Stenting of the carotid artery with CGuard and Acculink stents: interim results of a randomized trial. / Stentirovanie sonnoi arterii stentami CGuard i Acculink: promezhutochnye rezul'taty randomizirovannogo issledovaniia.

AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.

[Peripheral microcirculation in patients with lower-limb atherosclerosis on the background of metabolic syndrome].

The authors studied the peripheral microcirculatory blood flow (MCBF) by means of laser Doppler flowmetry in a total of 112 patients presenting with stage IIB-IV lower limb chronic ischaemia (LLCI) on the background of metabolic syndrome (MS). The study was aimed at assessing the state of the peripheral MCBF in LLCI patients on the background of MS. Atherosclerotic lesion of lower-limb vessels on the background of MS is characterised by more pronounced impairments of the functional state of microcirculation in the form of a decrease in the reserve of capillary blood flow during the occlusion test both before and in the early period after revascularization. Patients with LLCI combined with MS were found to have more pronounced alterations in sympathetic regulation and reactivity of the microcirculatory bed in the form of the paradoxical reaction of the blood flow during the breath-holding test.

[Results of endoprosthetic reconstruction in patients with aneurysm of the infrarenal portion of the aorta].

The authors herein share their experience with implantation of endografts in a total of 41 patients for an aneurysm of the infrarenal portion of the aorta. Of these, there were 34 (83%) men and 7 (17%) women, with the average age amounting to 71±7 years. All patients were found to have a history of coronary artery diseases (CAD) and arterial hypertension. The first stage in 15 (36.6%) cases consisted of stenting of coronary arteries and in 8 (19.5%) cases of coronary aortic bypass grafting. Seven patients were within 6 months diagnosed as having developed thrombosis of the stent-graft s branch, treated by recanalization with stenting in 5 cases, and by femoro-femoral cross-over bypass in 2 cases. One patient was found to have stenosis due to bending of the left branch of the stent-graft corrected by stenting; two patients showed endoleak (in one case that of type 2 due to retrograde blood flow from lumbar arteries and in the second case that of type 3 due to impairment of the stent-graft covering integrity). Thromboembolism into the distal bed during implantation of stent-grafts was verified in 3 cases, with two of them requiring thrombectomy. One more patient was diagnosed as having dissection of the intima of the iliac artery, treated by stenting of the arterial segment involved. There were no other complications, nor lethal outcomes.