scholarly journals A clinical case of staged endovascular treatment of a patient with coronary heart disease and multiple lesions of peripheral arteries

2021 ◽  
Vol 8 (1) ◽  
pp. 5-11
Author(s):  
M. A. Chernyavsky ◽  
Yu. A. Kudaev ◽  
N. N. Zherdev ◽  
R. S. Shumakher
Keyword(s):  
Endovascular Treatment ◽  
Clinical Case ◽  
Myocardial Revascularization ◽  
Perioperative Period ◽  
Left Internal Carotid Artery ◽  
Iliac Arteries ◽  
Multi Stage ◽  
Clinically Significant ◽  
Artery Disease ◽  
The Right

A clinical case of successful treatment of a patient with atherosclerotic peripheral artery disease and clinically significant lesion of the coronary and carotid arteries. Patients underwent multi-stage surgical treatment. The first stage performed endovascular treatment the left internal carotid artery, the second — myocardial revascularization, the third — endovascular treatment of the left iliac arteries, the fourth — rotational atherectomy with stenting of the right superficial femoral artery. There were no complications in the perioperative period. The technique of operations is described, explanations are given for the chosen treatment strategy. The conclusion is drawn about the advantage of endovascular techniques in the treatment of patients with multifocal atherosclerosis.

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

scholarly journals Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

2020 ◽  
Vol 27 (4) ◽  
pp. E202041
Author(s):  
Nestor Seredyuk ◽  
Andrii Matlakh ◽  
Yaroslava Vandzhura ◽  
Mykyta Bielinskyi ◽  
Oleksii Skakun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Right

Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12  inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

scholarly journals Staged approach to treating a patient with coronary artery disease and ventricular arrhythmias

2019 ◽  
Vol 24 (3) ◽  
pp. 101-106
Author(s):  
E. A. Artyukhina ◽  
E. D. Strebkova ◽  
A. Sh. Revishvili
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ventricular Arrhythmias ◽  
Clinical Case ◽  
Myocardial Revascularization ◽  
Comprehensive Approach ◽  
Interventional Treatment ◽  
Individual Choice ◽  
Staged Approach ◽  
Artery Disease

The presented clinical case demonstrates an individual choice of a staged comprehensive approach to interventional treatment of a patient with coronary artery disease and ventricular tachyrhythmias, focused on myocardial revascularization and interventional abolition of ventricular tachyrhythmias.

Anomalous Origin of Right Coronary Artery From Left Coronary Sinus—13 Cases Treated With the Reimplantation Technique

2017 ◽  
Vol 8 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Alain Cubero ◽  
Alejandro Crespo ◽  
Gadah Hamzeh ◽  
Andrés Cortes ◽  
Daniel Rivas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Anomalous Origin ◽  
Atypical Chest Pain ◽  
Asymptomatic Patients ◽  
Clinically Significant ◽  
Artery Disease ◽  
The Right

Objectives: Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up. Methods: Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation. Results: Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations. Conclusions: The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.

scholarly journals Endovascular treatment of patients with prolonged and diffuse coronary artery lesions

2020 ◽  
pp. 10-21
Author(s):  
М.Н. Баркалов ◽  
Р.В. Атанесян ◽  
Ю.Г. Матчин
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Endovascular Treatment ◽  
High Efficiency ◽  
Myocardial Revascularization ◽  
Interventional Cardiology ◽  
Developed Countries ◽  
Treatment Technology ◽  
Artery Disease ◽  
New Generation

