Safety and efficacy results of percutaneous renal stent implantation in patients with acute coronary syndrome with ectatic and aneurysmatic coronary arteries.

BACKGROUND: For the treatment of stenotic lesions developing in dilated coronary arteries, it is difficult to find an appropriately sized coronary stent given that the vessel diameter is too large. This poses a greater problem, especially in patients who require urgent intervention, such as acute coronary syndrome. OBJECTIVE: We aimed to evaluate the efficacy and safety of renal stents implanted in ectatic/aneurysmatic coronary arteries in such patients. METHODS: In total, 18 patients (renal stent group) who underwent renal stent implantation in ectatic/aneurysmatic coronary arteries requiring percutaneous coronary intervention (PCI) and 45 patients who underwent large-sized bare-metal coronary stent (BMCS) implantation (BMCS group) at our center were included in the study. The primary endpoints were MACE (myocardial infarction and cardiovascular mortality), and the secondary endpoints were restenosis and all-cause mortality. RESULTS: In the study patients with a mean follow-up of 25.3 ± 14.6 months (1-48 months), the control coronary angiography duration was 24.6 ± 14.8 months for the renal stent group and 22.8 ± 15.7 months for the BMCS group (p = 0.06). The MACE was observed in 2 (11.1%) patients in the renal stent group and 4 (8.9%) patients in the BMCS group (HR: 1.39 (0.24-7.82), p = 0.70). The secondary composite outcome was identified in 4 (22.2%) patients in the renal stent group and 6 (13.7%) patients in the BMCS group (HR: 1.93 (0.53-6.91), p = 0.31). No significant differences in primary and secondary outcomes were noted between the groups. CONCLUSION: Renal stents used during PCI in patients with acute coronary syndrome with ectatic/aneurysmatic coronary arteries have similar efficacy, and mid-term follow-up results those noted for BMCS. These findings support that renal stents can be used in ectatic and aneurysmatic coronary arteries when necessary. CLINICAL TRIAL REGISTRATION: This study has been registered on ClinicalTrials.gov (NCT05410678).

In vitro evaluation of anticoagulant therapy management when urgent percutaneous coronary intervention is required in rivaroxaban-treated patients.

We investigated in vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention (PCI) while using regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In the study group, a beginning (24 h after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th h following rivaroxaban intake. The effects of four different anticoagulant doses were evaluated in the control group. The anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. Beginning anti-Xa levels were significantly higher in the study group than in the control group (0.69 ± 0.77 IU/mL vs. 0.20 ± 0.14 IU/mL; p < 0.05). The study group's 4th and 12th-h anti-Xa levels were significantly higher than the beginning level (1.96 ± 1.35 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.001 and 0.94 ± 1.21 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels increased significantly in the study group with the addition of UFH and enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all doses). The safest anti-Xa level (from 0.94 ± 1.21 to 2.00 ± 1.02 IU/mL) was achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and additional anticoagulant administration may not be required at this time. Twelve hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide adequate and safe anticoagulant activity for immediate PCI. This experimental study result should confirm with clinical trials (NCT05541757).

The effect of contrast agents on the anticoagulant properties of oral factor Xa inhibitors.

