Effect of
antIcardIolIpIn antIbodIes on the development of restenosIs
Kılıçkap M,
Tutar E, Pamir G, Aydıntuğ O, Oral D.
One of the
triggering factors for the development of restenosis after
percutaneous coronary interventions is the thrombocyte
aggregation and the release of various growth factors from
these cells at the site of injury. İn this study we
investigated the effect of anticardiolipin antibodies
(AÇLA), which increase tendency to thrombosis at arterial
and venous bed, on the development of restenosis after
percutaneous coronary balloon angioplasty (PTCA) and stent
implantation.
Study groups consisted of 58 patients who undervvent
successful PTCA or stent implantation due to stable angina pectoris. Blood
samples were taken just before the intevention in order to measure AÇLA
levels. Follow-up coronary angiography was performed 4-6 months after the
intervention, and presence of 50% or more stenosis at the site of
intervention was considered restenosis. AÇLA levels were measured by ELISA
method, and compared betvveen patients with and those vvithout restenosis.
Restenosis was developed in 17 (29%) patients.
Restenosis rate was 42% in PTCA group, and 23% in the stent group. İn the
whole group (PTCA and stent groups), IgM and IgG type AÇLA levels vvere
similar in patients with and those vvithout restenosis (p<0.05). Levels of
these antibodies vvere also compared in the PTCA and stent groups separately,
and vvere found similar in the restenotic and non-restenotic subgroups of
each groups as well.
AÇLA is not play a role for the development of
restenosis after percutaneous coronary interventions.
The early
and late results of stent ImplantatIon In stabIe and unstable
angIna pectorIs
Pekdemir H, Çamsan A, Akkuş M.N, Döven O, Özcan İ.T, Katırcıbaşı
M.T, Cin V.G.
Our
knowledge about the differences of late results of stent
deployment in stable (SAP) and unstable angina pectoris (USAP)
patients is not enough. İn this paper, we studied the early
and late results of SAP and USAP patients retrospectively.
We investigated 128 SAP and 114 USAP patients who admitted
to our clinic betvveen July 1999 and December 2001 and
treated with intracoronary stenting and controlled with
angiography after 6+2.1 months. We com¬pared the basal
characteristics, early and late clinical and angiographic
results of both groups. The mean age (55.7+10.1-50.8±9.9,
p<0.05) and female gender [n=37 (32.5%)-n=23(18.6%), p<0.05]
were significantly higher in USAP patients. The clinical and
angiographic success and complication rates in SAP and USAP
patients vvere: relief of angina, 112 (87.5%)- 96(84.2%),
p=AD; complete revascularization,119(92.9%)-104(91.2%),
p=AD; myocardial infarction (MI), 1(0.8%)-2(1.7%), p=AD and
urgent hypass, 3(1.6%)-5(7.0%), p=AD, respectively.
The control results after 6±2.1 months
vvere: in-stent restenosis (ISR), 24(17.2%)-37(21.9%),
P<0.05; repeat angioplasty (PTCA), 18(14.1 %)-28(24.6%),
P<0.05; MI, 3(2.4%)-11(9.6%), P<0.05 and event free survival,
90(70.3%)-63(55.3%), p<0.05, respectively. USAP was found an
independent risk factor (despite some differences in basal
char¬acteristics) for long term ISR (OR=3.3; p<0.005),
repeat intervention (PTCA or bypass) (OR=3.1; p<0.005) and
acute Mİ (OR=2.8; P<0.05) vvith multivariate analysis.
According to these findings we conclude
that in patients who vvere treated with stenting, no
difference was found in early results betvveen SAP and USAP
patients but USAP was found an independent risk factor for
ISR and repeat intervention at long term basis.
The effect of coronary collateral cIrculatIon on left
ventrIcular funCtIon
Özaydın M, Alo F, Nişancı Y, Oflaz H, Erdoğan D, Öncül A,
Mercanoğlu F, Özsaruhan Ö, Erzengin F.
The functional
signifigance of collateral flow in coronary artery disease (CAD) remains
uncertain. The aim of this study was to determine the effect of well
developed coronary coliaterals on left ventricular systolic funçtion. Sixty
patients with > 50% coronary stenosis and well-developed coronary
coliaterals (group l) and 50 patients vvith > 50 % coronary stenosis
vvithout vvell-developed coronary coliaterals (group II) were included in
the present study.
İn group l there were 53 male and 7 female and mean age
of the group I was 55.9±8.6. İn group II there were 42 male and 8 female and
mean age of the group İl was 55.4±7.9. Functional capacity and the incidence
of CAD risk fac-tors were similiar in the both groups (ali p > 0.05).
Patients in group l had more likely a prior myocardial infarction (MI) (53
vs 26 patients, p = 0.0001). Duration of CAD was 12+4.3 and 1.5+0.7 months
in group I and group II, respective-ly (p < 0.0001). Forty-seven patients in
group I and 9 patients in group II had total coronary occlussions (p <
0.0001). Left ventricular ejection fraction (EF) was 49.6±0.5 % in group I
and 55.4±1.9 % in group II (p > 0.05). Left ventricular segmental wal)
motion score was 28.39±3.24 in group I and 27.81+2.94 in group II (p >
0.05).
Collateral circulation had no effect on left
ventricular global and segmental sytolic funçtion.
