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1.
Kardiologiia ; 61(2): 99-105, 2021 Mar 06.
Artigo em Russo | MEDLINE | ID: mdl-33715614

RESUMO

Despite successful and timely revascularization of the infarct-related artery, myocardial tissue remains underperfused in some patients. This condition is known as the no-reflow phenomenon, which is associated with a worse prognosis. The first part of the systematic review on no-reflow focuses on description of the no-reflow pathogenesis and predictors. This phenomenon has a complicated, multifactorial pathogenesis, including distal embolization, ischemic injury, reperfusion injury, and a component of individual predisposition. Meanwhile, this phenomenon undergoes spontaneous regression in some patients. Several studies have demonstrated the role of definite biomarkers and clinical indexes as risk predictors for no-reflow. The significance of each pathogenetic component of no-reflow is suggested to be different in different patients, which may warrant an individualized approach in the treatment.


Assuntos
Trombose Coronária , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Humanos , Miocárdio , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
2.
Angiol Sosud Khir ; 26(2): 76-83, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597887

RESUMO

The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.


Assuntos
Angiografia , Artéria Radial/cirurgia , Humanos , Radiografia , Federação Russa , Extremidade Superior
3.
Kardiologiia ; 59(2): 56-60, 2019 Mar 07.
Artigo em Russo | MEDLINE | ID: mdl-30853022

RESUMO

AIM: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. MATERIALS AND METHODS: Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. RESULTS: At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. CONCLUSION: Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.


Assuntos
Comunicação Interatrial , Intervenção Coronária Percutânea , Idoso , Cateterismo Cardíaco , Ecocardiografia , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Kardiologiia ; 57(3): 10-19, 2017 Mar.
Artigo em Russo | MEDLINE | ID: mdl-28762930

RESUMO

PURPOSE: to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) in conditions of a polyclinical department of cardiological rehabilitation (stage III of cardiorehabilitation). MATERIAL AND METHODS: We included in this study 36 men with IHD in 3-8 weeks (mean 7.8+/-1.6 weeks) after CABG. Patients were randomized in 2groups: patients of the main group attended special "School for patients recovering after CABG" [School] (60-80 min sessions once a week for 5 weeks) and participated in a program of monitored (up to 60 min 3 times a week for 4 months) and unmonitored (home based) exercise training. Patients of the control group attended School and were given advice to do physical exercises at home. Follow up duration was 1 year. RESULTS: Main group. Compared with baseline values after 4 months exercise duration increased 32.6% (p<0.05), this effect persisted at 12 month; threshold exercise load increased 35.2% (p<0.05) after 4, 53.9% after 6, and 49.5% after 12 month. After 4 and 12 months of training some increases of left ventricular (LV) ejection fraction and stroke volume, and decrease of LV end systolic volume occurred. Physical training in this group was associated with improvement of parameters of quality of life. During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol (TC, LDLC). In the control group slight increase of exercise duration was observed only at 12 months (9.8%, p<0.05), and it was not accompanied by dynamics of exercise tolerance. Increases of concentrations of TC (10.2%, p<0.05) and LDLC (15.6%, p<0.05) were registered at 12 months. Serious cardiovascular complications in the main group (physical training + educational School) were three times less frequent than in the control group (attendance of School only) (11.1 vs. 39.2%, respectively.


Assuntos
Ponte de Artéria Coronária/reabilitação , Doença da Artéria Coronariana/terapia , Ponte de Artéria Coronária/psicologia , Terapia por Exercício , Tolerância ao Exercício , Humanos , Masculino , Isquemia Miocárdica/terapia , Qualidade de Vida , Distribuição Aleatória , Volume Sistólico , Função Ventricular Esquerda
5.
Kardiologiia ; 54(7): 4-8, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25177807

