2017; 5 (8): 1100-1107. 2. Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N. Engl. J. Med. 2010; 362 (25): 2370-2379. 3. Bacalbasa N, Balescu I, Brasoveanu V. Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction - A Case Report and Literature Review. In Vivo. 2018; 32 (3): 699-702. 4. Degheili J., Chediak A., Dergham M, et al. Pancreaticoduodenal Artery Aneurysm Associated with Celiac Trunk Stenosis: Case Illustration and Literature Review. Hindawi. Case reports in radiology. Volume 2017, Article ID 6989673,7 pages. 5. Uchida H, Sakamoto S, Matsunami M., et al. Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: report of a case. Pediatr. Transplant. 2014; 18 (7): 232-235. 6. Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. Journal of Gastrointestinal Surgery. 2010; 14 (9): 1409-1413. 7. Chiang K, Johnson C, McKusick M, et al. Management of inferior pancreaticoduodenal artery aneurysms: a 4-year, single centre experience. CardioVascular and Interventional Radiology. 1994; 17 (4): 217-221. 8. Koganemaru M, Abe T, Nonoshita M, et al. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography. Diagnostic and Interventional Radiology. 2014; 20 (2): 129-135. 9. Bastante D, Raya M, Rabelo V., et al. Analysis of ischemic cholangiopathy after treatment of arterial thrombosis in liver transplantation in our series. Transplant Proc. 2018; 50 (2): 628-630. 10. Polikarpov AA, Tarazov PG, Granov DA, Polysalov VN. Arterial aneurysm of internal organs: the role of angiography and transcatheter embolization. Regional blood circulation and microcirculation. 2002; 1 (2): 30-36 [In Russ]. 11. Tien Y-W, Kao H-L, Wang H-P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. Journal of Gastroenterology. 2004; 39 (1): 81-85. 12. Granov AM, Granov DA, Zherebcov FK, Polysalov VN, Gerasimova OA et al. Experience of 100 liver transplantation in RSCRST. Herald of surgery I.I. Grekov. 2012; 171 (2): 74-77 [In Russ]. 13. Gautier SV, Moysuk YG, Homyakov SM. Organ donation and transplantation in Russian Federation in 2014. 7-th report of National Register. Russian Journal of Transplantology and Artificial Organs. 2015; 17 (2): 7-22 [In Russ]. 14. Tarazov PG, Granov DA, Polikarpov AA, Generalov MI. Orthotopic liver transplantation: The role of interventional radiology. Herald of transplantology and artificial organs. 2009; 3: 42-50 [In Russ].
Abstract: Background: article presents a case of 11-month-old baby weighing 6,590, with phenomena of circulatory decompensation, and non-standard hybrid intervention using retroperitoneal open access to the infrarenal aorta - stent implantation with the potential for increasing its diameter as the child grows Materials and methods: the patient underwent examination - echocardiography (Echo-CG), multispiral computed tomography (MSCT), angiography Indication for the operation was the restenosis of the distal aortic anastomosis after the stage-by-stage surgical correction of hypoplastic left heart syndrome (Norwood procedure). This tactic was chosen taking into account the extremely high risk of re-surgery, as well as the impossibility of stent implantation with the potential for increasing the diameter through access to the femoral artery (body weight of the child is Results: good early postoperative period, against the background of disaggregant therapy (aspirin 5 mg/kg per day) and antibiotic therapy In control echocardiography (Echo-CG), the systolic pressure gradient in the stent implantation zone is Conclusion: stenting of restenosis in distal aortic anastomosis using retroperitoneal access can be considered as a surgery of choice in specialized centers. References 1. Sakurai T., 2. Pavlichev G.V., Podoksenov A.YU., Krivoshchekov E.V. Obstruction of the aortic artery after 3. Bartram U., Granenfelder J., Van Praagh R. Causes of death after the modified 4. Vitanova K., Cleuziou J., Pabst von Ohain J. et. al. Recoarctation After 5. Thomas P, Doyle M.D., William E. et al.Aortic obstructions in infants and children. Progress in Pediatric Cardiology. 1994; 3(1): 37-44. 6. Rothman A., Galindo A., Evans W.N. et. al. Effectiveness and safety of balloon dilation of native aortic coarctation in premature neonates weighing <or = 7. Atalay A., Pac A., Avci T.et. al. Histopathological evaluation of aortic coarctation after conventional balloon angioplasty in neonates. Cardiol. Young. 2018; 18:1-5. 8. Dijkema E.J., Sieswerda G.T., Takken T.et. al. Longterm results of balloon angioplasty for native coarctation of the aorta in childhood in comparison with surgery. Eur. Cardiothorac. Surg. 2018 1; 53(1): 262-268. 9. Fiore A.C., Ficher L.K., Schwartz T. et. al. Comparison of angioplasty and Surgery for Neonatal Aortic Coarctation. The society of the thoracic surgeons. 2005; 80:1659-65. 10. Shaddy R., Boucek M., Sturtevant J., et.al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation.1993; 87:793-9. 11. Attia I.M., Lababidi Z.A. Transumbilicalballon coarctation angioplasty. Am. Heart. 1988; 166:1623-4. 12. Redington A.N., Booth P, Shore D.F., Rigby M.L., Primary ballon dilatation of coarctation of aorta. A multi-institutional study. Thor. Cardiovasc. Surg. 1994;108:841-51. 13. Richard E.R., Gauvreau K., Moses H., et.al. Coarctation of the Aorta Stent Trial (COAST): Study design and rationale. Am. Heart. 2012; 164 (1): 7-13. 14. Coulson J.D.,Vricella L.A., Alekyan B.G. Аlternative arterial and venous access for catheterization in children and infants. Endovaskulyarnaya hirurgiya. 2016;4: 24-39 [In Russ]. 15. Pursanov M.G., Svobodov A.A., Levchenko E.G. et. al. New Approach for Hybrid Stenting of the Aortic Arch in Low Weight Children. Structural Heart Disease. 2017;(3)5:147-151. 16. Dorfer C., Standhardt H., Gruber A., et. al. Direct Percutaneous Puncture Approach versus Surgical Cutdiwon Technique for Intracranial Neuroendovascular Procedures: Technical Aspects. World Neurosur. 2012; 77(1): 192-200. 17. Chakrabati S., Kenny D., Morgan G. et. al. Balloon expandable stent implantation for native and recurrent coarctation of the aorta - prospective computed tomography assessment of stent integrity, aneurysm formation and stenosis relief. Heart. 2010; 96 (15): 1212-6. 18. 19. Sivanandam, S., Mackey-Bojack S.M., Moller J.H. Pathology of the aortic arch in hypoplastic left heart syndrome: surgical implications. PediatrCardiol. 2011; 32: 189-192. 20. Hammel J.M., Duncan K.F., Danford D.A. et.al. Two- stage biventricular rehabilitation for critical aortic stenosis with severe left ventricular dysfunction. Eur. Cardiothorac. Surg. 2012; 1-6. 21. Alekyan B.G. X-ray endovascular surgery. National Guidelines. M: Litterra. 2017; 1: 247-262 [In Russ]. 22. Feltes T.F., Bacha E., Beekman R.H. et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease. А scientific statement from the Am. Heart Association. Circulation. 2011: 7;123(22): 2607-52.
Abstract: Introduction: for assessment of the significance of coronary artery stenosis, it is necessary to determine the minimum area of the residual square of the vessel lumen (VLRS) that can provide adequate blood flow to myocardial needs. This value is called «threshold» or «borderline». Numerous studies on this issue using modern intravascular and isotope techniques, randomized clinical trials have shown that the values of the «borderline» value of VLRS for proximal coronary arteries are within 3-4 mml. According to the literature, the angiographic method for assessing the severity of stenosis is not sufficiently informative and unreliable. In this article, a combination of coronary angiography with use of balloon catheter is proposed, that allows to eliminate disadvantages of the angiographic method in solving the task is shown. Aim: was to investigate possibilities of the method of determining the VLRS of coronary artery (CA) in the stenosis region and to assess its hemodynamic significance based on coronary angiography (CG) using a balloon catheter Materials and methods: the essence of the proposed approach is the obstruction of the artery at the site of stenosis with a balloon catheter with a known cross-sectional area; the VLRS value in this case is equal to or smaller than the area of the balloon catheter. In case of obstruction of the artery by balloon catheter with a transverse area up to 4 mm2, stenosis was considered to be hemodynamically significant and revascularization was recommended; with preserved intensive blood flow, stenosis is considered hemodynamically insignificant. Results: angiogram evaluation was performed in 120 patients with IHD with «intermediate» stenoses of proximal coronary arteries (from 40 to 70%) using the described technique. In 84% of cases, VLRS was estimated at 3,14 mm2 or less; in 8% of the VLRL was 3,86 mm2 or less. In such areas of coronary arteries, stenosis was considered hemodynamically significant. These patients underwent revascularization of the myocardium - balloon angioplasty and stenting of the coronary artery In 8% of cases, VLRS was more than 4 mm2, coronary stenosis in such cases was recognized as hemodynamically insignificant, and endovascular treatment was not performed in these patients. Conclusion: the proposed approach for assessment of the area of the residual square of coronary artery lumen at the site of constriction provides an opportunity for an optimal choice of treatment tactics. References 1. Shaw L.J., Berman D.S., Maron D.J., Mancini G.B., Hayes S.W., Hartigan PM. et al. Optimal medical therapy with or without percutantous coronary intervention to reduce ischemic burden: result from the Clinical Outcomes Revascularization and Aggressive Drug Evalution (COURAGE) trial nuclear study. Circulation. 2008; 117 (10): 1283-1291. 2. Shaw L.J., Iskandrian A.E. Prognostic value of gated myocardial perfusion SPECT. J. Nucl. Cardiol. 2004; 11(2): 171-85. 3. Tobis J., Azarbal B., Slavin L. Assessment of intermediate sеverity coronary lesion in the cateterisation laboratory. J. Am. Coll. Cardiol. 2007; 49(8): 839-848. 4. Ivanov V.A., Belyakin S.A., Vityazev S.P. i dr. Algoritm prinyatiya resheniya pri vyyavlenii pogranichnyx porazhenij koronarnogo rusla [Decision-making algorithm for patients with intermittent coronary artery lesions .] . Diagnosticheskaya i intervencionnaya radiobgiya. 2013; 7(3): 109-112 [In Russ]. 5. Bech G.J., De Bruyne B., Pijls N.H., de Muinck E.D., Hoorntje J.C., Escaned J. et al. Fractional flow reserve to determine the appropriateeness if angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001; 103(24): 2928-2934. 6. Pijls N.H., van Schaardenburgh P, Manoharan G., Boersma E., Bech J.W., van't Veer M. et al. Percutaneus coronary intervention of functionally nonsignificant stenosis. 5-year follow-up of the DEFER study. J. Am. College of Cardiology. 2007; 49(21): 2105-2111. 7. Iskander S., Iskandrian A.E. Risk assessment using single - photon emission computed tomografic technetium - 99m sestamibi imaging. J. Am. College of Cardiology. 1998; 32(1): 57-62. 8. Abizaid A., Mintz G.S., Pichard A.D., Kent K.M., Satler L.F., Walsh C.L. et al. Clinical, intravascular ultrasound, and quantitative angiographic determinants of the coronary flow reserve befom and after percutaneous transluminal coronary angioplasty. Am. J. Carliology. 1998; 82(4):423-842. 9. Abizaid A.S., Mintz G.S., Mehran R., Abizaid A., Lansky A.J., Pichard A.D. et al. Long-term follow-up after percutaneous transluminal coronary angioplasty was not performed based on intravascular ultrasound findings: importance of lumen dimensions. Circulation. 1999; 100 (3):256-261. 10. Toshihiko Nishioka et al., Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity. Cоmparison with stress myocarlial perfusion imaging. JAAC 1999; 33:1870-1878. 11. Ben-Dor I., Torguson R., Gaglia M.A. Jr., Gonzalez M.A., Maluenda G., Bui A.B. et al. Correlation between fractional flow reserve and intravascular ultrasound lumen area in intermediate coronary artery stenosis. Eurointervention. 2011; 7(2):225-233. 12. Pijls N.H., De Bruyne B., Peels K., Van Der Voort PH., Bonnier H.J., Bartunek J. et al. Measurement of fractional flow reserve to assess the functional severity of coronary - artery stenoses. N. Engl. J. Med. 1996; 334 (26):1703-1708. 13. Pijls N.H.,Van Gelder B.,Van der Voort P,Peels K.,Bracke F.A.,Bonnier H.J. et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995; 92 (11): 3183-3193. 14. Bech G.J., Pijls N.H., De Bruyne B., Peels K.H., Michels H.R., Bonnier H.J. et al. Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation. 1999; 99(7):883-888. 15. Lachance P, Dery J.P, Rodes-Cabau J., Potvin J.M., Barbeau G., Bertrand O.F. et al. Impact of fractional flow reserve measurement on the clinical management of patients with coronary artery disease evaluated with noninvasive stress tests prior to cardiac catheterization. Cardiovasc. Revasc. Med. 2008; 9 (4):229-234. 16. Guagliumi G., Sirbu V., Petroff C., Capodanno D., Musumeci G., Yamamoto H. et al. Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow. EuroIntervention. 2013; 8(10): 1172-1181. 17. Ozaki Y, Violaris A.G., Kobayashi T., Keane D., Camenzind E., Di Mario C. et al. Comparison of coronary luminal quantification obtained from intracoronary ultrasound and both geometric and videodensitometric quantitative angiography before and after balloon angioplasty and directional atherectomy. Circulation. 1997; 96(2): 491-499. 18. Nissen S.E., Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical application. Circulation. 2001; 103(4):604-616. 19. Ma YF., Fam J.M., Zhang B.C. Critical analysis of the correlation between optical coherence tomography versus intravascular ultrasound and fractional flow reserve in the management of intermediate coronary artery lesion. Int. J. Clin. Exp. Med. 2015; 8(5):6658-6667. 20. Waksman R, Legutko J, Singh J et al. Fractional Flow Reserve and intravascular Ultrasound Relationship Study. J. Am. Coll. Cardiol. 2013; 61:917-923. 21. Ivanov V.A., Movsesyants M. Yu., Trunin I. V. Vnutrisosudstye metody issledovaniya v intervencionnoj kardiologii [Intravascular methods of investigation in interventional cardiology.]. M., GEOTAR-Media. 2008: с. 212. [In Russ]. 22. СЫ M., Zhu D., Guo L.J. et al. Usefulness of lumen area parameters determined by intravascular ultrasound to predict functional significance of intermediate coronary artery stenosis. Chin. Med. J. (Engl) 2013; 126: 1606-1611. 23. Hanekamp C.E., Koolen J.J., Pijls N.H., Michels H. R., Bonnier H.J. Comparison of quantitative coronary angiography, intravascular ultrasound, and coronary pressure measurement to assess optimum stent deployment. Circulation. 1999; 99 (8): 1015-1021. 24. Voros S., Rinehart S., Vazquez-Figueroa J.G., Kalynych A., Karmpaliotis D., Qian Z. et al. Prospective, head-to-head comparison of quantitative coronary angiography, quantitative computed tomography angiography, and intravascular ultrasound for the prediction of hemodynamic significance in intermediate and severe lesions, using fractional flow reserve as reference standard (from the ATLANTA I and II Study). Am. J. Cardiol. 2014; 113 (1): 23-29. 25. Pijls N.H., Fearon W.F., Tonino P.A., Siebert U., Ikeno F., Bornschein B. et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J. Am. Coll. Cardiol. 2010; 56 (3):177-84. 26. Waller B.F. The eccentric coronary atherosclerotic plaque: morphologic observations and clinical relevance. Clin. Cardiol. 1989; 12(1):14-20.
