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Introduction: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study.

Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies.

Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices.

Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%.

Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%).

Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.



Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods.

Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation.

Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients.

Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices.

The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing.

Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used.

Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.




Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research.

Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method.

Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. 

Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research.

Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table.



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Aim: was to evaluate the effectiveness of endovascular interventions in patients with critical limb ischemia (CLI) with multilevel extended lesions of lower limb arteries of types C and D according to TASC II.

Materials and methods: a retrospective analysis of results of surgical treatment of patients with critical limb ischemia, who underwent 127 endovascular interventions on arteries of the femoral- popliteal-tibial segment for the period from 2007 to 2020, was carried out. 15 patients had ischemic limb pain at rest (11,8%) and 112 patients had trophic lesions (88,2%). Our study included patients with arterial lesions of type C (18 patients, 14,2%) and type D (109 patients, 85,8%) according to TASC II.

Results: technical success of performed endovascular interventions was 95,3%. Within a 30-day period, 2 patients (1,6%) had myocardial infarction, 3 patients (2,4%) underwent early «high» amputation. Perioperative mortality was 0,8% (1 patient). Primary patency of endovascular interventions was 87%, 58% and 36% after 1, 3 and 5 years, respectively, while secondary patency was 91%, 81% and 58% after 1, 3 and 5 years, respectively. Limb salvage rate was 93%, 89% and 79% after 1, 3 and 5 years, respectively. Patient survival rate was 95%, 84% and 78% after 1, 3 and 5 years, respectively.

Conclusions: endovascular interventions on femoral-popliteal-tibial arterial lesions of types C and D according to TASC II in patients with critical limb ischemia are effective, and modern method of treatment with good immediate and long-term results.



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Aim: was to determine the influence of blood plasma fibrinogen level on results of the left main coronary artery stenting.

Material and methods: clinical, laboratory and angiographic parameters of 819 patients after elective stenting of the unprotected left main coronary artery were used. The end-point was target lesion failure (TLF), including adverse events as repeated revascularization of the target lesion (TLR), myocardial infarction (MI) and death from cardiac causes.

Results: in 5 years follow-up period, end-point was achieved in 158 cases (19,3%). Independent predictors of TLF were: SyntaxScore > 32 (HR 1,089 95% CI 1,029-1,153, p = 0,003), creatinine level (HR 1,009 95% CI 1,004-1,013, p=0,001) and fibrinogen level (HR 1,4 95% CI 1,169-1698, p=0001). According to results of the Kaplan-Meier analysis, the cumulative probability of the TLF was higher in patients with fibrinogen values greater than 3,48 g/L (log-rank 0,001).

Conclusion: blood plasma fibrinogen level was an independent predictor of the TLF after left main coronary artery stenting. Increase in the level of blood fibrinogen for each 1 g/L led to an increase in the risk of TLF by 1,4 times per month.



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Aim: was to estimate results of endovascular treatment of subclavian arteries lesions.

Materials and methods: study analyzes results of endovascular treatment of patients with occlusive-stenotic lesions of subclavian arteries. For the period 2014-2018, 87 endovascular interventions were performed on subclavian arteries. Indication for surgery was occlusion of subclavian artery or stenosis of more than 70% with the development of steal-syndrome. Before surgery, all patients underwent duplex scanning of brachiocephalic vessels and CT angiography of branches of the aortic arch with cerebral phase. There was no difference in severity of symptoms and comorbidity between patients with stenosis or occlusions (р>0,05). In case of stenosis, direct stenting of subclavian artery was performed. For occlusions, mechanical recanalization was performed using hydrophilic wires, balloon angioplasty followed by stenting. In all cases, we used a balloon-expandable stent.

Results: technical success was achieved in 98,8% of interventions. There were no lethal outcomes, myocardial infarction, or stroke. In one patient, brachial artery thrombosis occurred in early postoperative period; thrombectomy from the brachial artery was performed with restoration of blood flow. Patency of subclavian artery after 1 and 3 years was 100% and 94%, respectively.

Conclusions: endovascular interventions for occlusive-stenotic lesions of subclavian arteries is an effective and safe method of treatment of vertebrobasilar insufficiency.





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Introduction: pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance that leads to the development of right ventricular heart failure and premature death of patients. Today, there are several ways to create an atrial communication: balloon dilatation, Park procedure, balloon knife atrial septostomy, atrial septum stenting and implantation of fenestrated occluder.

The main problem with positioning of the device is that the atrial septum is not visible on fluoroscopy, where the stent is visible throughout. And the stent is not visible throughout on echocardiography, where the septum is visible. Exactly for this operation, the combination of echo- and fluoroscopic image in real time is very useful in order to accurately place in the middle at the level of stent in the septum and to avoid its dislocation with embolization of right or left heart chambers, or vessels of pulmonary and systemic circuit.

Material and methods: we present a case report of atrial septostomy with stent implantation into the atrial septum using the EchoNavigator® hybrid imaging system in a patient with pulmonary arterial hypertension.Surgical intervention was performed on a patient with PAH: atrial septostomy with intubation anesthesia under the control of fluoroscopy and transesophageal echocardiography (TEE) using the EchoNavigator® system. The procedure was performed using a Palmaz stent, that was implanted without additional fixation.

Results: patient with pulmonary hypertension underwent an atrial septostomy using the EchoNavigator® hybrid imaging system, which was used for positioning and implantation of stent into the atrial septum as quickly and accurately as possible. This surgical intervention significantly improved patient's clinical condition, cardiac hemodynamics and, accordingly, increased the quality of life.

Conclusion: atrial septostomy is a surgical method for patients with severe pulmonary arterial hypertension. Carrying out this operation under the control of the EchoNavigator® system with the function of hybrid imaging in real time greatly facilitated the procedure for positioning and implanting of stent, facilitated the safe implementation.



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Aim: was to estimate long-term results of vertebral artery (VA) stenting in patients with vertebrobasilar insufficiency (VBI).

Material and methods: study included 194 patients with VBI caused by lesion of V1 segment of VA. All patients received the best course of drug therapy before admission to the clinic. In all these patients, atherosclerotic stenosis of 70% or more of VA was revealed in V1 sergment. All patients underwent surgical correction of V1 segment of VA. Open surgery was performed in «A» group – with a tortuosity of VA – 129(66,5%), in group «B» – without tortuosity of a VA – 65(33,5%) performed stenting of V1 segment of PA.

Bare-metal stents were implanted in 44 patients, drug-eluted stents - 14, renal stents – 7. Distal protection was used in 14 patients. In remaining patients, stenting was performed without embolic protection devices.

Main criteria for evaluating of results were: patency of the reconstruction zone and clinical improvement in the patient after surgery. Statistical processing of results was carried out by calculating ?2, the exact Fisher test (EFT) and constructing of Kaplan-Meier survival curves.

Results: it was determined that in «hopeless» patients, from the point of view of drug treatment, it is possible to achieve a significant clinical effect by surgical methods. Of 194 patients, clinical improvement in the early postoperative period was achieved in 189(97,4%) patients, after 1 year in 177 (91,2%) patients, and after 3 years in 156(80.2%) patients.

In case of stenting of V1 segment of VA – we received excellent immediate results – 100% of technical and clinical success. However, in the long term, results of open operations were better than results of stenting. 3 years after operation, a higher clinical efficacy of open methods was determined – 79,8%, in contrast to stenting – 73,8%. Although, differences were not statistically significant (p> 0,05). 3 years after operation, in case of open operations, a significantly smaller number of restenosis of the reconstruction zone was 1.6%, than with stenting – 15,4% (p <0.05). However, in patients with open operations, more thrombosis of the reconstruction zone were revealed – 5,5% than in patients with stenting – 1.5% (p>0,05). When performing open operations on V1 segment of VA, strokes were fewer – 2.3%, than in group of V1 stenting segment of VA – 3.1% (p> 0.05). When comparing Kaplan-Meyer curves, the median during open surgeries on VA is not achieved after 18 years, and in group of stenting of VA, it occurs after 7 years.

Conclusion: stenting of V1 segment of vertebral arteries in patients with VBI is not the operation of choice in terms of long-term results. However, this operation can be considered as the first stage of brain revascularization in the presence of significant stenosis of V1 segment of vertebral artery and low brain tolerance to ischemia in patients with multiple lesions of brachiocephalic arteries.



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15.   VIST (Vertebral artery Ischaemia Stenting Trial) ISRCT N 95212240.

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Aim: was to evaluate the effectiveness of carotid arterial revascularization by stenting of internal carotid arteries (ICA) in patients with a previous ischemic stroke.

Materials and methods: in FSBI «Treatment and rehabilitation center» of the Ministry of Health of Russia,104 patients on treatment and rehabilitation after previous ischemic stroke, underwent stenting of symptomatic atherosclerotic stenosis of the ICA. The average time since stroke was 67 days (from 28 to 273 days). ICA stenting was performed according to generally accepted standards with the mandatory use of intravascular protective devices against cerebral embolism. In most patients we used a filter protection system (77 observations), and for stenosis of more than 95% and in the presence of an unstable atherosclerotic plaque, a proximal defense system was used (27 patients). In some cases, if the situation required it, a combination of protective devices was used (5 observations). A few days before upcoming operation, all patients were evaluated for microcirculation and perfusion in brain tissue using single photon emission computed tomography (SPECT), followed by analysis of results and comparison with SPECT data in the postoperative period.

Results: when analyzing 30 days after stenting, there were no fatal outcomes. In one case (0.96%) after stenting of the subtotal stenosis of the ICA, a hemorrhagic stroke on the ipsilateral side developed on the fifth day. In another case, intraoperative embolism of the ophthalmic artery occurred on the side of the operation with partial loss of vision field.

In the long-term period (4 years and 7 months), the number of undesirable events was 2%. In one case (0.96%), the patient died of ischemic stroke on the ipsilateral side after 3 years and 2 months after stenting. In another case, patient after 1 year and 2 months had an ischemic stroke on the side of the operation. Thus, the total number of complications associated with ICA stenting (30-day period + long-term period) was 3.8%.

When evaluating results of stenting by the SPECT method, the state of cerebral perfusion was assessed using perfusion maps in two modes and by axial perfusion sections.