RESUMO

PURPOSE: To assess diagnostic potential of (99m)Tc-MIBI-single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) infusion in comparison with exercise stress (EX) SPECT in patients with microvascular angina. MATERIAL AND METHODS: Patients with angina, positive exercise test and normal coronary angiogram (n=25) were included in the study. Patients underwent a three-phase (99m)Tc-MIBI-SPECT scan: at rest, exercise stress test and pharmacological stress with ATP infusion. Perfusion was graded on scale of 0-4. RESULTS: EX- and ATP-SPECT images showed mild reversible perfusion defects in 43 and 50%, moderate - in 19 and 12.5%, severe - in 5 and 16.7% of patients, respectively. CONCLUSION: Our results demonstrate that adenosine triphosphate stress (99m)Tc-MIBI-SPECT is comparable with exercise (99m)Tc-MIBI-SPECT in detection of ischemia and may be useful tool for diagnosing microvascular angina.


Assuntos
Angina Microvascular/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Trifosfato de Adenosina , Adulto , Pesquisa Comparativa da Efetividade , Angiografia Coronária/métodos , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Tecnécio Tc 99m Sestamibi
6.
Ter Arkh ; 86(1): 23-32, 2014.
Artigo em Russo | MEDLINE | ID: mdl-24754065

RESUMO

AIM: To analyze the impact of a home exercise training (ET) program on quality of life, motor activity (MA), dietary habit, functional and biochemical parameters, and clinical course of the disease in patients who have experienced acute coronary syndrome (ACS) and/or endovascular coronary intervention (ECI). SUBJECTS AND METHOD: The trial included 100 patients after ECL who were randomized into 2 groups: those who had gone through Patient School (PS) and received a 6-week course of controlled ET (a study group (Group S)) and those who had gone through PS only (a control group (Group C). The patients of both groups were recommended a home ET program and, according to its implementation, they formed 2 subgroups: Subgroup A (home ET+) comprising 51 patients who had trained themselves at home) and Subgroup B (home ET-) consisting of 46 patients who had not. The follow-up lasted 1 year. Quality of life, risk factors, lifestyle and clinical parameters were assessed. RESULTS: As time elapsed, the patients' motivation to perform home ET; and, accordingly, the proportion of those who had trained themselves decreased in Group S to 67 and 61% and in Group C to 39 and 40% after 6 and 12 months, respectively. Among the reasons for refusal to perform home ET, disease was reported by only 5.6% of the patients (by all from Group C). The comprehensive physical rehabilitation program (RP) (controlled ET in combination with home ET) produced the best effect in raising the level of daily MA, exercise performance with a 21.3-fold increase in cardiac performance (p < 0.05) and a 14.3-fold decrease in heart rate increment in response to exercises. Group C patients who had refused the home ET program, as compared to those in the same group who had trained themselves at home, showed the worst daily MA levels, none body mass index reduction, and a rise in the low-density lipoprotein cholesterol (by 20.3%; p < 0.05) and in the number of angina attacks (by 1.9 times; p < 0.05). CONCLUSION: RP in the early-stage, which encompasses an educational program (PS), a short-term course of controlled ET and home ET used in patients with ACS, including in those after ECI, has clear clinical benefits. The participation of patients with coronary heart disease (CHD) in the home ET programs increases their motivation and, hence, the proportion of those who participate in therapeutic and rehabilitation measures. Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI.


Assuntos
Síndrome Coronariana Aguda/reabilitação , Procedimentos Endovasculares , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Motivação , Cuidados Pós-Operatórios/métodos , Síndrome Coronariana Aguda/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
8.
Kardiologiia ; 50(10): 27-34, 2010.
Artigo em Russo | MEDLINE | ID: mdl-21118176