Key Words: Coronary collateral, Left ventricular
systolic function
The
predIctors of procedural success of angIoplasty In chronIc total
occlusIon
Ermiş C,
Yalçınkaya S, Semiz E, Değer N.
The
procedural success rate of angioplasty in chronic total
occlusions (CTO), has improved to 70 % from 53 % in the last
decade owing to advances in equipment technology, to greater
operatör experience and to careful patient selection. İn
this study we sought to determine if there are some other
predictörs vvhich might have effect on proce¬dural success
rate in CTO.
39 patients, (34 male) whose coronary
angiography revealed at least one chronic total occlusion (CTO)
were involved. Clinic and demographic properties of the
patients and anatomic features of the coronary artery
lesions were determined. Then percutaneous transluminal
coronary angioplasty (PTCA) was attempted on each patient. 'Mann-Whitney
U' and 'Chi-Square' tests were performed to assess the
correlation betvveen procedural success and clinical and
angiographic features.
The mean age was 60.05±7.31 and the
procedureal success rate was calculated as 51.2 % (20 cases).
Sex, age, angina class, risk factors such as diabetes,
hypertension, smoking, hyperlipidemia and family history,
the occlu¬sion being absolute or functional, the presence of
coliaterals or retrograd flow were proved to be free of
procedural suc¬cess. The features which significantly
predicted procedural success were, the lesion being type B2
(p=0.03), the diam-eter of occluded vessel being över 2.5 mm
(p=0.01) and a proximal occlusion rather than a mid or
distal one (p=0.01). The patient's being normotensive
(p=0.04), an LAD as the occluded artery (p=0.04) and an
anterior infarct (p=0.04) also predicted procedural success.
Our findings revealed that procedural
success in CTO may be vvith different predictörs and that
this success rate is high in normotensive patients vvith
type B2 lesions having a diameter över 2.5 mm, vvith LAD and
proximal occlu¬sions and in patients who had had anterior
infarct.
InflammatIon: DetermInant role In atherosclerosIs and vulnerable
plaque rupture
Kültürsay H.
Atherosclerosis is a very complex process far beyond lipid
accumulation in the vessel wall. Inflammation plays an
important role in this process. The most prominent finding
from very early beginning is the presence of inflammatory
cells such as T lymphocytes and macrophages in large numbers.
Incrcased inflammatory activity creates a vicious cycle by
stimulating the expression of adhesion molecules, cytokines
and transcription factors and subsequently results in acute
coronary syndrome due to the rupture of vulnerabl plaques.
Systemic markers of local inflammation increase in the blood
reflecting the generalized vascular inflammation. Amongst
these markers, CRP (C reactive protein) is particularly
important both as an inflammatory marker and prognostic
indicator. Suppression of inflammatory activity through
various thereapeutic approaches is essential in the
retardation and therapy of atherosclerosis.
Rescue
PTCA after faIled thrombolysIs: PatIent selectIon
Altun A.
Clinical
outcome after thrombolytic therapy for acute myocardial
infarction is closely related to patency of the infarct-related
artery. This article revievvs the current literatüre on the
identification of patients vvith failed thrombolysis and
rescue PTCA.
Emergency
operatIon In a patIent In whom guIde wIre was broken durIng PTCA
Tokmakoğlu H, Günaydın S, Kandemir Ö, Yogancıoğlu C, Zorlutuna
Y.
A
fifty-two years old patient was planned to undergo PTCA to
diagonal and circumflex arteries following coronary
angiography. An emergency operation was performed due to a
broken guide wire during the PTCA procedure. At the time of
operation four saphenous bypass were performed after
extraction of the broken guide vvire. Retrograde car-dioplegia
was used to prevent embolization of the coronary artery.
Aneurysm
of the rIght coronary artery and coronary artery-artery fIstula:
Case report
Uncu H, Çağlı K, Yıldız U, Yavaş S, Küçükaksu S, Taşdemir O.
A
thirty eight year old female patient, applied to our clinic
with atypical chest pain, was hospitalized to further
investigation.After echocardiographic and angiographic
studies coronary artery-artery fistula and an aneurysm of
the apex of right ventriculy.Then surgical therapy was
planned to the patient.
We planned to report the case having
coronary artery-artery (Right coronary artery-Left anterior
desending artery) fistula and right ventricular aneurysm
vvhich is very rare in the literatüre.
MItral
stenosIs and cIrcumflex coronary artery anomaly orIgInated from
rIght sInüs of valsalva
Demirbağ R, Ekim H.
Coronary anomalies are rarely observed in all of the cases
of vavular heart disease. An association of rheumatic
valvular heart disease is considered to be a rare condition
in such cases.. İn this case report, we would like to
present one vvith mitral stenosis and circumflex coronary
artery anomaly originated from right sinüs of valsalva.
A 57-year-old patient, vvho has a
history of rheumatic fever was admitted to the hospital for
evaluation before the replacement of prosthetic mitral valve.
A sixteen mmHg gradient related to mitral valve was found in
cardiac catheterization and left circumflex artery
originated from right sinüs of valsalva with separate ostia
also attracted our attention in coronary angiography. Since
coronary arteries vvere found to be normal, only mitral
valve replacement was conducted vvith 29 No St-Jude bileflet
mechanic prosthesis valve.
