[Hybrid revascularization of the brain and myocardium: risk stratification for in-hospital complications]. / Gibridnaia revaskuliarizatsiia golovnogo mozga i miokarda: stratifikatsiia riska gospital'nykh oslozhnenii.

AIM: The study was aimed at determining efficacy of a new computer program of stratification of the risk for postoperative adverse cardiovascular events in patients with atherosclerotic lesions of coronary and carotid arteries. PATIENTS AND METHODS: Based on a mathematical analysis of the outcomes of treatment of patients with atherosclerotic lesions of coronary and carotid arteries over the period from 2011 to 2015, we created a program making it possible to determine a staged or simultaneous policy of revascularization, which was retrospectively and prospectively tested in our medical facility. RESULTS: Within the frameworks of a clinical example we carried out hybrid revascularization of the brain and myocardium in the scope of percutaneous coronary intervention and carotid endarterectomy. During the early postoperative hours, the development of myocardial infarction was registered. According to the program's calculations, in using other strategies of surgical treatment (carotid endarterectomy + coronary artery bypass grafting and carotid endarterectomy - coronary artery bypass grafting), the level of risk for the development of a complication was lowest. Thus, taking into consideration this risk stratification by a multidisciplinary team made it possible to avoid the development of complications. CONCLUSION: This program of decision-making regarding revascularization for atherosclerotic lesions of coronary and carotid arteries may be an additional tool in the armamentarium of the methods of determining therapeutic strategy for this patient cohort.

[Predictors of acute coronary syndrome in patients with ischaemic heart disease]. / Prediktory ostrogo koronarnogo sindroma u patsientov s ishemicheskoi bolezn'iu serdtsa.

Acute coronary syndrome has for a long time been giving no way of decreasing mortality related to ischaemic heart disease. The primary cause of acute coronary syndrome in the majority of cases is rupture of an unstable atherosclerotic plaque in the coronary artery followed by thrombosis thereof. The main missions of modern cardiology include: assessment of the risk of acute coronary syndrome, identification of predictors of adverse events, and working-out of measures aimed at prevention and optimal management of patients with ischaemic heart disease. This article deals with clinical and morphological factors associated with destabilization of coronary plaques, their rupture, and the development of an acute coronary event.

[Evolution of transcatheter aortic valve implantation: from planning to robotic systems]. / Évoliutsiia transkateternoi implantatsii aortal'nogo klapana.

Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has evolved dramatically and is now standard of care for intermediate risk patients with aortic stenosis. The development of innovative transcatheter heart valves and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step was the simplification of the procedure, which contributed to a further decrease in complications, reduced procedural time, and shorter hospital stay. Change-over from general anaesthesia to conscious sedation, refusal from predilatation, and use of the radial approach instead of the contralateral femoral approach are all instrumental in achieving optimal results. Prospects for development include visual assist systems and robotic systems that can potentially optimize the transcatheter aortic valve implantation process, improve safety and effectiveness of the procedure.

[Comparative assessment of in-hospital outcomes of transcatheter implantation and «open¼ prosthetic repair of the aortic valve]. / Sravnitel'naia otsenka gospital'nykh rezul'tatov transkateternoi implantatsii i "otkrytogo" protezirovaniia aortal'nogo klapana.

The authors carried out comparative assessment of in-hospital outcomes of transcatheter aortic valve implantation (TAVI) and «open¼ prosthetic repair of the aortic valve. The main criterion for inclusion into the study was the presence of indications for surgical correction of an isolated defect of the aortic valve (AV). Group One comprised 11 patients subjected to TAVI and Group Two (comparison group) consisted of 23 patients undergoing «open¼ prosthetic repair of the AV. There were no statistically significant between-group differences by the main parameters evaluated. In the Comparison Group, there was one lethal outcome; one patient developed significant haemorrhage requiring emergency mediastinotomy; more frequently revealed were pneumonia and hydrothorax, as well as wound complications. Analyzing the obtained results demonstrated comparable in-hospital outcomes of TAVI and «open¼ prosthetic repair of the AV in patients at intermediate surgical risk, despite older age of patients in the TAVI group.

[Aneurysmal lesions of the extracranial segment of the internal carotid artery]. / Anevrizmaticheskoe porazhenie ékstrakranial'nogo segmenta vnutrennei sonnoi arterii.