BACKGROUND: Contrast agents may affect the anticoagulant properties of novel oral anticoagulants. PURPOSE: To evaluate the effect of iohexol as a contrast agent on the anticoagulant activity of oral factor Xa inhibitors. MATERIAL AND METHODS: The study included 65 individuals who underwent contrast computed tomography(CT). Group 1 comprised 20 patients using rivaroxaban, Group 2, 20 patients using apixaban, and Group 3, 20 patients using edoxaban. Group 4 was the control group of five healthy volunteers. Iohexol (60 mL) was used as a contrast agent. Blood samples of 2 mL were withdrawn into two tubes at 4 h after the drug dose and 1 h after the contrast CT (CT was performed 3 h after the drug was taken) from all the patients, and for the control group, at any time before and 1 h after contrast CT. The anticoagulant properties of rivaroxaban, apixaban, and edoxaban were evaluated using anti-factor Xa levels. RESULTS: The anti-factor Xa level was increased after using the contrast agent in the rivaroxaban group (0.66 ± 0.32 U/mL vs. 0.67 ± 0.32 U/mL; P = 0.01) and the edoxaban group (0.74 ± 0.35 U/mL vs. 0.76 ± 0.36 U/mL; P = 0.006). No significant difference was observed in the apixaban group (0.66 ± 0.33 U/mL vs. 0.66 ± 0.32 U/mL; P = 0.21) and control group (0.02 ± 0.01 U/mL vs. 0.03 ± 0.01 U/mL; P = 0.33). CONCLUSION: The anticoagulant properties of rivaroxaban and edoxaban tended to increase significantly, but there was no statistically significant difference in the anticoagulant properties of apixaban after the administration of contrast agent. To determine whether the small laboratory difference has a clinical effect, there is a need for larger clinical trials (NCT04611386).

The way to a patient's heart is through their esophagus: A case of esophago-pericardial fistula.

Here in we present a 74-year-old case of esophago-pericardial fistula with pericardial effusion and pneumopericardium. Bone-related esophageal trauma was the cause of the esophago-pericardial fistula. The esophago-pericardial fistula was diagnosed with echocardiography, computerized tomography (CT) and endoscopy. Pericardiocentesis was performed for drainage the pericardial effusion. The esophago-pericardial fistula was treated with covered self-expandable esophageal stent.

The Predictive Value of the Left Atrial Kinetic Energy for Atrial Fibrillation Recurrence.

Background and aim Determining which patients will experience recurrence of atrial fibrillation (AF) is crucial for treatment modification. This study aimed to investigate the predictive value of left atrial kinetic energy (LAKE) in AF recurrence. Materials and methods A total of 120 consecutive patients who achieved sinus rhythm (SR) with electrical direct current cardioversion and met the inclusion criteria were included in the study. Transthoracic echocardiography (TTE) and LAKE values were calculated on the first day after cardioversion. Rhythm control was performed with 12-lead electrocardiography in the first-month follow-up. Results While 81 (67.5%) patients were in SR at one month, AF recurrence was detected in 39 (32.5%) patients. In the AF group, AF duration, cardioversion energy, number of diabetic patients, left atrium (LA) diameter, LA pre-mitral A wave volume, LA minimum volume, and pulmonary artery pressure values were significantly higher than in the SR group, while mitral A wave velocity and LAKE values were significantly lower. In multivariate regression analysis, AF duration (OR: 1.54; 95% CI: 1.22 - 1.93; p < 0.001), LA diameter (OR: 1.33; 95% CI: 1.10 - 1.61; p = 0.002), and LAKE (OR: 0.96; 95% CI: 0.94 - 0.99; p = 0.007) were determined to be independent predictors of AF recurrence at one month. Conclusions LA diameter, AF duration, and LAKE were found to be significant predictors of AF recurrence after cardioversion.

The predictive value of hemoglobin to creatinine ratio for contrast-induced nephropathy in percutaneous coronary interventions.