In all observations after stenting, improvement of cerebral perfusion was noticed, regardless of the side and severity of ICA stenosis and the presence of focal postischemic changes. Visually, perfusion sections show a general increase in cerebral blood perfusion (CBP), a decrease in one-sided focal deficiency of CBP . Same results were obtained for relative cortex perfusion (relCP) in four regions and in vascular basins.

Comparing results, obtained by the number of undesirable events (strokes, restenosis and death) with the four-year data of the analysis of the international CREST study, the complication rate in our group is significantly lower (3.8% versus 8.6% in the CREST stenting group and 8.4% in carotid endarterectomy group CREST).

Conclusion: carotid stenting is an effective method of treatment of atherosclerotic lesions of main cerebral arteries in patients with previous stroke. The effectiveness of this type of treatment is confirmed by a positive clinical result and with the help of modern diagnostic methods, in particular SPECT.



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This study presents an overview of modern methods of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery

Aim: was to analyze the state of surgical and endovascular treatment of atherosclerotic lesions of the superficial femoral artery according to the modern literature in the field of vascular surgery

Results: this review analyzes more than 30 relevant publications presented in both domestic anc foreign press over the past 20 years, taking into account a variety of meta-analyses.

Conclusions: this topic is very relevant today, as the increase in the number of surgical and endovascular interventions in lesions of the superficial femoral artery dictates new research to develop optimal tactics of treatment of this category of patients.



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20.   Lindgren H, Qvarfordt P, Ekesson M, et al Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg. 2017        May; 53(5):686-694.

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Aim: was to identify risk factors of early adverse cerebral events after carotid artery stenting anc endarterectomy

Materials and methods: 908 patients who underwent isolated carotid stenting (N = 522) and carotid endarterectomy (N = 386) were included in this retrospective analysis. Patients with simultaneous cardiac surgery and patients with symptomic stenosis of CA were excluded from research. The primary end point was ipsilateral perioperative ischemic stroke, proved by neurologist and CT/MRI data. To identify predictors, multivariate regression was used, with factors that could influence endovascular and surgical methods of treatment.

Results: patients from two groups were similar in main clinical and demographic characteristics. There were no deaths and cerebral hemorrhagic complications. The stroke rate in the endovascular and surgical groups was 1.7% and 1.04% respectively (p = 0.5). The total rate of strokes and transitory ischemic attack (TIA) using two methods was 1.4%. The TIA rate was higher in the endovascular group without statistically difference (1.3% vs. 0.3%, p = 0.1). The regression analysis showed that predictor of the adverse cerebral events was the degree of carotid artery stenosis in endovascular group (OR 1.318, 95% CI: 1.131-1.535, p <0.001). There were no any predictive factors of TIA or stroke in the surgical group.

Conclusions: the independent predictor of early TIA and stroke in endovascular group, unlike endarterectomy, was the degree of carotid stenosis.



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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. 



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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 6.6 kg). The patient underwent stenting of restenosis of the distal aortic anastomosis through retroperitoneal open access to the infrarenal aorta.

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 22 mm hg. The patient was discharged to an outpatient stage, followed by examination after 6 months and possible re-intervention (stent dilatation with a larger diameter balloon) as the pressure gradient rises as the child grows. Proposed hybrid approach in a child 11 months with a body weight of 6,590 kg allowed to avoid the risk of re-surgery in conditions of circulatory arrest and demonstrated a satisfactory angiographic and clinical result.

Conclusion: stenting of restenosis in distal aortic anastomosis using retroperitoneal access can be considered as a surgery of choice in specialized centers.



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Aim: was to assess dynamics of markers of endothelial dysfunction after open reconstructive and endovascular operations on the aortoiliac segment.

Material and methods: the study included 36 patients, who were divided into two groups depending on the method of performed operations. Patients of the first group (n = 20) underwent open surgery - aortofemoral bypass, the second group (n = 16) underwent endovascular stenting and angioplasty of iliac arteries. We examined the level of the endothelial dysfunction markers: homocysteine, oxidized low density lipoprotein, adhesion molecules of vascular endothelium type 1 (sVCAM-1) Annexin V the inhibitor (PAI-1) and tissue plasminogen activator (t-PA) in the systemic circulation and in operated limb before the operation and in the early postoperative period.

Results: an expression of endothelial dysfunction after reconstructive surgery on the aortoiliac segment was established in both, systemic and local blood flow. Carrying of X-ray-endovascular operations was accompanied by endothelial dysfunction, which was comparable with open repair. Increased concentration of sVCAM-1 after surgery was revealed in all groups with greater dynamics in the operated limb. Annexin V content in the local blood flow in patients of the second group is significantly lower than of the first (at 42,66%, p <0.05).The most significant changes were found in the fibrinolytic activity in the performance of X-ray-endovascular interventions. A significant increase in systemic and local concentrations of PAI-1 was marked in the second group. The level of PAI-1 in the operated limb after stenting was 1,93 times higher than that in an open procedure. In contrast, post-operative changes in t-PA in patients undergoing endovascular surgery, showed an increase in t-PA compared to open surgery group.

Conclusion: in the complex examination of patients with atherosclerosis obliterans before anc after reconstructive surgery is necessary to monitor markers of endothelial dysfunction with the aim of personalized correction.



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From January 2003 till January 2008 transhepatic endobiliar stenting was performed in 62 patients with obstructive jaundice due to high post-operative malignant strictures of hepaticocholedochus duct. In 49 cases (79 %) two-step intervention performed (biliary drainage followed by endobiliary stenting), 13 patients (21 %) underwent single-stage intervention. In 60 patients (96,8%) balloon dilatation was done prior to stent implantation. In 59 cases (95,2%) the procedure was completed by control drainage placement. Hospital stay for the endobiliary stenting procedure was 12,7-22,3 days (average hospital stay 17,5 days). Mortality was as high as 12,9% (8 cases). Average post-implantation life span appeared to be 9,7 months. In 5 patients (8,1%) mechanical jaundice relapse occurred, so they needed hospitalization for reintervention. Direct dependence found between the effectiveness of endobiliary stenting and the technical characteristics of stents, anatomy of biliary strictures, as well as the methods and techniques of the intervention. Single-stage endobiliary stenting, without prior drainage, decreases the complication rate, improves the quality of life during the hospital stay, and prolongs the post-implantation life expectancy. Single-stege interventions are also shown to decrease the hospital stay and reduce the costs. Balloon dilatation is the required stage of the intervention, especially if self-expandable stents are used in torturous biliary ducts. Post-implantation drainage placement can be skipped if the wall of the hepatico-choledochus duct is not edematous, there are no signs of tumor prolapse into the lumen, if the stent is completely expanded, and the contrast media evacuates easily into the intestine.



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10.   Kaassis M., Boyer J., Dumas R. et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003; 57: 178-182.

11.   Ikeda S., Maeshiro K. Interventional treat ment of biliary stricture. Nippon. Geka. Gakkai. Zasshi. 2004; 105 (6): 374-379.

12.   Brountzos E., Ptochis N., Panagiotou I. et al. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc. Intervent. Radiol. 2007; 30(1): 66-73.

13.   Nakamura T., Hirai R., Kitagawa M. et al. Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience. Cardiovasc. Intervent. Radiol. 2002; 25: 373-380.

14.   Tesdal I., Roeren T., Weiss С et al. Metallic stents for treatment of benign biliary obstruction: a long-term study comparing different stents. J. Vasc. Interv. Radiol. 2005; 16 (11): 1479-1487.

15.   Oikarinen H., Leinonen S., Karttunen A. et al. Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction.J. Vasc. Intervent. Radiol. 1999; 10: 1387-1393.

16.   Yoshida H., Taniai N., Mamada Y. et al. One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent. J. World. J. Gastroenterol. 2006; 21; 12 (15): 2423-2426.

17.   Cowling M., Adam A. Internal stenting in malignant biliary obstruction. World. J. Surg. 2001; 25: 355-361.

18.   Isayama H., Komatsu Y., Tsujino T. et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest. Endosc. 2002; 55 (3): 366-370.

19.   Yoon W., Lee J., Lee K. et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest. Endosc. 2006; 63 (7): 996-1000.

20.   Chen J., Sun C, Liao C, Chua C. Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors.J. World. J. Gastroenterol. 2006; 7; 12 (1): 119-122.

21.   Inal M., Aksungur E., Akgьl E. et al. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not? Cardiovasc. Intervent. Radiol. 2003; 26: 40-45.



19 males with unilateral symptomatic internal carotid artery stenosis were stented in 2007 using Mo.Ma cerebral protection device (Invatec, Italy). Angiographic success rate was 100%, average procedure time 53,7±9,9 min, ICA occlusion time 53,7±19,9 min. 2 patients presented transitory ischemic attack. Clinical improvement achieved in all cases. Our experience demonstrates that the Mo.Ma device effectively prevents intraprocedural cerebral embolism in carotid stenting, and the idea of proximal protection seems to be safe, user-friendly and very promising. 





1.     Brown M., Rogers J., Bland J. et al.Endovascular versus surgical treatment inpatients with carotid stenosis in the Carotidand Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.The Lancet. 2001; 357: 1729-1737.

2.     Brooks W., McClure R., Jones M. et al. Carotidangioplasty and stenting versus caroti-dendarterectomy: randomized trial in a comnity hospital.J. Am. Coll. Cardiol. 2001; 38 (6):1589-1595.

3.     Wholey M.H., Al-Mubarek N., Wholey M.H.Updated review of the global carotid arterystent registry. Catheter. Cardiovasc. Interv. 2003.60 (2): 259-266.

4.     Roubin G., New G., Iyer S. et al. Immediateand late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-yearanalysis. Circulation. 2001; 103 (4): 532-537.

5.     McKevitt F.M., Macdonald S., Venables S. Et al. Complications following carotid angioplasty and carotid stenting in patients with symptomatic carotid artery disease. Cerebrovasc. Dis. 2004; 17 (1): 285-34.

6.     Ahmadi R., Willfort A., Lang W. et al. Carotidartery stenting: effect of learning curve and intermediate-term morphological outcome./Endovasc. Ther. 2001; 8 (6): 539-546.

7.     Reimers B., Schluter M., Castriota F. et al.Routine use of cerebral protection duringcarotid artery stenting: results of a multicenterregistry of 753 patients. Am. J. Med. 2004;116 (4): 217-222.