The article contains a review of the literature devoted to the state-of-the-art data concerning management of patients presenting with an aneurysmal lesion of the extracranial segment of the internal carotid artery. This is followed by describing two clinical case reports regarding aneurysms of the extracranial segment of the internal carotid artery and the outcomes of endovascular treatment.

[Optimal timing of the second stage of revascularization in the treatment of patients with ST-elevation myocardial infarction and multivascular involvement].

An assessment of outcomes in 187 patients with ST elevation myocardial infarction (STEMI) with multivessel coronary disease who underwent primary percutaneous coronary intervention (PCI) was done. All patients were divided into two groups: in group 1 (n=39) second phase of revasculrization was performed within 60 days, in group 2 (n=148) it was carried out or planned in more than 60 days after index event. During 12 months of follow up rates of combined end point (death, myocardial infarction, target vessel revascularization [TVR]) and TVR in group 1 were lower than in group 2 (5.1 vs 27.7%, and 0 vs 11.5%, respectivelly, p=0.05). We also observed tendency to lower reinfarction rate in group 1 (0 vs 9.46%, p=0.09). There was no significant difference between groups in number of deaths (5.1% vs 6.7%, respectively).

[Transcutaneous coronary intervention accompanied by biventricular circulatory support and combined with extracorporeal membranous oxygenation].

In a multiple-vessel lesion of the coronary bed, pronounced accompanying pathology, low ejection fraction of the left ventricle, obesity, previously performed operation of coronary aortic bypass grafting may be causes of refusal from revascularization by means of coronary bypass grafting. A transcutaneous coronary intervention (TCI) in this patient cohort is also associated with the risk of an unfavourable outcome in case of a technically complicated procedure and a large volume of the myocardium supplied with blood by the target arteries. Haemodynamic support of such high-risk TCI by means of intra-aortic balloon contrapulsation or a left-ventricle assist device is associated with a series of shortcomings which are removed by means of a biventricular bypass used in a combination with extracorporeal membranous oxygenation. This article deals with a case report of successful stenting of the unprotected trunk of the left coronary artery and the right coronary artery in the conditions of a mechanical biventricular bypass.

[Effect of the terms of complete revascularization on the outcomes of treatment of patients with st segment elevation myocardial infarction and multivessel coronary artery disease].

The study was aimed at evaluating the results of treating a total of 227 patients presenting with ST segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent primary percutaneous interventions (PCI). The patients were subdivided into three groups: Group One consisted of the patients having endured multivessel stenting (MVS) within the framework of a primary PCI (n=40); Group Two comprised patients having endured stagewise revascularization (SWR) carried out within 60 days after the index event (mean 29.9±19.6 days) (n=39), and Group Three was composed of patients with stagewise revascularization either performed or planned to be performed within the terms exceeding 60 days (mean value 183.4±90.7 days) (n=148). During 12 months significant differences were observed between Group One and Group Three patients, as well as between Group Two and Group Three patients by the frequency of the composite end point (death, myocardial infarction, secondary revascularization of the target vessel (TVR) (p<0.05) and separately by the TVR between Group Two and Three patients (p<0.05). Besides, there was a tendency towards significant differences between Group One and Group Three patients, as well as Group Two and Group Three patients by the development of recurrent MI (p<0.05). By the number of lethal outcomes no statistically significant differences between the groups were observed. Hence, in the cohort of patients with STEMI and MVD who were subjected to primary PCIs, performing of MVS or secondary revascularization within 60 days has advantages as compared with the time period > 60 days by the frequency of the composite end point, TVR and is associated with a tendency towards lower incidence rate of recurrent MI during 12 months of follow up. The strategy of MVS and the secondary SoR within 60 days demonstrated comparable results during 12 months. Performing complete revascularization within the framework of primary PCI or shortly after discharge from the hospital (29.9±19.6 days) is associated with greater availability of the second SoR as compared with that planned for the terms of 183.4±90.7 days.

[Prognostic value of SYNTAX score for outcomes and revascularization strategy choice in ST-segment elevation myocardial infarction patients with multivessel coronary artery disease].