RESUMO

Aim of the study was to assess efficacy of a short program of medium intensity physical training of patients with ischemic heart disease (IHD) after endovascular intervention (EVI) in conditions of practical health care of Russia. Patients (n=100) were randomized into 2 groups - intervention (main group "M", n=50) and control (group "C", n=50) during weeks 2-8 after EVI. Efficacy of undertaken measures was assessed by results of laboratory (lipids), instrumental (electrocardiogram - ECG, exercise test on veloergometer - VEM-test, echocardiography - EchoCG) and clinical investigations. Patients of group M exercised for 45-60 min 3 times/week using work loads 50-60% of those achieved during VEMtest. All patients received therapy standard for EVI treatment IHD as well as lipid lowering drugs when indicated. The use of short program of physical training in this contingent of patients led to significant increase of duration of exercise compared with initial value (by 38% after 1 year, p<0.001) and with control group (p<0.05), increase of efficiency of heart work during VEM-test which differed from that in group "C" at points 1.5 and 6 months (p<0.05). According to EchoCG data parameters of left ventricular (LV) contractility in group "M" significantly improved. With that systolic LV volume diminished 3.1% in 6 months (p<0.05) while its ejection fraction (EF) increased 2.4% (p<0.01). In group "M" at the background of conducted from the very beginning therapy with statins blood concentrations of atherogenic fractions of lipids in blood did not change. At the same time in group "C"their values significantly rose (in 1 year level of total cholesterol - by 12.1%, level of low density lipoprotein cholesterol - by 18.6%, p<0.01 for all comparisons) and at points 4 months and 1 year differences in dynamics of these parameters at intergroup comparison were also significant. In the group of physical training compared with control group according to overall results of 1 year observation more favorable course of disease was registered with more cases of improvement of clinical state (p<0.01) and less cases of its worsening (p<0.01). The obtained results evidence for sufficient efficacy of the short program of physical training and feasibility of its introduction into ambulatory practice for rehabilitation of patients with IHD subjected to EVI on coronary arteries especially in acute coronary syndrome. In combination with the School for IHD patients subjected EVI it can be considered as method of secondary prevention because the study demonstrated its positive effect of risk factors and clinical course of the disease.


Assuntos
Angioplastia Coronária com Balão/reabilitação , Reestenose Coronária/prevenção & controle , Terapia por Exercício , Isquemia Miocárdica/terapia , Prevenção Secundária/métodos , Angioplastia Coronária com Balão/efeitos adversos , Reestenose Coronária/etiologia , Ecocardiografia , Teste de Esforço , Terapia por Exercício/métodos , Terapia por Exercício/normas , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Avaliação de Programas e Projetos de Saúde , Prevenção Secundária/organização & administração , Resultado do Tratamento
9.
Klin Med (Mosk) ; 87(9): 15-22, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19882874

RESUMO

The study included retrospective analysis of the results of treatment in 529 patients with CHD and multiple coronary lesions divided into 2 groups. Group 1 included 280 patients who underwent surgical myocardial revascularization, group 2 comprised 249 patients after coronary stenting. The groups did not significantly differ in the occurrence of serious clinical complications (death, acute myocardial infarction) in both early and mid-late postoperative periods. Patients in group 2 more frequently suffered anginal attacks and required repeat myocardial revascularization. The main factor limiting clinical efficiency of endovascular procedures was coronary restenosis in roughly 34% of the patients.


Assuntos
Angioscopia/métodos , Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/métodos , Angioplastia Coronária com Balão/métodos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Klin Med (Mosk) ; 87(8): 25-8, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19827526

RESUMO

Coronary artery stenting is a priority treatment of different forms of coronary heart disease. Hence, the importance of intrastent restenosis. This study demonstrates the relationship between acetylation rate and frequency of restenosis following coronary stenting with special reference to patients with chronic coronary heart disease. This knowledge may be helpful for the improvement of endovascular treatment using drug-coated stents.


Assuntos
Acetiltransferases/genética , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/epidemiologia , Stents , Acetilação , Acetiltransferases/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/enzimologia , Oclusão de Enxerto Vascular/enzimologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos
11.
Kardiologiia ; 49(3): 49-56, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19257867

RESUMO

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.