8.     Cremonesi A., Manetti R., Setacci F. et al.Protected carotid stenting: clinical advantagesand complications of embolic protectiondevices in 442 consecutive patients. Stroke.2003; 34 (8): 1936-1941.


9.     Aronow Н., Yadav J. Embolic Protection forCarotid Artery Stenting. A 'No Brainer'.Actachir. belg. 2004; 104: 65-70.




Internal carotid artery (ICA) pathological kinking considered to be one of the main causes of stroke. Aim of our study was to assess endovascular possibilities to manage this condition. Carotid stenting performed in 15 non-fixed human corpses with ICA kinking (6 - L-shaped, 5 - S-shaped, 4 - looping) under hydrodynamic monitoring.

It is shown that endovascular correction (stenting) of kinked ICA straightens the artery, considerably reduces pressure gradient, and increases volume of flow. At the same time carotid stenting, performed for ICA kinking, does not distress the vessel wall, in particular, it causes no significant intimal trauma. 




1.     Riser M.M., Gerause J., Ducoudray J., Ribaunt L. Dolicho-carotide interne avec syndrome vertigneux. Neurology. 1951; 85: 145-147.




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3.     Hurwitt E.S. Clinical evolution and surgical correction of obstruction in the branches of arteries. Ann. Surg. 1960; 152:472-475.




4.     Lorimer W.S. Internal carotid artery angioplasty. Surg., Gynecol., Obstet. 1961; 113:783-784.




5.     Паулюкас П.А., Бараускас Э.М. Хирургическая так ика при выпрямлении петель внутренних сонных артерий. Хирургия. 1989; 12: 12-18.




6.     Покровский А.В. Патологическое удлинение и извитость (петлеобразование, кольцеобразование) брахиоцефальных артерий. В кн.: Е.И. Чазов «Болезни сердца и сосудов». Руководство для врачей. М.: Медицина. 1992; 299-302.




7.     Булынин В.И., Мартемьянов С.В., Ласкаржевская М.А. Диагностика и хирургическое лечение различных вариантов патологической извитости внутренних сонных артерий. В сб. 2-й всерос. Съезд серд.-сосуд. хирургов. С.-Пб. 1993; 1: 34-35.




8.     Долматов Е.А., Дюжиков А.А. Хирургическое лечение патологической извитости внутренних сонных артерий. Кардиология. 1989; 3: 45-47.




9.     Еремеев В.П. Хирургическое лечение патологических извитостей, перегибов и петель сонных артерий. Ангиология и сосудистая хирургия. 1998; 2:82-94.




10.   Баркаускас Э.М., Паулюкас П.А. Способ реконструкции устья сонных артерий. Хирургия. 1988; 12: 98-102.




11.   Berger R. Surgical reconstruction of the extracranial carotid internal artery: Management and outcome.J. Vascular Surgery. 2000; 31: 9-18.




12.   Mascoli F., Mari C., Liboni A., VirgiliT., Аrcello D., Mari F., Donin I. The elongation of the internal carotid artery. Diagnosis and surgical treatment. J. Cardiovasc. Surg. 1987; 28 (1): 9-11.




13.   Zanneti P.P., Cremonesi V., Rollo S., Inzani E., Civardi C., Baratta V., Accordino R., Rosa G. Surgical therapy of the kinking of the internal carotid artery. Minerva Chir. 1989; 44 (11): 1561-1567.




14.   Freemann T., Zippit W. Carotid artery syndrome due to kinking: Surgical treatment in 44 cases. Amer. Surg.1962; 28 (11): 745-748.




15.   Derrick. J., Estess M., Williams D. Circulatory dynamics in kinking of the carotid artery. Surgery. 1965; 58 (2): 381-383.




16.   Vannis R.,Joergenson E., Carter R. Kinking of the ICA. Clinical significance and surgical management. Am. J. Surg. 1997; 134(1): 82-89.




17.   Негрей В.Ф., Чернявский А.М., Серкина А.В. Хирургическое лечение патологической извитости брахиоцефальных артерий. Тез. конф. «Диспансеризация и хирургическое лечение больных облитерирующими заболеваниями брахиоцефальных артерий». Москва - Ярославль. 1986; 96-97.




18.   Chino A. Simple method for combined carotid endarterectomy and correction of internal carotid artery kinking.J. Vasc. Surg. 1987; 6 (2): 197-199.




19.   Poindexter J., Patel K., Clauss R. Management of kinked extracranial cerebral arteries. J. Vasc. Surg. 1987; 6 (2): 127-133.




20.   Gyurko G., Reverz J. New surgical procedures for the management of carotid kinking. Acta.Chir. Hung. 1990; 31 (4): 325-331.




21.   Вагнер Е.А., Суханов С.Г., Цемехин Б.Д. Хирургическое лечение патологической извитости брахиоцефальных артерий. В 6 томах. Тез. док. IV съезданевропатологов. 1991; 18-20.




22.   Грозовский Ю.Л., Куперберг Е.Б.,Мучник М.С., Лясс С.Ф., Абрамов И.С., Грибов М.Ю. Тактика и показания к хирургическому лечению больных с сочетанными экстра- и интракраниальными поражениями сонных артерий. Невропатология и психиатрия. 1991; 7: 67-75.




23.   Фокин А. А. Современные аспекты диагностики и хирургического лечения окклюзионно-стенотических поражений ветвей дуги аорты. Дис. д-ра мед. наук. Челябинск. 1995; 320.




24.   Mathias K., Staiger J.,Thon A. et al. Perkutane Katheter Angioplastik der a. Subclavia.Dtsch. med. Wschr. 1980; 105(1): 16-18.




25.   Bachman D., Kim R. Transluminal dilatation for subclavian steal syndrome Amer. J. Roentgenol. 1980; 135: 995-996.




26.   Freitag G., Freitag J., Koch R. et al. Percutaneous angioplasty of carotid artery stenoses. Neuroradiology. 1986; 28 (2): 126-127.




27.   Galichia J. et al. Subclavian artery stenosis treated by transluminal angioplasty. Six cases cardiovasc. Intervent. Radiol. 1983; 6: 78-81.



28.   МашковскийМ.Д.Лекарственныесредства.М. 1984;2: 101.




РТА and stenting of lower limb s arteries was performed in 28 diabetic patients with critical limb ischemia. Technical success rate of interventions was 96,3%. Clinical success rate after the procedure was 64,3%. Mean values of basal ТсРО2 on the foot after operation increased on 11 mm of mercury. At a favorable outcome of treatment ankle-brachial index values increased on 0,2-0,4. Ischemia recurrence rate was 25%. All recurrences of ischemia were observed in period of 3 to 9 months. Cumulative limb salvage rate in 6 months was 80 %, in 12 months - 75%.

In short period of observation PTA and stenting in diabetic patients is able to eliminate the necessity of amputation in majority of patients. Considering weight of the general condition of such patients, presence of accompanying diseases, risk of development of complications of surgical treatment, РТА can be considered as operation of the first choice. 





1.     Rutherford R.B., Durham J. Percutaneous balloon angioplasty for arteriosclerosis obliterans: Long-term results. In Pearce W.H. (eds). Technologies in Vascular Surgery. 1992; 32-345.



2.     Шиповский В.Н. Баллонная ангиопластика в лечении хронической ишемии нижних конечностей.Дис. д-ра мед. наук. 2002; 16-17.



3.     Jeans W.D., Armstrong S. Fate of patients undergoing transluminal angioplasty for lower-limb ischemia. Radiology. 1990; 177: 559-564.



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5.     Харазов А Ф. Диагностика и результаты лечения пациентов с критической ишемией нижних конечностей при атеросклеротическом и диабетическом поражении артерий ниже паховой связки. Дис. канд.мед. наук. 2002; 12.



Authors present results of simultaneous transluminal coronary interventions (TCI) (stenting) in coronary patients with triple vessel disease. Stenting of right coronary artery (RCA) and major branches of left coronary artery (LCA) was performed in 44 patients with coronary artery disease, having angina of III—IV functional classes. In total 1 83 coronary stents were implanted (1 66 «Cypher» and 17 «BxVelocity»). Stents «Bx Velocity» were used only coronary arteries with diameter > 3,5 mm. 3 stents were implanted in 22 cases, 4 — in 9, 5 — in 4, 6 — in 4 and 7 — in 7. TCI were successful in all patients, with restoration of coronary blood flow up to TIMI III through stented segments. Clinical effectiveneness of TCI during long-term follow-up (up to 32 months) was 100%, patient's survival — 90,9%. In 3 patients (6,8%) restenosis developed inside drug-coated stents (4,8%). Repeated stenting was performed with satisfactory clinical and angiographic results. Complete transluminal coronary revascularization is an effective method for treatment of patients with multiple coronary lesions. It provides return to high level of life quality.






1.     Бокерия Л. А., Гудкова Р.Г. Сердечно-сосудистая хирургия-2004. Болезни и врожденные аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН. 2005; 118.



2.     Daemen S., Serruys P.W. Optimal revascularization strategies for multivessel coronary artery disease. Curr. Opin. Cardiol. 2006; 21(6): 595-601.



3.     Vaina S., Touchida K., Serruys P.W Treatment options for multivessel coronary artery desease. Expert Rev. Cardiovasc. Ther. 2006; 4(2): 143-147.



4.     Serruys P.W, Unger E, Sousa J.E. et al. Sirolimus eluting stent implantation for patients with multivessel disease: rationale for the Arterial Revascularization Therapies study part II (ARTS II). Heart. 2004; 90(9): 995-998.


5.     Legrand VH., Serruys P.W, Unger E et al. Three-year outcome after coronary stenting versus bypass surgery for the treatment of multivessel disease. Circulation. 2004; 109(9): 1079-1081.

6.     Алекян Б.Г., Бузиашвили Ю.И., Стаферов А.В. Ангиопластика при множественном поражении коронарных артерий. М.: НЦССХ им. А.Н. Бакулева РАМН. 2002; 146-178.

7.     Меркулов Е.В., Ширяев А.А., Самко А.Н. и др. Сравнительная оценка результатов ангиопластики и коронарного шунтирования у больных ИБС с многососудистым поражением коронарного русла. Материалы 1-й межрегиональной конференции по проблемам кардиологии. Ханты-Мансийск. 2003; 65. 


