Results of activities of the department of vascular surgery amidst COVID-19 pandemic

Aim. To conduct comparative analysis of the activities of the department of vascular surgery before and during the spread of new coronavirus infection COVID-19 (SARS-CoV-2).Methods. The analysis was performed on the number of outpatient visits of vascular surgeon for types of diagnosis, number and type of surgeries performed at the inpatient facilities of the LLC “Grand Medica” over 2019 (whole year) and 2020 (quarterly).Results. Significant decrease was noted in the number of visits of patients with cardiovascular diseases to vascular surgeon in the outpatient facility. The number of surgeries on limb arteries in patients among Kuzbass residents decreased by 26.4 %, among residents of other regions – by 59.5 %; in brachiocephalic arteries – by 12.5 % and 54.5 %, respectively. The number of percutaneous transluminal coronary angioplasty (PTCA) in patients among Kuzbass residents increased by 25.3 %, among residents of other regions remained unchanged.Conclusion. Decrease in the volume of provision of care for patients with cardiovascular diseases over 2–4 quarters of 2020 is caused by two groups of factors. The first one is associated directly to the epidemiological situation and countermeasures against the spread of SARS-CoV-2 while the second one is associated indirectly.

The Effects of PCSK9 and Apolipoprotein E Functional Gene Variations On Hypercholesterolemia and Clinical Phenotype in Restenosis Patients After Percutaneous Coronary Angioplasty

Background: In-stent-restenosis is a case restricting the benefits of percutaneous-transluminal coronary angioplasty (PTCA). PCSK9 controls LDLR levels, and variations in PCSK9, ApoE and ApoER genes may affect the development of restenosis. The aim of this study was to assess the effects of genetic variants on restenosis risk after PTCA.Methods and Results: The study groups include 109 CAD-patients with restenosis (S-CAD) and 82 CAD-patients without restenosis (open-stent,OS-CAD). SNPs were analyzed by RT- PCR. PCSK9 levels were detected via ELISA method. The distributions of ApoE Epsilon, APOER (rs5174), PCSK9 rs2182833 and rs11206510 polymorphisms were found similar between study groups while the frequency of the PCSK9 E670G G allele in S-CAD group was found significantly higher than OS-CAD patients (p= 0.015). No difference was found between study groups in terms of the serum levels of PCSK9. LDL-C was found lower and HDL-C was found higher in OS-CAD group comparing with S-CAD group (p=0.042, p=0.008, respectively). Frequencies of Type 2 DM and hyperlipidemia were also found higher in S-CAD group than OS-CAD group (p=0.007, p=0.001, respectively) while EF% was found lower in S-CAD group than OS-CAD group (p=0.007).Conclusions: Our findings indicate that although ApoE Epsilon, APOER (rs5174), PCSK9 rs2182833, rs11206510 and E670G polymorphisms has no effect on serum PCSK9 levels, PCSK9-rs505151G-allele and hyperlipidemia may be risk factors in the development of restenosis.

Temperature-dependent tensile properties of polyamide 12 for the use in percutaneous transluminal coronary angioplasty balloon catheters

Background Percutaneous transluminal coronary angioplasty (PTCA) balloon catheters must withstand high pressures required for the lesion treatment, pushing loads during insertion, and pulling loads during withdrawal. These loads pose a challenge especially for polymeric tubular shafts with small cross sections. In order to enable new design innovations and to better understand the mechanics of current catheter technologies, the tensile properties of polyamide (PA) 12 were investigated. PA 12 dog bone specimens and medical PA 12 tubes were either stored at ambient temperature and humidity or conditioned in water, and subjected to tensile loads at different temperatures. In addition, the effect on the tensile properties of the necking process, a forming process to reduce the wall thickness of the tubes, was determined. Results The tested tubes showed a reduction in both Young’s Modulus (− 41.5%) and yield stress (− 29.2%) compared to standardized specimens. Furthermore, an increase in temperature and water absorption softens the material and reduces the mechanical properties like the Young’s Modulus and the yield stress. It was found that the material strengthens during the necking process. Likely due to the orientation of the polymers chain molecules in load direction (Rösler et al., 2007), the Young’s Modulus of the material could be increased by 43.5%. Furthermore, the absence of a yield point after necking allows for a greater loading capacity of the material without unstable neck growth. Besides the strengthening, the ultimate strain is reduced by 50%. This indicates that the necking process induces plastic deformation. Conclusion The investigation showed that the environmental conditions like temperature and humidity can influence mechanical properties. It could also be shown that pre-forming processes such as necking can enhance the mechanical properties, such as the Young’s Modulus, while reducing the wall thickness. These findings suggest possible further development of catheters with a small cross section and higher mechanical strength and highlight the importance to account for the targeted operating temperature during the design process.