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. References 1. Bauters С, Banos J.L., Van BelleE., McFadden E., Lablanche J.M., Bertrand M. Six months outcome after successful repeat percutaneous intervention for in stent restenosis. Circulation.1998; 97: 318-321. 2. Elchaninof H., Koning R., Tron C, Gupta V, Cribier A. Balloon angioplasty for the treatment of coronary in stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate. J. Am. Coll. Cardiology .1998; 32:980-984. 3. Reimers В., Moussa I., Akiyama T. et al. long term clinical follow-up after successful repeat percutaneous intervention for stent restenosis. J. Am. Coll. Cardiology.1997; 30: 186-192. 4. Sharma S., Kini A., Garapati A. et al. Randomized trial of rotational atherectomy vs balloon angioplasty for in stent restenosis (Abstr.). Circulation.1998; 98 (1): 511. 5. Yokoi H., Kimura Т., Nakagawa Y, Nosaka H., Nouyoshi M. Long term clinical and quantitative angiographic follow-up after the Palmaz-Schatz stent restenosis. / Am. Coll. Cardiology.1993; 76: 618-622. 6. Mehran R., Dangas G., Mintz G. et al. In stent restenosis: «the great equalizer». Disappointing clinical outcomes with all interventional strategies (Abstr.). J. Am. Coll. Cardiology. 1999; 33: 1129-1191. 7. Mehran R., Mintz G.S., Popma JJ. et al. Mechanisms and results of balloon angioplasty for the treatment of in stent restenosis. Am. J. Cardiology. 1996; 78; 618-622. 8. Schiele E, Vuillemenot A., Meneveau N., Pales-Espinosa D., Gupta S., Bassand J.P. Effects of increasing balloon pressure on mechanism and results of balloon an gioplasty for treatment of restenosis after Palmaz-Schatz stent implantation. An angiographic and intra vascular ultrasound study. Cathet. Cardiovasc. Diagn. 1999; 46 (4): 3321. 9. Goldberg S.L., Berger P.B., Cohen DJ. et al. balloon angioplasty versus rotational atherectomy for in stent restenosis (abstr.). Circulation. 1998; 98 (1): 363. 10. Mehran R., Mintz G., Satler L. et al. Treatment of in stent restenosis with eximer laser coronary angioplasty. Mechanism and results compared to PTCA alone. Cir culation. 1997; 96: 2183-2189. 11. Dauerman H., Bairn D., Cutlip E. et al Mechanical debulking versus balloon angioplasty for the treatment of diffuse in stent restenosis. Am.]. Cardiol. 1998; 82: 277-284. 12. Lee S., Whan C, Cheong S. et al. Immediate and long term outcomes of rotational atherectomy versus balloon angioplasty alone for treatment of diffuse in stent restenosis. Am. J. Cardiology.1998; 82: 140-143. 13. Mahdi N.A., Pathan A.Z., Harrel L. et al. Directional atherectomy for the treatment of Palmaz-Schatz in stent restenosis. Am.]. Cardiology. 1998; 82: 1345-1351. 14. Kini A., Sharma S.K., Dangas G., Vidhun R., Duvvuri S. Marmur J. Predictors of restenosis after rotational at herectomy for in-stent restenosis (abstr.). Circulation.1998; 98 {!): 111. 15. Vom Dahl J., Radke P., Haage P. et al. Clinical and an giographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in stent restenosis. Am. J. Cardiology.1999; 833: 862-867. 16. Schiele E, Meneveau N., Vuillemenot A. et al. Impact of intravascular ultrasound guidance in stent deployment on 6 month restenosis rate. J. Am. Coll. Cardiology. 1998; 32: 320-328.
Abstract: The research covered the results of the endovascular surgical operations in 81 patients with CHD aged 36-76 with bifurcational stenoses of coronary arteries. The peculiarity of the method was the primary delivery of the guides for balloon catheters behind the stenosis area in the "main" and side branches of the left coronary artery. This was prophylaxis of the side artery occlusion after implantation of the "Cypher select" stent into the "main" branch. During the post-operational period (after 6-8 months) 69 patients have passed the examination including coronaroventriculography. The results of the endovascular surgical treatment were successful, no deaths or myocardial infarctions were registered. According to coronarography data, hemodynamically significant stenosis in the stent lumen was observed in 1,2 % cases. References 1. Puel J., Joffre E, Rousseau H. et al. Endoprostheses coronariennes autoexpansives dans le prevention das restenoses apres angioplastie transluminele. Arch. Mai. Coeur, 1987; 8: 1311 - 1312. 2. Serruys P.W, De Jaegere P.P.T., Kiemeneij E et al. Comparison of Balloon-expandabie stent implantation with balloon angioplasty in patients with coronary artery disease. N. Engl. J. Med., 1994; 331, 489 - 495. 3. Kastrati A., Dirschinger J., Boekstegers P. et al. Influens of stent design on 1 year outcome after coronary stent placement: A randomized comparisone of five stent types in 1147 unselected patients. Caih. Cardiovasc. Interv., 2000; July, 50(03): 290 - 297. 4. Reimers В., Colombo A., Tobis J. Bifurcation lesions. In: 5. Schofer J., Schluter M., Gershlick A.H. et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomized controlled trial (E-SIRIUS). Lancet, 2003; 362: 1093 - 1099. 6. Colombo A., Moses J.W, Morice M.C. et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation, 2004; 109: 1244- 1249. 7. Ge L., Tsagalou E., Iakovou I. et al. In-Hospital and Nine- Month Outcome of Treatment of Coronary Bifurcational Lesions With Sirolimus-Eluting Stent. Am. ]. CardwL, 2005; 95: 757 - 760.
Abstract: A multicentered study based on retrospective data covered 2012 patients and aimed at ascertaining the eficiency of various methods of treating patients with coronary restenosis after stenting. The average percent of complications after restenosis was about 20% during the period of study (1 1+4 months). The metaregression data analysis showed the positive correlation between the stage of residual stenosis of the stentet segment and the probability of complications. As the residual stenosis decreased at 1%, the frequency of complications diminished at 0,9%. Another factors under analysis did not show any evident influence, although we have registered a tendency towards better outcomes of the recurring operations as the diameter of the vessel increased. The recurring balloon angioplasty in cases of short restenosis and intracoronar radiation in cases of diffused restenotic lesions have proved to be the most effective operations. The indications for implanting the additional stents must be given very carefully, especially in cases of diabetes. References 1. Fischman D.L., Leon M.D., Baim D.S., et al. A randomized comparison of coronary stent placement and balloon angioplasty in treatment of coronary artery disease. N. Engl. J. Med. 1994; 331: 496 - 501. 2. Serruys P.W, de Jaeger P., Kimeneij E, et al. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary heart disease. N. Engl]. Med. 1994; 331: 489 - 495. 3. Di Mario C, Marsico E, Adamian M. et al. New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima? Heart. 2000; 84: 471 - 475. 4. Hoffmann R., Mintz G. S. Coronary in-stent restenosis-predictors, treatment and prevention. Eur. Heart J. 2000; 21: 1739- 1749. 5. Leon M.B., Tierstein P.S., Moses J.W et al. Localized intracoronary gamma-radiation therapy to inhibit the occurrence of restenosis after stenting. N. Egl. J. Med. 2001; 344: 250-256. 6. Waksman R., White R.L., Chan R.C., et al. Intracoronary gamma-radiation therapy after angioplasty inhibits reccurence in patients with in-stent restenosis. Circulation. 2000; 101: 2165 - 2171. 7. Sousa J. E., Costa M.A., Abizaid A., et al. Lack of neoitimal proliferation after implantation of sirolimus-coated stents in human coronary arteries: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2001; 10: 192 - 195. 8. Kuntz R.E., Gibson СМ., Nobuyoshi M., et al. Generalized model of restenosis after conventional balloon angioplasty, stenting and directional atherectomy. J. Am. Coll. Cardiology. 1993; 21: 15 - 25.
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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. References 1. Andres, Vicente & Wessely,Rainer (2009, January 15). In-stent restenosis: Molecular mechanisms and therapeutic principles. SciTopics. Retrieved March 9, 2011, from http://www.scitopics.com/ In_stent_restenosis_Molecular_mechanisms_ and_therapeutic_principles.html. 2. Sigwart U., Puel J., Mirkovitch V. et al. Intravascular stents to prevent occlusion and restenosis after transluminal angio-plasty. N. Engl. J. Med. 1987; 316: 701-6. 3. Fischman D.L., Leon M.D., Baim D.S. et al. for the Stent Restenosis Study Investigators. A randomized comparison of coronary-stent placement and balloon angioplasty in treat-ment of coronary artery disease. N. Engl. J. Med. 1994; 331: 496-501. 4. Till F.V., Aliabadi D., Kinn J.W., Kaplan B.M., Benzuly K.H., Safian R.D. Real life stenting: a comparison of target vessel revascularization in Benestent-Stress lesions to non Benestent-Stress lesions. Circulation. 1996; 94: I-332. 5. Fenton S.H., Fischman D.L., Savage M.P. et al. Long-term angiographic and clinical outcome after implantation of balloon expandable stents in aortocoronary saphenous vein grafts. Am. J. Cardiol. 1994; 74: 1187-91. 6. Serruys P.W., de Jaeger P., Kiemeneij F. et al. for the Benestent Study Group. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary heart disease. N. Engl. J. Med. 1994; 331: 489-95. 7. Hoffmann R. and Mintz G. S. Coronary in-stent restenosis - predictors, treatment and prevention. European Heart Journal. 2000; 21: 1739-1749. 8. Vom Dahl J., Dietz U., Haager P.K. et al. Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the Angioplasty versus Rotational Atherectomy for Treatment of Diffuse In-Stent Restenosis Trial (ARTIST). Circulation. 2002; 105:583-588 9. Waksman R., Cheneau E., Ajani A.E. et al. Intracoronary radiation therapy improves the clinical and angiographic outcomes of diffuse in-stent restenotic lesions: results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies. Circulation. 2003; 107:1744-1749. 10. Radke P.W., Kobella S., Kaiser A. et al. Treatment of in-stent restenosis using a paclitaxel-eluting stent: acute results and long-term follow-up of a matched-pair comparison with intracoronary beta-radiation therapy. Eur. Heart J. 2004; 25:920-925. 11. Lemos P.A., Hoye A., Goedhart D. et al. Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex patients: an evaluation from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) study. Circulation. 2004; 109:1366-1370. 12. Scott N.A., Cipolla G.D., Ross C.E. et al. Identification of a potential role for the adventitia in vascular lesion formation after balloon overstretch injury of porcine coronary arteries. Circulation. 1996; 93: 2178-87. 13. Axel D.I., Kunert W., Goggelmann C. et al. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation. 1997; 96:636-645. 14. Scheller B., Speck U., Romeike B. et al. Contrast media as carriers for local drug delivery: successful inhibition of neointimal proliferation in the porcine coronary stent model. Eur. Heart J. 2003; 24:1462-1467 15. Scheller B., 16. Osiev A.G., Mironenko S.P., Krestyaninov O.V., Vereshagin M.A., Kretov E.I., Biryukov A.V., Grankin D.S., Prokopenko R.N. Clinical and angiographic efficacy of the coated balloon catheters in patients with restenosis of the coronary stents. Pathology of blood circulation and heart surgery. 2010; 4: 29-35 [In Russ].