8.     Babunashvili A.M., Iudin I.E., Dundua D.P., Kartashov D.S., Kavteladze Z.A. Efficacy of the use of sirolimus covered stents in the treatment of diffuse atherosclerotic lesions of coronary arteries. Cardiology. 2006; 46 (11): 21- 29.






Lesions of the LCA stem are found in 2,5-4 % of patients with coronary heart disease who endured coronography, and are accompanied by more severe symptomatology, higher morbidity and mortality rates, and difficulty of radical correction. According to the generally accepted guidelines, the operation of coronary artery bypass has up to now been a method of choice in treatment of the LCA stem. Nevertheless, endovascular methods of treatment for LCA stem lesions have relatively long been used, while implementation into clinical practice of drug-eluding stents has considerably improved the remote outcomes, which made it possible to consider LCA stem stenting as a real alternative to ACB. Hence, the problem concerning indications for and contraindications to LCA stem stenting remains unsolved today. We retrospectively analysed a total of 75 endovascular interventions on the LCA stem in 67 patients, with an isolated lesion of the LCA stem being found only in 7,4 % of the patients. The remaining subjects had lesions of the LCA stem on the background of a multivascular lesion of the coronary bed, including occlusion of the RCA observed in 16,4 % of cases. Successive revascularization was performed in 98,64 % of cases, with no lethal outcomes. One patient required urgent ACB due to development of occluding dissection of the circumflex branch. Complications in the immediate postoperative period were observed in two patients and were represented by non-Q myocardial infarction and stroke. LCA stem stenting proved an efficient and safe method of treatment for coronary heart disease. A comparative analysis of the immediate results of LCA stem stenting and ACB revealed advantages of stenting, consisting in no lethal outcomes (in our series) and a lower short-term rate of postoperative complications.



1.     Cohen МУ Cohn PF, Herman MV, Gorlin R. Diagnosis and prognosis of main left coronary artery obstructtion. Circulation 1972; 45 (Suppl 1): 57 - 65.

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4.     Seung-Jung Park, MD, PHD, Young-Hak Kim, MD, Bong-Ki Lee, MD et al. Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis Comparison With Bare Metal Stent Implantation. Journal of the American College of Cardiology. 2005; 3 (45): 351-6.

5.     Seung-Jung Park, Young-Hak Kim, Bong-Ki Lee, Seung-Whan Lee, Cheol Whan Lee, Myeong-Ki Hong, Jae-Joong Kim, Gary S. Mintz, MD, Seong-Wook Park. Sirolimus-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis. J. Am. Coll. Cardiol. 2005; 45: 351-6.

6.     Colombo A, Moses JW, Morice MC, et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004; 109: 1244-9.

7.     Arampatzis CA, Hoye A, Saia F, et al. Elective sirolimus-eluting stent implantation for left main coronary artery disease: six-month angiographic follow-up and 1-year clinical outcome. Cathet. Cardiovasc. Interv. 2004; 62: 292 - 6.

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11.   Park S, Hong M, Lee CW, et al. Elective stenting of unprotected left main coronary artery stenosis: effect of debulking before stenting and intravascular ultrasound guidance. J. Am. Coll. Cardiol. 2001; 38: 1054 - 1060.

12.   TakagiT, Stankovic G, Finci L, Toutouzas K, Chieffo A, Spanos У Liis-tro F, Briguori C, Corvaja N, Albero R, Sivieri G, Paloschi R, Di Mario C, Colombo A. Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery. Circulation. 2002; 106: 698 - 702.

13.   Sorin J. Brener, MD; Bruce W Lytle, MD; Ivan P. Casserly, MD; Jakob P. Schneider, RN; Eric J. Topol, MD; Michael S. Lauer, MD. Propensity Analysis of Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease and High-Risk Features. Circulation. 2004; 109: 2290 -2295.

14.   Silvestri M, LefПvre T, Labrunie P, Khalife K, Bayet G, Morice MC, Bedossa M, Chmait A.. On behalf of the FLM registry investigators. The French registry of left main coronary artery treatment: Preliminary results. J. Am. Coll. Cardiol. 2003; 41: 45.

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16.   Бокерия Л. А., Алекян Б. Г., Бузиашвили Ю. И. и др




Endovascular methods of treatment for coronary heart disease are of considerable current use. Stenting of coronary arteries is the most widely used intervention in management of coronary heart disease. Present-day models of coronary stents make it possible to selectively perform direct stenting in certain roentgenomorphology of the lesion concerned. The authors analysed the outcomes of direct and conventional stenting of coronary arteries in 74 patients presenting with coronary heart disease. No differences as to the mortality rate were observed between the groups. The group of direct stenting demonstrated lower percentage of ischemic events: myocardial infarction on the background of acute or subacute thrombosis of the stent (1 - in the direct-stenting group, 3 - in the conventional-stenting group), transitory myocardial ischaemia (1 case in the direct-stenting group, 3 cases in the conventional-stenting group). Of the angiographic peculiarities, dissection complicated a total of three procedures of traditional stenting, and did not occur in the direct-stenting group. The no-reflow syndrome was noted to have developed in one case in the stenting group with predilatation. Of the technical peculiarities in the direct-stenting group, we observed a statistically reliable decrease in the average duration of the intervention by 11,76 minutes (P = 0,039), that of roentgenoscopy by 5,91 minutes (P = 0,027), a decrease in the average consumption of the radiopaque medium by 68,36 ml (P < 0,01), and a decrease in the average expenditure of coronary balloon catheters by 0,59 pc. (P < 0,001). Hence, the method of direct stenting of coronary arteries turned out to offer advantages over the conventional-stenting technique with predilatation in the clinical, angiographic and economic aspects, provided a careful selection of patients is performed.



1.     Фуфаев Е.Н. К вопросу о методике клинико-социальных исследований по изучению потребности в кардиохирургической помощи. Качественная Клиническая Практика. 2003; (31) 2: 13-108.

2.     Бокерия Л.А., Гудкова Р.М. Сердечно-сосудистая хирургия - 2004. Болезни и врожденные аномалии системы кровообращения. М., НЦССХ им. А.Н. Бакулева РАМН. 2005; 118.

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10.   Schuhlen H., Kastrati A., Dirschinger J. Intracoronary Stenting and Risk for Major Adverse Cardiac Events During the First Month. Circulation. 1998; (98): 104-111.





The article gives account of coronary stenting impact on the dynamics of left ventricle index. The study covered 94 postinfarction patients, including 80 men and 14 women. Among them 52 patients with Q-forming myocardium infarction and 42 with non-Q myocardium infarction were observed. 1 3 patients that suffered Q-forming myocardium infarction didn't show any segment contractility disorders (group 1), while 39 showed contractility disorders (group 2). The analysis revealed that index improvement of the left ventricle is observed in the 1st group in 77% cases after stenting, while the 2nd group shows no improvements. Among the 2nd group of patients the full recovery is observed in 21% cases, the partial recovery - in 46% and 1 3% didn't overcome any dynamics.

The EchoCG study performed on 42 patients revealed that 31 men have no segmental activity disorders (group 3) and 1 1 suffered segmental activity disorder (group 4). Stenting procedure improved the myocardium function in the 3rd group in 65% cases. In the long prospect 1 0 patients of the 4th group fully recovered their myocardium function and only 1 man showed no dynamics in contractility improvement. Taking into consideration what has been said one can be sure that EchoCG proves to be an effective method of valuing the left ventricle function improvement before and after coronary stenting.



1.     Бокерия А.А. Современное общество и сердечно-сосудистая хирургия. Тезисы докладов V Всероссийского съезда сердечно-сосудистых хирургов. М., 1999; 3-6.

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3.     Белов Ю.В., Вараксин В.А. Современное представление о постинфарктном ремоделировании левого желудочка. Русский медицинский журнал. 2002; 10: 469-471.

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This article presents a review of the literature on treatment of multifocal atherosclerosis of iliac arteries and arteries of lower extremities. Adequate correction of arterial inflow provides normal functioning of distal reconstructions. Combination of endovascular correction of arterial inflow with open surgical reconstructions of arterial outflow maximizes limb revascularization and this leads to less surgical trauma and less complications. Hybrid operations allow to achieve maximum results in terms of hemodynamics in patients with multi-segmental lesions. Immediate and long-term results of such operations are not worse than similarly isolated interventions in each segments. Hybrid operations show their worth and effectiveness in all lesions of aorto-iliac segment, including TASC C and D. Reduced operational trauma during hybrid operations, compared with one-stage surgical reconstruction, and the possibility to perform interventions under regional anesthesia, are particularly important in patients at high risk of comorbidity



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Background. Significant coronary artery disease (CAD), occurring in 7-10% of patients with obstructive hypertrophic cardiomyopathy (HCM), deteriorates the clinical course and survival rates. Until recently, such combination of abnormalities was an indication for coronary artery bypass graft (CABG) and septal myoseptecmy

Aim: was to investigate the efficacy, safety and technique of combined percutaneous intervention in patients with obstructive HCM and CAD. Materials and methods. We have performed 15 combined percutaneous interventions: alcohol septal ablation (ASA) and coronary revascularization. All patients had a marked asymmetric hypertrophy of LV with outflow tract obstruction at rest, as well as severe coronary lesions (75% - 95%). During the procedure, we performed consistently ASA of target zone in charge of obstruction and coronary stenting (10 stents in LAD, 8 stents in RCA, 4 stents in LCX).

Results. Among the effects of interventions were disappearance of angina pectoris and dyspnea, reduction of the pressure gradient in the LV outflow tract and a significant decrease in the thickness of septum. No serious complications (such as MI, complete av-block, ventricular tachiarrhythmias) occured

Conclusion. These results indicate efficacy and safety of ASA combined with coronary revascularization in patients with obstructive HCM who have concomitant CAD.



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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. 



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Percutaneous coronary intervention in octogenarian patients with myocardial infarction (literature review)


For quoting:
Berezhnoi K.Yu., Vanyukov A.E., Kokov L.S. "Percutaneous coronary intervention in octogenarian patients with myocardial infarction (literature review)". Journal Diagnostic & interventional radiology. 2017; 11(3); 79-84.