A Prospective Observational Study on Evaluation of Therapeutic Efficacy of Antiplatelets in Coronary Artery Disease with Percutaneous Transluminal Coronary Angioplasty

Coronary artery disease otherwise named as Coronary heart disease. Coronary Artery Disease means narrowing of the coronary arteries. This narrowing causes reduction of blood flow to the heart muscle by buildup of plaque in the arteries of heart. A common symptom of Coronary artery disease is chest pain or chest discomfort which can travel to the shoulder, arm, back, neck or jaws. Other symptoms may include Shortness of breath, palpitations and even fatigue. Majorly antiplatelets are given in the treatment of CAD and followed by angioplasty for the clearing of plaques in the coronary artery. Collected a sample size of 200 patients, among them 126 are males and 74 are females. Patient with age group of 51-60 are more prone to CAD in both males and females. Chest pain is majorly seen in males compared to females. Chest pain, Sweating and shortness of breath is seen in both males and females and the number of male patients are more when compared to females. Patients with only shortness of breath are less when compared to other chief complaints. Social history includes Smokers are 26 (47.2%), alcoholic are 48 (57.14%).. Among all these patients the length of hospital stay of patients treated with combination of aspirin and clopidogrel is less when compared with ticagrelor, aspirin, clopidogrel.Based on the follow up observations we may consider that combination of antiplatelet therapy is effective in CAD patients undergone with percutaneous transluminal coronary angioplasty.

Application of in silico Platform for the Development and Optimization of Fully Bioresorbable Vascular Scaffold Designs

Bioresorbable vascular scaffolds (BVS), made either from polymers or from metals, are promising materials for treating coronary artery disease through the processes of percutaneous transluminal coronary angioplasty. Despite the opinion that bioresorbable polymers are more promising for coronary stents, their long-term advantages over metallic alloys have not yet been demonstrated. The development of new polymer-based BVS or optimization of the existing ones requires engineers to perform many very expensive mechanical tests to identify optimal structural geometry and material characteristics. in silico mechanical testing opens the possibility for a fast and low-cost process of analysis of all the mechanical characteristics and also provides the possibility to compare two or more competing designs. In this study, we used a recently introduced material model of poly-l-lactic acid (PLLA) fully bioresorbable vascular scaffold and recently empowered numerical InSilc platform to perform in silico mechanicals tests of two different stent designs with different material and geometrical characteristics. The result of inflation, radial compression, three-point bending, and two-plate crush tests shows that numerical procedures with true experimental constitutive relationships could provide reliable conclusions and a significant contribution to the optimization and design of bioresorbable polymer-based stents.

Arrhythmogenic anterior myocardial infarction with QRS-complex fragmentations and Passing phenomenon or Yasser’s phenomenon; the risk and serious implications

Rationale: The arrhythmias associated with myocardial infarction may be serious. Increasing morbidity and mortality in myocardial infarction-induced arrhythmias will be expected. The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated Passing phenomenon or “Yasser’s phenomenon” may have an apparent hemodynamic impact. Patient concerns: A 68-year-old married, housewife, Egyptian female patient presented to the physician outpatient clinic with acute chest pain and anterior myocardial infarction with QRS-complex fragmentations and Passing phenomenon or “Yasser’s phenomenon”. Diagnosis: Arrhythmogenic acute extensive anterior infarction with QRS-complex fragmentations and Passing phenomenon or Yasser’s phenomenon. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute arrhythmogenic anterior ST-segment elevation myocardial infarction with QRS-complex fragmentations to streptokinase and percutaneous transluminal coronary angioplasty. Lessons: The presence of runs of ventricular tachycardia, multiform frequent premature ventricular contractions, and QRS-complex fragmentations, elderly, female sex are prognostic factors for the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase, fibrinolytic, and percutaneous transluminal coronary angioplasty. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications. Passing phenomenon or “Yasser’s phenomenon” should be directed at the disease progression.