OBJECTIVES: Hemoglobin and creatinine levels are important factors for contrast induced nephropathy (CIN) development. Our aim in this study is to investigate the predictive value of hemoglobin to creatinine ratio for CIN development in patients with percutaneous coronary intervention (PCI). METHODS: A total of 500 patients who underwent PCI in our clinic were evaluated prospectively in terms of CIN. Hemoglobin to creatinine ratio is calculated as baseline hemoglobin/baseline serum creatinine value. glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. The definition of CIN includes absolute (≥0.5 mg/dL) or relative increase (≥25%) in serum creatinine at 48-72 h after exposure to a contrast agent compared to baseline serum creatinine values. RESULTS: CIN was detected in 13.8% (69 patients) of 500 patients. In multivariate lineer regression analysis, hemoglobin to creatinine ratio (beta: -0.227, p=0.03) and ejection fraction (EF) (beta: -0.161, p<0.001), contrast amount used (beta: 0.231, p<0.001) were found to be significant predictors for the development of CIN. In receiver operating characteristics (ROC) analysis; AUC=0.730 (0.66-0.79) for hemoglobin to creatinine ratio, p<0.001, AUC=0.694 (0.62-0.76) for EF, p<0.001 and AUC=0.731 (0.67-0.78) for contrast amount used p<0.001. CONCLUSIONS: Hemoglobin to creatinine ratio, EF and contrast amount used were independent predictors for CIN development in patients with PCI (NCT04703049).

Reconsidering the Relationship Between Hand Preference and Cerebral Vascular Dominance: A Computed Tomography (CT) Angiography Study.

Background: To date, it has been suggested that there may be many genetic, environmental, and vascular factors that affect hand preference. In previous studies evaluating the relationship between cerebral dominance and hand preference, carotid and vertebral artery (VA) Doppler ultrasonography (USG) was generally preferred; and these studies only measured VA diameters. Unlike other studies, we aimed to reevaluate the relationship between hand preference and cerebral vascular dominance by measuring VA and internal carotid artery (ICA) diameters. In addition, we used carotid and VA computed tomography (CT) angiography instead of Doppler USG. Methods and Material: A total of 345 participants were included in the study. The results of carotid and VA CT angiography taken during hospitalization were retrospectively evaluated by two radiologists, and the Edinburgh Hand Preference Questionnaire was applied to these patients. Results: In right-handed patients, the diameter of the left VA was significantly larger than the diameter of the right VA (p = 0.005). In left-handed patients, the diameter of the left ICA was larger than the diameter of the right ICA, but the difference was not statistically significant (p = 0.055). There was no significant difference between the diameter of the right and left ICA in right-handed patients (p = 0.771). Conclusions: In our study, we found a correlation between the dominant hemisphere VA diameter and hand preference. Using CT angiography, we were able to eliminate many challenges of ultrasonography that make radiological evaluation difficult, such as differences of opinion between radiologists, and technical and anatomical reasons.

Thoracic endograft placement using a transfemoral snare in a patient with angled aortic arch.

OBJECTIVE: In complex anatomical challenges, endovascular endograft implantation to the thoracic aorta may not be performed. Various techniques have been put forward for endograft therapy. In this report, we present the effect of femoral snare support for a patient with an aortic arch angle. METHOD: Thoracic endovascular aneurysm repair (TEVAR) was used for treating a 60-year-old male patient who suffered from severe angulation in the arcus aorta and aneurysmal enlargement of the left subclavian artery and descending aorta. The endovascular graft could not be advanced into the aortic arch with the guidewire because of the aortic arch angle. Therefore, the TEVAR graft distal end was caught with the snare advanced from the femoral artery, and the TEVAR graft was advanced into the aortic arch. CONCLUSION AND RESULT: The femoral snare technique is a simple and successful method for endograft implantation of the aortic arch disease without the risk of heart trauma, especially in cases with aortic arch tortuosity.

The effect of whole blood viscosity on contrast-induced nephropathy development in patients undergoing percutaneous coronary intervention.