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

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

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

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



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

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

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

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

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

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

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

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



Choice of treatment strategy in patients with recurrent angina after coronary artery bypass graft surgery (CABG) is still an actual question. Repeat CABG is associated with an increased risk of mortality and large cardiovascular events, so percutaneous coronary intervention (PCI) is the main strategy in these patients. Criteria for choosing between the bypass and the native vessel stenting are not fully understood, as well as not resolved the question of the differentiated approach to the choice of defeat for stenting

Aim: was to compare long-term results of stenting of bypass and native coronary arteries in patients with recurrent angina after CABG using the algorithm proposed in the study.

Materials and methods: study was conducted in 2010-2014 years. in «3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence». A total of 168 patients with the defeat of coronary bypass graft were operated: revascularization of the native vessel - 80 patients, stenting of coronary bypass graft was performed in 88 patients.

Treatment groups were comparable in all major clinical characteristics of patients, as well as on the number of affected arteries, the total number of bypasses, the number of working bypasses, and diffuse lesion of the native channel.

The degree of stenosis of the native vessel was significantly higher in the second group, and the degree of stenosis of bypasses was significantly higher in the first group. Diffuse lesions of coronary bypasses were significantly more frequent in the first group.

Long-term results of the study were followed up in patients in the observation period of 3 to 36 months (mean follow-up was 21(14-27) months). The average duration was not significantly different between treatment groups.

Results: the incidence of myocardial infarction was comparable between groups. In group of coronary bypass graft stenting, revascularization procedures frequency was higher than in the native vessel revascularization (20,45% and 16,25%, respectively, p = 0,0045), and also had a higher incidence of target lesion revascularization (11.36% and 6.25%, respectively, p = 0,0045).

The cumulative rate of major cardiovascular events did not differ significantly, but there was a certain tendency toward a lower incidence of major cardiovascular events in the group of revascularization of the native vessel. 



1.    Goldman S., Zadina K., Moritz T., et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J. Am. Coll. Cardiol. 2004; 44:2149 -56.

2.    Бокерия Л.А., Алекян Б.Г. Руководство по рентгеноэндоваскулярной хирургии сердца и сосудов. Москва. Издательство НЦССХ им. А.Н. Бакулева РАМН. 2008. том 3; 592с.

Bokerija L.A., Alekjan B.G. Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov [Guideline for endovascular surgery of vesels and heart]. Moskva. Izdatel'stvo NCSSH im. A.N. Bakuleva RAMN. 2008. tom 3; 592s [In Russ].

3.    Brilakis E.S., de Lemos J.A., Cannon C.P., et al. Outcomes of patients with acute coronary syndrome and previous coronary artery bypass grafting (from the Pravastatin or Atorvastatin Evaluation and Infection Therapy [PROVE IT-TIMI 22] and the Aggrastat to Zocor [A to Z] trials). Am.J. Cardiol. 2008;102:552-8.

4.    Brilakis E.S., Wang T.Y, Rao S.V., et al. Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology National Cardiovascular Data CathPCI registry. JACC Cardiovasc Interv. 2010; 3:1068-73.

5.    Brodie B.R., Wilson H., Stuckey T., et al. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv. 2009; 2:1105-12.

6.    Brilakis E.S1, Rao S.V., Ba


Aim: was to carry out a comparative evaluation of results of stenting of bifurcation lesions in the segment of coronary chronic total occlusions (CTO) using different methods of percutaneous coronary intervention (PCI).

Materials and methods: present study is based on results of treatment of 146 patients (2010-2013) with coronary artery disease (CAD), who underwent CTO recanalization and had bifurcation with side-branch diameter more than 2mm. After successful recanalization of CTO, patients were randomized into two groups with respect to the used method of stenting: a group with stenting of major vessel and side branch with technique «Mini Crush», and a group with Provisional «Т-stenting» technique. The primary composite endpoint - incidence of major adverse cardiac and cerebrovascular events (MACCE), which includes thrombosis, restenosis, repeated intervention in the target vessel, acute myocardial infarction, stroke and cardiovascular death.

Results: absence of MACCE in the remote period of observation was significantly higher when using and amounted to 87,7% against 63,1% at 12 months after surgery

Conclusions: the use of technique «Mini crush» stenting is more effective (to reduce frequency of post-operative complications, risk of restenosis and repeat intervention in long term) in patients with bifurcation lesions in chronic total occlusion of coronary artery in comparison with using «T-provisional» stenting. 



1.    Popma J., Mauri L., O’Shaughnessy C., et al. Frequency and clinical consequences associated with side branch occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary stents. Circ. Cardiovasc. Interv. 2009; 2:133-9.

2.    Colombo A., Moses J., Morice M., et al. The randomized study to evaluate sirolimus-eluting stents implanted in coronary bifurcation lesions. Circ. 2004; 109:1244-9.

3.    Garot P, Lefevre T., Savage M., et al. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) Trial. J. Am. Coll. Cardiol. 2005; 46:606-612.

4.    Nakamura S., Muthusamy T., Bae J., et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions: multicenter registry in Asia. J. Am. Coll. Cardiol. 2004; 43:35A.

5.    Werner G., Krack A., Schwarz G., et al. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

6.    Hoye A., Tanabe K., Lemos P, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J. Am. Coll. Cardiol. 2004; 43: 1954-1958.

7.    Kini A., Lee P, Marmur J., et al. Correlation of post-percutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am. J. Cardiol. 2004; 93:18-23.

8.    Osiev A.G., Baystrukov V.I., Biryukov A.V. Taktika endovaskulyarnogo lecheniya pri bifurkacionnom porazhenii posle rekanalizacii khronicheskoy okklyuzii koronarnyh arteriy.[ Endovascular treatment tactics in patients with bifurcation lesions after recanalization of chronic coronary arteries occlusions]. Diagnosticheskaya i intervencionnaya radiologiya. 2013; 7(1): 27-31[In Russ].

9.    Albiero R., Boldi E. Provisional Stenting Technique for Non-Left Main Coronary Bifurcation Lesions: Patient Selection and Technique. Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions, 1st ed. By Issam D. Moussa and Antonio Colombo. London: Informa Healthcare. 2010; 48.

10.  Galassi A., Colombo A., Buchbinder M., et al. Long term outcome of bifurcation lesions after implantation of drug-eluting stents with the «Mini-Crush technique». Catheter. Cardiovasc. Interv. 2007; 69:976-83.

11.  Galassi A., Tomasello S., Capodanno D., et al. «Mini Crush» versus «T-provisional» techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. J. Am. Coll. Cardiol. Intv. 2009; 2: 185-94.


Percutaneous coronary intervention is a method of choice in patients with recurrence of angina after aorto-coronary bypass. Endovascular interventions after aorto-coronary bypass are associated with a high risk of distal embolism and technical difficulties. On the other hand, revascularization of native coronary arteries in patients after aorto-coronary bypass, leads to worse results than PCI in patients without prior cardiac operations.

Aim: was to compare results of stenting of coronary bypass graft and native artery stenting in patients with recurrence of angina after aorto-coronary bypass, with use of proposed algorithm.

Materials and methods: for the period 2010-2014, in 3rd Central Military Clinical Hospital named after A.A.Vishnevsky of Ministry of Military Defence, 168 patients with coronary bypass defeat underwent operation: in 80 patients native artery reconstruction and in 88 - aorto-coronary bypass graft stenting were performed.

Due to impossible endovascular revascularization, 14 patients underwent repeated aorto-coronary bypass; after that they were excluded from research.

Included into research patietns were treated by different stents: drug-eluting stents (DES), bare metal stents (BMS) and combination BMS+DES. In first group the rate of DES implantation was higher (60% vs 37,5%); in the second group stent placement was comparable (DES 46,6% vs BMS 50%).

The results of this study show that the choice of revascularization strategy according to the presented algorithm, the short-term outcomes of both tactics are comparable.  



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3.    Morrison D.A., Sethi G., Sacks J., et al. Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients. J. Am. Coll. Cardiol. 2002;40:1951-4.

4.    Harskamp R.E., Lopes R.D., Baisden C.E., de Winter R.J., Alexander J.H. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann. Surg. 2013; 257(5):824-833.

5.    Bryan A.J., Angelini G.D. The biology of saphenous vein graft occlusion: etiology and strategies for prevention. Curr. Opin. Cardiol. 1994;9:641-9.

6.    Brilakis E.S., Wang T.Y, Rao S.V., et al. Frequency and predictors of drug-eluting stent use in saphenous vein bypass graft percutaneous coronary interventions: a report from the American College of Cardiology National Cardiovascular Data CathPCI registry. JACC. Cardiovasc. Interv. 2010;3:1068-73.

7.    Brodie B.R., Wilson H., Stuckey T., et al. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC. Cardiovasc. Interv. 2009;2:1105-12.

8.    Nguyen T.T., O'Neill W.W., Grines C.L., et al. One-year survival in patients with acute myocardial infarction and a saphenous vein graft culprit treated with primary angioplasty. Am. J. Cardiol. 2003;91:1250-4

9.    Serruys P.W., Stoll H.P., Macours N. et al. Multivessel coronary revascularization in patients with and without diabetes mellitus 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J. Am. Coll. Cardiol. 2008; 52(24): 1957-1967.

10.  Rodriguez A., Baldi J., Pereira C.F. et al. for the ERACI II Investigators: Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II). J. Am. Coll. Cardiol. 2005; 46: 582-588.

11.  Serruys P.W., Donohoe D.J., Wittebols K. et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II). Eur. Heart J. 2007; 28(4): 433-442.

12.  Iakovou I., Schmidt T., Bonizzoni E. et al. Incidence, predictors and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293: 2126-2130.

13.  Banning A.P, Westaby S., Morice M.C. et al. Diabetic and Nondiabetic Patients With Left Main and/or 3- Vessel Coronary Artery Disease: Comparison of Outcomes With Cardiac Surgery and Paclitaxel-Eluting Stents. J. Am. Coll. Cardiol. 2010; 55: 1067-1075.

14.  Kappetein A.P, Dawkins K.D., Mohr F.W. et al. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.: Insights from the SYNTAX run-in phase. Eur. J. Cardiothorac. Surg. 2006; 29: 486-491.

15.  Serruys P.W., Morice M.C., Kappetein A.P et al. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N. Engl. J. Med. 2009; 360: 961-972.