Abstract: Renal artery stenosis is a common condition that can cause renovascular hypertension or ischemic nephropathy. Endovascular treatment for atherosclerotic renal artery stenosis is performed frequently and its usage has rapidly increased during the last few years. However clinical benefit of renal artery stenting is questionable. Many researchers suppose that clinical outcomes after renal artery stenting may be improved. Several potential ways to this improvement is discussed: the evaluation of hemodinamical parameters of the stenosis, viability of the renal tissue, prophylactic of the atheroembolisation and restenosis. This article reviews the recent data concerning perspective trends in endovascular procedures on renal arteries that can improve long-term clinical outcomes after renal artery stenting. References 1. Wheatley K., Phil D., Ives N. Revascularization versus medical therapy for renal-artery stenosis. N. Engl. J. Med. 2009; 36: 1953 - 62. 2. Textor S. Despite results from ASTRAL, jury still out on stenting for atherosclerotic renal artery stenosis. Nephrology. Times .2010; 3: 2-7. 3. Kapoor N., Fahsah I., Karim R et al. Physiological assessment of renal artery stenosis: comparisons of resting with hyperemic renal pressure measurements. Catheter. Cardiovasc. Interv. 2010; 76(5): 726-32. 4. Rundback J.H., Sacks D., Kent K.C., et al. Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation. 2002; 106: 1572-1585. 5. Jones N., Bates E., Chetcuti S. Usefulness of tran- slesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease. Catheter. Cardiovasc. Interv. 2006; 68(3): 429-34. 6. Mitchell J., Subramanian R., White C. et al. Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: renal fractional flow reserve. Catheter. Cardiovasc. Interv. 2007; 69(5):685-9. 7. Kadziela J., Witkowski A., Januszewicz A. Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography. BloodPress. 2011; 20(4): 211-7. 8. Drieghe B., Madaric J., Sarno G. et al. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. European. Heart. Journal. 2007; 29 (4): 517-24. 9. Subramanian R., White C.J., Rosenfield K. et al. Renal fractional flow reserve: a hemodynamic evaluation of moderate renal artery stenoses. Catheter. Cardiovasc. Interv. 2005; 64: 480-486. 10. Leesar M., Varma J., Shapira A. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J. Am. Coll. Cardiol. 2009; 53(25): 2363-71. 11. Radermacher J., Chavan A., Bleck J. et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N. Engl. J. Med. 2001; 344: 410-417. 12. Doi Y., Iwashima Y., Yoshihara F. Et al. Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension. 2012; Jul 23. Epub ahead of print. 13. Zeller T., Ulrich F., Mflller C., Bbrgelin K., Sinn L. Angioplasty of severe atherosclerotic ostial renal artery stenosis: predictors of improved renal function after percutaneous stent-supported intervention. Circulation 2003; 108: 2244-2249. 14. Liew Y., Bartholomew J. Atheromatous embolization. hsc. Med. 2005; 10: 309-326. 15. Holden A. Is there an indication for embolic protection in renal artery intervention? Tech. Vasc. Interv. Radiol. 2011; 14(2): 95-100. 16. Rocha-Singh K., Eisenhauer A.,Textor S. Atherosclerotic peripheral vascular disease symposium II: intervention for renal artery disease. Circulation. 2008; 118: 2873-2878. 17. Feldman R., Wargovich T., Bittl J. No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter. Cardiovasc. Interv. 1999; 46(2): 245-8. 18. Kolluri R., Goldstein J., Rocha-Singh K. Percutaneous vascular interventions in renal artery diseases. Minerva. Cardioangiol. 2006; 54: 95-107. 19. Hiramoto J., Hansen K., Pan X. Atheroemboli during renal artery angioplasty: an ex vivo study. J. Vhsc. Surg. 2005; 41(6): 1026-30. 20. Holden A., Hill A. Renal angioplasty and stenting with distal protection of the main renal artery in ischemic nephropathy: early experience. Journal Vascular. Surgery. 2003; 38: 962-968. 21. Perkovic V., Thomson K., Mitchell P. et al. Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Austral. Radiol. 2001; 45: 438-43. 22. Paulsen D., Klow N., Rogstad B. et al. Preservation of renal function by percutaneous transluminal angioplasty in ischaemic renal disease. Nephrol. Dial Transplant. 1999; 14: 1454-61. 23. Leertouwer T., Gussenhoven E., Bosch J. et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000; 216: 78-85. 24. Vignali C., Bargellini I., Lazzereschi M. et al. Predictive factors of in-stent restenosis in renal artery stenting: a retrospective analysis. Cardiovasc. Intervent. Radiol. 2005; 28: 296-302. 25. Corriere M., Edwards M., Pearce J. et al. Restenosis after renal artery angioplasty and stenting: incidence and risk factors. J. Vasc. Surg. 2009; 50(4): 813-819. 26. Leertouwer T., Gussenhoven E., van Overhagen H. et al. Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound. J. Vasc. Interv. Radiol. 1998; 9: 945-952. 27. Zeller T., Rastan A., Rothenpieler U. et al. Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents? Catheter. Cardiovasc. Interv. 2006; 68(1): 125-30. 28. Sapoval M., Zghringer M., Pattynama P. et al. Low- profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial. J. Vasc. Intern Radiol. 2005; 16(9): 1195-202.
The effectiveness of percutaneous intermittent coronary sinus occlusion in acute coronary syndrome in patients without ST elevation and non significant coronary arteries stenosis
DOI: https://doi.org/10.25512/DIR.2015.09.3.08
For quoting:
Shakhov E.B. "The effectiveness of percutaneous intermittent coronary sinus occlusion in acute coronary syndrome in patients without ST elevation and non significant coronary arteries stenosis". Journal Diagnostic & interventional radiology. 2015; 9(3); 57-63.
Abstract: According to newest clinical studies, 20%-30% of acute coronary syndrome patients without БТ elevation have nonsignificant coronary artery stenosis Aim: was to estimate the effectiveness of percutaneous intermittent coronary sinus occlusior (ICSO) in acute coronary syndrome patients without БТ elevation and nonsignificant coronary arteries stenosis. Materials and methods: results of endovascular treatment of patients with acute coronary syndrome patients without БТ elevation, for the period 09.10.2014-02.02.2015 were analyzed. All patients underwent ICSO for 10-13 minutes until intravenous wedge pressure plateau was achieved. Results: in the beginning of the intervention all patients had nonsignificant coronary arteries stenosis, peripheral coronary angiospasm and slow flow in left anterior descending arteries (LAD): Т1М1 frame count in LAD (TFCLAD) was 85,9±17,6 frm; distal diameter of LAD (DLAD) was 2,1±0,5 mm; quantitative blush evaluation score in LAD (QuBELAD) was 11,8±1,4. After the ICSO procedure coronary hemodynamic was improved: TFCLAD=59,5±9,8 frm; DLAD=2,5±0,4 mm; QuBELAD= 27,4±2,2; p=0,01). Conclusion: ICSO procedure led to the both improvement of the antegrade blood flow in LAD anc myocardial blush flow and reduction of the peripheral coronary angiospasm. ICSO procedure significantly improved the electrocardiography and clinical conditions. References 1. 2014 ESC/EACT Guidelines on myocardial revascularization/The Task Force on Myocardial Revascalarization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACT). European Heart Journal. 2014; 35(37): 2541-619. 2. Moiseenkov G.V., Gajfulin R.A., Barbarash O.L., Berns S.A., Barbarash L.S. «Chistye» koronarnye arterii u bol'nyh ostrym koronarnym sindromom: [«Clean» coronary arteries in patients with acute coronary syndrome]. Mezhdunarodnyj zhurnalintervencionnoj kardioangiologii. 2008;14: 17 [In Russ]. 3. Ong P., Athanasiadis A., Hill S. Vogelsberg H. et al. Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. JACC. 2008; 52 (7): 528-530. 4. Antman E.M., Cohen M., Bernink PJ., McCabe C.H., Horacek T., Papuchis G., Mautner B., Corbalan R., Radley D., Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000; 284(7):835-42. 5. Tang E.W., Wong C.K., Herbison P Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome. Am. Heart J. 2007 Jan; 153(1): 29-35. 6. Gibson C.M., Cannon C.P, Daley W.L., et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1995; 93 (5): 879-88. 7. Porto I., Hamilton-Craig C., Brancati M., Burzotta F., et al. Angiographic assessment of microvascular perfusion-myocardial blush in clinical practice. Am. Heart J. 2010; 160(6):1015-22. 8. Vogelzang M., Vlaar PJ., Svilaas T. et al. Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial. European Heart Journal. 2009; 30: 594-599. 9. Van de Hoef T.P, Nolte F., Delewi R. et al. Intracoronary Hemodynamic Effects of Pressure-Controlled Intermittent Coronary Sinus Occlusion (PICSO): Results from the First-In-Man Prepare PICSO Study. Journal of Interventional Cardiology. 2012; 25 (6): 549-556. 10. Incorvati R.L., Tauberg S.G., Pecora M.G., et all. Clinical applications of coronary sinus retroperfusion during high risk percutaneous transluminal coronary angioplasty. JACC 1993; 22(1):127-34. 11. Petrov V.I., Nedogoda S.V. «Medicina, osnovannaja na dokazatel'stvah»: Uchebnoe posobie: [Medicine, based on evidence]. Moskva: Gjeotar-Media, 2009; 144 s [In Russ]. 12. Meerbaum S., Lang T.W., Osher J.V., et al. Diastolic retroperfusion of acutely ischemic myocardium. Am. J. Cadiol. 1978; 41:1191-201. 13. Mohl W., Gangl C., Jusi A., et al. PICSO: from myocardial salvage to tissue regeneration. Cardiovascular Revascularization Medicine. 2015; 16: 36-46. 14. Valuckien Z., Vasylius T., Unikas R. Left anterior descending coronary artery spasm and «accordion effect» mimicking coronary artery dissection. Medicina. 2014; 50 (5): 309-311.
Abstract: Aim: was to investigate possibilities of multislice computed tomography in estimation of stenosis degree in coronary arteries in patients with ischemic heart disease (IHD). Materials and methods: we examined 64 patients (18 female, 46 male, mean age 62,4± 9,5 years), who primary had been admitted to hospital and had high risk of IHD; and those who had early diagnosed IHD of 1,2,3 and 4 functional class, they were hospitalized for condition correction. Mainly spreaded risk factor was arterial hypertention in 55 patients - (85,9%) with highest level 200/100 mm hg and minimal 140/80 mm hg. All patients underwent multislice computed tomography (MSCT) on the 256-slice tomography station «Somatom definition flash (Siemens, Germany)»: collimation 128 x 0,6, the temporal resolution of 75 ms and a spatial resolution of 0.33 mm, slice thickness of 0.6 mm, with simultaneous use of two tubes with different voltage (kV 120/100), the current mAs - with programs to reduce radiation exposure Care Dose - is calculated automatically according to the constitution of man. Post-processing of obtained data was performed on a workstation Syngo Via, in the application of CT-Soronary with automatic longitudinal separation of each coronary artery In view of image quality was analyzed data from end-diastolic phase of the cardiac cycle (80% R-R), or evaluated complex of multiphase images. We analyze the state of the main arteries of the main coronary: left anterior descending artery, the circumflex artery and the right coronary artery (LAD, CA, RCA). We performed estimation of coronary artery stenosis of segments according to the American Heart Association (AHA). Results were displayed in percentage. Obtained data was compared with those obtained using the reference method - X-ray coronary angiography, which was performed according to standard protocol Results: comparison of results of coronary angiography and MSCT using correlation analysis showed the presence of strong direct significant correlation coefficients in the evaluation of coronary artery disease according to two methods. It was demonstrated a high inter-operator and intraoperator reproducibility of MSCT in the study of vessels conditions. Following characteristics of the method related to the identification of coronary artery stenosis segments: sensitivity - 95.8%, specificity - 92.8%, diagnostic accuracy - 95.1%, positive predictive value - 97.9%, negative predictive value - 86.6 %. It was concluded that the high importance of the method of MSCT in the diagnosis of cardiovascular diseases and the need for its widespread use in cardiology practice. References 1. Chazov E.I. Perspektivyi kardiologii v svete progressa fundamentalnoy nauki. [Prospects of Cardiology in light of the progress of fundamental science.] Ter. Archive. 2009; 9 : 5-8 [In Russ.] 2. Данилов Н.М., Матчин Ю.Г. и др. Показания к проведению коронарной артериографии. Consilium Medicum. Болезни сердца и сосудов. 2006; 1(1). Danilov N.M., Matchin Yu.G. et al. Pokazaniya k provedeniyu koronarnoy arteriografii. Consilium Medicum. Bolezni serdtsa i sosudov. [Indications for coronary arteriography. Consilium Medicum heart disease and vascular. ]2006; 1(1) [In Russ.]. 3. Sun Z., Choo G.H., Ng K.H. Coronary CT angiography: current status and continuing challenges. Br. J. Radiol. 2012; 85: 495-510. 4. Sun Z., Aziz YF., Ng K.H. Coronary CT angiography: how should physicians use it wisely and when do physicians request it appropriately. Eur. J. Radiol. 2012; 81: 684-687. 5. Haberl R., Tittus J., Bohme E. et al. Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography. Am. Heart J. 2005; 149: 1112-1119. 6. Steigner M.L., Otero H.J., Cai T. et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography. Int. J. Cardiovasc. Imaging. 2009; 25: 85-90. 7. Achenbach S., Marwan M., Schepis T. et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J. Cardiovasc. Comput. Tomogr. 2009; 3: 117-121. 8. Budoff M.J., Dowe D., Jollis J.G. et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J. Am. Coll. Cardiol. 2008; 52: 1724-1732. 9. Petcherski O., Gaspar T., Halon D. et al. Diagnostic accuracy of 256-row computed tomographic angiography for detection of obstructive coronary artery disease using invasive quantitative coronary angiography as reference standard. Am. J. Cardiol. 2013; 111: 510-515. 10. De Graaf F.R., Schuijf J.D., Van Velzen J.E. et al. Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur. Heart J. 2010; 31: 1908-1915.
