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 Health Care Analysis on Myocardial Revascularization in Patients with Chronic Coronary Artery Disease: The Multicenter REVASK Study: Design and Protocol

2020 ◽  
Author(s):  
Andreas Beckmann ◽  
Eva-Maria Bitzer ◽  
Mareike Lederle ◽  
Peter Ihle ◽  
Jochen Walker ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Health Care ◽  
Decision Making ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Care Providers ◽  
Chronic Coronary Artery Disease ◽  
Care Guideline ◽  
Artery Disease

AbstractCoronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are available for revascularization of coronary artery disease (CAD) with the aims to reduce cardiovascular morbidity and mortality and to improve disease-related quality of life in particular. The German National Care Guideline (NVL-cKHK) on chronic CAD recommends the establishment of so-called heart teams for decision making in myocardial revascularization to improve the quality of care. Preferred recommendations for PCI or CABG are given for different patient subgroups depending on patient characteristics, concomitant diseases, and coronary morphology. The myocardial revascularization study (REVASK) is a noninterventional cohort study on care of patients undergoing PCI or CABG based on retrospective statutory health insurance (SHI) routine data, registry data from the German Cardiac Society (DGK) resp., the German Society for Thoracic and Cardiovascular Surgery (DGTHG), combined with prospective primary data collection from health care providers and patients. The primary goal is to investigate whether and to which extent heart teams, consisting of cardiologists and cardiac surgeons, increase guideline adherence in decision making for myocardial revascularization. Ultimately the study project aims to improve patient care in terms of decision making for appropriate myocardial revascularization. Through the consistent implementation of the German National Care Guideline on chronic Coronary Artery Disease (NVL-cKHK) and the European Guidelines on myocardial revascularization, the reduction of morbidity, mortality and the reduced need for subsequent revascularization procedures are also desirable from a health economics perspective.

Abstract 177: Interleukin 17 and Coronary Stenosis in Patients With Stable Coronary Artery Disease

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Dinaldo Oliveira ◽  
Elaine Heide ◽  
Maira Pita ◽  
Danielle A Oliveira ◽  
Ricardo Pontes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Interleukin 17 ◽  
Left Circumflex Artery ◽  
Artery Disease ◽  
Stable Cad

Introduction: The role of the immune and inflammatory pathways in patients with coronary artery disease (CAD) is important but not complete understood. The aim of this study was to evaluate concentrations of the interleukins 17 (IL 17) according to severity of coronary stenosis in patients with stable CAD Hypothesis: There is no association between severity of coronary stenosis and IL 17 in patients with stable CAD. Methods: This is a cross-sectional, prospective, analytical study, conducted from january to september, 2013. We included 40 patients (P) with stable CAD, CCS III or IV, ischemic myocardial scintigraphy, who had not been subjected to any kind of myocardial revascularization and with coronary stenosis ≥ 50% according to current coronary angiography. There were 20 healthy volunteers (C), to take up comparison of concentrations of IL 17. Interleukins were evaluated in serum of patients and after 48 hours of cells in culture with and without stimulus. IL 17 A concentrations were expressed in pg / ml. Coronary stenosis were classified as severe (> 70%) [SS] and intermediate (50 - 69%) [MS] according to coronary angiography. Results: Stenosis ≥ 50% were found in the anterior descending artery in 31 patients, in the left circumflex artery in 19 patients, and in the right coronary artery in 24 patients. No cases of stenosis were observed in the left main. Eighteen patients (45%) had single-artery disease, 8 patients (20%) had two-artery disease, and 14 patients (35%) had multiarterial disease. The comparison between the groups showed: IL 17: Serum: P with SS = 3.91 (3.91 -- 72.27) vs P with MS = 3.91 (3.91 -- 3.91) vs C = 3.91 (3.91 -- 28.8), p = 0.53; culture 48 hours without stimulus: P with SS = 3.91 (3.91 -- 3.91) vs P with MS = 3.91 (3.91 -- 86.8) vs C = 3.91 (3.91 -- 53.3), p = 0.55; culture 48 hours with stimulus: P with SS = 241.8 (3.91 -- 2200) vs P with MS = 217.5 (3.91 -- 1346) vs C = 154.3 (3.91 -- 1353), p = 0.7. Conclusions: There were no differences in concentrations of IL 17 according to severity of coronary stenosis, does not matter in serum or cell in culture. In conclusion, there was no association between severity of coronary stenosis and IL 17 in patients with stable CAD

Abstract 275: Interleukins 17th and 22th in Stable Coronary Artery Disease

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Dinaldo Oliveira ◽  
Maira R Pitta ◽  
Ivan R Pitta ◽  
Elayne Heide ◽  
Viviane R Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Analytical Study ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Myocardial Scintigraphy ◽  
Cross Sectional ◽  
Artery Disease ◽  
Stable Cad

Introduction: The role of the immune and inflammatory pathways in coronary artery disease (CAD) is important but not complete understood. The aim of this study was to evaluate expressions of the interleukins 17th and 22th in patients with stable coronary artery disease. Hypothesis: Interleukins 17th and 22th are not increased in stable CAD. Methods: This is a cross-sectional, prospective, analytical study, conducted from August to December 2012. We included 40 patients (P) with stable CAD, CCS III or IV, ischemic myocardial scintigraphy, who had not been subjected to any kind of myocardial revascularization and with coronary stenosis equal or major than 50% according to current coronary angiography. There were 20 healthy volunteers (C), to take up comparison of expression of interleukins (IL). We evaluated the levels of IL 17th and 22th of the patients and controls. Interleukins were evaluated in serum of patients and after 48 hours of cells in culture with and without stimulus. IL concentrations were expressed in pg / ml. Statistical analysis was performed using the Mann-Whitney or Student t test. P ≤ 0,05 was considered statistically significant. Results: There were 26 men and 14 women in the group of the patients and 12 men and 8 women in the controls. The age was similar between the groups (63.2 ± 8.9 years vs 57.9 ± 9.4, p = ns). The comparison between the groups showed: Interleukin 17th: Serum: P = 3.9 (972.2 -- 2.93) vs C = 3.90 (28.8 -- 1.74), p = 0.5; culture 48 hours without stimulus: P = 3.90 (3.90 -- 3.90) vs C = 6.37 (3.90 - 11), p = 0.8; culture 48 hours with stimulus: P = 302.42 (2200 -- 3.90) vs C = 815 (1353 -- 3.90), p = 0.06. Interleukin 22th: Serum: P = 15.62 (64.72 -- 15.62) vs C = 15.62 (121 -- 15.62), p = 0.2; Culture 48 hours without stimulus: P = 11 (128.93 -- 7.81) vs C = 7.81 (7.81 -- 7.81), P = 0.8; Culture 48 hours with stimulus: P = 135 (2486.7 -- 7, 81) vs C = 322.86 (1319.11 -- 7.81), p = 0.4. Conclusions: There were no differences in concentrations of interleukins, but the trend of higher expression of the IL 17th in the controls after cell culture with stimulus. In conclusion, in patients with stable CAD the interleukins 17th and 22th did not exhibit increased concentrations.

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