Long term (3-5 years) outcome of
patIents wIth coronary stents and no restenosIs In the fIrst sIx
months follow up angIography
Turan F, Sönmez K, Gençbay M.
The restenosis after coventional
percutaneous transluminal coronary angioplasty mainly occurs
in the first six months. None of the medical treatments
aiming to reduce restenosis have been able to totally solve
this problem. Among the invasive methods, coronary stent
implantations reduce the short-term complications and
restenosis. It has been suggested that perhaps stents do not
prevent but postpone the restenosis.
The aims of our study were to
examine the long term (3-5 years) angiographic follow-up results of the
patients, which had no angiographic restenosis in the first six months after
stenting, and to investigate the new restenosis in the long term follow-up
period.
Our study consists of 184 cases (164
M, 20 F, mean age 54±10), which had 201 coronary stents in our clinic
between June 1995 and December 1997 and which had no restenosis in the
6-month follow-up coronary angiography. Late angiographic evaluation was
obtained 38±16 months after stenting. The following late events were
considered: late significant coronary lesion, late restenosis, target and
non-target lesion revascularization, and myocardial infarction.
A new restenosis have been observed
in 5.5% (11/201) of the stents. New significant coronary lesion was found
24% (44/184) of the cases. Late target lesion revascularisation was 4%
(8/201 stents) and late non-target lesion revascularisation rate was 18%
(33/184 cases). Late non-fatal Q wave myocardial infarction rate was 5%
(9/184).
In patients who had no restenosis in
the first 6-months after stent implantation, the rate of late restenosis is
low, beyond this period in the 3-5 years follow up. Development of new
coronary lesion and following revascularisations are the main problem among
these cases. Therefore, efforts aiming to prevent the atherosclerosis
progression in long-term follow-ups after the stent implantation should be
emphasize
P wave
dIspersIon as a predIctor of atrIal fIbrIllatIon after coronary
artery bypass surgery
Uçar H.İ, Atalar E, Aytemir K, Özer N,
Güvener M, Yılmaz M, Doğan R, Demircin M, Paşaoğlu İ, Ersoy Ü,
Böke E.
Atrial fibrillation (AF) remains the most
common postoperative arrhythmia that occurs after coronary
artery bypass grafting (CABG). We have investigated 50
consecutive patients (11 female, 39 male, Mean age 60±10)
undergoing CABG for coronary artery disease. All patient
had normal sinus rhythm before surgery. The relation of AF
to several variables was also evaluated. The variables
examined included age, gender, smoking, presence of
diabetes, hypertension, coronary lesions, echocardiographic,
cardiopulmonary bypass and biochemical findings. There were
no significant differences in the gender, diabetes,
hypertension, MI, number of the grafts.
The mean age of AF
group was significantly higher than the others (p<0.001).
Echocardiographic values; EF (p<0.01), FK (p<0.021), LVESD
(p<0.01) and ESV (p<0.018) were statisticaly significant.
The prolongation of atrial conduction time have been shown
in patients with AF.P wave dispersion was found to be
significantly higher in patient with AF; preoperative
(p<0.0001), postoperative 1. day (p<0.001) and 5. day
(p<0.001). In conclusion we found that P wave dispersion is
a good predictor of AF in patients after coronary artery
bypass surgery.
TransradIal coronary angIography: Safety and applIcabIlIty
Badak Ö, Akdeniz B, Barış N, Aslan Ö, Güneri
S.
This study is planned to assess the safety and
applicability of transradial coronary angiography on Turkish
population. 100 patients who underwent transradial coronary angiography (transradial
group) were compared with those 100 patients who underwent transfemoral
coronary angiography (transfemoral group). Variables such as procedural
success rate, scopy time, number of catheters used in a procedure,
complication rate and hospitalization duration were compared between two
groups.
In transradial group, mean age was
lower (54.3±8.3 vs. 57.2±10.1 years, p=0.03) and percentage of men was hig-her
than transfemoral group (83 % vs. % 70, p=0.03). When compared with
transfemoral group, the number of the catheters used (p<0.001), duration of
hospitalization (p<0.001) and complication rate of the procedure (p=0.024)
were lower in transradial group. However, success rate was also lower
(p=0.043), and scopy time was higher (p<0.001) in transradial group than
transfemoral group. Transradial approach for diagnostic coronary angiography
is effective, safe and applicable alternative to the transfemoral approach.