Abstract: One of complications of using hemodialysis catheters is stenosis or occlusion of central veins. This may cause dysfunction of an ipsilateral arteriovenous fistula in the future. Despite of high restenosis rate - balloon angioplasty is a method of choice. Materials and methods: we present a case report of successful recanalization and balloon angioplasty of left brachiocephalic vein in a patient, undergoing chronic hemodialysis with a functioning arteriovenous fistula on left forearm . Results: the absence of restenosis during a year is an evidence of the effectiveness of this methoc as a treatment of central vein stenosis or occlusion in order to preserve and increase duration of use of permanent vascular access. References
1. Beljaev A.Ju., Kudrjavceva E.S. Rol' vrachej nefrologicheskih i gemodializnyh otdelenij v obespechenii postojannogo sosudistogo dostupa dlja gemodializa[The role of physicians of nephrology and hemodialysis departments in ensuring of permanent vascular access for hemodialysis]. Nefrologija i dializ. 2007; 9(3): 224-227 [In Russ].
2. Hernandez D., Diaz F., Rufino M., Lorenzo V. et al. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J. Am. Soc. Nephrol. 998; 9 (8): 1507-1510.
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4. Barrett N., Spencer S., Mclvor J., Brown E.A. Subclavian stenosis: a major complication of subclavian dialysis catheter. Nephrol Dial Transplant. 1988; 3 (4): 423-425.
5. Chan M.R., Yevzlin A.S., Asif A. Vascular Access for the General Nephrologist. Nova Science Publishers, Inc (US). 2013; 423. 6. Surratt R.S., Picus D., Hicks M.E., Darcy M.D. et al. The importance of preoperative evaluation of the subclavian vein in dialysis access planning. AJR Am.J. Roentgenol. 1991; 156 (3): 623-625. 7. Dheeraj K. Rajan. Essentials of Percutaneous Dialysis Interventions. Springer. 2011; 604. 8. McNally PG., Brown C.B., Moorhead PJ., Raftery A.T. Unmasking of subclavian vein obstruction following creation of arteriovenous fistulae for haemodialysis. A problem following subclavian line dialysis? Nephrol Dial Transplant. 1987; 1 (4): 258-260. 9. Abbasi M., Soltani G., Karamroudi A., Javan H. Superior Vena Cava Syndrome Following Central Venous Cannulation. International Cardiоvascular Research Journal. 2009; 3 (3): 172-174. 10. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am. J. Kidney Dis. 2006; 48 (suppl 1): S1-S322. 11. Kundu S. Central venous obstructionmanagement. Semin Intervent Radiol. 2009; 26(2): 115-121. 12. Scott O. Trerotola. Venous Interventions. Society of Cardiovascular & Interventional Radiology (SCVIR). 1995; 556.
Abstract: Aim: was to demonstrate the unique case of tracheal transplantation using method of regenerative medicine. Materials and methods: article presents results of clinical and diagnostic procedures of patient, shows images of trachea before and after transplantation. In order to detect possible complications after surgery were conducted MDCT and bronchoscopy Results: using of MDCT and bronchoscopy can give all the necessary information about the status of the trachea, as in the pre-hospital period and in the early and late postoperative periods. This case demonstrates satisfactory results for the period of four years after trachea transplantation.
Abstract: Aim: was to estimate the efficiency and safety of stenting of subtotal stenosis of internal carotid artery Materials and methods: we analyzed data of 31 patients who underwent stenting of subtotal stenosis of internal carotid artery. Middle age was 68,2±6,9 yrs. Research included 23 males (74,2%). 28 patients (90,3%) had ischemic stroke or transient ischemic attack in anamnesis. Asymptomatic patients (9,7%) in the pre-operative stage underwent single-photon emission computed tomography of the brain, which revealed the presence of subtotal stenosis of internal carotid artery complicated with ishemia. Stenting of internal carotid arteries were made with the help of embolic protection devices in all cases (100%), in 90,3% - with additional proximal protection. In 100% - predilatation of critical stenosis zones were performed. Two patients (6,4%) underwent simultaneous stenting of internal carotid artery and vertebral artery in 1 patient (3,2%) - stenting of internal carotid artery and subclavian artery The operative time was equal to the average 32,6±8,7 minutes. The results of endovascular interventions were assessed by the presence / absence of neurological symptoms during hospitalization and in the late postoperative period. Stent patency and the presence / absence of restenosis were determined by ultrasound, selective angiography of the brachiocephalic arteries. Before discharge in asymptomatic patients evaluated cerebral perfusion using single photon emission computed tomography Results: successful stenting of subtotal stenosis of the internal carotid artery with blood flow restoration (TICI-3) achieved in 100% of cases. According to the single-photon emission computed tomography of the brain, performed before discharge in asymptomatic patients (9.7%) noted improvement in cerebral blood flow. During the observation period, which amounted to 11,6 ± 3,1 months, the new transient ischemic attacks or ischemic strokes were not observed, no deaths. According to the ultrasonic examination - stents in the internal carotid arteries are passable, with no signs of restenosis. Conclusion: stenting of critical subtotal stenosis of the internal carotid artery is effective and safe. Application of the proximal cerebral protection can reduce the potential risk of embolism during stenting of subtotal stenosis of the internal carotid artery as it provides protection at all stages of the procedure. It is necessary to conduct large randomized studies to confirm the clinical efficacy and determine the indications for this kind of intervention in these group of patients. References 1. Berman S.S., Devine J.J., Erodes L.S. et al. Distinguishing carotid artery pseudo-occlusion with color flow Doppler. Stroke. 1995; 26:434-438. 2. Dix J.E., McNulty B.J., Kalimes D.F. Frequency and significance of a small distal ICA in carotid stenosis. AJNR Am. J. Neuroradiol. 1998;19:1215-1218. 3. Fox AJ. How to measure carotid stenosis. Radiology. 1993;186:316-318. 4. Gabrielsen T.O., Seeger J.F., Knake J.E. et al.The nearly occluded internal carotid artery: a diagnostic trap. Radiobgy. 1981;138:611-618. 5. Henderson R., Eliasziw M., Fox AJ. et al. The importance of angiographically defined collateral circulation in patients with severe carotid stenosis. Stroke. 2000; 31:128-132. 6. Lee D.H., Gao F., Rankin R.N. et al. Duplex and color Doppler flow sonography of occlusion and near occlusion of the carotid artery. AJNR AmJ. Neuroradiol. 1996;17:1267-1274. 7. Gonzalez A., Gil-Peralta A., Mayol А. et al. Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome. AJNR Am.J. Neuroradiol. 2011;32:252-258. 8. Fox A.J., Eliasziw M., Rothwell P.M. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am.J.Neuroradiol. 2005;26:2086-2094. 9. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N.Engl.J.Med. 1991; 325:445-453. 10. Rothwell P.M., Gutnikov S.A., Warlow C.P., The European Carotid Surgery Trialists’ Collaboration. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 2003;34:514-523. 11. Berman S.S., Bernhard V.M., Erly W.K. et al. Critical carotid artery stenosis: diagnosis, timing of surgery, and outcome. J.Vasc.Surg. 1994;20:499-510. Samson R.H., Showalter D.P., Yunis J.P. et al. Color 12. flow scan diagnosis of the carotid string sign may prevent unnecessary surgery. Cardiovasc.Surg. 1999; 7:236-241. 13. Archie Jr J.P. Carotid endarterectomy when the distal internal carotid artery is small or poorly visualized. J.Va,sc.Surg. 1994;19:23-30. 14. Barnett H.J., Meldrum H.E., Eliasziw M., North American Symptomatic Carotid Endarterectomy Trial (NASCET) collaborators. The appropriate use of carotid endarterectomy. CMAJ. 2002;166: 1169-1179. 15. Pappas J.N. The angiographic string sign. Radiology. 2002; 222: 237-238. 16. Giannoukas A.D., Labropoulos N., Smith F.C.T. et al. Management of the near total internal carotid artery occlusion. Eur.J.Vasc.Endovasc. Surg. 2005; 29: 250-255. 17. O’Leary D.H., Mattle H., Potter J.E. Atheromatous pseudo-occlusion of the internal carotid artery. Stroke. 1989; 20:1168 1173. 18. Houser O.W., Sundt T.M., Holman C.B. et al. Atheromatous disease of the carotid artery. Neurosurg. 1974;41:321-331. 19. Heros R.C., Sekhar L.N. Diagnostic and therapeutic alternatives in patients with symptomatic «carotid occlusion» referred for extracranial-intracranial bypass surgery. J.Neurosurg. 1981; 54:790-796. 20. Sekhar L.N., Heros R.C., Lotz P.R. et al. A
Abstract: Purpose. Was to improve results of aortic stenosis (AS) treatment by transluminalballoon valvuloplasty (TLBVP) technicalskill's mprovement Materials and methods. The article reviews a group of 56 patients who underwent TLBVP of at Republic specialized surgery centre named after V. Vakhidov Results. It is noted that after TLBVP the peak systolic pressure gradient drecreases from 136,0 ± 39,36 to 38,27 ± 12,55 mm Hg (67,1% shift., р < 0,001), that confirms efficiency of the AS TLBVP All the patients notice better health conditions, increased stability to physical activities and had been discharged from hospital in satisfactory condition. Conclusions. TLBVP of aortic valve (AV) is an effective and safe method that can be used for treatment of aortic valve stenosis. Indication for the procedure is occurrence of peak systolic gradient at AV of over 50 (with average at 35-40) mm Hg. At the same time aortic regurgitation type 1 is not a contraindication for the procedure. References 1. Алекян Б.Г., Бондарев Ю.И., Ильин В.Н. и др. Опыт баллонных дилатаций при врожденном клапанном и подклапанном стенозах аорты. М. Грудная и сердечно-сосудистая хирургия. 1996; 1: 121-126. 2. Бокерия Л.А., Гудкова Р.Г. Тенденции развития кардиохирургии в 2007 году. М.: Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2008; 3-4. 3. Дземешкевич С.Л., Стивенсон Л.У., Алексин-Месхишвили В.В. Болезни аортального клапана. Функция, диагностика, лечение. М.: Гэотар-Мед. 2004;267-299. 4. Feldman T. Core curriculum for interventional cardiology. Percutaneous valvuloplasty Cath. Cardiovas. Interv. 2003; 60: 48-56. 5. Gao W. et al. Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvular aortic stenosis in children. Chin. Med. J. 2001; 114: 453-455. 6. Hidehiko H. et al. Percutaneous balloon аortic valvuloplasty. Revisited Circulation. 2007; 115: 334-338. 7. Kusa J., Biaikowski J., Szkutnik M. Percutaneous balloon aortic valvuloplasty in children. Early and long-term outcome. Kardiol. Pol. 2004; 60: 48-56
Abstract: Cardiovascular diseases of atherosclerotic genesis are one of the most actual problems of modern medicine. The purpose was to estimate the efficiency of interventional radiology treatment of stenosis and occlusions of arteria iliaca interna et externa (lat.) with self-extracting sten Jaguar SM 95 patients aged 44-79 years (71 male and 34 female) were included into experiment: during the period of 2005-2007 they were underwent nterventional radiology treatment of occlusion-stenosis arteria iliaca defeat. All patients in group had atherosclerotic genesis of disease Minimal length of stenosis was 10 mm, the longest stenosis - 90 mm All the stenosis were estimated due to TASC II. 10 patients had stenosis type A$ 39 patients - type D, 36 patients - type C, and 10 patients - type D. Endovascular recanalization failed in 5 cases of type D stenosis, and these patients were sent for traditional surgical treatment n 1 case a complication occurred - artery perforation during pre-dilatation, and such problem demanded implantation of stent-graft Afterimplantation balloon dilatation was performed in 95% cases. All patients had angiographycally confirmed restored blood flow. Clinica estimation and angiographycal inspection were spent within 2 years. The inspection in 30 days showed the efficiency 100% in case of stenotic defeat and 80% in case of occlusion defeat. The success rate in 12 month was 87%, in 2 years - 82%. References 1. Liapis C.D., Tzortzis E.A. Advances in the management of iliac artery occlusive disease. А short review. Vasc. Endovascular. Surg. 2004: 38 (6): 541-545. 2. Gray B.H., Sullivan T.M. Aortoiliac occlusive disease. Surgical versus interventional therapy. Cur. Interv. Cardiol. Rep. 2001;3 (2):109-116. 3. Adam D.J., Bradbury A.W. TASC II document on the management of peripheral arterial disease. Eur. J. Vasc. Endovasc. Surg. 2007; 33 (1): 1-2. 4. Dotter C.T., Judkins M.P. Transluminal Treatment of arteriosclerotic obstruction. description of a new technic and a preliminary report of its application. Circulation. 1964; 30: 654-670. 5. Gruntzig A., Hopff H. Percutaneous recanalization after chronic arterial occlusion with a new dilator-catheter (modification of the Dotter technique) (author's transl). Dtsch. Med. Wochenschr. 1974; 99 (49): 2502-2511. 6. Palmaz J.C. et al. Expandable intraluminal graft. А preliminary study. Work in progress. Radiology. 1985;156 (1): 73-77. 7. Mohler E., Giri J. Management of peripheral arterial disease patients. Comparing the ACC/AHA and TASC II guidelines. Cur. Med. Res. Opin. 2008; 24 (9): 2509-2522. 8. Bosiers M. et al. Present and future of endovascular SFA treatment. Stents, stent-grafts, drug coated balloons and drug coated stents. J. Cardiovasc. Surg. 2008; 49 (2): 159-165. 9. Lagana D. et al. Percutaneous treatment of complete chronic occlusions of the superficial femoral artery. Radiol. Med. 2008; 113 (4): 567-577. 10. O'Sullivan G.J. Endovascular management of aorto-iliac occlusive disease. Abdom. Imaging. 2008; 4: 25. 11. Tsetis D., Uberoi R. Quality improvement guidelines for endovascular treatment of iliac artery occlusive disease. Cardiovasc. Intervent. Radiol. 2008; 31 (2): 238-245. 12. Kudo T., Chandra F.A., Aim S.S. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J. Vasc. Surg. 2005; 42 (3): 466-475. 13. Van Walraven L.A. et al. The use of vascular stents in the treatment of iliac artery occlusion. Int. J. Angiol. 2000; 9 (4): 232-235.' 14. Carreira J.M. et al. Long-term follow-up of symphony nitinol stents in iliac arteriosclerosis obliterans. Minim. Invasive. Ther. Allied. Technol. 2008; 17 (1): 44-42. 15. Norgren L. et al. Inter society consensus for the management of peripheral arterial disease (TASC II). J. Vasc. Surg. 2007; 45: S5-67. 16. Diehm N. et al. TASC II section E3 on the treatment of acute limb ischemia. Commentary from European interventionists. J. Endovasc. Ther. 2008; 15 (1): 126-128. 17. Mousa A.Y. et al. Endovascular treatment of iliac occlusive disease. Review and update. Vascular. 2007; 15 (1): 5-11. 18. Karwowski J., Zarins C.K. Endografting of the abdominal aorta and iliac arteries for occlusive disease. J. Cardiovasc. Surg. 2005; 46 (4): 349-357. 19. Sasaki Y. et al. Stenting for superficial femoral artery atherosclerotic occlusion. Long-term follow-up results. Heart. Vessels. 2008; 23 (4): 264-270. 20. Sapoval M.R. et al. Self-expandable stents for the treatment of iliac arter. Am. J. Roentgenol. 1996; 166 (5): 173-1179. 21. Sixt S. et al. Acute and long-term outcome of endovascular therapy for aortoiliac occlusive lesions stratified according to the TASC classification. А single-center experience. J. Endovasc. Ther. 2008; 15 (4): 408-416. 22. Zana K. et al. Risk of embolism in diagnostic and therapeutic intravascular procedures - in vitro model. Orv. Hetil. 2001; 142 (34): 1837-1841. 23. Zana K. et al. In vitro evaluation of the embolic risk of diagnostic and therapeutic intravascular procedures. Med. Sci. Monit. 2001; 7 (1): 148-152. 24. Saratzis A. et al. Pharmacotherapy before and after endovascular repair of abdominal aortic aneurysms. Cur. Vasc. Pharmacol. 2008; 6 (4): 240-249. 25. Harnek J. et al. Insertion of self-expandable nitinol stents without previous balloon angioplasty reduces restenosis compared with PTA prior to stenting. Cardiovasc. Intervent. Radiol. 2002; 25 (5): 430-436.