Ишемическая болезнь сердца до сих пор является основной причиной инвалидизации и смертности среди взрослого населения в развитых странах мира, в том числе в России. Несмотря на значительные успехи в развитии технологий эндоваскулярного лечения и инструментального оснащения в интервенционной кардиологии, пациенты с диффузным поражением коронарного русла по-прежнему являются одной из самых обсуждаемых групп при выборе методики реваскуляризации миокарда. С целью решения данной проблемы разрабатываются новые инстру- менты, в том числе появились стенты новой генерации с биодеградируемым полимером длиной до 60 мм. Первые исследования показывают высокую эффективность и безопасность использования данной технологии лечения. В данном обзоре представлены сведения о морфологических особенностях коронарного русла пациентов с протяженным атеросклероти- ческим поражением и их влияние на прогноз. Также приведены данные о возможностях применения различных, в том числе современных методик эндоваскулярного лечения больных с протяженным поражением коронарных артерий. Приведен анализ результатов исследований, где сравниваются безопасность и эффективность различных методик эндоваскулярного лечения, а также особенности антитромбоцитарной терапии при лечении данной группы пациентов Coronary heart disease is still the main cause of disability and mortality among adults in developed countries, including Russia. Despite significant advances in the development of endovascular treatment technologies and instrumental equipment in interventional cardiology, patients with diffuse coronary artery disease are still one of the most discussed groups in the choice of myocardial revascularization method. In order to solve this problem, new instruments are being developed, including new generation stents with biodegradable polymer up to 60 mm long. The First studies show the high efficiency and safety of this treatment technology. The review presents information on the morphological features of the coronary bed of patients with prolonged atherosclerotic lesions and their impact on prognosis. The data on the possibilities of using various, including modern, methods of endovascular treatment of patients with prolonged coronary artery disease are also presented. The analysis of numerous results of researches where safety and efficiency of various methods of endovascular treatment, and also features of antiplatelet therapy at treatment of this group of patients are compared is resulted

scholarly journals Clinical Case: Condition of the patient after repeated acute cerebrovascular disruption by ischemic type in the basin of the right middle cerebral artery with left-sided hemiparesis

2018 ◽  
pp. 32-37
Author(s):  
N. Svyrydova ◽  
N. Ingula ◽  
І. Bieliakova ◽  
N. Ruda ◽  
K. Pidgirna ◽  
...  
Keyword(s):  
Death Rate ◽  
Clinical Case ◽  
Heart Diseases ◽  
Significant Risk ◽  
Heart Rhythm ◽  
Heart Rhythm Disorders ◽  
Artery Disease ◽  
Ischemic Attack ◽  
The Right ◽  
Basic Treatment

Cardiovascular diseases (CVD) – represent between 30 percent to 50 percent of all cardiovascular system’s diseases, and account 110 thousands of new stroke cases every year in Ukraine, death rate during first 30 days is 30-40 % and 50 % during 1st year. Primary stroke morbidity is higher in 1.5-2 times than world’s average. The most significant risk factors of stroke are hypertension, heart diseases (coronary artery disease, heart rhythm disorders), transient ischemic attack in anamnesis, diabetes, atherosclerosis (dyslipidemia). According conducted researches it is proven, that level of systolic blood pressure correlates with decreased risk of stroke in patients with hypertension. This article describes a case from clinical practice – management of patient with acute ischemic stroke. The attention is focused on the methods of examination, basic treatment strategy and rehabilitation of patient with this pathology.

Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents

VASA ◽  
2012 ◽  
Vol 41 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Schoenefeld ◽  
P. Donas ◽  
Schönefeld ◽  
Osada ◽  
Austermann ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Popliteal Artery ◽  
Primary Patency ◽  
Stent Fracture ◽  
Fracture Rate ◽  
Term Outcome ◽  
Technical Success Rate ◽  
Endovascular Interventions ◽  
Artery Disease

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

1978 ◽  
Vol 17 (04) ◽  
pp. 161-171
Author(s):  
H.-J. Engel ◽  
H. Hundeshagen ◽  
P. R. Lichtlen
Keyword(s):  
Wall Motion ◽  
High Flow ◽  
Detection Technique ◽  
Fatty Tissue ◽  
Technical Aspects ◽  
Residue Detection ◽  
High Affinity ◽  
Artery Disease ◽  
The Right ◽  
Drug Interventions

Methodological and technical aspects as well as application and results of the precordial Xenon-residue-detection technique are critically reviewed. The results concern mainly normal flow in various regions of the heart esp. in the free wall of the right and left ventricle, poststenotic flow in patients with coronary artery disease in relation to the degree of proximal nar-rowings as well as wall motion of the corresponding LV segment, bypassgraft flow and flow after drug interventions esp. nitrates, betablockers, the calcium-antagonist Nifedipine and the coronary dilator Dipyridamole. In spite of its serious limitations (high affinity of Xenon for fatty tissue, geometrical problems in the assessment of flow and its relation to anatomy, gas exchange in situations of high flow etc.), the technique is found to be a usefull investigatory tool. Due to its technical display and the related high costs routine application is, however, prohibitive.