Care must be taken in terms of radiation safety while transradial coronary
angiography is being performed because of the high scopy duration of the
procedure.
Atherosclerosis is a chronic systemic
inflammatory disease, present in the vascular wall. It is
seen both in the coronary and in the peripheral vascular
bed, and is characterized by endothelial dysfunction,
chronic inflammation, lipid deposition, smooth muscle cell
proliferation and calcifications. Atherosclerotic plaques
are the most common cause of coronary artery disease. Tissue
Factor-associated platelet activation, which is released
into the circulation when atherosclerotic plaques rupture
or fissure, plays a central role in the pathophysiology of
acute coronary syndromes. There is no correlation between
the degree of coronary stenosis and the risk of plaque
rupture. Rupture usually occurs in plaques, which cause only
mild or moderate coronary stenosis. These plaques, which are
called vulnerable plaques, contain increased depositions of
lipids and signs of inflammation, in addition to a weakened
fibrous cap. Several safe techniques can be used to identify
in particular the vulnerable plaques in earlier stages,
before these high risk lesions cause acute coronary
syndromes. Today, these vulnerable plaques can be identified
by means of several invasive and noninvasive techniques.
Use of
thrombolytIc therapy and percutaneous coronary reperfusIon
InterventIons wIth combInatIon of glycoproteIn 2b/3a InhIbItors
In patIents
Ağırbaşlı M.
The most important target in the
treatment of acute myocardial infarction with ST segment
elevation is the achievement of complete and prompt
myocardial reperfusion. This can be accomplished by
pharmacological or percutaneous approaches. The treatment of
the thrombus burden in the infarct related artery requires
adjunctive therapy with antiplatelet and antithrombin agents
in either approach. Although the initial studies with
combination of GP IIb/IIIa inhibitors and thrombolytic
treatment failed to show major benefit in outcome, tissue
level perfusion and myocardial protection studies are
ongoing. Recent studies show clear benefit of percutaneous
coronary intervention (PCI) over thrombolysis. The best
combination of bolus fibrinolytics, platelet inhibition,
thrombin inhibition, PCI, and agents to improve
microvascular circulation is a major focus of ongoing
trials.
Spontaneous coronary artery dIssectIon: Case report and revIew
of the lIterature
Kılıç H, Atalar E, Nazlı N.
A 55-years old man who admitted to the
hospital with a recent onset substernal chest pain underwent
coronary angiography. A long segment of dissection was
present in the right coronary artery (RCA) extending
from the proximal vessel to posterior descending artery
with TIMI III flow. There was a partial thrombus in the mid
left anterior descending coronary artery(LAD) with resultant
TIMI 2 flow.
Spontaneous coronary
artery dissection is a rare cause of acute myocardial
ischaemia and optimal management of spontaneous coronary
artery dissection has not been established.
Herein, we report a
case of spontaneous coronary artery dissection and the
review of the literature.
Left
ventrIcular dysfunctIon assocIated wIth anomalous orIgIn of all
three coronary arterIes from rIght sInüs of valsalva: A case
report
Kılıçkap M, Kurtul A, Sayın T, Berkalp B,
Kervancıoğlu C.
Coronary anomalies were seen
approximately 1.3% of the patients undergoing coronary
angiography, and have usually benign course. We reported a
rarely seen case in which severe left ventricular
dysfunciton was associated withanomalous origin of all
three coronary arteries from right sinus of Valsalva.
Key Words:
Coronary anomaly, Anomalous origin of coronary artery, Heart
failure, Left ventricular dysfunciton
ConcomInant carotIs endarterectomy, complete coronary
revascularIzatIon, left ventrIcle thrombectomy and
endoaneurysmorrhaphy: a case report
Nisanoğlu V, Erdil N, Battaloğlu B, Özgür B.
Significant carotid artery stenosis and
left ventricular aneurysm with mural thrombosis are the most
important risk factors for development of neurologic
complications after coronary artery bypass surgery. In this
paper, we present a case of left ventricular thrombectomy,
aneurysmectomy and complete coronary revascularization with
concomitant carotid endarterectomy.