16.  Serruys P.W., Ong A.T., Piek J.J. et al. A randomized comparison of a durable polymer everolimus-eluting stent with a bare metal coronary stent: The SPIRIT fist trial. Eurointervention. 2005; 1: 58-65.

17.  Babunashvili A.M. Ivanov V.A.: Hronicheskie okkljuzii koronarnyh arterij: anatomija, patofiziologija, jendovaskuljarnoe lechenie:[ Chronic occlusion of coronary arteries: anatomy, pathophysiology, endovascular interventions.] Monografija. Moskva: Izdatel'stvo ACB. 2012; 487-509 s [In Russ].

18.  Rolf A., Werner G.S., Schuhback A., et al. Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion. Int. J. Cardiovasc. Imaging. 2013 29(8):18191827.


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

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

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

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

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




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12.  Suslina Z.A., Vereshagin N.V., Piradov M.A., Podtipi ishemicheskikh narusheniy mozgovogo krovoobrasheniya: diagnostika i lechenie. [Subtypes of ischemic cerebrovascular disorder: diagnosis and treatment]. Consilium medicum. - 2001; 3(5): 218-221.



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


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

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

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

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

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



1.    Morino Y, Kimura T., Hayashi Y, Muramatsu T., Ochiai M., Noguchi Y, Kato K., Shibata Y, Hiasa Y, Doi O., Yamashita T., Morimoto T., Abe M., Hinohara T., Mitsudo K.; J-CTO Registry Investigators. In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). JACC Cardiovasc Interv. 2010 Feb;3(2): pp. 143-51.

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6.    Costa M.A,, Angiolillo D.J., Tannenbaum M., Driesman M., Chu A., Patterson J., Kuehl W., Battaglia J., Dabbons S., Shamoon F., Flieshman B., Niederman A., Bass T.A.; STLLR Investigators. Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am. J. Cardiol. 2008 Jun 15; 101 (12): 1704-11. doi: 10.1016/j.amjcard.2008.02. 053. Epub 2008 Apr 9.

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Case report is devoted to atypical recanalization of chronic occlusions of the common iliac artery Today, there are several ways for recanalization of chronic occlusions of arteries of lower limbs. Recanalization is known to be the major point of endovascular procedures. The success of endovascular surgery at recanalization depends mainly on 2 factors. One of the most important factors is the choice of access. Another factor is the choise of recanalization method . In case of rare failures - performing open surgery.



1.    Pokrovsky A.V. and other. Russian consensus. Recommended standards for the evaluation of patients with chronic lower limb ischemia. M. 2001; 16 [In Russ].

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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. 



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Palliative surgery plays a major role as a stage of congenitalheart disease treatment.Palliative endovascular interventions are safe n neonates. Such treatment can stabilize patients and adequately prepare them for radical operation and in some cases it is an alternative to classic bypass methodic.



1.    Бокерия Л.А., Гудкова Р.Г. «Сердечно-сосудистая хирургия-2009». Врожденные пороки системы кровообращения. М.: изд-во НЦССХ им. А.Н. Бакулева РАМН. 2010; 76-115.

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3.    Шарыкин А.С. Врожденные пороки сердца. Руководство для педиатров, кардиологов, неонатологов. М.: изд-во «Теремок». 2005; 8-14, 224-234.

4.    Любомудров В.Г., Кунгурцев В.Л., Болсуновский В.А. и др. Коррекция врожденных пороков сердца в периоде новорожденности. Российский вестник перинатологии и педиатрии. 2007; 3: 9-13.

5.    Lacour-Gayet F., Anderson R.H. A uniform surgical technique  for transfer of both simple and complex patterns of the coronary arteries during the arterial switch procedure. Cardiol. in the Young. 2005; 15 (1): 93-101.

6.    Gibbs J.I. Treatment options for coarctation of aorta. Heart. 2000; 84: 11-13.

7.    Zales V.R., Muster A.J. Ballon dilatation angioplasty for the management of aortic coarctation. In C. Mavroudis, C.L. Backer et al. Coarctation and interrupted aortic arch. Cardiac surgery. State of art review. Philadelphia. Huley & Belfus. 1993; 7: 133.

8.    Chen Q., Parry A.J. The current role of hybrid procedures in the stage 1 palliation of patient with hypoplastic left heart syndrome. Eur. J.Cardiolthorac. Surg. 2009; 36: 77-83.

9.    Michel-Behnke I. et al. Stent implantation in the ductus arteriosus for pulmonary blood supply in congenital heart disease. Catheter. Cardiovasc. Interv. 2004; 61  (2): 242-252. 10.  

10.  Bisoi A.K. et al. Primary arterial switch operation in children presenting late with d-transposition of great arteriaes and intact ventricular septum. When is it too late for a primary arterial switch operation? Eur. J. Cardiothorac. Surg. 2010; 38: 707-713.





Aim. Was to analyze atherosclerotic disease dynamics and long-term results (up to 5 years) after implantation of bare-metal stents (BMS) and sirolimus-eluting stents (SES) in patients with multivascular coronary disease

Methods and results. We have analyzed clinicaland angiographic results data of percutaneous coronary interventions (PCI) of 585 patients with multivascular coronary disease during 5-years of follow-up period. 264 patients were treated with BMS, 321 - with SES We used Cypher drug-eluting stents (sirolimus-eluting stents) in the first group and BX Velocity bare-metal stents in the second group of patients

During first year of follow-up the incidence of symptoms reoccurrence in BMS and SES groups was 22,3% and 11,8% (р < 0,05) repeated PCI was performed in 15,6% and 3,9% (р < 0,05), CABG - 2,8% and 0,3% (р < 0,05), the incidence of myocardial infarction (MI) was 1,4% and 0,9%. The restenosis rate in BMS and SES groups was 19,7% and 2,3% (р < 0,05), late thrombosis (LT) - 0,3% and 1,4% The survival without MACE was higher in SES group

During 5 years of follow-up the cumulative incidence of symptoms reoccurrence in BMS and DES groups was 30,7% and 22,7% repeated PCI was performed in 23,9% and 18,1% (р < 0,05), CABG - 6,4% and 4,7%, the incidence of myocardial infarction (MI) was 6,5% and 7,8%. The progression of atherosclerosis in early stented segments in BMS and SES groups was 6,6% and 10,1%, late thrombosis (LT) - 0,4% and 2,1%. There was no difference in survival without MACE between groups

Conclusions. By the end of the first year of follow-up the incidence of angina reoccurrence and repeat revascularization in patients with multivascular coronary disease was higher in BMS group compared with SES group. The survival without MACE was also higher in SES group. By the end of the fifth year of follow-up there was no difference in angina reoccurrence, repeated revascularization and surviva without MACE because the late thrombosis and atherosclerosis progression in early stented segments was more common in DES group. 




1     Henderson R.A. et al. Seven year outcome in the RITA-2 trial. Coronary angioplasty versus medical therapy. Ibid. 2003; 42: 1161-1170.




2.    Pocock S.J. et al. Quality of life after coronary angioplasty or continued medical treatment for anginan. Three year follow up in the RITA-2 trial. J. Am. Col. Cardiol. 2000; 35:907-914.




3.    Sculpher M.J. et al. Coronary angioplasty versus medical therapy for angina. Health service costs based on the Second Randomized Intervention Treatment oj Angina (RITA-2) trial. Eur. Heart. J. 2002; 23: 1237-1239.




4.    Serruys P. W. et al. For the Benestent Study Group. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N. Engl. J. Med. 1994; 331: 489-495.




5.    Hueb W. et а!. The medicine, angioplasty or surgery study (MASS-II). A randomized, controlled clinical trial of three therapeutic strategies for multivessel согоnary artery desease. J. Ат. СоИ. Cardiol.   2004;  43: 1743-1751.




6.    Orlich D. et al. Treatment of multivessel coronary artery disease with sirolimus-eluting stent implantation: immediate and mid-term results. J. Am. Coll. Cardiol. 2004; 43: 1154-1160.




7.    Буза В.В., Лопухова В.В., Карпов Ю.А. Поздние тромбозы после имплантации стентов с лекарственным покрытиемКардиология. 2007; 6: 85-86.




8.    Camenzind E., Steg P.G., Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents. А cause for concern. Circulation. 2007; 115: 1440-1455.






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. 



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.




We had analyzed percutaneous coronary intervention (PCI) of non-standard complications - coronary artery dissection with extension on the eft main coronary artery (LMCA) and aorta. There was the coronary dissection of LMCA and aorta after left internal thoracic arteries and left anterior descending anastomosis (LIMA-LAD) balloon predilatation. Satisfactory angiographic result was achieved with blood flow TIMI III after stent implantation. In connection with the stable condition of the patient there was no endovascular or surgical treatment. The patient had stable hemodynamics in hospital period. The angiografic control was performed after 8 days. There was no coronary and aorta dissection and stent-thrombosis.

In conclusion in can be said that conservative tactics may be useful in a case of retrograde coronary and aorta dissection after LIMA-LAD stent mplantation.



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We have retrospectively analyzed results of 12 patients underwent radiological interventions for scarring strictures correction of biliodigestive anastomoses after reconstructive surgery due to iatrogenic damage of extra hepatic biliary ducts. It was determined that ultrasonography is the main technique of biliary hypertension diagnostics. Antegrade cholangiography gives an ability to determine the level and type of extrahepatic biliary ducts strictures. Adequate biliary decompression was achieved by transcutaneous transhepatic drainage of biliary tree with insertion of cholangiostomical drainage near the biliodigestive anastomoses. Antegrade recanalization technique and dilatation of biliodigestive anastomosis strictures was used for dilatation of scarring stricture. Balloon plastic of anastomoses was ended with forming of external-internal draining for 9-12 months with step-by-step balloon dilatations every 3 months. Stenting of biliodigestive anastomosis' strictures was made in 4 cases Postoperative period without relapses after radiological interventions lasts from 2 till 7 years of observing.



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Purpose: Was to observe the immediate and long-term results of hybrid operations in multilevel atherosclerotic lesions of aorto-iliac(AIS) and femoral-popliteal segments (FPS). Article describes the method of the hybrid intervention in the aorto-iliac segment

Materials and Methods: For the period of 2007-2011 - 40 patients with multilevel lesions of iliac arteries and lower limb arteries underwent hybrid operations. 57.5% of patients had aorto-iliac segment disease, classified as TASC C, and 42,5% - TASC D. Lesions of femoral-popliteal segment was divided in the following order: TASC A - 15,0%, TASC B - 35,0%, TASC C - 42,5% and TASC D - 7,5%. We applied loop endarterectomy with stenting for the correction of the aorto-iliac lesions. For arterial outflow correction we applied surgical operations. Follow-up period has been traced for 3 years.

