scholarly journals Anesthesiologic management of elective endovascular stenting of coronary artery

2021 ◽  
Vol 20 (5) ◽  
pp. 4-10
Author(s):  
A. V. Tsarkov ◽  
A. L. Levit
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Anesthetic Management ◽  
Endovascular Stenting ◽  
Endovascular Interventions ◽  
Anginal Pain ◽  
Coronary Artery Stenting ◽  
Comparison Groups ◽  
Invasive Method ◽  
Sedation Group

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

Management and Anesthetic Considerations for Patients With Anomalous Aortic Origin of a Coronary Artery

2018 ◽  
Vol 22 (4) ◽  
pp. 383-394 ◽  
Author(s):  
Benjamin Kloesel ◽  
Martina Richtsfeld ◽  
Mojca Konia ◽  
John L. Bass
Keyword(s):  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Arteries ◽  
Anesthetic Management ◽  
Heterogeneous Group ◽  
Coronary Anomalies ◽  
Disease Group ◽  
Coronary Artery Anomalies ◽  
Fatal Disease ◽  
Anesthetic Considerations

The term “coronary artery anomalies” encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.

scholarly journals The usage of personalized scheme of fentanyl administration during coronary artery stenting

2020 ◽  
pp. 11-19
Author(s):  
D.О. Dziuba ◽  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Comparison Group ◽  
Study Groups ◽  
Stress Markers ◽  
Coronary Artery Stenting ◽  
Group 2 ◽  
Personalized Approach ◽  
Fentanyl Administration ◽  
Group 1

The aim – to develop a personalized scheme of fentanyl administrationfor coronary artery stenting. Materials and methods. Ninety patients with ischemic heart disease who underwent planned stenting of the coronary arteries were studied. The patients who underwent surgery were evenly divided into three study groups, depending on mode of the intraoperative analgesic sedation and the approaches to anesthesia. The first comparison group consisted of patients who received slow intravenous administration of diazepam and fentanyl solutions. The second comparison group consisted of patients with balanced administration of fentanyl and propofol solutions to provide analgesic sedation at the level of conscious anesthesia. The study group consisted of patients with a personalized approach to the administration of opiates, namely, we used the original fentanyl test described in the article. Analgesic sedation at the level of conscious anesthesia (ІІІ by Ramsey) was maintained by propofol infusion. Results. The usage of a personalized scheme of fentanyl administration for stenting of the coronary arteries, compared to the standard sedation using combination of diazepam and fentanyl, was accompanied by better indicators of intraoperative blood saturation with oxygen and carbon dioxide (respectively (103.67 ± 22.05) and (39.64 ± 6.85) mm Hg in group 1, (105.70 ± 31.64) and (37.68 ± 7.11) in group 2 and (109.42 ± 34.36) and (36.25 ± 6.52) mm Hg in patients of the 3rd group), lower blood pressure after surgery ((127.85 ± 9.87)/(79.64 ± 8.62) mm Hg in patients of group 1, (129.48 ± 8.73)/(81.05 ± 7.92) mm Hg in group 2 and (131.15 ± 10.64)/(82.68 ± 9.72) mm Hg in group 3), lower level of stress markers (blood cortisol during surgery in patients of the 1st group (8.83 ± 4.58) mmol/L, in patients of the 2nd group – (7.73 ± 2.79) mmol/L, in patients of the 3rd group – (7.55 ± 4.35) mmol/L), as well as lower frequency of detecting episodes of perioperative pain of various origins. Conclusions. A method of personalized anesthesia was elaborated, based on individual scheme of fentanyl administration («fentanyl test») during coronary artery stenting. Its usage is safe (due to the optimal parameters of gas exchange and hemodynamics and fewer side effects, such as nausea and residual sedation) and effective (due to the lower level of stress markers and less frequent complaints of pain of various origins) than when the routine technique was used. Key words: analgesic sedation, individual sensitivity, fentanyl, diazepam, propofol.

scholarly journals EVALUATION OF STRENGTH CHARACTERISTICS OF CORONARY STENTS IN THE CREATED MODEL OF “MYOCARDIAL BRIDGE”

2018 ◽  
Vol 8 (1) ◽  
pp. 64-68
Author(s):  
V. V. Plechev ◽  
T. Sh. Sagatdinov ◽  
R. Yu. Rizberg ◽  
I. V. Buzaev ◽  
I. E. Nikolaeva ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Structure Design ◽  
Coronary Stents ◽  
Strength Characteristics ◽  
Myocardial Bridge ◽  
Strength Limit ◽  
Coronary Artery Stenting ◽  
Bridge Type ◽  
Usb Camera

