IS THERE ANY ROLE OF OF PACLITAXEL-ELUTING STENTS IN STENT THROMBOSIS?
Döven O, Özcan T, Çamsarı, Çiçek D, Yurttaş M, Akkus N,
Tokuççu E, Cin G.
At recent years, by the development in the stent
technology, drug eluting stents (DES) in different designs and have
different characteristics could be produced. The main aims of these modern
stents are the decreases in major cardiac event (MACE) and long term
restenosis with the use of new and effective antithrombocyte agents. In the
stu-dies done with these stents there have been some suspicion about the
increased stent thrombosis in the DES. In this study our aim is to determine
the stent thrombosis risk related with the pa axel eluting stents. Our
study involves 151 patients (202 stents) who have undergone taxus stent
implantation between March 2003 and June 2005. Patients with symptomatic
coronary artery disease, patient with positive exercise test and the
patients who have > 2mm and > 70% (focal or multiple) lesions in the
angiography are included in study. Control coronary angiography was
performed after 12±2.8 months. Patients were followed up 16.7±7.4 months.
Two stent thromboses were detected at follow up. As a result polymer based
pa axel eluting stents were related with stent thrombosis at a low rate .
It was shown that use of antithrombotic combination (acetylsalicylate and
tienopiridins) was related with late thrombosis and if not contraindicated
antiplatelet therapy is recommended to be continued for a long term.
Key Words:
Pa axel eluting stents, Stent thrombosis.
PRESERVED ENDOTHELIAL CELL INTEGRITY AND
NITRIC OXIDE SYNTHESES FOLLOWING ENDOSCOPIC HARVESTING TECHNIQUE
OF SAPHENOUS VEIN GRAFTS
Kaplan S, Bisleri G, Morgan J.A, Emir M,
Akman H.O,Kılınç K,Çobanoğlu A, Oz M. C.
Functional integrity of harvested saphenous vein has
important implications for immediate and long-term graft survival. Surgical
trauma during vein harvesting can cause endothelial injury, therefore,
preservation of endothelial integrity and endothelial nitric oxide (NO)
synthesis in harvested saphenous vein grafts is important in increasing vein
graft longevity and improving graft patency rate after implantation. In this
study, therefore, we sought to investigate whether the harvesting technique
(either conventional or endoscopic) may affect endothelial inflammation
(leukocyte infiltration into the endothelium) and nitric oxide syntheses in
human saphenous veins grafts (HSVGs).
Segments of 10 saphenous veins were
harvested from 10 different patients undergoing CABG surgery with the
endoscopic (Gorup A) or conventional (Group B) techniques. Human saphenous
vein specimens were stored in heparinized blood for 1 h at room temperature.
Saphenous vein specimens were analyzed by Greiss method: nitric oxide
(nitrate -NO3 - and nitrite - NO2 -) levels in vein grafts harvested by
endoscopic and conventional techniques were measured. Saphenous tissue
myeloperoxidase (MPO) activity, as a marker of neutrophil infiltration into
the saphenous vein graft endothelium, was also measured in each group and
the degree of neutrophil induced saphenous vein endothelial injury was
determined.
Nitric oxide formation, nitrate plus
nitrite, (Group A=36.77±4.72 µM vs. Group B=21.49±1.95 µM, p<0.001) was
higher in endoscopically harvested SVGs as compared with conventionally
harvested HSVGs. In contrast, saphenous tissutal MPO activity (Group
A=6.63±0.92 nm/min vs. Group B=9.89±1.09 nm/min, p<0.001) was significantly
lower in endoscopically harvested HSVGs as compared with conventionally
harvested grafts.
These results demonstrate that
neutrophil infiltration into the vascular endothelium and neutrophil induced
endothelial injury is reduced in the endoscopically harvested saphenous
grafts. Moreover, these results demonstrate that endothelial nitric oxide
synthesis is better preserved in the endoscopically harvested saphenous
grafts. Our findings suggest that minimally invasive harvesting techniques
can be used without major detrimental effects on vascular endothelial
function and integrity in human saphenous vein grafts.
ASYMPTOMATIC CAROTID ARTERY STENOSIS
AND TREATMENT
Topsakal, R, Ergin A.