Results: Primary technical success was achieved in 97.5%. Complications of the immediate postoperative period were noted in 15%. Long-term results were traced for 3 years in 70% of patients. Three-year assisted patency of aorto-iliac segment was 89%. All complications have been corrected only by endovascular procedure. Three-year cumulative patency of femoral-popliteal segment was 87%.

Conclusions: This technique allows achieving the best results in reducing lower limb ischemia. Simultaneous correction of both - inflow and outflow segments improved long-term results of each of the reconstruction. The method shows its effectiveness in patients with TASC C and TASC D lesions of aorto-iliac segment. Reduction of surgical trauma significantly affects the results in group of high risk patients. 



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Angiographic characteristics of dimensional placement of coronary arteries bifurcations in case of endovascular correction


For quoting:
Chebotar E.V. "Angiographic characteristics of dimensional placement of coronary arteries bifurcations in case of endovascular correction". Journal Diagnostic & interventional radiology. 2011; 5(3); 55-63.



Aim. Was to investigate features of interposition of coronary bifurcations with different localizations in the aspect of their endovascular corrections, on the base of angiographycal imaging

Materials and methods. For research 238 patients were selected (193 men, 36 women) with 255 bifurcations - all the patients before stenting were underwent coronar arteries angiography (KAG). Registration and imaging processing were made on Axiom Artis dFC («Siemens») and CS-60 («Omega»). Omnipaque 350 mgl/ml («Nycomed/GE Healthcare») was used as contrast agent on KAG Results. Dimensional structure of coronary bifurcations is very variable. Main branch (MB) rarely has rectilinear course. Most spread bifurcation angle was between proximal and distal MB segments, less spread - between distal segment of MB and lateral brunch (LB).



1.    Dzavik V. et al. Predictors of long-term outcome after crush stenting of coronary bifurcation lesions. Importance of the bifurcation angle. Am. Heart. J. 2006; 152: 762-759.

2.    Chen S.-L. et al. Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting. А subgroup analysis    from DKCRUSH-1    bifurcation    study.    Chin. Med. J.2009; 122 (4): 396-402.

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5.    Ramcharitar S. et al. A novel dedicated quantitative coronary analysis methodology for bifurcation lesion. Eurointervention. 2008; 3 (5): 553-557.




Purpose. To assess safety and efficiency of simultaneous RCA and major branches of LCA stenting in patients with myocardial infarction (MI).

Material and methods. Authors analyzed data of 237 patients. Coronary angiography (CAG) revealed triple vessel stenotic and/or occlusive disease. Pre-procedure systemic thrombolysis (streptokinase) used in 54 patients. Endovascular interventions (PTCA and stenting of the infarct related artery) performed in all the cases; in 24 patients, simultaneous complete anatomical coronary revascularization (CACR) attempted. In 30 cases, after PTCA of the infarct related artery (PTCA IRA) patients were transferred to other hospitals for bypass surgery as a second stage.

Results. Systemic thrombolysis efficiency was 40 %(22 patients) according to echocardiography and 26% (14 patients) by CAG. TIMI III flow restored in 100%, immediate clinical success rate was 97,5%. There were no procedural complications. Six patients died early after the PTCA for cerebral hemorrhage, acute LV failure, and LV rupture. Absence of myocardial ischemia in CACR subgroup was confirmed clinically and in treadmill test. Patients of PTCA IRA subgroup presented with angina of various functional class.

Conclusions. Endovascular interventions are highly efficient as a component of complex IM treatment. Primary CACR is proved to decrease symptoms of myocardial ischemia. 



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13.  Colombo A. et al. Sirolimus-Eluting Stents in bifurcation Lesions. Six-Month Angiographic Results According to the Implantation Technique. Presented at the American College of Cardiology 52nd Annual Scientific Session. 2003.

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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.



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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.

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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.

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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.




The article presents the experience of stenting the internal carotid arteries (ICA) in 45 patients. The patients' age ranged from 49 to 78 years, on average 64.8 years. The degree of ICA stenosis ranged from 60% to 95%, on average 72.7 ± 7.2%. 28 (62.2%) patients had a history of acute cerebrovascular accident, 17 (37.7%) patients had cerebral symptoms of circulatory disorders. After 48 endovascular procedures, neurological complications developed in 3 (6.2%) cases: transient ischemic attack - in 2 (4.1%) patients, minor stroke - in one (2%) patient. Hospital mortality was 2.2%. In the remote period, 13 (28.8%) patients were examined. There were no myocardial infarctions and strokes.  





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. 




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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.




Case report: successful stenting of right ventricular outlet in 6-month age patient with pulmonary artery atresia in combination with interventricular septum defect as a first step of surgical treatment


For quoting:
Shmatkov M.G., Chernogrivov A.E., Morozova E.V. "Case report: successful stenting of right ventricular outlet in 6-month age patient with pulmonary artery atresia in combination with interventricular septum defect as a first step of surgical treatment". Journal Diagnostic & interventional radiology. 2014; 8(3); 101-104.



A case report of right ventricular outlet (RVO) stenting as palliative treatment of pulmonary artery atresia (PAA) in combination with interventricular septum defect (ISD), in situation when radical surgical intervention has high operative risk due to condition severity and low weight RVO stenting in newborn and children with low weight is made seldom and noted as a case reports. Peculiarity of this case is that intervention was made in patient with extremely low weight and age (age - 6 month, weight - 3 kg) after performed early central aorto-venous bypass and further palliative reconstruction of right ventricular outflow.



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Importance: despite generally promising outcomes after stenting for unprotected left main coronary artery (ULMCA) disease, the ULMCA bifurcation lesions remain challenging, and their restenosis rate is still relatively high.

Objective: aim of the current study was to analyze possible factors influencing one year MACE rate in distal ULMCA patients.

Design, setting and patients: from year 2002 until end of year 2011 at Latvian Centre of Cardiology Pauls Stradins Clinical University hospital in ULMCA registry 1052 patients were enrolled. Interventions: In 723 patients distal bifurcations were treated, out of them in 449 patients one year follow-up were completed and those patients were included in current analyses Main outcome measures: cardiac death, target vessel revascularization (TVR), target lesion revascularization (TLR), major cardiac adverse events (MACE) were assessed at one year.

Results: two stent technique was used in 8,5% of cases. MACE, cardiac death, TVR and TLR rates at one year was 15,6%, 2,9%, 4,7% and 12,9%, respectively Cardiac death was associated with diabetes mellitus and NSTEMI, however, TLR was associated with SYNTAX score >30. MACE was associated with NSTEMI and 2 stent technique. True bifurcation was not associated with adverse cardiovascular outcomes.

Conclusions: Use of two stent technique and NSTEMI at presentation were associated of MACE at one year in distal ULMCA patients. 



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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. 



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Article describes the clinical case of a patient suffering from Takayasu's disease and stenotic lesion of the renal artery with early restenosis of renal artery after stenting, causes of mistakes in diagnosis and choice of treatment are also discussed.



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

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

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

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



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A literature review is devoted to endovascular treatment of occlusive and stenotic lesions in arteries of femoral-popliteal segment.

Currently, 2-3% of the RF population suffer from atherosclerotic lesions of arteries of lower limbs. In the structure of cardiovascular disease, atherosclerosis of lower limbs has the level about 20%. In 82% the cause of vascular disease is atherosclerosis. In the structure of atherosclerotic arterial disease of lower limbs more often (47% to 65%) occurs defeat of the femoral-popliteal segment particularly in patients older than 60 years; that is confirmed by numerous statistical observations. The aim of the article was to compare results of endovascular treatment of arterial lesions of the femoral-popliteal segment.

This article presents results of a solo balloon angioplasty, balloon angioplasty with drug-eluting balloons, subintimal angioplasty, stenting drug-eluting and bare-metal stents, cryo-plastics,catheter atherectomy, hybrid interventions and compare results of open and endovascular interventions. Data of STAR register, published in 2001, show that the correction of lesions category C, TASC II, using balloon angioplasty is quite possible to count on similar results in category B.

According to Conrad M., Amato B. and Dey C., despite the high incidence of the primary success of endovascular interventions for femoral-popliteal segment long-term results often look depressing.

Great importance is given to study the possibility of the use of drug-eluting stents, which have proven effectiveness in suppressing the inflammatory response and intimal hyperplasia after stenting of coronary arteries, as evidenced by research SIROCCO, SIROCCO II, STRIDES, Zilver PTX. Thus, the use of drug-eluting stents in the femoral-popliteal segment did not reduce the frequency of restenosis.

THUNDER, FemPac and LEVANT researches indicate that drug-eluting balloons provide some benefits that are absent in other endovascular techniques such as solo balloon angioplasty and stenting.

The final stage of a multicenter randomized trial BASIL, which carried out a comparative analysis of FPB and PTA groups, was reached in 2010. As a result, the preservation of limbs and survival did not differ significantly

Thus, the literature report reveals a clear tendency of domination of endovascular strategies in defeated limb blood-flow recovery Minimally invasive balloon angioplasty and stenting compared with results of bypass operations, reconstructions - is not worse and consider endovascular treatment strategy in the surgical treatment of femoral-popliteal segment to be method of first choice. 



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results. EuroIntervention. 2011. May; 7. Suppl K:K77-82.

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29.     Forbes J.F., Adam D.J., Bell J., Fowkes F.G., Gillespie I., Raab G.M., Ruckley C.V., Bradbury A.W. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis. J. Vasc. Surg. 2010 May; 51(5 Suppl):43S-51S. 



Article presents case report of successful bifurcation stenting of external and internal iliac arteries ir 64-year old patient, with expressed claudication and vasculogenic impotence. Article shows good immediate and nearest results. 



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Coronary flow limitation during high risk angioplasty in acute coronary syndrome (ACS) patients is an important problem, connecting with inadequate myocardial protection during the coronary intervention.

Aim: was to compare intraoperative cardiohemodynamic in ACS patients during the high risk angioplasty of difficult stenoses in anterior heart arteries with- or without a coronary venous retroperfusion support.