Assuntos
Terapia por Exercício , Isquemia Miocárdica/prevenção & controle , Isquemia Miocárdica/reabilitação , Prevenção Secundária/métodos , Feminino , Hemodinâmica , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Prognóstico
12.
Klin Med (Mosk) ; 84(7): 13-6, 2006.
Artigo em Russo | MEDLINE | ID: mdl-16924793

RESUMO

The paper presents an analysis of correlations between long-term results of coronary arterial stenting and anticholesterol therapy with statins in 131 patients with chronic forms of coronary heart disease. The study revealed that anticholesterol therapy, when administered regardless the initial cholesterol level, improved the clinical condition of patients with initial hypercholesterolemia, and lowered the necessity of repeated endovascular procedures for restenosis and the progression of atherosclerotic changes. The necessity of repeated interventions is lowered by statin application rather than by normal levels of total cholesterol and low-density lipoproteins.


Assuntos
Colesterol/sangue , Ponte de Artéria Coronária/instrumentação , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/cirurgia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Stents , Adulto , Idoso , Doença Crônica , Doença das Coronárias/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Klin Med (Mosk) ; 84(5): 47-51, 2006.
Artigo em Russo | MEDLINE | ID: mdl-16827280

RESUMO

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.


Assuntos
Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Revascularização Miocárdica/métodos , Adulto , Idoso , Doença das Coronárias/diagnóstico , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Índice de Gravidade de Doença
15.
Kardiologiia ; 45(3): 4-9, 2005.
Artigo em Russo | MEDLINE | ID: mdl-15821700

RESUMO

Since July 2002 we have been conducting a study of efficacy of prehospital thrombolytic therapy combined with subsequent endovascular procedures in the treatment of patients with acute myocardial infarction. Fifty nine patients received prehospital fibrinolysis with tissue-type plasminogen activator (TPA, n=28) or streptokinase (n=31) within 6 hours after onset of symptoms. TPA infusion compared with that of streptokinase was associated with smaller ischemic myocardial damage and lower frequency of side effects (3.6 and 38.7%, respectively). Angioplasty or stenting of infarct related arteries were carried out in 47 of these patients. The group of patients subjected to endovascular interventions was characterized by a low rate of in-hospital cardiac events and zero mortality.


Assuntos
Angioplastia Coronária com Balão , Serviços Médicos de Emergência/métodos , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/terapia , Terapia Trombolítica , Angiografia Coronária , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Estreptoquinase/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
16.
Angiol Sosud Khir ; 10(3): 125-8, 2004.
Artigo em Russo | MEDLINE | ID: mdl-15622403

RESUMO

Combination of the methods of interventional cardioangiology with current techniques of vascular surgery allows a considerable broadening of the potential for the treatment of different signs of multifocal atherosclerosis in "high risk" patients. For instance, a 70-year-old patient (height 152 cm, weight 32 kg; initial concentration of serum creatinine 174 mumol/l) with the clinical evidence of progressing angina pectoris and critical ischemia of the lower extremities underwent angioplasty (the first stage) using a transradial access and stenting of the critically narrowed circumflex branch of the left coronary artery and angioplasty of the proximal segment of the right coronary artery. Good angiographic and clinical results were obtained. This provided a possibility of accomplishing aortofemoral bifurcation bypass grafting. So, the staged combined treatment made it possible to eliminate the life- threatening signs of multifocal atherosclerosis and to improve disease prognosis in an elderly patient classified with a group of inoperable subjects.


Assuntos
Aorta/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Artéria Femoral/cirurgia , Idoso , Angiografia Coronária , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Stents
17.
Klin Med (Mosk) ; 82(10): 22-6, 2004.
Artigo em Russo | MEDLINE | ID: mdl-15584594

