Management of Renal Artery Occlusion during Endovascular Aortic Repair.

A 67-year-old man was admitted to the emergency unit with abdominal pain. An infrarenal aortic aneurysm with a diameter of 70 millimeters was detected by computed tomography. In the catheter laboratory, graft stents were implanted into the infrarenal aorta. Total occlusion of the right renal artery was seen in angiography. The graft stent was punctured with a 30° angled Brockenbrough catheter, and another stent was implanted.

Copeptin level and copeptin response to percutaneous balloon mitral valvuloplasty in mitral stenosis.

We aimed to investigate copeptin levels in mitral stenosis (MS) patients and the behavior of copeptin after hemodynamic improvement achieved by percutaneous balloon mitral valvuloplasty (PBMV). The study involved 29 consecutive symptomatic patients with moderate to severe rheumatic MS who underwent PBMV. Twenty-eight age- and gender-matched healthy volunteers composed the control group. Blood samples for copeptin were obtained immediately before and 24 h after PBMV, centrifuged, then stored at -70°C until assayed. The copeptin level of the patient group was statistically different from that of the control group (61.8 ± 34.4 and 36.8 ± 15.2 pg/ml, respectively; p = 0.001). PBMV resulted in a significant increase in mitral valve area and a significant decrease in transmitral gradient as well as systolic pulmonary artery pressure. While hemodynamic relief was obtained, we detected a statistically significant decline in copeptin levels 24 h after PBMV compared to the baseline levels (from 61.8 ± 34.4 to 44.1 ± 18.2 pg/ml; p = 0.004).

Does nebivolol prevent contrast-induced nephropathy in humans?

BACKGROUND: An experimental study showed that nebivolol is an effective agent in contrast-induced nephropathy (CIN) prophylaxis. HYPOTHESIS: We hypothesized that prophylactic nebivolol use had protective effects on renal function in human beings subjected to iodinated contrast agent since it has vasodilatory effect and antioxidant properties. METHODS: The present study enrolled 120 patients scheduled for coronary angiography and ventriculography. All patients were hydrated with intravenous isotonic saline. The patients in group I received 600 mg N-acetylcysteine every 12 hours for 4 days. The patients in group II received 5 mg nebivolol every 24 hours for 4 days. The patients in group III were only hydrated. The primary endpoint was the occurrence of CIN. The secondary endpoint was the change in serum creatinine (Cr) levels at 2 days and 5 days after the contrast exposure. RESULTS: Nine (22.5%) patients in group I developed CIN, as did 8 patients (20.0%) in group II and 11 patients (27.5%) in group III (P = 0.72). Changes in mean Cr level from baseline to day 2 were not statistically significant in all groups. However, we detected a statistically significant increase in mean Cr levels at day 5 compared with baseline levels in group I and group III (from 1.42 ± 0.13 to 1.52 ± 0.26, p2 = 0.02; and from 1.43 ± 0.14 to 1.55 ± 0.30, p2 = 0.01, respectively). Although an increase was detected in mean Cr level from baseline to the 5-day Cr level in group II, this did not reach statistical significance (from 1.40 ± 0.12 to 1.48 ± 0.23, P = 0.06). CONCLUSIONS: Pretreatment with nebivolol is protective against nephrotoxic effects of contrast media.

Relationship between no-reflow phenomenon and serotonin levels in patients with acute ST-elevation myocardial infarction who underwent primary percutaneous intervention.

OBJECTIVE: Our aim was to investigate the effects of serotonin, which is a severe vasoconstrictor agent, on the occurrence of no-reflow phenomenon. METHODS: In this cross-sectional controlled study, 40 patients, admitted to our clinic with chest pain in the first 12 hours and underwent primary percutaneous coronary intervention because of acute myocardial infarction were enrolled. Patients with TIMI 0 grade basal flow and normal post-procedure flow were included in group 1 and patients with flow grade TIMI < or =were enrolled in group 2. To measure the serotonin levels, blood samples were collected from the coronary ostium before the procedure. RESULTS: In group 1, there were 25 patients (20 males, 5 females) and the mean age was 58+/-11 years; in group 2 there were 15 patients (13 males, 2 females) and the mean age was 62+/-8 years. The mean serotonin level in platelet in group 1 was 476+/-208 ng/109 platelet and in group 2-542+/-273 ng/109 platelet. The difference was not statistically significant (p=0.39). When we compared the serum serotonin levels, it was 41.4+/-40.8 ng/ml for group 1, but 66.7+/-45.7 ng/ml for group 2. Although the serum serotonin levels were higher in group 2, the difference was not statistically significant (p=0.07). CONCLUSION: There was no effect of serotonin level in the development of no-reflow, in patients to whom primary coronary percutaneous intervention was applied.