OBJECTIVE: In our study, we aimed to investigate how whole blood viscosity (WBV) affects the development of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). METHODS: In our study, 500 patients who applied to the cardiology clinic and underwent PCI for elective procedure, ST segment elevation myocardial infarction (STEMI), and non-STEMI were prospectively included. Before the procedure, we calculated WBV using the formula [(0.12× hematocrit) + (0.17×(total protein - 2.07)]. We defined CIN as the absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine 48-72 h after exposure to a contrast agent compared with baseline serum creatinine values. RESULTS: CIN was developed in 69 (13.6%) of the 500 patients in the study. PCI was performed in 206 patients (41.2%) electively, 175 (35%) due to non-STEMI, and 119 (23%) due to STEMI. CIN was observed in 20.2% of the STEMI group, 13.7% of the non-STEMI group, and 10.2% of the elective PCI group. Multivariate logistic regression analysis results show that the independent predictors of CIN are low ejection fraction [OR:0.95 (95% CI:0.92-0.97); p < 0.001], low glomerular filtration rate [OR:0.96 (95% CI:0.95-0.98); p < 0.001], and increased amount of contrast agent [OR:1.008 (95% CI:1.004-1.01); p < 0.001]. When all patients were examined, no significant relationship was found between WBV and CIN. However, in the subgroup evaluation, it was concluded that low WBV was an independent predictor in elective PCI patients [OR:0.60 (95% CI:0.36-0.99); p = 0.04] for CIN. CONCLUSION: We found that low WBV was an independent predictor of CIN in patients undergoing elective PCI(NCT04703049).

Anxiety and depression levels in Covid-19 disease and their relation to hypertension.

Objectives: The study aimed to assess the relation of anxiety and depression levels with hypertension in COVID-19 outbreak. The analysis of the association of selected socio-demographic and clinical parameters on the presence and severity of psychological distress was also performed. Methods: The study involved 91 patients applying with a medical history supportive of COVID-19 infection. According to the hospitalization criteria and diagnostic result of SARS-CoV-2 nucleic acid test certainty of the disease, three groups were created. Patients with positive SARS-CoV-2 nucleic acid test results were consisted of 31 hospitalized subjects. To assess the applicant psychological state, a specially developed questionnaire was used, as the presence and severities of the symptoms were assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Results: Statistically, a significantly higher average level of depression and a higher incidence of anxiety were demonstrated among applicants in the Covid-19 pandemic (% 24 and % 44). Also a higher level of anxiety was demonstrated in hospitalized patients compared with the outpatient group. Different from the presence of depression symptoms, the presence of anxiety symptoms was associated independently with hypertension in our study group OR 2.6 (95% CI, 0.99-6.78) P = .04). Conclusions: In the aftermath of COVID-19 outbreak both anxiety and depression are common psychological disorders. Also, different from the symptoms of depression, the symptoms of anxiety are associated independently with hypertension. The described socio-demographic parameters and clinical characteristics had no impact on the symptoms of depression and anxiety irrespective of hospitalized status in the investigated groups.

Transcatheter treatment of partial anomalous pulmonary venous connection to left subclavian vein.

Reports of transcatheter treatment for dual drainage of an abnormal pulmonary venous connection are rare. Presently described is the case of a 27-year-old female with exertional dyspnea and a partial anomalous pulmonary venous connection of the left upper pulmonary vein with dual drainage to a vertical vein (VV) and the left atrium. The patient was evaluated with a balloon occlusion test to determine whether closing the anomalous VV connection would increase pulmonary pressure. The results of this test are an important guide to treatment decisions. A 12x9 mm Amplatzer Vascular Plug II device was successfully used to occlude the anomalous pulmonary venous connection using a transcatheter technique. This is a less invasive option than surgical repair and can be an appropriate choice in suitable cases.

Comparison of the effects of ticagrelor and clopidogrel on heart rate variability and heart rate turbulence in patients with percutaneous coronary interventions.

