[Intravascular ultrasound with virtual histology in assessment of atherosclerotic plaque composition in patients with coronary artery disease and type 2 diabetes mellitus].

Type 2 diabetes mellitus (T2DM) is a serious medical and social problem leading to early disability of patients and high mortality from cardiovascular complications. The development of cardiovascular events is associated not only with the degree of coronary artery stenosis, but also with the structure of the atherosclerotic plaque. AIM: This study aimed to characterize structure and composition of coronary artery atherosclerotic plaque in target lesion of T2DM patients and patients without diabetes using intravascular ultrasound (IVUS) and IVUS with virtual histology (IVUS-VH). MATERIALS AND METHODS: We observed 25 patients with coronary artery disease (CAD) with T2DM and without T2DM, which admitted to Endocrinology Research Centre to perform percutaneous coronary intervention (PCI). Patients with CAD and T2DM were included at group 1 and patients with CAD and without T2DM were included at group 2. IVUS and IVUS-VH assessment of target lesion were performed prior to stent implantation. We observed 24 plaques at group 1 and 10 plaques at group 2. RESULTS: In grey - scale IVUS 2D analysis there were no differences in mean cross - sectional area of the vessel (12.5 [10.4; 15.8] mm2 vs. 13.5 [12,7; 16.5] mm2; p=0.223, respectively) and lumen area (3.71 [2.5; 4.5] mm2 vs. 3.2 [2.7; 3.8] mm2; p=0.589, respectively). Plaque burden were higher in patients without T2DM (71.6 [65.5; 75.7] % vs. 77.6 [74.4; 80.4] %; p=0.008, respectively). IVUS-VH analysis showed that percent of necrotic core and dense calcium areas were significantly higher in the T2DM group (31.3 [25.3; 36.5] % vs. 21.65 [14.3; 27.8] %; p=0.01 and 4.7 [2.3; 7.8] % vs. 2.45 [1.2; 4.05] %; p=0.046, respectively). Percent of the fibrotic tissue were higher in non-T2DM group (55.35 [49.7; 63.6] % vs 67.7 [61.8; 76.5] %; p=0.004, respectively). There were no differences in percent of lipidic tissue in both groups. CONCLUSIONS: IVUS-VH assessment of coronary artery atherosclerotic plaques showed greater amount of necrotic core and dense calcium in patients with T2DM compared to patients without diabetes.

[Risk factors and glycation end products in patients with different forms of coronary heart disease and type 2 diabetes mellitus]. / Faktory rosta i konechnye produkty glikirovaniya u bol'nykh s razlichnymi formami ishemicheskoi bolezni serdtsa i sakharnym diabetom 2-go tipa.

AIM: To determine the levels of growth factors and glycation end products in patients with different forms of coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: A total of 134 patients with CHD and T2DM, including 38 patients with non-ST-elevation acute coronary syndrome (ACS), were examined. The arterial and venous serum levels of basic fibroblast growth factor-ß (FGF-ß), transforming growth factor-ß (TGF-ß), placental growth factor (PlGF), advanced glycation end products (AGEs) and their receptors (RAGE) were estimated in all the patients. RESULTS: A direct correlation was found between the degree of arterial stenosis and the level of growth factors and AGEs in the patients with T2DM; there was also a direct correlation of the examined factors with lipid metabolic parameters. There was a significant two-fold increase in FGF-ß, PlGF, and RAGE levels in the patients with ACS. CONCLUSION: Hyperglycemia was found to negatively affect the progression of atherosclerotic changes in the vessel wall and on that of fibrotic processes.

[Fatal coronary artery spasm in a patient with thyrotoxicosis].

According to some data up to 20% of patients with thyrotoxicosis suffer from vasospastic angina. But presence of coronary artery spasm can be rarely confirmed. We describe a case of development of spasm of coronary arteries in a patients with severe thyrotoxicosis. Despite active treatment of thyrotoxicosis and use of drugs aimed at prevention of coronary spasm this patient with minor changes in coronary arteries (according to autopsy data) developed episode of acute myocardial ischemia leading to lethal outcome. This clinical case shows that patients with thyrotoxicosis and documented transitory myocardial ischemia should receive therapy with thyrostatics and drugs preventing coronary spasm in maximal doses until stable normalization of levels of thyroid hormones.