Abstract: Purpose. Was to investigate ability of videodensitometry for assessment the effect of renal artery stenosis on parenchymal perfusion. Materials and methods. Аngiographic data of 97 patients with and 55 patients without renal artery stenosis were analyzed by means of videodensitometry, using «Multivox» software. All patients underwent renal arteries duplex ultrasound and kidneys ultrasound examination. Levels of blood pressure and kidney function as a clinical signs of renovascular hypertension were assessed. Risk factors of kidney parenchymal injury such as diabetes mellitus, chronic kidney diseases were monitored. Results. Videodensitometric analysis allows to detect statistically significant differences in parenchymal perfusion between kidneys with and without renal artery stenosis. A grade of changes in parenchymal perfusion correlates with angiographicaly measured degree of renal artery stenosis and renal artery blood flow velocity. Conclusion. Videodensitometric perfusion parameters can be used to assess the effect of renal artery stenosis on parenchymal blood flow. Thus, videodensitometry extends diagnostic capability of angiographic study. References 1. Hansen K.J. et al. Prevalence of renovascular desease in eldery. А populaton based study. J. Vasc. Surg. 2002; 36: 443–451. 2. Safian R.D., Textor S.C. Renal artery stenosis. N. Engl. J. Med. 2001; 344: 431–442. 3. Rihal C.S. et al. Incedental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. May. Clin. Proc. 2002; 77:309–316. 4. Olin J.W. et al. Prevalence of atherosclerotic RAS in patients with atherosclerosis else-where. Am. J. Med. 1990; 88: 46–51. 5. Galaria I.I. et al. Percutaneous and open renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surgery. 2005; 19 (2): 218–228.
6. Weibull H. et al. Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis. А prospective randomized study.J. Vasc. Surg. 1993; 18: 841–850. 7. Murphy T.P. et al. Increase of utilization of percutaneous renal artery interventions. Am.J. of Roentgenol. 2004; 183: 561–568. 8. Wheatley K. et al. Revascularization versus medical therapy for renal artery stenosis. N.Engl. J. Med. 2009; 361: 1953–1962. 9. Rocha-Singh K.J. et al. Atherosclerotic Peripheral Vascular Disease Symposium II: Intervention for Renal Artery Disease. Circulation. 2008; 118: 2873–2878. 10. Волынский Ю.Д., Кириллов М.Г., Шамалов Н.А. и др. Анализ экстра- и интракраниальной гемодинамики с помощью метода рентгеноденситометрии. Спец. выпуск «Инсульт». Ж. невр. и псих. им. С.С.Корсакова. 2007; 243. 11. Meier P., Zierler K.L. On the theory of the indicator-dilution method for measurement of blood flow and volume. J. Appl. Physiol. 1954; 12: 731–744.
Abstract: In 2010, Kawasaki T et al. presented a modification of the bifurcation technique named «culotte» - «cross-stenting» technique. The purpose of this technique - minimization of metal overlap in the proximal part of the main branch and, thus, reducing the risk of stent thrombosis and restenosis. In this article, we have present a case report of successful application of «cross-stenting» technique. Also we have described technical features of this technique and principles of choice stent for the side branch. References 1. Erglis A., Kumsars I., Niemela M., Kervinen K., Maeng M. et al. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: The Nordic Stent Technique Study. Circ. Cardiovasc. Intervent. 2009; 2: 27-34. 2. Chevalier B., Glatt B., Royer T., Guyon P. Placement of coronary stents in bifurcation lesions by the «culotte» technique. Am J. Cardiol. 1998; 82: 943-949. 3. Hildick-Smith D., Lassen J.F., Albiero R., Lefevre Th., Darremont O., Pan M., Ferenc M., Stankovic G., Louvard Y. Consensus from the 5th European Bifurcation Club meeting. Eurolntervention. 2010; 6: 34-38. 4. Iakovou I., Ge L, Colombo A. Contemporary stent treatment of coronary bifurcations. J. Am. Coll. Cardiol. 2008; 46: 1446-1455. 5. Kawasaki T., Koga H., Serikawa T. Modified culotte stenting technique for bifurcation lesions: the cross-stenting technique. J. Invasive Cardiol. 2010; 22: 243-246. 6. Examination of stent deformation and gap formation after complex stenting of left main coronary artery bifurcations using microfocus computed tomography. J.Interv. Cardiol. 2009; 22: 135-144.
Abstract: Aim. Was to study long-term results of drug eluting stents implantation: angiographic frequency of prolong stenosis, frequency of restenosis, endotelization dynamics, and other morphological indicators on the base of intravascular ultrasound (IV-US) Materials and methods. The research consisted of 220 patients with angina pectoris or/and myocardial ischemic indexes: all of them were after drug eluting stents implantation. 174 patients on the first year and 82 on the second were underwent coronaroventriculography Double antiaggregant theraphy was given on the first year to 198(90%) patients, on the second - 21(9,5%) Results. The whole angiographic success was 89,5%. 44% patients were underwent of lateral arterial branches defense. Unsuccessfu stenting was due to technical impossibility of movement threw variated coronar arteries segment in 5%; 1,8% was due to incomplete disclosing of stent; 2,7% - occlusion of lateral arterial branch Conclusions. On the base of IV-US, at the end of the 1st year, 40% stents had full endotelization, at the end of the 2nd - 91%. Double antiaggregant theraphy was given to 99,1% patients on the first year. All coronary situations (morbidity, heart stroke, restenosis) was much more ess, than on the 2nd years, on which drug therapy was given only to 9,6% patients. References 1. G. Ertaio et al. Late stent thrombosis, endothelialisation and drug-eluting stents. Neth. Heart. J. 2009l; 17 (4): 177-180. 2. Ako J. et al. Late incomplete stent apposition after sirolimus-eluting stent implantation. A serial intravascular ultrasound analysis. J. Am. Coll. Cardiol. 2005; 46 (6): 1002-1005. 3. Virmani R. et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent. Should we be cautious? Circulation. 2004; 109 (6): 701-705. 4. Lee S.H., Chae J.K., Ko J.K. Consecutively developed late stent malappositions following the implantation of two different kinds of drug-eluting stents associated with spontaneous healing. Int. J. Cardiol. 2009; 134 (1): 7-10. 5. Yamen E. et al. Late incomplete apposition and coronary artery aneurysm formation following paclitaxel-eluting stent deployment. Does size matter? J. Invasive. Cardiol. 2007; 19 (10): 449-450. 6. Yasumi U. and Yasuto U. Angioscopic evaluation of neointimal coverage of coronary stents. Curr. Cardiovasc. Imaging. Rep. 2010; 3 (5): 317-323. 7. Mayraj A. et al. Comparison of one year clinical outcomes with paclitaxel-eluting stents versus bare metal stents in everyday practice. Can. J. Cardiol. 2008; 24 (10): 771-775. 8. Kim J.S. et al. Comparison of neointimal coverage of sirolimus-eluting stents and paclitaxel-eluting stents using optical coherence tomography at 9 months after implantation. Circ. J. 2010; 74: 320-326. 9. Suwaidi J.A. et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000; 101: 948-954. 10. Hofma S.H. et al. Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur. Heart. J. 2006; 27: 166-170. 11. Togni M. et al. Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J. Am. Col. Cardiol. 2005; 46: 231-236. 12. Shin D.I. et al. Drugeluting stent implantation could be associated with long-term coronary endothelial dysfunction. Comparison between sirolimus-eluting stent and paclitaxel-eluting stent. Int. Heart. J. 2007; 48: 553-567. 13. Takano M. et al. Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare-metal stents after 6-month implantation. Eur. Heart. J. 2006; 27: 2189-2195. 14. Moore P. et al. A randomized optical coherence tomography study of coronary stent strut coverage and luminal protrusion with rapamycin-eluting stents. JACC Cardiovasc. Interv. 2009. 15. Oyabu J. et al. Angioscopic evaluation of neointimal coverage. Sirolimus drug-eluting stent versus bare metal stent. Am. Heart. J. 2006; 52: 1168-1174. 16. Kotani J. et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J. Am. Col. Cardiol. 2006; 47: 2108. 17. Wilson G.J. et al. Comparison of inflammatory response after implantation of sirolimus- and paclitaxel-eluting stents in porcine coronary arteries. Circulation. 2009; 120: 141-149. 18. Higo T. et al. Atherosclerotic and thrombogenic neointima formed over SES. JACC Cardiovasc. Imaging. 2009; 2: 616-624 19. Latchumanadhas K. et al. Early coronary aneurysm with paclitaxel-eluting stent. Indian. Heart. J. 2006; 58 (1): 57-60. 20. Levisay J.P., Roth R.M., Schatz R.A. Coronary artery aneurysm formation after drug-eluting stent implantation. Cardiovasc. Revasc. Med. 2008; 9 (4): 284-287. 21. Chen D. et al. Spontaneous resolution of coronary artery pseudoaneurysm consequent to percutaneous intervention with paclitaxel-eluting stent. Tex. Heart. Inst. J. 2008; 35 (2): 189-192. 22. Lee S.E. et al. Very late stent thrombosis associated with multiple stent fractures and peri-stent aneurysm formation after sirolimus-eluting stent implantation. Circ. J. 2008; 72 (7): 1201-1204. 23. Kim J.S. et al. Delayed stent fracture after successful sirolimus-eluting stent (Cypher®) implantation. Korea
Abstract: Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE) Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible. Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression. References 1. Покровский А.В. Клиническая ангиология. Руководство. В двух томах. Т.2. М.: Медицина. 2004; 888. 2. Савельев В.С., Кошкин В.М. Критическая ишемия нижних конечностей. М.: Медицина. 1997; 160. 3. Jeans W.D. et al. Fate of patients undergoing transluminal angioplasty for lover-limb ischemia. Radiology. 1990; 177: 559-564. 4. Hunink M.G. et al. Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Med. Decis. Making. 1994; 14: 71-81. 5. Stokes K.R. et al. Five-year results of iliac end femoropopliteal angioplasty in diabetic patients. Radiology. 1990; 174: 977-982. 6. Минкин С., Рабкин Д. Экспериментально-морфологическое исследование динамики «вживления» рентгеноэндоваскулярных протезов в сосудистую стенку. Материалы 8-го симпозиума по рентгеноэндоваскуляр-ной хирургии. Москва - Ереван. 1987; 12. 7. Maas D. et al. Radiological follow-ap of transluminalli inserted vascular endoprothes-es. An experimental study using expanding spirals. Radiology. 1984; 152: 659-663. 8. Blum U. et al. Percutaneous recanalization of iliac occlusions. Resultsof a prosrective study. Radiology. 1993; 189: 536-540. 9. Henry M. et al. Stenting of femoral and popliteal arteries. Tenth international book of peripheral vascular intervention. 1995; 199: 368-369. 10. Henry M. et al. Palmaz stent placement in iliac and femoropopliteal arteries. Primary and secondary patency in 310 patients 2-4 year follow-up. Radiology. 1995; 197: 167-174. 11. Коков Л.С., Покровский А.В., Балан А.Н. и др. Отдаленные результаты клинического применения отечественного нитинолово-го стента для лечения стенозирующих поражений артерий. Ангиология и сосудистая хирургия. 2002; 8 (1): 41-46. 12. Scheinert D. et al. Stent supported recanaliza-tion of chronic iliac artery occlusions. Tenth international book of peripheral vascular intervention. Edited by M. Hanry. M. Fmor.Paris. 1999; 303-313. 13. Zeller T. Long-term results after recanalisation of thrombotic occlusions of native and stented arteries using a rotationals thrombectomy device. The Paris Course on Revascularization. Paris. 2002; 435-441. 14. White C.J. Peripheral аtherectomi with the рullback аtherectomy сatheter. Procedural safety and efficacy in a multicenter trail. J. of Endovascular. Surgery. 1998; 5: 9-17. 15. Yoffe B. et al. Preliminary experience with the Xtrak debulking device the treatment of peripheral occlusions. J. Endovasc. Ther. 2002; 9: 234-240. 16. Zeller T. et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the silverhawk device. J. Intervent. Radiol. 2004; 15: 1391-1397. 17. Ramaiah V. et al. Midterm outcomes from the TALON registry. Treating peripherals with «Silverhawk». Outcomes collection.J. Endovasc. Ther. 2006; 13 (5): 592-602.