AIM: To study the prognostic significance of the SYNTAX score in the evaluation of outcomes of primary percutaneous coronary interventions (PCIs) and revascularization strategy choice in patients with ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease. MATERIAL AND METHODS: The long-term outcomes of primary PCIs were analyzed in 163 patients with STEMI in terms of the objective assessment of the severity of the coronary bed lesion according to SYNTAX scores. RESULTS: In a cohort of STEMI patients who had undergone primary PCI, the SYNTAX score of > or = 23 (a severe lesion) was associated with the higher incidence of acute heart failure (Killip class II) and three-vessel coronary artery disease (odds ratio (OR) 2.8), with the higher risk of death (OR 7.5) and the higher rate of the combined endpoint of death, myocardial infarction, and target vessel revascularization (OR 2.8) as compared with patients with a SYNTAX score of < or = 22 (a moderate lesion). CONCLUSION: The SYNTAX score has a prognostic value in assessing the outcomes of primary PCIs in the cohort of STEMI patients with multivessel disease, which can find use in the differential choice of the optimal revascularization strategy and improve treatment results. In the group of patients with a SYNTAX score of > or = 23, the incomplete revascularization strategy shows the least favorable results as compared to multivessel stenting and staged revascularization.

[Left anterior descending bypass grafting from the anterolateral minitorakotomy].

Current efficient methods of open revascularization in patients with multivessel coronary artery lesions are associated with a certain amount of general and local complications depending on traumatic interventions, bypass, manipulation on the ascending aorta. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) allows to avoid certain perioperative risk factors and appears to be a promising myocardial revascularization model in isolated lesion of left anterior descending (LAD) and multivessel lesions, applying combines percutaneous intervention (PCI).

[Coronary atherosclerosis and total serum cholesterol in men and women].

The study shows that the extent of atherosclerotic changes in the coronary arteries, revealed during coronaroangiography, has a significant correlation with the serum level of total cholesterol (TC). In patients with normal (less than 5.2 mmol/ l) TC the number of involved arteries and the number of stenotic segments are significantly smaller than those in patients with a TC level higher than 6.5 mmol/l.

[Acute diffuse thrombosis of left coronary artery complicating coronary angioplasty]. / Ostryi diffuznyi tromboz levoi venechnoi arterii kak oslozhnenie koronarnoi angioplastiki.

The paper presents a case report for successful treatment of acute diffuse thrombosis developed in left coronary artery after coronary angioplasty fulfilled for 39-year-old patient with acute coronary syndrome. Heparin resistance accompanied by intracoronary intervention triggered severe ascending thrombosis of the whole anterior descending artery with involvement of circumflex artery ostium. Therapeutic measures included: repeated Heparin bolus injection (total 27,000 U), bolus intracoronary Streptokinase injection (500,000 U) with subsequent Streptokinase infusion (1,000,000 U in 1 hour), stenting of circumflex artery ostium for thrombus mechanical destruction. This enabled us to restore adequate coronary flow and to resolve critical condition with minimal loss (periprocedural complication - repeated non-Q wave myocardial interfaction).

[Size of viable myocardium and collateral blood flow in patients with coronary artery occlusion]. / Ob"em zhiznesposobnogo miokarda i kollateral'nyi krovotok u patsientov s okkliuziei koronarnykh sosudov.

The aim of the study was to investigate correlation between collateral blood flow to occluded coronary vessel and the size of viable myocardium in the area fed by that artery. Total 295 patients with coronary artery occlusion were divided into 2 groups. The 1st group included 193 patients with the history of Q-wave myocardial infarction (MI), the 2nd group - 102 patients with non-Q-wave MI or without MI. Left ventriculography evidenced lesser volume of viable myocardium in the 1st group compared with the 2nd. All patients were assessed for collateral blood flow (CBF) to occluded vessel. There was significantly higher incidence of minor (grade I) or absent (grade 0) CBF in the 1st group - 71 (36.9%) and 10 (5.1%) cases, respectively - compared with the 2nd group - 15 (14.7%) and 0 (0%) cases, respectively (p<0.05). Unlike this, satisfactory (grade II) and good (grade III) CBF to distal segments of occluded artery was more frequent in the 2nd group - 71 (69.6%) and 16 (15.7%) cases, respectively, compared with the 1st group - 102 (52.9%) and 10 (5.1%) cases, respectively (p<0.05). The authors conclude that evaluation of CBF level can complement the assessment of viable myocardium in the occluded coronary artery area, and the presence of the II-III grade CBF can support the necessity of occluded vessel angioplasty.