A Case Report on Single Vessel Disease

Introduction: Coronary artery disease (CAD) involves the decrease flow of blood to muscle of the heart because of the to build-up of plaque (atherosclerosis) in arteries of the heart. It is one of the most common cardiovascular disease. Tiny branches off larger coronary arteries are get damaged and not able to dilate proper. Small vessels need to expand and also providing oxygen-rich blood to heart. Coronary arteries are damaged, blood flow to the heart decreases. Background: Coronary artery disease affected 110 million people and resulted in 8.9 million deaths. It makes up 15.6% of all deaths, making it the most common cause of death globally. In the developed country risk of death from CAD decreased between 1980 and 2010. Case Presentation: A case of 60 year old men admitted in the cardiac unit with complaints about the abdominal pain and Nausea, vomiting, weakness from the 2 days after examining and blood pressure is 110/70 mm of Hg. He had these complaints since 2 days. Interventions: The patient was treatment started with orally Tab. Ecosprin 150mg, Tab.Ultracet, Tab. Pantop 40 mg, Tab. Augmentin 625 mg. Patient is also undergone PTCA(Percutaneous Transluminal Coronary Angioplasty). Treatment consisted of medication, therapeutic exercise, and health education. Conclusion: In this study, we mainly focus on medical and surgical management and outstanding nursing care helped prevent further complication. Over all the patient response was good and improvement occur after PTCA.

Coronary artery dissection after exercise stress

The article represents data on the frequency and causes of coronary artery dissection. The types of dissections and approaches to their treatment are given. A case of dissection of the right coronary artery (type F) in a young man after signifi cant physical stress with the development of type 2 myocardial infarction is described. Percutaneous transluminal coronary angioplasty with stenting of the remaining dissection of the proximal segment of the right coronary artery made it possible to prevent the recurrence of the disease.

A case report of entrapped angioplasty balloon in circumflex coronary artery

Entrapment of coronary angioplasty hardware during coronary artery interventions is rare but in most cases requires prompt treatment. This article reported a case of 65-year-old woman who underwent a percutaneous transluminal coronary angioplasty to the circumflex artery. A ruptured angioplasty balloon was entrapped in the circumflex artery with proximal end of the guidewire placed in the descending aorta. The patient underwent surgical removal of the foreign body and coronary artery bypass grafting. The case and the management are discussed. Keywords: Angioplasty; coronary artery bypass; equipment failure; angioplasty balloon.

Latest Developments in Robotic Percutaneous Coronary Intervention

Interventional cardiovascular medicine has seen constant progress over the last few decades. Since the first angiograms and percutaneous transluminal coronary angioplasty were carried out, this progress has been tremendous and has led to a substantial decline in cardiovascular morbidity and mortality. The purpose of this article is to report and review the latest developments and evidence in robotics-assisted percutaneous coronary intervention (rPCI) and its potential future applications, opportunities, and limitations. Contemporary evidence shows that rPCI can lead to a significant reduction in radiation exposure as well as medical hazards for cardiologists. Rates of device and procedural success remain high and there is no evidence of a disadvantage for the patient. The accuracy of implantation with a reduced geographic mismatch is a further advantage that can result in a higher quality of treatment. Even in complex coronary lesions and procedures, rPCI seems to be safe and efficient. The latest developments include telestenting over hundreds of kilometers from a remote platform. Currently, the main limitations are the absence of large-scale randomized trials for the valid assessment of the benefits and disadvantages of rPCI as well as the technical limitations of the currently available rPCI systems. rPCI is a forward-looking innovation in cardiology that is applicable to a wide range of coronary interventions. Despite the present lack of knowledge and the limited data concerning the outcome for the patient, the available literature reveals promising results that should lead to improvements for physicians and patients.