RESUMO

The study was undertaken to comparatively assess the results of stenting and transluminal balloon angioplasty (TBAP) of coronary arteries in patients with chronic forms of coronary heart disease concurrent with restenosis of primary TBAP. The data on 77 patients undergone endovascular procedures for restenosis of prior primary TBAP of coronary arteries at the Moscow Research and Practical Center of Interventional Cardioangiology in March 1997 to May 2003 were analyzed. Group 1 comprised 35 patients with a stent implanted at the site of coronary restenosis; Group 2 included 42 patients undergone repeated TBAP. These groups did not significantly differ in main clinical and functional characteristics, the extent coronary bed lesion, the number of diseased arteries and the morphological type of a coronary lesion (p < 0.05). The angiographic success of secondary TBAP, as well as coronary stenting was 100%. Survival was 100% in the late period. A control examination revealed the clinical picture of angina on exertion in 57.1% and 76.2% of the patients in Groups 1 and 2, respectively (p = 0.039). In the late period, a satisfactory angiographic result of coronary stenting was revealed in most cases (74.3 and 35.7% in Groups 1 and 2, respectively); restenosis was detected in 20 and 59.5% of cases, respectively (p < 0.01); occlusion in 5.7 and 4.8% (p > 0.05). Need for repeated interventional and surgical (aortocoronary bypass surgery) procedures was significantly less after coronary stenting than that after repeated TBAP (20 and 40.5%, respectively). In the late period, the factors significantly increasing a risk for in-stent restenosis were hypercholesterolemia (cholesterol > or = 5.5 mmol/l); the length of restenosis of an operated segment was > or = 18 mm and that of a stent > or = 20 mm. It is expedient to use coronary endroprosthesis to reduce the incidence of repeated restenosis and needs for repeated procedures for myocardial revascularization in the late period.


Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Reestenose Coronária/terapia , Stents , Angiografia Coronária , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Reestenose Coronária/cirurgia , Interpretação Estatística de Dados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Fatores de Tempo
18.
Kardiologiia ; 44(10): 107-12, 2004.
Artigo em Russo | MEDLINE | ID: mdl-15477802

RESUMO

Linkage between acute coronary syndrome and narcotic drug (cocaine) intake was first described by D. Colleman in 1982. However risk of development of acute myocardial infarction during replacement therapy after opioid withdrawal has not been elucidated. The paper contains description of two cases of development of myocardial infarction in young persons with intact coronary arteries who received synthetic opioid methadone for facilitation of heroine discontinuation. These clinical cases should draw attention of physicians to side effects of the use of methadone for the treatment of heroine addiction.


Assuntos
Dependência de Heroína/reabilitação , Metadona/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Entorpecentes/efeitos adversos , Adulto , Angiografia Coronária , Eletrocardiografia , Seguimentos , Humanos , Masculino , Metadona/uso terapêutico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Entorpecentes/uso terapêutico , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento
19.
Kardiologiia ; 42(2): 8-10, 2002.
Artigo em Russo | MEDLINE | ID: mdl-12494199

RESUMO

Stent implantation is as a rule preceded by balloon angioplasty (predilation). This increases duration and cost of the procedure. Low profile stents with improved design allow to perform direct (i.e. without predilation) stenting. Immediate results of our series of direct coronary artery stenting procedures evidence for high efficacy and safety of the technique.


Assuntos
Angioplastia com Balão/métodos , Infarto do Miocárdio/cirurgia , Stents , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Resultado do Tratamento
20.
Kardiologiia ; 42(2): 11-3, 2002.
Artigo em Russo | MEDLINE | ID: mdl-12494200

RESUMO

AIM: To study possible link between inflammatory response of the body to stent implantation and development of instent restenosis. METHODS: C-reactive protein (CRP) was determined in 24 patients subjected to coronary stenting. Coronary angiography was repeated in 7.1-/+0.68 months after initial procedure. RESULTS: At repeat angiography positive results of stenting persisted in 18 while restenosis developed in 6 patients. All patients had increased CRP levels on days 2-3 after stenting. Day 2 CRP levels were higher in patients with than without restenosis (28-/+4.22 mg/l and 14.17-/+2.14 mg/l, respectively, p<0.05). CRP levels tended to normalize by day 5. CONCLUSION: Coronary artery stenting in patients with angina pectoris is associated with transitory elevation of CRP level. Day 2 CRP >or=24 mg/l with high degree of probability predicts restenosis in remote period.


Assuntos
Proteína C-Reativa/metabolismo , Estenose Coronária , Complicações Pós-Operatórias , Stents , Adulto , Idoso , Estenose Coronária/etiologia , Estenose Coronária/metabolismo , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
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