Methods: intervention results of 14 ACS patients were analyzed. In 1st group there were 6 patients (42,9%) with intraoperative myocardial retroperfusion support. In 2nd group - 8 patients (57,1%) without any intraoperative myocardial perfusion support.

Results: during the retroperfusion support in the 1st group , «ST»-segment elevation at 60 sec left main (LM) or left anterior descending artery (LAD) occlusion was significantly lower (ST in V4-V6 - 1,9±1,7 mm) than in patients without retroperfusion (ST in V4-V6 - 3,1±1,7; p = 0,043). In the 2nd group, patients without coronary flow support the «ST»-segment elevation at 60 sec LM or LAD occlusion was significantly higher (ST в V4-V6 - 2,5±0,5; p = 0,043) than at 5 sec LM or LAD occlusion. No significant differences between «ST»-segment and «T»-wave deviation in the beginning and in the end of intervention were in both groups. The same dynamics was demonstrated at the time of blood pressure indexes measurement.

Conclusion: coronary venous retroperfusion is an effective method of coronary flow support during the high risk angioplasty in ACS patients. Retroperfusion technology had no influence on cardiohemodynamic, but reduced the risk of intraoperative adverse cardiac events. 



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Article describes results of single-balloon angioplasty and stenting in patients with occlusive-stenotic lesions of femoral-popliteal segment for the period of 30 months. It was performed 209 endovascular interventions, single-balloon angioplasty in 95 patients; stenting - 114 patients. Long-term results of primary patency: 43,1% in group of single-balloon angioplasty 57,1% - in group with stenting.



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Article describes experience of Novosibirsk scientific-research institute of blood circulation pathology named after E.N.Meshalkin in hybrid interventions in aortic dissection.

Aim: was to estimate efficacy of hybrid methods in surgical treatment of aortic dissection .

Materials and methods: since 2011 - 17 operations on proximal aortic dissections and 8 operations on distal aortic dissection with use of hybrid methodics were made.

Results: mortality in early post-operative period - 2 patients and was determined by progression of heart insufficiency In late post-operative period, basing on MSCT data, thrombosis of false lumen of aortic dissection on the mark of stent-graft or bare-metal stent (descending thoracic aorta) was revealec in 7 of 10 patients (70%) and in all patients with hybrid endoprothesis. During observation in post-operative period, none of patients were marked as needed of operation on thoracic-abdominal aorta.

Conclusion: used techniques allow to gain number of advantages in this severe group of patients as n early post-operative period, and also in late post-operative period. Endovascular treatment, performing simultaneously with open surgical interventions - are safe for patient and easy for surgeon. More extended reconstruction of aorta in single-stage operation can exclude aneurysmatic degeneration and prevent operations on distal aorta. 



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7.     Di Bartolomeo R., Di Marco L., Armaro A., et al. Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur. J. Cardiothorac.Surg. 2009;35:671-675.

8.     Hirotani T., Nakamichi T., Munakata M., et al. Routine extended graft replacement for an acute type A aortic dissection and the patency of the residual false channel. Ann.Thorac.Surg. 2003; 76: 1957-1961.

9.     Milewicz D.M., Guo D.C., Tran-Fadulu V., et al. Genetic basis of thoracic aortic aneurysms and dissections: focus on smooth muscle cell contractile dysfunction. Annu. Rev. Genomics Hum. Genet. 2008;9:283-302.

10.   Kay-Hyun Park, Cheong Lim, Jin Ho Choi, et al. Midterm change of descending aortic false lumen after repair of acute type I dissection Ann. Thoracic Surgery. 2009; 87(1): 103-108.

11.   Kato M., Ohnishi K., Kaneko M. et al., New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996; 94 (9): 188-193.

12.   Di Bartolomeo R., Di Marco L., Armaro A., et al. Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur. J. Cardiothorac.Surg. 2009;35:671-675.

13.   Chernjavskij A.M., Al'sov S.A., Ljashenko M.M. i dr. Hybrid prosthesis in reconstruction of the arch and the proximal thoracic aorta in aortic dissection De Bakey type I Grudnaja i serdechno-sosudistaja hirurgija. 2012; 5: 11-15 [In Russ].

14.   Chernjavskij A.M. , Al'sov S.A., Lomivorotov V.V. i dr. Hybrid approach in the treatment of chronic proximal aortic dissection. Kardiologija i serdechno-sosudistaja hirurgija. 2012; 6: 103-106 [In Russ].

15.   Leobon B., Roux D.,Saccani S. et al: Type A aortic dissection: New surgical strategy using intraoperative stenting. J. Thorac.Cardiovasc. Surg.2006;131:482-483.

16.   Fattouch K., Sampognaro R., Navarra al. LongTerm results after repair of Type A acute aortic dissection according to false lumen patency. Ann. Thoracic Surgery. 2009; 88: 1244-1250.

17.   Geirsson A., Bavaria J.E., Swarr D. et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann. Thorac.Surg. 2007;84:1955-64.

18.   Chernjavsij A.M., Al'sov S.A., Ljashenko M.M. i dr. Status of the thoracoabdominal aorta after reconstruction of the ascending aorta at the dissection De Bakey type I. Patologija krovoobrashhenija i kardiohirurgija. 2013; 2: 29-35 [In Russ].

19.   Czerny M., Stohr S., Aymard T., Sodeck G., et al. Effect on false-lumen status of a combined vascular and endovascular approach for the treatment of acute type A aortic dissection. European Journal of Cardio-Thoracic Surgery. 2012; 41: 409-413.

20.   Upchurch G. R., Creado E. Aortic aneurysms. Pathogenesis and treatment. 2008; 156p.

21.   Chang Ch.-P, Liu J., Liou Y-.M. The role of false lumen size in prediction of in-hospital complication after acute type B aortic dissection JACC V. 2008; 52: 1170-1176.

22.   Trimarchi S., Tolenaar J., Jonker F. Importance of false lumen thrombosis in type B aortic dissection prognosis. J. of Thoracic and Cardiovascular Surgery. 2013; 145: 208-212. 




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). 



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. 




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.



1.     Grollman J.H., Del Vicario M., Mittal A.K. Percutaneous transluminal abdominal aortic angioplasty. Am.J.Roentgenol. 1980; 134(5):1053-1054.

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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].

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Aim: was to combine results of surgical treatment of patients with primary reconstruction of arteries of lower limbs with patients who underwent reconstructive operations on early stented arteries.

Materials and methods: research included 93 patients with critical ischemia of lower limbs. All patients were devided into two groups with division to subgroups. Group 1a - 23 patients after stenting of iliac arteries. Group 1b - 23 patients with stenosis or occlusion of iliac arteries without previous operations. Group 2a - 22 patients with thrombosis or restenosis of arteries lower than inguinal ligament after previous endovascular treatment. Group 2b - 25 patients with primary atherosclerotic lesion of arteries of lower limbs lower than inguinal ligament .

Results: in early postoperative period and 6 months after reconstructive operation there were no difference in all groups and subgroups of treated patients. The level of complications in late post-operative period is lower in case of primary reconstruction of arteries lower than inguinal ligament in comparison with operations after endovascular interventions.  



1.     Bokeria L.A., Temrezov M.B., Kovalenko M.I. et al. Urgent problems of surgical treatment of patients with KINK solutions of (state the problem). Annals ofsurgery. 2011; 1: 5-9 [In Russ].

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5.     Gruberg L., Hong M.K., Mintz G.S., Mehran R., Waksman R., Dangas G., Kent K.M., Pichard A.D., Satler L.F., Lansky A.J., Kornowski R., Stone G.W., Leon M.B. Optimally deployed stents in the treatment of restenotic versus de novo lesions. Am. J. Cardiol. 2000 Feb 1; 85(3):333.

6.     Bondarenko O.N., Galstjan G.R., Ajubova N.L., Egorova D.N., Dedov 1.1. Rol' ul'trazvukovogo dupleksnogo skanirovanija v ocenke ishodov jendovaskuljarnyh vmeshatel'stv u bol'nyh saharnym diabetom i kriticheskoj ishemiej nizhnih konechnostej v rannie sroki nabljudenija [The role of ultrasonic duplex scanning in estimation of results of endovascular interventions in patients with diabetus mellitus and critical ischemia of lower limbs in early postoperative period]. Diagnosticheskaja i intervencionnaja radiologija. 2014; 8(3)15-28 [In Russ]. 



Aim: was to show the role and possibilities of 128-slice computed tomography (MSCT) iirfhe dynamic observation of patients; after open and endovascular surgery of lower limb's arteries;

Material and methods: 1st group - 36 patients (30,5%) who (underwent endovascular procedures;, 2nd group - 51 patients; (44,2%) who underwent open reconstructive operations;, 3rd group - 31 patients; (26,3%) after hybrid operations;. 108 patients; were examined in post-operative period (7 women, 101 men), average age was 57,28±15,08. All patients underwent MSCT-angiography on the background of the contrast bolus;. 55 patients; had standard procedure, other patients; underwent examination with low-close protocol.

Results: obtained images of low-close protocol had satisfactory condition of information: arterial walls were visualized well, inner lumen and para-prosthesis space, atherosclerotic lesions were also visualized. Obtained results of MSCT-angiography during low-dose protocol were confirmed ntraoperatively Obtained data of MSCT-angiography: all patients; of 1st group had passable stents; but 2 patients; who had hernodynarnically non-significant stenosis. In 2nd group 5 patents; had restenosis of prosthesis and grafts;, 20 patients; had thrombosis. In 3rd group, 2 patients; had restenosis of prosthesism femoral-popliteal segment, 13 patient had thrombosis of prosthesis/grafts, 6 patients; had restenosis of stents;, 1 patient had stent thrombosis in femoral-popliteal segment, n case of hernodynarnically significant stenosis (50%) of the stent or prosthesis in the absence of clinical manifestations; we made correction of drug therapy. If the patent had a detected boundary stenosis (50-74%) with the absence of complaints;, the patient had correction of drug therapy, with the appointment of a dynamic MSCT-angiography in 3-6 months. Patents; with occlusion of the prosthesis, or a stent with a satisfactory distal vessels clue to good collaterals; we performed thrombectomy or repeated prosthetics. Patients who according to th