Introduction. Presently there is no unified tactics to treat patients with aberrantly localized coronary arteries of “muscular bridge” type. There are controversial data regarding the benefit of coronary artery stenting due to often stent breakage or perforation of tunneled vessel. There are no major randomized studies regarding this issue. In this regard the goal of this research was to assess strength characteristics of stents in the model of muscular growth that we restored.Materials and methods. The originally developed model enabled to determine the strength limit of coronary stents under conditions that are maximum close to the physiological ones. The stents were placed into a polytetrafluoroethylene tube, the bridge-imitating oscillation frequency was configured to 250 beats per minute. The results of the experiment were recorded on USB-camera each 30 minutes in order to register mechanical defects of the stent.Results and discussion. The stent consisting of cells that are joined with V-shaped connections, showed first signs of strut deformity on the 10th day. Complete breakage happened on the 17th day after implantation. After 2 months observation the stent preserved mechanical firmness without V-shaped connections.Conclusion. Thus, it is not quite correct to support the hypothesis on infeasibility of stent implantation into the coronary artery with a muscular bridge. Taking into consideration the findings it is possible to suppose that the structure, design, form and content of stents predetermine the possibility to implant it into coronary artery with muscular bridge, but require individual approach to every particular patient. 

INDEPENDENT PREDICTORS AND PROGNOSIS OF LONG-TERM MYOCARDIAL INFARCTION IN PATIENTS WITH UNSTABLE ANGINA AFTER CORONARY ARTERY STENTING

2021 ◽  
Vol 5 (1) ◽  
pp. 1109-1120
Author(s):  
A. Miadzvedzeva ◽  
◽  
L. Gelis ◽  
O. Polonetsky ◽  
I. Russkikh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Coronary Arteries ◽  
C Reactive Protein ◽  
Endogenous Thrombin Potential ◽  
Reactive Protein ◽  
Coronary Artery Stenting

Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk.

scholarly journals Multislice computed tomography in the evaluation of coronary atherosclerosis dynamics: data three-year observation in patients with myocardial infarction-segment elevation ST and stenting of coronary arteries

2021 ◽  
Vol 27 (6) ◽  
pp. 19-30
Author(s):  
L. M. Babii ◽  
V. O. Shumakov ◽  
O. P. Pogurelska ◽  
A. Yu. Rybak ◽  
I. E. Malynovska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Multislice Computed Tomography ◽  
Atherosclerotic Lesions ◽  
Msct Coronary Angiography ◽  
Coronary Artery Stenting ◽  
Progression Of Atherosclerosis

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

scholarly journals Cytokine status in middle-aged men with acute coronary syndrome after coronary artery stenting

2021 ◽  
Vol 12 (2) ◽  
pp. 5-12
Author(s):  
Vadim A. Gostimskiy ◽  
Vladimir S. Vasilenko ◽  
Elena A. Kurnikova ◽  
Sergey V. Shenderov ◽  
Ol’ga P. Gurina
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Reference Values ◽  
Proinflammatory Cytokines ◽  
Coronary Syndrome ◽  
Coronary Artery Stenting ◽  
Anti Inflammatory ◽  
Artery Disease

Background. Inflammatory cytokines and growth factors are involved in various mechanisms of coronary artery disease. Clinical studies have shown the correlation between the increase in the level of proinflammatory cytokines and the severity of coronary artery disease, while the data on the role of proinflammatory interleukin IL-8 and anti-inflammatory interleukin IL-4 are contradictory. The aim of the study is to assess the levels of proinflammatory cytokines (IL-8, TNF-) and anti-inflammatory interleukin (IL-4) in patients with various forms of coronary artery disease who underwent coronary artery stenting. Materials and methods. By the method of enzyme-linked immunosorbent assay, the levels of cytokines were determined in 30 patients with acute coronary syndrome who underwent primary stenting of the coronary arteries and in 24 patients with chronic coronary syndrome who had previously had myocardial infarction with stenting of an infarction-associated artery, who were admitted to the clinic for staged stenting of the coronary arteries. Results. In patients with chronic coronary syndrome the levels of IL-4 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-4 there was an increase 3,70 0,24 and 240,85 49,25 pg/ml, р 0,001. In patients with chronic coronary syndrome the levels of IL-8 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-8 there was an increase 7,34 1,29 and 110,33 27,67 pg/ml, р 0,001. Conclusion. Most likely the increase in the level of IL-4 has a compensatory character and, along with a slight increase in TNF-, can be considered as a positive factor stabilizing the course of the disease. There may be some relationship between of the increase in the level of interleukins in patients with acute coronary syndrome on the degree of stenosis of the coronary arteries (9095%) and impaired myocardial contractility was established.

Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

2005 ◽  
Vol 8 (1) ◽  
pp. 42 ◽  
Author(s):  
C. Probst ◽  
A. Kovacs ◽  
C. Schmitz ◽  
W. Schiller ◽  
H. Schild ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Invasive Coronary Angiography ◽  
Bypass Graft ◽  
Heart Association ◽  
Artery Stenosis ◽  
Vessel Disease ◽  
Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

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