INTRODUCTION: Clopidogrel and ticagrelor are commonly used, antiplatelet agents. Ticagrelor has an effect of enhancing the plasma level of adenosine that may alter the autonomic function. The aim of this study is to compare the effects of ticagrelor and clopidogrel on heart rate variability (HRV) and heart rate turbulence (HRT). METHODS: Thirty subjects who performed percutaneous coronary intervention (PCI) were included in the randomized, crossover study. These patients were divided into two groups. Clopidogrel or ticagrelor was administered in two different testing sessions (1-month treatment for each session). In group 1, clopidogrel and ticagrelor treatment were used while in group 2, ticagrelor and clopidogrel treatment were used respectively. Three times rhythm Holter recording (baseline, 1st and 2nd month) was performed. The HRV (time domain and frequency domain) and HRT (turbulence onset (TO) and turbulence slope (TS)) parameters were analyzed from the Holter recordings. RESULTS: According to baseline Holter recording, pNN50 (5.82 ± 5.83 vs 10.56 ± 8.28; p = 0.03) and HF(nu) (6.85 ± 9.33 vs 9.53 ± 7.41; p = 0.04) parameters were higher in group 2 than in group 1, while TO(0.004 ± 0.02 vs -0.01 ± 0.02; p = 0.01) parameter was positive and higher in group 1 than in group 2. In the second month, the LF/HF ratio (4.47 ± 2.43 vs 3.18 ± 2.45; p = 0.04) was higher in group 1 than in group 2. However, when the evaluation was done within the groups themselves, there were no statistically significant differences in HRV and HRT parameters obtained before and after clopidogrel and ticagrelor administration in group 1 and group 2. CONCLUSION: Ticagrelor and clopidogrel treatments did not have a significant effect on HRV and HRT parameters.

Elevated eosinophil count is related with lower anti-factor Xa activity in COVID-19 patients.

Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with coronavirus disease 2019 (COVID-19). This study aimed to evaluate the factors influencing anti-factor Xa activity in COVID-19 patients receiving low molecular weight heparin (LMWH). We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase chain reaction test, who were admitted to our clinic and administered LMWH; LMWH (enoxaparin) was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-factor Xa activity in blood, drawn 4 h after the 3rd dose of LMWH, was measured and an activity of < 0.2 IU/mL was considered subprophylactic. Patients were followed up clinically, and anti-factor Xa activity was re-examined before discharge. Groups 1 and 2 included 13 and 67 patients with subprophylactic (mean ± SD: 0.18 ± 0.06) and prophylactic (mean ± SD: 0.43 ± 0.23) anti-factor Xa activity, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (mean ± SD; 2.96 ± 2.55 vs 0.90 ± 1.28; p = 0.001). At the time of discharge, the eosinophilic proportion of patients was significantly higher (eosinophil %, mean ± SD; 3.06 ± 1.49 vs 2.07 ± 1.92; p = 0.001), but the activated partial thromboplastin time was significantly lower (22.34 ± 1.38 vs 24.38 ± 3.58; p = 0.01) in group 1 than in group 2. Of 14 patients with eosinophil content > 4%, 6 were in group 1 ((6/13) 46.2%), while 8 were in group 2 ((8/63) 11.9%); (p = 0.009), and all had a D-dimer level < 1 µg/mL (p = 0.03). ROC analysis for the presence of anticoagulation at subprophylactic level revealed an area under curve of 0.79 (95% CI: 0.64-0.93); p = 0.001). In conclusion; Elevated eosinophil count is related to lower anti-factor Xa activity in patients with COVID-19 receiving LMWH. The clinical significance of the subprophylactic anti-factor Xa activity should be studied in COVID-19 patients (NCT04507282).

The predictive value of the combined systolic-diastolic index for atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is a factor that causes an increase in mortality and morbidity. Therefore, predicting post-CABG AF development is important for treatment management. In this study, we investigated the value of the ratio E/(Ea × Sa) as a combined systolic-diastolic index in predicting post-CABG AF development. METHODS: This prospective study included 102 patients who underwent only isolated coronary bypass. Preoperative demographic features, biochemical, and hematological parameters, and the electrocardiographic data of all patients were recorded. The E/(Ea × Sa) indices were calculated from the echocardiographic measurements. Those who retained their postoperative sinus rhythm were defined as group 1, and those who developed AF were defined as group 2. RESULTS: Group 2 had significantly higher lateral (group 1:1.14 ± 0.61 vs. group 2:1.47 ± 0.87; P = .02), medial (group 1:1.61 ± 0.70 vs. group 2:1.99 ± 0.91; P = .02), and mean (group 1:1.30 ± 0.58 vs. group 2:1.62 ± 0.74; P = .001) E/(Ea × Sa) indices than group 1. In the univariate analysis, age, CHA2 DS2 -VASc score, sPAP, IABP use, and mean E/(EaxSa) index were found to be significant predictors of post-CABG AF development. However, only the mean E/(EaxSa) index was found to be a significant predictor of post-CABG AF development in the multivariate analysis (OR: 2.19 95% CI 1.01-5.96; P = .045). CONCLUSIONS: The combined systolic-diastolic index predicted the development of post-CABG AF.

