Long-term (3-5 years) clInIcal and
angIographIc results of Intracoronary stentIng
Sönmez K, Turan F, Gençbay M, Değertekin M, Duran E.N,
Akçay A.
The purpose of our study was to evaluate
the long-term clinical and angiographic follow-up results of
intracoronary stenting.
We followed 495 pts. (435 male, mean
age 54±12) who underwent coronary stenting between January 1996 and December
1997. Five hundred thirty stents (133 Multilink, 122 NIR, 121 JO, 75 AVE, 55
Wiktor, 24 other types of stents) were implanted to treat de-novo or
restenotic lesions of native coronary arteries.
Stent implantations were elective in
53%, suboptimal in 35%, bailout in 12% of the angiographically followed
patients. The mean reference diameter of stented vessels was 3.2±0.3 mm. The
mean percentage of stenosis was 78±11% and 7±10% before and after stent
implantation respectively in those patients. Long term (42±11 months)
clinical follow-up was completed in 73% and angiographic follow-up was
completed in 56% of the patients. There was no statistically significant
difference between the baseline clinical and angiographic features of the
cases who were angiographically followed-up or who were not.
Angiographic restenosis detected in
28% of stents, target lesion revascularisation, non-target lesion
revascularisation, death, and new MI were occured in 19%, 20%,11% and 6% of
patients respectively.
Our study provides long-term
follow-up results of intracoronary stent implantations for native coronary
artery lesions. An important rate of major cardiac events and non target
lesion revascularisation occurs during these follow-up period. This study
stresses the importance of interventions aiming to slow the progression of
atherosclerosis in patients who had undergone coronary stent implantation
P wave duratIon and P wave dIspersIon In
adult patIents wIth secundum atrIal septal defect durIng normal
sInus rhythm
Güray Y, Güray Ü, Yılmaz M.B, Mecit B, Şaşmaz
H, Korkmaz Ş, Kütük E.
Paroxysmal atrial arrhythmias especially atrial fibrillation
(AF) are frequently encountered in adult patients with
atrial septal defect (ASD). Previously it was shown that
maximum P wave duration and P wave dispersion in 12-lead
surface electrocardiograms are significantly increased in
individuals with a history of paroxysmal AF. The aim of
this study was to determine whether P maximum and P
dispersion in adult patients with ASD and without AF are
increased as compared to healthy controls. In addition, the
relationship of pulmonary to systemic flow ratio (Qp/Qs) and
these P wave indices were investigated.
Sixty-two
consecutive patients (39 women, 23 men; mean age 33±13 years
[range 16 to 61 years])with ostium secundum type ASD and 47
healthy subjects (25 women, 22 men; mean age 36,6±9,5 years
[range 18 to 50 years]) were investigated. P maximum, P
minimum and P dispersion (Maximum minus minimum P wave
duration) were measured from the 12-lead surface ECG. There
were no significant differences with respect to age
(p=0,08), gender (p=0,3), heart rate (p=0,3), left atrial
diameter (p=0,5) and left ventricular ejection fraction
(p=0,3) between patients and controls. Pulmonary artery peak
systolic pressure was significantly higher in patients with
ASD as compared to controls (p<0,0001). P maximum was
significantly longer in patients with ASD as compared to
controls (p<0,0001). In addition, P dispersion of the
patients was significantly higher than controls (p=0,001). P
minimum was not different between groups (p=0,12). Mean Qp/Qs
of the patients with ASD was 2,5±0,7 (minimum1,5; maximum
4,1) and found to be significantly correlated with P maximum
(r=0,34; p=0,006) and P dispersion (r=0,61; p<0,0001).
Prolongation of P
maximum and increased P dispersion could represent
mechanical and electrical changes of atrial myocardium in
patients with ASD. These changes of atrial myocardium may be
more prominent with higher left to right shunt volumes.
Key Words:
Atrial septal defect, Electrocardiography, P wave duration,
P wave dispersion
The IncIdence of coronary ectasIes
and aneurysms In 6700 coronary angIographIes performed between
1993-2000
Gemici K, Özdemir B, Ekicibaşı E, Baran İ,
Yeşilbursa D, Güllülü S, Aydınlar A, Serdar A, Kazazoğlu A.R,
Kumbay E, Cordan J.
Coronary anomalies such as coronary ectasies and
aneurysms are congenital or acquired pathologies that is rarely seen. These
pathologies are coronary dilatations of varying degrees, and their
incidences according to cardiac catheterization data vary between %0.3 and %
4.9. Half of coronary ectasia and aneurysms are due to atherosclerosis while
%20-30 is congenital in origin and the remaining %10-20 is due to
inflammatory and connective tissue diseases. These anomalies may cause
myocardial infarction and sometimes may cause myocardial ischemia without
accompanying coronary stenosis. Coronary aneurysm or anomaly should be
suspected in case of angina pectoris or acute MI before age of 20. Coronary
artery aneurysms are reported in %15 of necropsies and coronary
angiographies.
Our study is retrospective and aimed
to determine the incidence of aneurysm and ectasia in 6700 coronary
angiographies that were performed between 1993-2000. We reviewed all the
registries for this reason. Coronary ectasia is defined as a lesion having a
diameter of 1.5-2 times the normal segment without a stenosis and coronary
aneurysm as a dilatation having a diameter more than 2 times the normal
segment.
In 147 of 6700 patients whom
coronary angiography was performed coronary ectasia and aneurysm was
detected. Mean ages of patients with coronary ectasia and aneurysm were
55±10 and 56±10 respectively.
In our study overall coronary
ectasia and aneurysm incidence was found as %2.11. In coronary angiography
laboratories, the criteria of coronary aneurysm and ectasies should be
standardized and assessments should be made in an objective manner.