Abstract: Purpose: on the basis of long-term results of renal angioplasty and stenting, the authors define the indications for endovascular interventions in patients with renovascular hypertension (RVH). Materials and methods: since 1992-2008 in Tashkent Medical Academy Vascular Surgery Center were performed 131 endovascular interventions in 119 patients for renal arteries (RA) stenoses of various origins. 97 patients underwent balloon angioplasty (BA) of renal arteries (105 interventions), and stenting was performed in 22 cases (26 stenting procedures). Systolic blood pressure varied from 170 to 300 mm Hg (219,4±23,1 mmHg), with diastolic blood pressure from 170 to 300 mm Hg (118,1±8,9 mm Hg). Average arterial hypertension history was 5,2±3,7 years (6 months - 16 years). Results: technical success rate was 85,6% for balloon angioplasty, and 100 % for stenting procedures. Immediate hypotensive effect was good to satisfactory. Complication rate was 2,5% (3 patients). Long-term results were assessed in 76 cases of balloon angioplasty (78,4%), and in all patients with renal arteries stenting. The average follow-up was 72±32,5 months (6-144 months) for balloon angioplasty, and 6-24 months for stenting group. In the angioplasty group long-term hypotensive effect lasted in 54(71,1%) of patients, and the restenosis rate was as high as 28,9% (22 cases). In the stenting group, the long-term hypotensive effect was preserved in all the patients, and there were no cases of restenosis. Conclusions: high rates of technical and clinical success, as well as low rates of restenosis, allow the renal artery stenting procedure to be seen as the method of choice for renovascular hypertension. References 1. Клиническая ангиология в 2 томах. Под редакцией А.В. Покровского. М.: Медицина. 2004; 2: 94-114. 2. Алекян Б.Г., Бузиашвили Ю.И., Голухова Е.З. и др. Ближайшие и отдаленные результаты стентирования почечных артерий у больных с вазоренальной гипертензией. Ангиология и сосудистая хирургия. 2006;1: 55-62. 3. Carmo M., Bower T.C. Surgical мanagement of renal fibromuscular dysplasia. Challenges 11.in the endovascular era. Ann. Vasc. Surgery. 2005; 19: 208-217. 4. Baert A.L., Wilms G., Amery A., Vermylen J.,Suy R. Percutaneous transluminal renal angioplasty: initial results and long-term follow-up in 202 patients. Cardiovasc. Intervent. Radiol. 1990; 13: 22-28. 5. WongJ.M., Hansen K.J., Oskin T.C. et al. Surgery after failed percutaneous renal artery angioplasty.J. Vasc. Surg. 1999; 30: 468-483. 6. Yutan E., Glickerman D.J., Caps M.T. et al.Percutaneous transluminal revascularizationfor renal artery stenosis. Veterans affairs puget sound health care system experience. J. Vasc. Surg. 2001; 34: 685-693. 7. Петровский Б.В., Гавриленко А.В. 40-летний опыт реконструктивных операций при вазоренальной гипертензии. Ангиология и сосудистая хирургия. 2003; 2: 8-12. 8. Троицкий А.В., Елагин О.С., Хабазов Р.И. и др. Одномоментная реконструкция висцеральных ветвей аорты и почечных артерий. Ангиология и сосудистая хирургия. 2006; 2: 132-136. 9. Крылов В.П., Реут Л.И., Дергачева И.М. и соавт. Отдаленные результаты хирургического лечения вазоренальной гипертензии. Клиническая кардиология. 2004; 2: 34-39. 10. Bonelli F.S., McKusick M.A., Textor S.C. et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo. Clinic. Proc. 1995; 70: 1041-1052. 11. Surowiec S.M., Sivamurthy N., Rhodes J.M. et al. Percutaneous therapy for renal artery fibromuscular dysplasia. Ann. Vasc. Surg. 2003; 17: 650-655. 12. Galaria I.I., Surowiec S.M., Jeffrey M. Percutaneous and оpen renal revascularizations have equivalent long-term functional outcomes. Ann. Vasc. Surg. 2005; 25: 218-224.
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Abstract: Aim. To compare safety and efficiency of drug-eluting stents (DES) and bare metal stents (BMS) implantation for coronary artery disease (CAD). Materials and methods. 230 patients with CAD were divided in 2 groups: patients in group 1 received DES; in group 2 we performed BMS implantation. Results. Long-term results (over 12 months follow-up) of DES primary implantation reduces risk of the angiographic restenosis by 15% compared to BMS (р < 0,001). Conclusions. Notwithstanding low basic risk of restenosis, DES demonstrate no statistically significant advantages in MACE rate. It is also shown that DES implantation is associated with higher mortality and greater risk of non-cardiac complications, related to prolonged antiplatelet therapy. Thus, decision of DES implantation should be made in consideration of the patients' tolerance for double antiplatelet therapy, risk of bleeding, possible elective surgery, as well as any pre-procedure immune system disturbances. References 1. Sigwart U., Puel J., Mirkovitch V., Joffre F. et al. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.New. Engl. Med. 1987; 316: 701-706. 2. Van der Giessen W.J., Lincoff A.M., Schwartz R.S. et al. Marked inflammatory sequel to implantation of biodegradable and nonbiode-gradable polymers in porcine coronary arteries. Circulation. 1996; 94: 1690-1697. 3. Бокерия Л.А., Алекян Б.Г., Голухова Е.З. и др. Применение стентов с лекарственным антипролиферативным покрытием в лечении больных ишемической болезнью сердца. Креативная кардиология. 2007; 1:193-198. 4. Befeyter PJ. Percutaneous coronary intervention for unstable coronary artery disease. Text-book of interventional cardiology, 4th ed. by Topol E. Philadelphia. W.B. Saunders Company. 2003: 183-199. 5. Bauters C., Lablanche J.M., McFadden E.P. et al. Clinical characteristics and angiographic follow-up of patients undergoing early or late repeat dilation for a first restenosis. J. Am. Coll. Cardiol. 1992; 20: 845-848. 6. Бабунашвили А.М., Юдин И.Е., Дундуа Д.П. и др. Стенты с лекарственным покрытием при лечении диффузных атеросклеротиче-ских поражений коронарных артерий. Актуальные вопросы болезней сердца и сосудов. 2007; 4: 57-63. 7. Waters R.E. 3 cases following DES for in-stent-restenosis (at 16, 20, 43 mo) - shortly after interruption of antiplatelet Tx. Catheter. Car-diovasc. Interv. 2005; 4: 107-115. 8. PeterJ., Fitzgerald S. etal. Is angiographic late loss still a worthwhile surrogate endpoint in DES trials? Circulation. 2006; 54: 237-291.
Role of duplex ultrasound in the assessment of early follow-up period outcomes, after endovascular procedures in patients with critical limb ischemia and diabetes melitus
DOI: https://doi.org/10.25512/DIR.2014.08.3.02
For quoting:
Bondarenko O.N., Galstyan G.R., Ayubova N.L., Egorova D.N., Dedov I.I. "Role of duplex ultrasound in the assessment of early follow-up period outcomes, after endovascular procedures in patients with critical limb ischemia and diabetes melitus". Journal Diagnostic & interventional radiology. 2014; 8(3); 15-28.
Abstract: Aim: was to evaluate morphological features of lesions in lower limb arteries before percutaneous transluminal angioplasty (PTA) and its arterial complications in patients with critical lower limb ischemia (CLI) combined with diabetes mellitus(DM). Materials and methods: for the period from September 2010 to June 2013, a prospective single-center study was conducted involving 171 patients with CLI and DM (80(47%) men, mean age 64,1[54-68] years, mean HbA1c 8,3[7,4-9,6]%, mean duration of diabetes 16,5[8-23] years, diabetes type 1/2-18/153) who underwent PTA in 193 lower limbs. Myocardial infarction and brain stroke in anamnesis had 53(31%) and 19(11%) patients, respectively Chronic kidney disease (CKD) 3-4 stages had 40 patients(24%), end-stage renal disease - 16 cases (10%). Diagnosis of CLI was based on recommendation of TASC II. Patency of arteries of lower limbs was evaluated by duplex ultrasound (DU) before PTA and during early follow-up period (30 days). PTA in all patients was considered technically successful in restoring continuous arterial flow to the foot of at least one crural artery without residual stenosis >50%. Results: stenosis>50% and occlusions of tibial arteries were found in all patients. Peripheral arterial disease 4-6 classes according Graziani L. classification was marked in 180(93%) cases. Extensive tibial arterial calcification was found in 123(64%) cases, in patients with residual stenosis (> 50% remaining diameter) -113 (89%). The mean value of transcutaneous oxygen pressure (tcpO2) before PTA was 14,7(8-25) mmHg, after PTA - 35,2 (31-38) mmHg. After PTA , residual stenosis (>50%) in treated arteries was in 125(79,1%) cases, thrombosis in treated arteries - 9(5,7%), intimal dissection - 18(11,4%), incomplete stent disclosure - 3(1,9%), incomplete capture stent area stenosis - 2(1,3%), dislocation of the stent - 1(0,6%). Repeat PTA in the early follow-up period was performed in 15 patients with clinically significant complications (6%). Conclusion: CLI in diabetic patients is characterized by having severe morphological lesions of lower limb arteries, infrapopliteal arterial calcification. DU plays important role in evaluation of arterial patency and PTA complications in early follow-up period. The high level of residual stenosis of tibial arteries after PTA is associated with chronic complications of diabetes mellitus, including renal insufficiency Timely reintervention in diabetic patients with clinical significant PTA complications promotes optimal arterial patency and permission of CLI in theese cases. Reference 1. Ajubova N.L., Bondarenko O.N., Galstjan G.R., Manchenko O.V., Dedov 1.1. Osobennosti porazhenija arterij nizhnih konechnostej i klinicheskie ishody jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom s kriticheskoj ishemiej nizhnih konechnostej i hronicheskoj pochechnoj nedostatochnost'ju [Peculiarities of arteries' lesions of lower limb, and clinical outcomes of PCI in patients with critical ishemia of lower limbs with diabetes mellitus and chronic renal insufficiency]. Saharnyj diabet. 2013; 4:85-94 [In Russ]. 2. TASC. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J.Vasc Surg., 2000;31(1 part2):S1-287. 3. Lumley J.S. Vascular management of the diabetic foot- a British view. Journal Annals of the Academy of Medicine, Singapore. 1993, Vol 22, N 6, P 912-6 4. M.Doherty T., Lorraine A.F., Inoue D., Jian-Hua Qiao, M.C.Fishbein, R.C.Detrano, PK.Shan, T.B. Rajavashisth. Molecular, endocrine, and genetic mechanisms of arterial calcification. Endocrine Reviews. 2004, 25 (4):629-672 5. Bublik E.V., Galstjan G.R., Mel'nichenko G.A., Safonov V.V., Shutov E.V., Filipcev P.Ja. Porazhenija nizhnih konechnostej u bol'nyh saharnym diabetom s terminal'noj stadiej hronicheskoj pochechnoj nedostatochnosti, poluchajushhih zamestitel'nuju pochechnuju terapiju [Lower limbs’ lesions in patients with diabetesmellitus with end-stage chronic renal insufficiency, receiving replacement therapy]. Saharnyj diabet. 2008; 2: 17-23 [In Russ]. 6. Jager K.A., Phillips D.J., Martin R.L., Hanson C., Roederer G.O., Langlois YE. et al. Noninvasive mapping of lower limb arterial lesions. Ultrasound Med. Biol. 1985;11: 515-21. 7. Ciaverella A., Silletti A., &Mustacchio A., et al. Angiographic evaluation of the anatomic pattern of arterial obstructions in diabetic patients with critical limb ischemia. Diabet. Metab. 1993;19:586-589. 8. Jude E.B., Oyibo S.O. & Chalmers N., et al. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433-1437. 9. Bandyk D.F. Surveillance after lower extremity arterial bypass. perspect vasc surg endovasc ther. Eur Heart J. 2007;19:376-83. 10. Faglia E., Mantero M. & Caminiti M. et al. Extensive use of peripheral angioplasty, especially infrapopliteal, in the treatment of ischemic foot ulcer: clinical results of a multicentric study of 221 consecutive diabetic subjects. J. Intern. Med. 2002; 252:225-232. 11. Adam D.J., Beard J.D., Cleveland T., Bell J., Bradbury A.W., Forbes J.F. et al.; BASIL Trial Participants. Bypass versus Angioplasty in Severelschaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005; 366:1925-34. 12. Norgen L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes FGR. Inter-society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg. 2007; 45(Suppl S):S5-67. 13. Hirsch A.T., Haskal Z.J., Hertzer N.R., Bakal C.W., Creager M.A., Halperin J. et al; American Association for Vascular Surgery/Society for Vascular Surgery;Society for Cardiovascular Angiography and Interventions;Society for Vascular Medicine and Biology; Society for Inerventional Radiology; ACC/AHA TASC Force on Practice Guidelines. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower exteremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA TASC Forc on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. Circulation. 2006 113: e463-654, 14. Dick F., Ricco J.B., Davies A.H.: Chapter VI: Follow-up after Revascularisation. Eur. J. Vasc. Endovasc. Surg. 2011; 42: S75-S90. 15. Bondarenko O.N., Ajubova N.L., Galstjan G.R., Dedov 1.1. Dooperacionnaja vizualizacija perifericheskih arterij s primeneniem ul'trazvukovogo dupleksnogo skanirovanja u pacientov s saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej [Preoperative visualization of peripheral arteries with the help of ultrasonic duplex scanning in patients with critical ischemia of lower limbs and diabetes mellitus]. Saharnyj diabet. 2013; 2: 52-61 [In Russ]. 16. Arvela E., Dick F: Surveillance after Distal Revascularization for Critical Limb Ischemia. Scandinavian Journal of Surgery. 2012; 101:119-124. 17. Diehm N., Baumgartner I., Jaff M., Do D.D., Minar E., Schmidli J. et al. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischemia of lower limb arteries. Eur. Heart J. 2007; 28: 798-805.