[Single-step endovascular revascularization of the kidney, lower limb and endovascular reconstruction of abdominal aortic aneurysm in a patient with type 2 diabetic mellitus].

Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the development of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm. The comprehensive treatment of the patient resulted in safe performance of the endovascular intervention, saving the supporting function of the limb, improvement of glycemic control, decreasing the risk of sudden death on the background of abdominal aortic aneurysm rupture, decreased rate of progression of renal insufficiency, better control of symptoms of angina pectoris and cardiac failure. Also the article reflects importance of rendering medical care for patients with multifocal atherosclerosis and diabetes mellitus, also showing the necessity of creating multi-modality medical centres and working out of algorithms for treatment of this patient cohort.

[Management of coronary artery disease in diabetic patients with lower limb critical ischaemia: assessment of operational risk, drug therapy and indications for interventions].

Despite obvious progress in management of diabetes mellitus, the DM-related complications rate remains inadmissibly high. Macroangiopathy is known to rank first amongst complications of diabetes mellitus, and coronary artery disease remains to be the major cause of death. Analysed herein are peculiarities of the clinical course in diabetic patients presenting with coronary artery disease and lower limb critical ischaemia, followed by discussing the issues concerning drug therapy, preoperative examination, and methods of diagnosis in this cohort of patients prior to vascular operations, assessment of the preoperative risk, indications for coronarography and myocardial revascularization. Also presented are the results of the main clinical trials dedicated to preoperative myocardial revascularization, including those in diabetic patients with limb critical ischaemia, and finally highlighting current importance of optimizing approaches to managing and working out algorithms of treatment policy for diabetic patients with a combination of coronary artery disease, diabetes mellitus, and critical limb ischaemia.

[Own experience endovascular prosthetic repair of abdominal aortic aneurysms].

Endovascular prosthetic repair has increasingly been used over the last several decades. This type of intervention is indicated for patients running a high surgical and anaesthesiological risk of an open surgical procedure. The experience gained in endovascular prosthetic repair of abdominal aortic aneurysms makes it possible to extend the indications for its practical application. The authors describe herein their experience gained in a total of 20 procedures of endovascular prosthetic repair of abdominal aortic aneurysms using the Gore Excluder endograft device in patients running a high risk of an open surgical intervention. There were neither short -nor long-term lethal outcomes. Three patients after endovascular prosthetic repair were found to have type 1 endoleak and two appeared to have type 2 endoleak. Type 1 endoleaks were coped with intraoperationally. Dynamic follow-up (at 1, 6, 12 months after surgery) of patients including computed tomography showed no complications whatsoever (i. e., no endoleaks, endograft migration, nor increase in the aneurysm's diameter). After endografting of abdominal aortic aneurysms there were neither cardiac nor respiratory complications in the immediate postoperative period. Hence, endografting of an abdominal aortic aneurysm is a method of choice for high-risk patients.

[Comparative studies of carotid endarterectomy and carotid stenting in patients with coronary artery stenosis (part I)].

Carotid artery stenosis has over the last decade been treated increasingly more often by means of angioplasty and stenting, with the indications for these interventions being gradually broadening. The authors review and analyse the results of multicenter randomized studies and registers regarding carotid artery stent grafting and carotid endarterectomy (CAVATAS, SAPPHIRE, ARCHeR, EVA-3S, CaRESS, SPACE, BEACH, CABERNET, CREATE Pivotal). Presented herein are the outcomes of management of symptomatic and symptom-free patients running both usual and high surgical risks for carotid endarterectomy. The commonly accepted criteria for surgical risks are conventionally subdivided into the absolute and relative ones (i.e., correction-prone). Carotid stenting turned out to be superior to carotid endarterectomy in patients running a high surgical risk.

[Experience of treatment of patients with myocardial infarction without raise of ST segment on ECG of high risk of cardiocomplications by method of coronary angioplasty].

