[The Clinical Value of no-Reflow Phenomenon in the Routing Operation of The Regional Vascular Center].

Coronary no-reflow phenomenon (CNR) is a complication of primary percutaneous coronary intervention (PCI). According to different reports, CNR occurs in 10 to 60 % of cases. Despite the long history of studying this phenomenon many issues remain unsolved. This article presents a clinical case of electrocardiographically confirmed ST-segment elevation myocardial infarction. In this case, the CNR phenomenon occurred during PCI and was associated with heart rhythm disorders, left ventricular (LV) cavity dilatation with a decrease in LV contractility, and formation of intracavitary thrombus. The patient asked for medical care late, which could influence the development of CNR. This case demonstrates the clinical significance, diagnostic characteristics, and successful drug correction of the no-reflow phenomenon.

[Clinical Case of Successful Nephrectomy and Stenting of the Coronary Arteries in Acute Period of Myocardial Infarction in a Patient With Kidney Cancer].

We describe in this case report the clinical situation of development of massive macrohematuria at the background of dual antiplatelet therapy in a patient in the acute period of myocardial infarction with an established diagnosis of kidney cancer and a burdened cardiac anamnesis. Despite the high anesthetic and operational risk of complications, due to the need for coronary angiography with possible stenting of the coronary arteries, left ventricular thrombus and the impossibility of canceling antiplatelet agents and anticoagulants, the patient underwent radical nephrureterectomy, which allowed further stenting of the anterior interventricular artery occlusion and thus to reduce the risk of developing a repeated myocardial infarction.

[Takotsubo Cardiomyopathy as a Consequence of Myocardial Infarction. It is Possible?]

Takotsubo cardiomyopathy (TCM) is a well-known complication of many conditions associated with emotional or physical stress. Abnormal catecholamine release has been hypothesized to be the main cause of TCM. Myocardial infarction (MI) is associated with release of large amounts of catecholamines. We present here two cases in which patients simultaneously suffered from acute MI and TCM. In these elderly women without prior history of severe somatic diseases we have not revealed any external stressing factor responsible for the initiation of the disease. Therefore, we have considered primary coronary event (acute MI) to be a triggering factor of TCM manifestation.

[Postcardiotomy syndrome outside a cardiosurgical clinic].

Postcardiotomy syndrome (PCTS) is an idiopathic inflammatory disease affecting pericardium and pleura; it complicates the postoperative period in cardiosurgery. High efficiency of corticosteroid therapy suggests autoimmune nature of PCTS. As a rule, this condition develops within two weeks after surgery although cases of its delayed onset (after 1 year) were reported too. PCTS may proceed both as an acute disease and as a mild disorder characterized by general inflammation and obscure serositis making difficult its diagnosis. The existence of such "restricted" forms of PCTS is not universally recognized, however glucoocticoids are widely prescribed to patients with this condition.

[Resistance to antiplatelet drugs in patients with non ST elevation acute coronary syndrome].

Rate of resistance to aspirin and clopidogrel was assessed in 44 patients with non ST elevation acute coronary syndrome. Platelet aggregation was studied by method of Born. Criterion of resistance to aspirin was arachidonic acid induced aggregation > or =20%. Patients with lowering of ADP induced aggregation < 10%, 10 - 29% and 30% relative to initial level were considered resistant, partially resistant, and sensitive to therapy with clopidogrel, respectively. It was shown that rate of resistance to aspirin, clopidogrel, and both drugs reached 25.7, 17.1, and 5.7%, respectively.

[The use of isoosmolar contrast medium for lowering of rate and clinical significance of contrast-induced nephropathy in patients with diabetes mellitus].

As a contrast medium during percutaneous coronary intervention (PCI) we used iodixanol in 31 patients with diabetes mellitus and various degree of impairment of renal excretory function and amidotrizoate - in 12 patients with diabetes mellitus without clinical signs of renal involvement. Blood plasma creatinine (BPC) level was measured before and on days 3,5, and 10 after procedure. When iodixanol was used no significant differences of blood surem creatinine (BSC) levels before PCI and BPC levels before and on days 3,5,10 after PCI were obtained. When results of the use of iodixanol and amidotrizoate were compared pronounced advantage of iodixanol became evident (increment of BPC on days 3 and 5 after PCI were significantly higher in amidotrizoate group - 1,30 +/- 0,17 and 1,39 +/- 0,40 mg/dl, p=0,006; 1,33 +/- 0,19 and 1,42 +/- 0,41 mg/dl, p=0,016). Thus the use of iodixanol in patients with initial stages of chronic renal failure (with BSC 1,5 - 2,5 mg/dl) was sufficiently safe. The use of amidotrizoate in patients with diabetes mellitus even in the absence of signs of renal failure led to pronounced damage of the kidney which manifested as elevation of BPC levels on days 3, 5, and 10 after intervention.

[Use of covered stent grafts in treatment of embolism-threatening stenoses and arterial occlusions]. / Primenenie pokrytykh stentov-graftov pri lechenii stenozov i okkliuzii arterii.

The present work was aimed at demonstrating possibilities and prospects of using covered stent grafts in treatment of patients with embolism-hazardous parietal thrombi, embolism-endangered stenoses, and occlusions of peripheral arteries. Using stent grafts covered with non-woven materials, including PTFE films ("Hemobahn endograft" and "JOSTENT Peripheral Stent Graft") in the arteries of the iliac and femoropoplietal segments, makes it possible to avoid not only acute and delayed occlusions, but to use a PTFE-covered stent graft as a means of isolating the intima from the blood flow, as a method of "inhibiting" intimal hyperplasia in the stented arterial segment. The article deals with clinical follow-ups of patients with embolism-dangerous atherosclerotic stenoses and occlusions of iliac arteries, who underwent successful implantation of covered stents into the affected segments of the arterial bed. These findings demonstrably show high efficacy of using methods of endografting in clinical situations wherein surgical treatment is associated with increased risk.