Internal carotid artery stenosis (ICAS)
is an important cause of ischemic strokes. An ICAS is defined sypmtomatic
carotid artery stenosis associated with ipsilateral neorologic hemispheric
lesions and/or retinal deficit, an ICAS is defined asymptomatic when it
lacks the above criteria for sypmtomatic stenoses that is in abscence of
recent, focal and ipsilateral neurological episodes.
Multicenter trials
have suggested the superiority of carotid endarterectomy over medical
therapy in sypmtomatic patients with severe ICAS. The role of carotid
endarterectomy in patients with asymptomatic carotid artery stenosis is
controversial. Carotid endarterectomy for asymptomatic ICAS should be
considered only for medically stable patients with 80% or greater stenosis
who are expected to live at least 5 years and only in centers with surgeons
who have demonstrated low perioperative complication rate. Patients with
ICAS have a significantly increased risk of myocardial infarction and
vascular death therefore risk factor modification program should be
performed.
REPERFUSION
THERAPY IN ACUTE MYOCARDIAL INFARCTION AND CLINICAL TRIALS
Güneri S, Akdeniz B.
Important developments and survival benefist have been
achieved in the treatment of ST elevated acute myocardial infarction (STEMI)
that has an important cause of mortality and morbidity in recent years. The
most important factor that positively influencing the short and long term
results of the therapy in patients with STEMI is restoring the blood flow in
the infarct related artery as quickly as possible no matter which method was
used. Thrombolytic therapy has important handicaps such as bleeding risk.
This therapy can not be performed in all patients. Additionally It has
decreased efficacy in patients who had delayed admission to hospitals.
Primary percutaneous coronary intervention (PCI) should be performed primary
PCI. However, situations such as requirement of experienced operator and
high volume centers limit to comman usage of primary PCI. Current options
for reperfusion therapy in patients admitted to a community hospital without
cardiac catheterization facilities are as follows: If patients present to
hospital during 2 hours after sysmptoms onset, thrombolytic therapy could
be given, but if they admit after this time period; a strategy of
transporting them to a tertiary hospital should be applied. Prehospital
thrombolysis and facilitated PCI with pharmacologic agents such as
glycoprotein IIbIIa inhibitors are tried to find reperfusion therapy for
STEMI.
Key Words: Acute myocardial infarction,
Reperfusion strategies, Thrombolysis, Primer PCI
THE EVALUATION OF PERCUTANEOUS
CORONARY INTERVENTION IN MULTIVESSEL DISEASE
Dönmez Y, Kanadaşı M, Demirtaş M.
Coronary artery disease is a leading cause of mortality
and manpower loss in our country. Severity and extension of the disease is
the most powerful factor for survival of these patients. The patients with
multi vessel disease are the less benefit gaining section of these groups.
More percutaneus coronary interventions are applied to patients with the
advancing techniques recent years as an alternative therapy to bypass
surgery. But major problem for these patients is still failure of restenosis
prevention. Therapy alternative choice can seriously affect the survival and
quality of life in these patients. We tried to evaluate multi vessel disease
treatment options in terms of different patient groups, treatment strategies
and methods in this review.
A RARE FROM OF AORTIC DISSECTION: FAMILIAL
AORTIC DISSECTION İN A YOUNG MAN (CASE REPORT)
Çelik T, Kurşaklıoğlu H, İyisoy A, Öngörü Ö,
Demirkol S, Köz C, Işık E.
Aortic dissection is a rare disease often associated with
fatal consequences. In this case report, we reported a 20 year-old male with
familial form of thoracic aortic dissection undergoing emergent surgery. It
was found that cystic medial degeneration in the media layer of aortic wall
in the histologic examination of the dissected segments of aorta
A COMBINATION OF TRIPLE RENAL
ARTERIES-A RARE CONGENITAL RENAL ARTERY ANOMALY AND HYPERTENSION
Karabulut A, İltimur K, Kadiroğlu A. K,
Toprak N.
Congenital anomalies of renal arteries are congenital
anomalies which occur in various frequencies in different series. However,
triple renal artery can be present in a frequency of 1% and lower, in nearly
all series. A linear relationship between the presence of multiple renal
arteries and renovascular hypertension has been reported in some studies. We
wish to present this rare congenital anomaly we observed in a young patient
of ours during screening for secondary hypertension, to share the pictures
and to draw attention to some points.
Combination of multiple renal arteries and hypertension
must be kept in mind. Non-selective angiography may be necessary to
determine multiple renal arteries.