Abstract: Aim: was to study properties of nanostructured carbon coating stents in coronary arteries with the help of intravascular ultrasonic visualization. Materials and Methods: experimental implantation of stents in coronary artery was performed on 8 yearling sheep. Estimation of bioinertness properties of stents was made by intravascular ultrasonic method on the 14, 28, 180 day. Bioinertness properties were estimated in comparison with analogical bare-metal stents. Results: The analysis of results showed that in early stages (up to 28 days) experimental samples of stents cause less formation of trombus than simple balloon-extendable stents. In the period of late outcomes, coronary nanostructured carbon coating stents have lower level of «in-stent stenosis». Conclusion: stent implantation with nanostructured carbon coating does not prevent the natural reparative processes taking place in the artery wall, does not cause the formation of thrombotic masses under standard doses of antiaggregants. Experimental stents significantly less affected in-stent stenosis, than stents without surface modification, indicating their higher bioinertness. References 1. Libby P., Ganz P. Restenosis revisited.- new tsrgets, new therapies. - N. Egl.S.Med. 1997; 37: 418-419. 2. Aref'eva T.I. et. al. Uvelichenie jekspressii monocitarnyh molekul adgezii i obrazovanija monocitotrombocitarnyh agregatov v krovi pri koronarnom restenoze [Increased expression of monocyte adhesion molecules and the formation of aggregates monotsitotrombotsitarnyh blood in coronary restenosis]. Terapevticheskijarhiv. 2002; 4:46-49 [In Russ]. 3. Morice M.C. A randomized comparison of sirolimus-eluting stent with a standard stent for coronary revesculazation. N. Engl. J. Med. 2002; 346:1773-1780. 4. Topol E.J. Artery size, neointima and remodeling time for some standards. J. Am. Coll Cardiol. 1998; 32:2087-2094. 5. Kremneva L.V. Vospalenie kak faktor riska restenoza i serdechno-sosudistyh oslozhnenij posle chreskozhnyh intrakoronarnyh vmeshatel'stv [Inflammation as a risk factor for restenosis and cardiovascular events after percutaneous intracoronary intervention]. Terapevticheskij arhiv. 2006; 3: 89-95 [In Russ]. 6. Lazarenko O.N. Vlijanie pokrytij stentov na tromboobrazovanie i razvitie restenozov [Tekst] [Influence of coatings on the stent thrombosis and restenosis. [Text]. Prakticheskaja angiologija. 2007; 2 (7): 10-13 [In Russ]. 7. Demin V.V. Klinicheskoe rukovodstvo po vnutrisosudistomu ul'trazvukovomu issledovaniju [Clinical guidelines for intravascular ultrasound]. O. IPK JuzhnyjUral. 2005; 400 s. [In Russ]. 8. Fedorchenko AN., Osiev A.G., Kochkina T.A., Protopopov A.V. Prognozirovanie klinicheskih rezul'tatov jendovaskuljarnogo vosstanovlenija prosveta stentirovannyh koronarnyh arterij. Diagnosticheskaja i intervencionnaja radiologija [Prediction of clinical results of endovascular stented recovery lumen of the coronary arteries. Diagnostic and intewentional Radiology. 2007; 3(1): 54-65 [In Russ]. 9. Vlodaver Z., French R., Van tassel R.A. et. al. Corellation of the atamortem coronary arteriogram and the postmortem specimen. Circulation. 1973; 47:162-9. 10. Grondin C.M., dyrda I., Pasternac A. et al. Discrepancies between cineangiographic and postmortem findings in partients with coronary artery disease and recent myocardial revascularheart diseases: comparison of ciuneangiographic and necropsy findings. Ann. Intern. Med. 1979; 91:350-6. 12. Isner J.M., Kishel J., Kent K.M. et. al. Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic - histologic correlative analisys in 28 patients. Circulation. 1981; 63: 1056-64. 13. Ivanov V.A., Movsesjanc M.Ju., Trunin I.V. Vnutrisosudistye metody issledovanija v intervencionnoj kardiologii [Intravascular methods of research in interventional cardiology]. Medpraktika. M. 2008; 112S. [In Russ]. 14. Nakamura S., Colombo A., Gaglione A. et al. Intracoronary ultrasound observations during stent implantations. Circulation. 1994; 89; 2026-34. 15. Colombo A., Hall P., Nakamura S. et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995; 91: 1676-88. 16. Goldberg S.L., Colombo A., Nakamura S. et al. Benefit of intracoronary ultrasound in the deployment of Palmaz - Schatz stents. J. Am. Coll. Cardiol. 1994; 24:996-1003.
Abstract: Aim: was to analyze long-term results of coronary artery stenting with drug-eluting stents «Zotarolimus» and bare metal stents in patients with a concomitant diabetes mellitus type II. Materials and methods: 37 patients with ischemic heart disease and concomitant diabetes mellitus type II were selected for analysis; they underwent implantation of stents without drug coverage («Intergrity» «Medtronic») or stents with drug-eluting «Zotarolimus» («Resolute Integrity» «Medtronic»). All patients were divided into 2 groups: first group consisted of 11 patients, who underwent implantation of bare metal stents, second group - 26 patients who underwent implantation of drug-eluting stents, «Zotarolimus». Follow-up period was 26±4 months. Criteria of stenting efficiency were: angiographic assessment of coronary arteries anatomy in control angiography after stent implantation, reccurence of angina or functional class increase, the survival rate in the nearest postoperative period, before discharge, but not more than 30 days, and in the early post-operative period up to 6 months. In the medium-distant post-operative period - 12 months, and in the late postoperative period - 24 months. Results: all patients underwent successfully performed endovascular revascularization. The optimal angiographic result was achieved in all patients. Regression of ischemic changes on ECG data and increase myocardial contractility by echocardiography data also were marked in all patients. In long-term follow-up period, in 5 (45%) patients with bare metal stents we noted the appearence of hemodynamically significant restenosis, that needed performance of secondary angioplasty with stenting. Conclusion: the use of antiproliferative drug-eluting stents «Zotarolimus» is possible in treatment of patients with coronary artery disease and comorbid diagnosis of diabetes mellitus type II. Bare metal stents in coronary stenting in patients with concomitant diagnosis of diabetes mellitus type II is impractical due to developing in-stent restenosis (45% of patients). References 1. Kereiakes D.J., Cutlip D.E., Applegate R.J., Wang J., Yaqub M., Sood P., Su X., Su G., Farhat N., Rizvi A., Simonton C.A., Sudhir K., Stone G.W. Outcomes in diabetic and nondiabetic patients treated with everolimus- or paclitaxel-eluting stents: results from the SPIRIT IV clinical trial (Clinical Evaluation of the XIENCE V Limus Eluting Coronary Stent System). J. Am. Coll. Cardiol. 2010 Dec 14; 56(25):2084-2089. 2. Petrova K.N., Kozlov S.G., Ljakishev A.A., Savchenko A.P. Vlijanie saharnogo diabeta 2 tipa na rezul'taty jendovaskuljarnogo lechenija IBS s pomoshhju stentov s lekarstvennym pokrytiem (dannye godichnogo nabljudenija) [Influence of diabetes mellitus type 2 on results of endovascular treatment of IHD with help of drug-eluting stents (data monitoring for one year)]. Kardiohgija. 2006; 12: 22-6 [In Russ]. 3. Abizaid A., Costa M.A., Blanchard D. et al. Sirolimus-Eluting Stents Inhibit Neointimal Hyperplasia in Diabetic Patients. Insights from the RAVEL Trial. Eur. Heart J. 2004; 25: 107-12. 4. Moussa I., Leon M.B., Baim D.S. et al. Impact of Sirolimus-Eluting Stents on Outcome in Diabetic Patients. Circulation .2004; 109: 2273-8. 5. Hermiller J.B., Raizner A., Cannon L. et al. TAXUS-IV Investigators. Outcomes With the Polymer-Based Paclitaxel-Eluting TAXUS Stent in Patients With Diabetes Mellitus: the TAXUS-IV trial. JACC. 2005; 45: 1172-9. 6. Sabate M., Jim Onez-Quevedo P., Angiolillo D.J. et al. Randomized Comparison of Limus-Eluting Stent Versus Standard Stent for Percutaneous Coronary Revascularization in Diabetic Patients. Circulation. 2005; 112: 2175-83. 7. Jensen J., Lagerqvist B., Aasa M., Sarev T., Nilsson T., Tornvall P. Clinical and angiographic follow-up after coronary drug-eluting and bare metal stent implantation. Do drug-eluting stents hold the promise? J. Intern. Med. 2006 Aug; 260(2):118-24. 8. Jain A.K., Lotan C., Meredith I.T., Feres F., Zambahari R., Sinha N., Rothman M.T. E-Five Registry Investigators. Twelve-month outcomes in patients with diabetes implanted with a zotarolimus-eluting stent: results from the E-Five Registry. Heart. 2010 Jun; 96(11):848-53. doi: 10.1136/hrt.2009.184150. 9. Stettler C., Allemann S., Egger M. et al. Efficacy of drug eluting stents in patients with and without diabetes mellitus: indirect comparison of controlled trials. Heart. 2006; 92: 650-7. 10. Scheen A.J., Warzee F. Diabetes Is Still a Risk Factor for Restenosis After Drug-Eluting Stent in Coronary Arteries. Diabetes Care. 2004; 27: 1840-1. 11. Park K.W., Lee J.M., Kang S.H., Ahn H.S., Kang H.J., Koo B.K., Rhew J.Y, Hwang S.H., Lee S.Y, Kang T.S., Kwak C.H., Hong B.K., Yu C.W., Seong I.W., Ahn T., Lee H.C., Lim S.W., Kim H.S. Everolimus-eluting xience v/promus versus zotarolimus-eluting resolute stents in patients with diabetes mellitus. JACC. Cardiovasc. Interv. 2014 May;7(5):471-81. doi: 10.1016/j.jcin.2013.12.201.