There was realized a risk-stratification in accord with elaborated evaluative hazard rating of cordial complications during effectuating of transcutaneous coronary operations (TCO) by 109 patients with myocardial infarction without increasing of ST segment on ECG (MIWIST). There were marked 2 groups: group of the 1st and the 2nd stage of risk with using of 2-component (aspirin+klopidogrel) and 3-component (aspirin+klopidogrel+blocker of glycoprotein IIb/IIIa receptors of thrombocytes) ancillary contra-thrombocyte therapy (CTT). Was concluded, that in conditions of effectuating of TCO by patients with MIWIST, relating to the 1st stage of risk of cordial complications in accord with elaborated evaluative hazard rating, 2-component CTT permits achieve 100% of clinical-angiographic effect; there was showed using of 3-component CTT among patients of the 2nd stage of risk.

[Molecular-genetic analysis of the Batai virus strains isolated from mosquitoes in Volgograd Region of the Russian Federation, West Ukraine, and Czech Republic].

Partial nucleotide sequence of the M-segment from five Batai virus strains was determined. These strains were isolated in Volgograd Region, West Ukraine, and Czech Republic. Our data based on the partial sequence of the M-segment of Batai virus strains demonstrated that the strains isolated in Russian Federation, Ukraine, and Czech Republic grouped together into an European genetic group that was distinct from Asian and African strains of Batai virus.

[Surgical correction of cerebral blood flow steal syndrome by aortic branches stenosis].

Results of surgical treatment of 119 patients with cerebral/coronary blood flow steal syndrome were analyzed. Vertebro-subclavian steal syndrome was registered in 91.5%. 80 patients were treated with the use of endovascular methods, open procedure was performed in 62 cases. Physiological blood flow was successfully reconstructed in 95.8%. Postoperative lethality was 5,1% after open operations, there were no deaths among patients, treated endoscopically. Bypass thrombosis was registered in 3.4% of patients treated by traditional method; restenosis or occlusion occurred after 34.3% of endovascular operations. Endovascular operations should be a method of choice in treatment of patients with severe occlusion of branches of aorta and cerebro-vascular insufficiency. By impossibility of subclavian artery or brachiocephal trunk recanalization with the use of endovascular techniques, open procedure should be performed.

[Results of examination of healthy residents in the southern region of Russia and patients feverish to pappataci fever virus antibodies].

Sera from patients with acute seasonal fevers and apparently healthy individuals living in the Astrakhan Region, Krasnodar Territory, or Rostov Region were examined in two modifications of enzyme immunoassay for detection of IgM and IgG antibodies to Neapolitan and Sicilian pappataci fever viruses. IgM antibodies to Sicilian pappataci fever virus were detected in a patient from the Volodarsky District, Astrakhan Region, who had been admitted for the unverified diagnosis of Q fever. A donor residing in the Novorossiysk District, Krasnodar Territory, was found to have IgA antibodies to Neapolitan pappataci fever virus. The findings show it expedient to conduct further investigations of the serodiagnosis and seroepidemiology of pappataci fevers in the southern Russian region where mosquitoes of the genus Phlebotomus inhabit.

[Administration of Gadobutrol in coronary artery stenting in a female patient with allergy to iodine-containing radiopaque agents].

Presented herein is a case report of a successful treatment of subtotal stenosis of the anterior interventricular artery (over 95%) using paramagnetic contrast agent Gadovist 1.0 in a female patient with a polyvalent allergy, including that to iodine-containing radiopaque substances. Immunological tests for drug intolerance according to the Demyanenko technique using Gadovist 1.0 were followed by coronography and stenting of the anterior interventricular artery. The immediate outcomes were assessed as good: the lumen of the anterior interventricular artery was restored completely, with sufficient filling in of the distal portions of the artery. The total volume of the administered contrast substance amounted to 1.8 ml/kg. No alterations in the markers of the renal function were noted. This case report demonstrates a possibility of using contrast medium Gadovist 1.0 as a radiopaque substance in an endovascular intervention, also confirming that Gadobutrol exerts no side effect on the kidneys, even if administered in high doses.

[Roentgenendovascular stenting (stent-graft) of the external iliac artery for elimination of post-traumatic arteriovenous anastomosis].

Presented herein is a case report concerning successful treatment of the post-traumatic pathological anastomosis between the left external iliac artery and iliac vein using the stent-graft Jostent-graft. The anastomosis emerged after gunshot injury to the abdominal cavity.