Stenting in small vessels and bifurcation lesions are
technically demanding procedures. The aim of this review
was to discuss advances in these procedures in the light of
recent studies.
Presence of a relatively decreased amount
of post-procedural minimal lumen diameter of the lesion is
the major disadvantage of small vessel stenting. This
shortcoming yields complications of thrombus and restenosis.
In the scope of all recent studies stenting in focal lesions
of small vessels appears to be superior than plain old
balloon angioplasty (POBA). In long lesions POBA and spot
stenting seems to be a superior strategy. Drug eluting
stents and gen therapy are future promising techniques.
Stenting in bifurcation lesions has been
performed by Culotte or similar techniques. Usually both
side branch and main branch have been stented by these
techniques. A novel "Provisional stenting" technique (stenting
in main branch and POBA in side branch and a final kissing
balloon angioplasty of both branches) appears to yield more
favorable outcomes. Threshold for intervention of side
branch decreased to 2.0 mm. If main branch is smaller than
side branch (usually in circumflex artery) main branch is
accepteed as side branch. Six French catheters with internal
luminal diameter larger than 0.68" or 7 French catheters can
be used in bifurcation stenting procedures. POBA outcomes in
bifurcation lesions were not satisfactory and rotablator and
atherectomy results were similar to POBA. Nowadays
provisional stenting with new low profile balloons and last
generation stents seems to be a superior method in dealing
with bifurcation lesions.
Key Words:
Small vessel, Stent, Bifurcation lesions
Should all totally occluded arterIes be
opened followIng acute myocardIal InfarctIon?
Semiz E.
The clinical importance of a patent
rather than an occluded infarct-related artery (IRA), the
so-called open IRA theory, is that early reperfusion of
IRA has been shown to reduce infarct size, preserve
ventricular function, and improve both the short- and
long-term prognoses. It has further been hypothesized that
late reperfusion of infarcted myocardium, the so-called
late open artery hypothesis, still exerts a favorable impact
on left ventricular function and survival beyond that
expected from myocardial salvage alone. However, the
recently revised 2001 American College of
Cardiology/American Heart Association Percutaneous Coronary
Intervention Guidelines state that there is conflicting
evidence and a divergence of opinion about the efficacy of
percutaneous coronary intervention for establishing an open
artery in asymptomatic patients after an acute myocardial
infarction, on the basis of expert opinion. Late open artery
hypothesis remains to be proved and is currently being
tested in OAT and DECOPI.
What would be the treatment strategy
In cardIogenIc shock patIents wIth ST elevatIon and non ST
elevatIon myocardIal InfarctIon?
Döven O, Akkuş M.N
Mortality rates in patients with
cardiogenic shock remain high. Its pathophysiology involves
a downward spiral in which ischemia causes myocardial
dysfunction, which in turn worsens ischemia. Areas of viable
but nonfuntional myocardium can contrubute to the
development of cardiogenic shock. Rapid diagnosis, and
prompt initiation of supportive therapy to maintain blood
pressure and cardiac output, followed by expeditious
coronary revascularization are, crucial. The SHOCK
multicenter randomized trial has provided important new data
that support a strategy of emergent cardiac catheterization
and revascularization with angioplasty or coronary surgery
when feasible. This strategy can improve survival and
represents standart therapy at this time. In hospitals
without direct angioplasty capability, stabilization with
intra-aortic ballon pumping and thrombolysis followed by
transfer to a tertiary care facility may be the best option.
Left cIrcumflex coronary artery
arIsIng as a termInal extensIon of rIght coronary artery
Sağkan O, Yazıcı M, Demircan S.
Many types of coronary anomalies have
been detected, and most of them are seen in the left
circumflex artery.
In this report the
very rare coronary artery anomalies which belong to the
origin of left circumflex artery is presented in two cases
one of them has been published reviously. In these two cases
circumflex coronary artery is originated from the distal
part of right coronary artery and extend to supply the
circumflex artery region.
Total occlusIon of left maIn
coronary artery In a patIent wIth myocardIal InfarctIon
Selçuk H, Selçuk M.T, Korkmaz Ş.
Total occlusion of the left main coronary
artery is a serious condition with a severe and potentially
lethal clinical course. A 53 year-old male presented to our
clinic with the complaint of exertional chest pain for the
past two years. Exercise test showed 3 mm. of horizontal ST
segment depression in inferolateral leads. A subsequent
coronary arteriography revealed total occlusion of the left
main coronary artery, with the left anterior descending and
circumflex arteries being filled by collaterals emerging
from the right coronary artery. No wall motion abnormality
was observed on left ventriculography. The patient was
referred to the Cardiovascular Surgery Department for urgent
surgery.
Key Words:
Left main coronary artery, Total occlusion
Treatment of thrombI embolIzed dIstally
durIng percutaneous coronary InterventIon of the occluded stent
wIth tIrofIban : A case report
Uyan C, Duran S, Akdemir R, Özer İ.
Angiographic evidence of coronary
thrombus adversely affects the outcomes of percutaneous
coronary intervention. Percutaneous revascularization of
thrombus containing lesions is associated with an increased
incidence of death, myocardial infarction, abrupt closure
and emergency coronary artery bypass surgery. In this case,
we discussed a patient who had a myocardial infarction after
two months of coronary stent replacement and had
successfully thrombolytic treatment. He was stent out to our
hospital because of post-MI anginal pains. Successfully PTCA
was performed for patients %100 thrombotic occluded RCA.
But, although angiographic success had been achieved, there
was not distally TIMI-III flow due to thrombosis in the
stent region and distal of RCA. Intarvenous nytroglycerin
infusion gave were dissolved completely after tirofiban
infusion.