AB0 Blood Groups and Coronary Heart Disease (CHD)

1980 ◽  
Vol 43 (02) ◽  
pp. 137-140 ◽  
Author(s):  
Jan Erikssen ◽  
Erik Thaulow ◽  
Helge Stormorken ◽  
Ole Brendemoen ◽  
Arvid Hellem
Keyword(s):  
Coronary Artery ◽  
Blood Group ◽  
Artery Bypass ◽  
Laboratory Data ◽  
Epidemiological Data ◽  
Consecutive Series ◽  
Related Factors ◽  
Ab0 Blood Groups ◽  
Clinically Significant ◽  
Artery Disease

SummaryThe view based on epidemiological and laboratory data that blood group A subjects (=A) have clinically significant higher thrombotic potential than blood group 0 subjects (= O), is supported by the present finding of a significantly higher platelet retention in A than 0.The completely normal ABO distribution found among 71 cases of proven latent CHD, and the disproportionate excess of 0 vs. A in a consecutive series of 191 coronary artery bypass candidates apparently conflict with epidemiological data indicating a higher risk of achieving CHD in A than 0. The conflict may be solved by suggestinga) that the »thrombotic proneness« in A compared with 0 causes a poorer prognosis in CHD among the former, leaving a disproportionate excess of 0 among longterm CHD survivors, and b) that AB0-related factors have had an insignificant, independent impact on the evolution of preclinical coronary artery disease in our 71 men with latent CHD.

Ridogrel Inhibits Systemic and Renal Formation of Thromboxane A2 and Antagonizes Platelet Thromboxane A2/Prostaglandin Endoperoxide Receptors upon Chronic Administration to Man

1992 ◽  
Vol 68 (02) ◽  
pp. 214-220 ◽  
Author(s):  
C Weber ◽  
J R Beetens ◽  
F Tegtmeier ◽  
P Van Rooy ◽  
E Vercammen ◽  
...  
Keyword(s):  
Uric Acid ◽  
Potent Inhibitor ◽  
Ex Vivo ◽  
Thromboxane A2 ◽  
Chronic Administration ◽  
Response Curves ◽  
Clinically Significant ◽  
Synthase Inhibitor ◽  
The Right ◽  
Steady State Plasma Level

SummaryThe effects of ridogrel, a dual thromboxane A2 (TXA2) synthase inhibitor and TXA2/prostaglandin (PG) endoperoxide receptor antagonist, on systemic and renal production of prostaglandins and on platelet TXA2/PG endoperoxide receptors was evaluated upon chronic administration (300 mg b. i. d. orally, for 8 and 29 days) to man. Such a medication with ridogrel inhibits the systemic as well as the renal production of TXA2 as measured by the urinary excretion of 2,3-dinor-TXB2 and TXB2 respectively without inducing significant changes in systemic or renal PGI2 production. Simultaneously with the latter effects, the production of TXB2 by spontaneously coagulated whole blood ex vivo is inhibited (>99%) while that of PGE2 and PGF2α is largely increased. Administration of ridogrel causes a three- to five-fold shift to the right of concentration-response curves for U46619 in eliciting platelet aggregation; no tachyphylaxis is observed after 29 days of treatment in this respect. Apart from a reduction of serum uric acid levels with a concomitant increase in urinary uric acid excretion during the first days of treatment, no clinically significant changes in hematological, biochemical, hemodynamic and coagulation parameters occur during the 8 days or 29 days study. The study demonstrates that ridogrel is a potent inhibitor of the systemic as well as renal TXA2 synthase and an antagonist of platelet TXA2/PG endoperoxide receptor in man, covering full activity during 24 h at steady-state plasma level conditions without tachyphylaxis during 29 days of medication. The compound is well tolerated, at least during 1 month of administration.

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