Restenosıs ın ıntracoronary stent
ımplantatıon applıed due to myocardıal brıdge
Yazar Ş,
Gök H, Soylu A, Kayrak M.
It was aimed to compare the intracoronary stent implantation in the
symptomatic myocardial bridge (MB) with the intracoronary stent implantation
in "de novo" atherosclerotic lesions in similar localizations, despite the
medical treatment.
Having refractory angina to the optimal medical treatment, 14 patients with
positive at exercise stress test (EST) and MB leading to systolic narrowing
of > 75% in the coronary angiography composed the study group, yet due to
"de novo" atherosclerotic lesion being of similar age and lesion features,
stent-placed 13 patients composed the control group. Control coronary
angiography was performed 6 months after the intervention or when there
existed serious complaints and electrocardiography (ECG) changes.
Determining narrowing of > 50% in the coronary angiography was accepted to
be restenosis.
Stent implantation was successfully managed in all patients. In the study
group, 17 stents were implanted in 14 patients (3 women, average age rate:
54±10 years) (2 stents for 3 patients each), and 13 patients in the control
group were placed 15 stents (7 women, average age rate: 60±7 years) (2
stents each 2 cases). The diameters and lengths of the used stents were
similar in each group (p>0.05). All patients were followed up for average
8±2.4 months in the study group and for average 7.5±2.2 months in the
control group until their control angiographies (p>0.05). Restenosis was
detected in 7 stents of 17 (41%) in the study group, and 4 stents of 15
(27%) in the control group (p>0.05).
By atherosclerotic lesions, the rate of in-stent restenosis in MB was found
to be high no matter how insignificant it was.
Be TIMI-III flow must target ın
ınterventıonal treatment of acute myocardıal ınfarctıon
Yavuzkır M, İlkay E,
Karaca I, Balin M, Akbulut M, Özbay Y, Kazancı Y,S, Tırıklı L,
Aslan İ.N.
Ischemic heart
diseases especially AMI have a special place in heart
diseases. Because of the resultant chronic heart proplems as
well as sudden death. In angiographic studies, it was shown
that achievement of TIMI-III flow in infarct related
coronary artery decreased the mortality and morbidity.
Currently there are some reports that this does not mean
sufficient tissue perfusion. ST segment resolution follow-up
is advised in tissue perfusion studies.
Our aim was to compare the TIMI-III flow and
electrocardiography ST resolution in primary angioplasty and
to test whether TIMI-III flow achieve tissue perfusion or
not. Sixty-nine AMI patients (mean age;57,77±12,2 years, 9
female, 60 male) in whom TIMI III flow achieved by primary
angioplasty were enrolled to study. Pre- and post-procedurel
ST segment elevation were noted. ST segment resolution was
classified as complete, partial and any when the resolution
>70%, 30-70%, <30% respectively. Complete, partial and any
resolution were seen in 9 (13%), 57 (83%), 3(4%) patients
respectively.
As a result, complete ST resolution was achieved in only 9
(13%) patients though TIMI III flow was established in AMI.
These findings indicate that TIMI III flow is not sufficient
to show the tissue reperfusion.
Key Words: ST resolution, Primary PTCA, TIMI-III flow
Statıns ın atherosclerosıs, acute coronary
sydrome an percutanesus coronary ınterventıon
Şan M, Ateş A.
Endothelium plays a key role in
pathophysiology of acute coronary sydrome. The productions and the damage of
nitric oxide (NO) and the biyochemical pathways which regulate then are the
indacators of endotehelial function. LDL inactivates NO statius decreases
LDL.
It has been shown that in the stable or unstable angina patients with the
use of lipid lowering drugs the endothelial function gets better.
Hiperlipidemia increases the formation of thrombocyte aggregation and
thrombocyte-derived tromboxan B2. Besides, the deficiency of NO increases
the trombogenicity. The high level of CRP in the stable and unstable angina
patients is the predictor of cardiac events which will develops later. The
efffect of statins on CRP levels are independent from the antilipidemic
effects. The statin treatment which is started early, decreases the
frequency number of major cardiac events, the heed of repeating intervention,
the incidence of restenosis, and total mortality after the percutaneous
coronary interventions.
In recent years,
important developments has been achieved about clarifying
the base reasons of atherosclerosis. Enlightenment of the
connection between atherosclerosis and inflamation caused
new cardiovascular risk factors and indicators to enter the
clinical practice. The studies have shown the need of new
coronary risk factors. In nowadays, basic epidemiological
new risk factors such as hsCRP and other inflamation signs;
like lipoprotein a, homosistein, fibrinolytic indicators and
fibrinogen, D-dimer, t-PA and PAI-1 as hemostatic functions
which ar the most po-pular indicators.