A novel index combining diastolic and systolic tissue Doppler parameters for predicting cardiac resynchronization therapy response.

OBJECTIVE: Identification of patients who are nonresponders to cardiac resynchronization therapy (CRT) with the use of simple and objective parameters may be helpful in tailoring treatment. The aim of this study is to investigate whether E/(Ea × Sa) could be a predictor of CRT nonresponders (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Sa = systolic mitral annular velocity). METHODS: In total, 53 heart failure patients were evaluated for this study, and 33 patients were included according to the study criteria. Before and 6 months after CRT-D(CRT with a defibrillator) implantation, E, Ea, and Sa were determined at the medial and lateral mitral annular sites, and the average values were obtained. E/(Ea × Sa) was calculated (medial, lateral, average). The patients were followed for 6 months to monitor their CRT response. A responder was defined as a patient with a reduction in end-systolic volume of ≥15% and an increase in 6-minute walking distance of 50 m. RESULTS: At a 6-month follow-up, 24 (72.7%) of the 33 patients responded to CRT. At the 6-month follow-up, in the responder group, the E/Ea ratio, lateral mitral, and average E/(Ea × Sa) indices were significantly reduced (P < .01 for all). The baseline lateral mitral, medial mitral, and average E/(Ea × Sa) indices were significantly lower in the responder group than in the nonresponder group (P ≤ .01 for all). The receiver operating characteristic analysis showed that all the E/(Ea × Sa) indices predict the CRT nonresponder patients. The AUC values were 0.89 (lateral E/(Ea × Sa)), 0.85 (average E/(Ea × Sa)), and 0.77 (medial E/(Ea × Sa)) (P ≤ .01 for all). CONCLUSION: We found that the E/(Ea × Sa) index is a novel predictor of CRT nonresponder patients.

A Novel Embolization Technique for Renal Hemorrhage Complication by Autologous Fat Tissue

The percutaneous nephrolithotomy method is the most used treatment option for urinary stone disease. Bleeding is the most feared complication of this method. Transcatheter coil or medical glue embolization is currently the used treatment option for this bleeding complication. The aim of this report to show the novel subcutaneous fat tissue embolization technique for percutaneous nephrolithotomy related bleeding complications. In these two cases, we treated the percutaneous nephrolithotomy related bleeding complication with subcutaneous fat tissue. Subcutaneous fat tissue was taken with subcutaneous fascia from the femoral site by 1 cm incision. This tissue to be used for embolization was passed on the 0.014 guidewire from the back end of this guidewire (like shish kebab). The fat tissue passed on the 0.014 wire was sent to the bleeding site through the guiding catheter and guideliner, over the 0.014 guidewire with the monorail balloon (as a pusher) placed behind this fat tissue. The subcutaneous fat tissue with subcutaneous fascia embolization was completely stopped the bleeding and fistula. We have successfully used a novel embolization technique for fat tissue embolization to the bleeding site (Ari technique). Subcutaneous fat tissue embolization with the novel embolization technique for percutaneous nephrolithotomy related bleeding is a safe and reliable treatment option.

In vitro analysis of the effect of contrast agents on the antiaggregant effects of P2Y12 inhibitors.