Abstract: The article presents the experience of endovascular treatment of abdominal aortic atherosclerotic lesions using different types of stents, performed in the Central Military Clinical Hospital named after A.A.Vishnevskogo. Materials and methods: nine patients underwent 11 operations - stenting of aorta. Direct stenting of terminal aorta was performed in 5 patients, 4 - bifurcation stenting of aorta and both iliac arteries. Endovascular surgery combined with the "open" reconstruction of arteries below the inguinal ligament (hybrid operation) were performed in 2 cases. Results: technical perioperative success of interventions with the restoration of the aortic lumen was achieved in all cases. Our experience in endovascular treatment of atherosclerotic lesions of the abdominal aorta, allows to characterize this surgical intervention as a highly effective and low-impact. References 1. Grollman J.H., Del Vicario M., Mittal A.K. Percutaneous transluminal abdominal aortic angioplasty. Am.J.Roentgenol. 1980; 134(5):1053-1054. 2. Velasquez G., Castaneda-Zuniga W., Formanek A., Zollikofer C., Barreto A., Nicoloff D., Amplatz K., Sullivan A. Nonsurgical aortoplasty in Leriche syndrome. Radiology. 1980;134(2) 359-360. 3. Onder H., Oguzkurt L., Gur S., Tekba$ G., Gurel K., Co kun I., Ozkan U. Endovascular treatment of infrarenal abdominal aortic lesions with or without common iliac artery involvement. Cardiovasc Intervent Radiol. 2013; 36(1):56-61. 4. Ritter J.C., Ghosh J., Butterfield J.S., McCollum C. N., Ashleigh R. Chimney stent technique for treatment of severe abdominal aortic atherosclerotic stenosis. J. Vasc. Interv. Radiol. 2011; 22(3): 391-394. 5. Sabri S.S., Choudhri A., Orgera G., Arslan B., Turba U.C., Harthun N.L., Hagspiel K.D., Matsumoto A.H., Angle J.F. Outcomes of covered kissing stent placement compared with bare metal stent placement in the treatment of atherosclerotic occlusive disease at the aortic bifurcation. J. Vasc. Interv. Radiol. 2010; 21(7): 995-1003. 6. Bruijnen R.C., Grimme F.A., Horsch A.D., Van Oostayen J.A., Zeebregts C.J., Reijnen M.M. Primary balloon expandable polytetrafluoroethylene-covered stenting of focal infrarenal aortic occlusive disease. J. Vasc. Surg. 2012; 55(3): 674-678. 7. Donas K.P, Schonefeld T., Schwindt A., Troisi N., Torsello G. Successful percutaneous endovascular treatment of symptomatic infrarenal aortic stenosis caused by soft-plaque with the Endurant stent-graft. J. Cardiovasc. Surg. (Torino). 2011;52(1): 89-92. 8. Gavrilenko A.V., Egorov A.A. Tradicionnaja hirurgija sosudov i rentgenjendovaskuljarnye vmeshatel'stva - konkurencija ili vzaimodejstvie, vedushhee k gibridnym operacijam? [Traditional angiosurgery and endovascular procedures - competition or cooperation] Angidogija i sosudistaja hirurgija. 2011; 17(4): 152-156 [In Russ]. 9. Masmoudi H., Mordant P, Francis F., Karsenti A., Paraskevas N., Cerceau P, Duprey A., Leseche G., Castier Y Focal atherosclerotic abdominal aortic stenosis. J. Mal. Vasc. 2011; 36(3):196-199. 10. Schwindt A.G., Panuccio G., Donas K.P, Ferretto L., Austermann M., Torsello G. Endovascular treatment as first line approach for infrarenal aortic occlusive disease. J. Vasc. Surg. 2011; 53(6):1550-1556.
Abstract: Acute cerebrovascular accident (CVA) is one of leading causes of death and disability in the population, both in Russia and around the world. Aim: was to improve the effectiveness of the prevention of ischemic stroke (IS) in patients with asymptomatic stenosis of internal carotid arteries (ICA). Materials and methods: this article is an analysis of the world literature on the subject of stroke in patients without focal or ocular symptoms (asymptomatic stenosis), medical and surgical (carotid stenting / carotid endarterectomy) correction of such stenotic lesions, postoperative complications, and the risk of stroke in the immediate and late postoperative period. We presented data on development of stroke, depending on the type of plaques, brain CT data, comorbidities in these patients, the method of surgical correction of stenosis. On the basis of international multicenter studies and experience of individual domestic and foreign clinics we performed evaluation of IS conservative anc surgical prophylaxis in this group of patients. Results: performed analysis allowed to formulate recommendations on the tactics of treatment and examination of patients with asymptomatic internal carotid artery stenosis. References 1. Bokerija L.A., Gudkova R. G. Serdechno-sosudistaja hirurgija. 2010; Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija. [Cardio-vascular surgery. 2010. Diseases and congenital abnormalities of blood circulation]. M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 192 [In Russ]. 2. Pokrovskij A.V. Klinicheskaja angiologija. A.V. Pokrovskij. [Clinical Angiology]. Moscow; 2004;1; 808. [In Russ]. 3. Chernjavskij A.M. Programma bor'by s insul'tom, prehodjashhimi narushenijami mozgovogo krovoobrashhenija i discirkuljatornymi jencefalopatijami: metod. rekomendacii A.M.Chernjavskij, T.E.Vinogradova. 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Surg. 2009;49;903-909. 22. Hougaku H., Matsumoto M., Handa N. et al. Asymptomatic carotid lesions and silent cerebral infarction. Stroke. 1994;25:566-70. 23. Tegos T.J., Sabetai M.M., Nicolaides A.N. et al. Patterns of brain computed tomography infarction and carotid plaque echogenicity. J. Vasc. Surg. 2001;33:334-9. 24. Hashimoto H., Tagaya M., Niki H. Htani H. Computer-assisted analysis of heterogeneity on В-mode imaging predicts instability of asymptomatic carotid plaque. Cerebrovasc. Dis. 2009;28:357-64. 25. Liapis С., Kakisis J., Kostakis A. Carotid Stenosis. Factors Affecting Symptomatology. Stroke. 2001; 32:2782-2786. 26. Nicolaides А., Kakkos S., Kyriacou E. et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J.Vasc. Surg. 2010;52:1486-96. 27. Yi-Ning Qian, Yong-Ting Luo, Hong-Xia Duan et al. Adhesion Molecule CD146 and its Soluble Form Correlate Well with Carotid Atherosclerosis and Plaque Instability. 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Multiple biological predictors for vulnerable carotid lesions. Cerebrovasc. Dis. 2009;28:601-610. 34. Abbott A.L., Paraskevas K.I., Kakkos S.K. et al. Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis. Stroke. 2015 Nov;46(11):3288-301. 35. Goldstein L.B. Bushnell C.D. Adams RJ. et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 ;42(2): 517-84. 36. Brott T.G., Hobson 2nd R.W. Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N. Engl. J.Med. 2010;363(1): 11-23. 37. Voeks J.H., Howard G., Ronbin G.S, Malas M.B et al. Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke. 2011;42( 12):3484-90. 38. Nallamothu B.K., Lu M., Rogers M.A. et al. 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Abstract: Aim: was to improve the efficiency of diagnosis of patients with coronary heart disease, by estimating of possibilities of cardiac multislice computed tomography in comparison with coronary angiography. Materials and methods: study included 64 patients (18 women and 46 men, mean age 62,4 ± 9,5 years) with a high risk of developing coronary heart disease. In 34 patients - myocardial infarction in anamnesis (18 patients - in pool right coronary artery in 16 patients - in left anterior descending artery). Clinics of angina pectoris - in 40 patients (functional class (FC) I - 10; FC II - 22, FC III - in 6, FC IV - 2 patients). Selection criteria: the absence of disease progression for at least 6 weeks, and at least 3 months of optimal treatment. All patients underwent cardiac MSCT at 256-slice CT scanner. Obtained data was compared with data of reference method - x-ray coronary angiography. Results: comparison of MSCT coronary angiography with invasive data showed a high comparability of results of two methods in the evaluation of coronary artery disease. It was revealed that discrepancies between cardiac MSCT and CAG in detection of hemodynamically insignificant stenoses ranging from 0 to 4%, hemodynamically significant stenoses - from 0 to 2.6%, subtotal stenosis - from 0 to 1%, occlusions - 0%. The presence of strong correlations between data of cardiac MSCT and coronary angiography of stenosis, demonstrated the high quality of MSCT imaging of coronary artery segments in the examination with a variety of modes of application method. Conclusion: multislice computed tomography is a highly effective method for diagnosing of structural and anatomic changes of coronary arteries in patients with coronary heart disease. References 1. Chazov E.I. 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Kolichestvennyj analiz urovnja kal'cinoza koronarnyh arterij: sravnenie informativnosti mul'tispiral'noj komp'juternoj tomografii i jelektronno-luchevoj tomografii[Quantitative analysis of the level of calcification of the coronary arteries: comparison of informativeness of multislice computed tomography and electron beam tomography.]. Terapevticheskij arhiv. 2006;12:15-19 [In Russ]. 5. Ternovoj S.K., Veselova T.N., Sinicyn V.E. i dr. Rol' mul'tispiral'noj komp'juternoj tomografii v diagnostike infarkta miokarda [The role of multislice computed tomography in the diagnosis of myocardial infarction.]. Kardiologija. 2008; 1: 4-8 [In Russ]. 6. Sinicyn V.E., Ternovoj S.K., Ustjuzhanin D.V. i dr. Diagnosticheskoe znachenie KT-angiografii v vyjavlenii gemodinamicheski znachimyh stenozov koronarnyh arterij [The diagnostic value of CT angiography in the detection of hemodynamically significant stenoses of coronary arteries]. Kardiologija. 2008; 1: 9-14 [InRuss]. 7. Ustjuzhanin D.V., Veselova T.N., Sinicyn V.E. i dr. Cravnitel'nyj analiz diagnosticheskogo znachenija neinvazivnoj angiografii koronarnyh arterij s pomoshh'ju jelektronno-luchevoj i mul'tispiral'noj komp'juternoj tomografii [Comparative analysis of the diagnostic value of noninvasive coronary angiography using the electron beam and multislice computed tomography.]. Terapevticheskij arhiv. 2008; 4:12-15[In Russ]. 8. Veselova T.N., Merkulova I.N., Mironov V.M., Merkulov E.V., Ternovoj S.K., Ruda M.Ja. Neinvazivnaja ocenka ateroskleroticheskogo porazhenija koronarnyh arterij u bol'nyh s ostrym koronarnym sindromom metodom mul'tispiral'noj komp'juternoj tomografii[Noninvasive assessment of atherosclerotic lesions of coronary arteries in patients with acute coronary syndrome by multislice computed tomography.]. Medicinskaja vizualizacija. 2010; 4:100-109 [In Russ]. 9. Petcherski O., Gaspar T., Halon D. et al. 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Abstract: Aim: was to estimate efficacy and safety of carotid stenting and carotid endarterectomy Г patients, admitted to center of cardiovascular surgery. Material and methods: we investigated possibilities of treatment with randomization one-by-one, according to admittance to hospital and use of carotid endarterectomy or stenting. Final decision in each case was made by consilium. For the period 2011-2013, 269 patients were treated including 132 patients who underwent carotid endarterectomy and 137 patients who underwent carotid stenting. The majority of patients had an anamnesis of coronary heart disease or needed coronary revascularization. Symptomatic stenosis was an indication for 19,0 % revascularization in both groups (p = 0.994). Results: there were no in-hospital deaths registered. Incidence of stroke after carotid endarterectomy was 6(4,5%) and 2(1,5%) after stenting. Transient ischemic attack occurred in 3(2,2 %) patients in the stenting and 1 patient (0,76 %) in endarterectomy groups. Major bleeding was observed in both groups with equal frequency (p = 0,584). Defeat of cranial nerves (7,6 %; p = 0,001) was only observed in the endarterectomy group. Finally both methods of carotid revascularization showed the same level of complications (p = 0,569) besides cranial nerve defeat. Conclusion: carotid stenting and endarterectomy show similar results in the treatment of patients with atherosclerotic lesions of carotid arteries. Both methods can equally be used in clinics with adequate experience in surgical interventions on the heart and peripheral vessels. The complex assessment of the patient and the lesion by the vascular team is necessary. References 1. Casserly I.P, Sachar R., Yadav J.S. Practical peripheral vascular interventions. Second edition. Wolters Kluwer Health/Lippincott Williams & Wilkins. Philadelphia. 2011; 466 p. 2. Cutlip D. E., Pinto D. S. Extracranial carotid disease revascularization. Circulation. 2012; 126(22): 2636-2644. 3. Eller J. L., Dumont T. M., Sorkin G. C., Mokin M., Levy E. I., Kenneth V., L. Hopkins N., Siddiqui A. H. Endovascular advances for extracranial carotid stenosis. Neurosurgery. 2014; 74: 92-101. 4. Al - Damluji M. S., Nagpal S., Stilp E., Remetz M., Mena C. Carotid revascularization: A systematic review of the evidence. J. Interv. Card. 2013; 26 (4): 399- 410. 5. Tendera M., Aboyans V., Bartelink M-L., Baumgartner I., Clement D., Collet J-P, Cremonesi A., De Carlo M., Erbel R., Gerry F., Fowkes R., Heras M., Kownator S., Minar E., Ostergren J., Poldermans D., Riambau D., Roffi M., Rother J., Sievert H., van Sambeek M., Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. European Heart Journal. 2011; 32: 2851 - 2906. 6. White C. J., Ramee S. R., Collins T. J., Jenkins J. S., Reilly J. P, Patel R. A. G. 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D., Jim J., Kenwood C. T., Siami F. S., White R. A. The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry. J. Vasc. Surg. 2013; 57: 1318 - 1324. 12. Roffi M., Sievert H., Gray W. A., White C. J., Torsello G., Cao P., Reimers B., Mathias K., Setacci C., Schonholz C., Clair D. G., Schillinger M., Grunwald I., Bosiers M., Abou-Chebl A., Moussa I. D., Mudra H., Iyer S. S., Scheinert D., Yadav J. S., van Sambeek M. R., Holmes D. R., Cremonesi A. Carotid artery stenting versus surgery: adequate comparisons? Lancet. Neurol. 2010; 9: 339 - 341. 13. Timaran C.H., Mantese V. A., Malas M., Brown O. W., Lal B. K., Moore W. S., Vocks J. H., Brott T. G. Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J. Vasc. Surg. 2013; 57: 303-308. 14. Fokkema M., de Borst G. J., Nolan B. W., Indes J., Buck D. B., Lo R. C., Moll F. L., Schermerhorn M. L. Clinical relevance of cranial nerve injury following carotid endarterectomy. Eur. J. Vasc. and Endovasc. Surg. 2014; 47(1): 2-7. 15. Thirumala P., Kumar H., Bertolet M., Habeych M., Crammond D., Balzer J. Risk factors for cranial nerve deficits during carotid endarterectomy: A retrospective study. Clinical Neurol. and Neurosurg. 2015; 130:150-154.