Aspırın resıstance and clopıdogrel as a
treatment alternatıve
Çiftçi O, Atalar E.
Acetyl salicylic acid
remains the major agent against thromboembolic complications
of atherosclerosis and has a class I indications in most
acute and chronic manifestations of the disease. However,
despite adequate use of aspirin not all patients with
established atherosclerotic disease are protected against
thromboembolic complications leading to disastrous
consequences. Aspirin resistance refers to a phenomenon of
lack of protection of patients by aspirin against
thromboembolic events and it may be responsible at least
part of all clinical thromboembolic events encountered in
clinical practice. The reported prevalence of aspirin
resistance in literature varies considerably, however, this
number reflects in-vitro measurements, and relatively lacks
the ability to predict the clinical endpoints. Moreover, the
different methods measuring the so-called thrombocyte
aggregability lack standardization and are away from
clinical use for the time-being. The proposed mechanisms for
aspirin resistance include erythrocyte-induced platelet
aggregation, smoking, increased levels of circulating
catecholamines, increased sensitivity of platelets to
collagen, and increased production of F2 isoprostane 8-isoprostaglandin
(PGF2alpha). Increasing the dose of aspirin beyond
recommended doses, however, do not ameliorate the aspirin
resistance while increasing the hemorrhagic complications.
Thus, different agents are being constantly sought either
alone, or in combination with aspirin. Apparently the most
promising one is clopidogrel, a thienopyridine analogue
which blocks the thrombocyte ADP receptors. A number of
clinical trials highlighted the importance of clopidogrel in
preventing the major adverse cardiac endpoints in various
clinical settings. This paper reviews the literature and
focuses on the main reasons, assessment techniques of
aspirin resistance and possible alternatives to overcome
this phenomenon.
Treatment of a coarctatıon of the aorta
wıth self-expandable stents: mıgratıon of two stents and
adequate ımplantatıon of a thırd stent
Akgül F, Demirbaş Ö,
Batyraliev T, Karben Z, Igor Pershukov
Balloon angioplasty
and stent implantation are safe and effective
treatment option in coarctation of the aorta. The
majority of the stents have been used for treatment
of coarctation of the aorta in clinical reports
were balloon-expandable stents. However, the use of self-expandable
stents has been sporadic. We report for the first
time a clinical presentation of migration of two
Memotherm self-expandable stents implanted for
coarctation of the aorta and effective treatment of the
coarctation with implantation of a third Memotherm self-expandable
stent overlapping the migrated stents partially.
Key words:
Coarctation of aorta, Stent, Self-expandable stent, Stent
migration
Spontaneous recovery of guıdıng
catheter severe coronary dıssectıon durıng coronary stentıng
procedure
Dağdelen S, Yüce M,
Çağlar N.
A 59 year-old male was
admitted for stable angina. He had a known coronary artery
disease, moderate controlled hypertension and hyperlipidemia.
He had no past history of myocardial infarction, but had a
history of coronary stent procedure four years ago. His
coronary angiography revealed; normal left main coronary
artery, plaque formation in proximal left anterior
descending artery, 80% stenosis in mid left anterior
descending artery, normal circumflex system with patent
previous stent and chronic total occlusions in the right
coronary artery.
Percutaneous coronary intervention was decided for mid left
anterior descending artery and he agreed to undergo PCI. The
Judkins-left 4 6Fr catheter was engaged in the left main
artery. First contrast injection was showed normal left main,
and little spasm formation in the stenotic segment of mid
left anterior descending artery and much less fix stenosis.
During the second contrast injection, it revealed a large
dissection where the tip of the guide catheter contacted
superior margin of the left main artery, and immediately the
catheter was draw back.
The patient suddenly complained of anterior chest pain with
ST change on the electrocardiogram. It showed a large
dissection in the mid left main artery, we decided direct
stent implantation for left main artery to close coronary
dissection.
Contrast injection was showed normal left main artery
without any dissection, and it revealed the same normal
coronary artery segment with repeated contrast injection
after three minutes. The patient was followed for 48 hours
in coronary care unit. There was no ECG change, chest pain
and troponin rising during the follow-up period, and then
the patient was discharged without any other complication.
Key words: Coronary dissection, Left main coronary
artery, Stent implantation