OBJECTIVES: The contrast agents have different molarities and ionic structures. The high osmolar contrast agents could increase platelet aggregation but the ionic contrast agents decrease platelet aggregation. However there is insufficient data on whether the antiaggregan effect of P2Y12 inhibitors used during coronary interventions are affected by the contrast agents. This study aimed to evaluate the in vitro effects of different contrast agents on the antiaggregant activity of P2Y12 inhibitors (clopidogrel, ticagrelor and prasugrel). MATERIALS AND METHODS: Thirty patients (who underwent percutaneous coronary interventions and were treated with a P2Y12 inhibitor for a minimum of 10 days) and five healthy volunteers were divided into four groups: the clopidogrel (10 patients), ticagrelor (10 patients), prasugrel (10 patients) and control (five volunteers) groups. Antiaggregant activity was measured by using the Verify-Now method and was represented as P2Y12 reaction unit (PRU) values. Three tubes of blood were collected from the participants in the three patient groups and in the control group; as the contrast material, 10% iohexol was added to a second tube, and 10% iodixanol was added to a third tube. PRU values of the control and the contrast tubes were measured at 5 min and at 30 min after the contrast material was added. RESULTS: Iohexol and iodixanol led to a significant decrease in the PRU values in the control group (iohexol: 188.4 ±â€¯39.2 vs 142.4 ±â€¯17.0, p = .04; iodixanol: 188.4 ±â€¯39.2 vs 159.2 ±â€¯33.7, p = .04) and in the clopidogrel group (iohexol: 140.8 ±â€¯50.8 vs 106.3 ±â€¯44.4, p = .04; iodixanol: 140.8 ±â€¯50.8 vs 109.4 ±â€¯47.6, p = .009) but not in the ticagrelor and prasugrel groups. The PRU values were significantly lower in the ticagrelor (23.1 ±â€¯26.2) and prasugrel (23.4 ±â€¯27.5) groups than in the clopidogrel (140.8 ±â€¯50.8) and control (188.4 ±â€¯39.2) groups (p < .01), and the PRU values for the ticagrelor and prasugrel groups were similar for both the 5-min and 30-min time periods (p > .05). The antiaggregant activities of iohexol and iodixanol were observed to be similar at the 5- and 30-minute time points for all of the groups (p > .05). CONCLUSION: Iohexol and iodixanol had in vitro antiaggregant effects, and their antiaggregant effects were similar. Iohexol and iodixanol increased the clopidogrel antiaggregant activity in vitro, but they did not significantly alter the antiaggregant activities of prasugrel and ticagrelor.

Percutaneous transcatheter closure of ruptured sinus of Valsalva aneurysm.

Sinus of Valsalva aneurysms are rare congenital anomalies. Sinus of Valsalva aneurysm rupture, leads to biventricular failure due to systemic to pulmonary shunting. Surgical repair has been the traditional treatment for these aneurysms. Recently, percutaneous treatment has been successfully performed to selected patients. We present a 36-year-old man who had ruptured sinus of Valsalva aneurysm, that was successfully treated with using a catheter-based approach with the patent ductus arteriosus occluder device.

Axillary artery as alternative access for transcatheter aortic valve implantation in a patient with thoracic and abdominal multilayer flow modulator stents, and in a patient with occluded bilateral carotid and iliac arteries.

Transaxillary access is an alternative to femoral access in patients with iliofemoral occlusion for transcatheter aortic valve implantation (TAVI). A Multilayer Flow Modulator (MLFM) stent is frequently used in patients with a complex thoracic and abdominal aortic aneurysm. The MLFM stent is particularly used in cases where large arteries, such as the renal or celiac artery, feed from the aneurysmal sac. To the best of our knowledge, there is no prior report in the literature of a TAVI case with a pre-existing MLFM stent. Presently described are 2 TAVI cases, one with thoracoabdominal MLFM stents, and the second with occluded bilateral carotid and iliac arteries.