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Late lumen loss In the proxImal and
dIstal vessel walls adjacent to the stent I s due to IntImal
hyperplasIa In the stented populatIon wIth non- radIatIon
İlkay E, Yavuzkır M, Rahman A,
Özercan İ, Karaca I, Dağlı N, Dağlı F, Tırıklı A.L, Köksal H.
Edge effect has been reported recently to take
place in the stent population with non- radiation. The mechanism of this
edge effect is not clear yet. This study investigated the role of intimal
hyperplasia in the late lumen loss at the stent/vessel margin.
The study was carried out on
10 New Zealand rabbits. On the 90th day after infra-renal stent implantation,
the abdomen was opened by median laparotomy incision, after which the site
from the abdominal aorta to common iliac arteries was excised. Tissue
sections were described as A1-5 for proximal edge and as B1-5 for distal
edge.
Intimal hyperplasia was
evident in the vessel walls adjacent to the stent and hyperplasia was
becoming lesser when going far from the edge of the stent. Hyperplasia was
not observed in A4,5 and B4,5 sections. At the proximal and, statistical
significances as p=0,011 for A1-A2, p=0,012 for A1-A3, p=0,011 for A1-A4
and p=0,011 for A1-A5 were observed when comparison was made for each
section. However, there observed no significance for A4-A5. At the distal
and statistical significances as p=0,012 for B1-B2, p=0,012 for B1-B3,
p=0,012 for B1-B4 and p=0,012 for B1-B5 were observed. No significance was
observed for B4-B5 (p=1). When comparison was made for the proximal edge
and distal edge, statistical significance was observed as p<0.001 for A1-B1,
p <0.001 for A2-B2, p <0,001 for A3-B3. However, no significances were
observed between A4-B4 and between A5-B5 (p=1 and p=1 respectively).
Late lumen loss in the
proximal and distal vessel walls adjacent to the stent is due to intimal
hyperplasia and the degree of the hyperplasia is reduced when going far away
from the stent edge.
The effect of coronary
artery stentIng In patIents wIth low left ventrIculary ejectIon
fractIon to the decrIsed myocardIal functIon
Dinler G, Bokeria L.A,
Batyraliev T.
The aim of this study
was to evaluate the effectivity of endovascular approaches
to coronary arteries in patients with left ventricular
ejection fraction (LVEF) lower than 40 %.
Totally 135
patients with chronic ischemic heart disease with low LVEF
were subjected to endovascular approac-hes since 1997 till
first half 2006 years in Bakulev Cardiovascular Surgery
Center (Moscov) and Sani Konukoglu Medical Center
(Gaziantep). According to NYHA classification, 47 (34,8%)
patients had Class I, 78 ( 57,7 % ) Class II, and Class III
was observed in 10 (7,4%) patients. LVEF value ranged from
14 to 40, the mean value was 33 ± 4,5 %. Single artery
stenting was performed in 69 (51,1%), 2 arteries 52 (37,8%)
and 3 arteries stenting in 15 (11,1%) patients. In 60
(44,4%) of the patients were implanted drug eluting stents .
The
angiografi cally success of intervention has been reached
in 100 % of cases. In hospital death was deve-loped in 2
(1,5%) cases. After endovascular approaches, 105 (78,9%)
patients had Class I-II and 10 (7,5%) Class III-IV according
to the CCS classification. In 18 (13,5%) patients, angina
disappeared. After stenting at 74,0 % of patients change of
expressiveness of heart failure at least on 1 class was
observed. LVEF mean values raised from 33±4.5 % to 42±6,2 %
(p< 0,01).
Like
investigators opinion, stenting to coronary arteries seemed
to be effective methods to treat the stabl form of ischemic
heart disease (IHD) in patients with low LVEF. These methods
do not have high surgery risks as well as they increase the
life quality and the function of left ventricular myocardium.
The effect of successful
electIve percutaneous coronary InterventIon on left ventrIcular
functIons assessed wIth tIssue Doppler ImagIng method
Çaylı M, Usal A, Demir M,
Kanadaşı M.
Reperfusion after percutaneous
coronary intervention (PCI) has been shown to improve the left ventricular
systolic and diastolic functions. Tissue Doppler imaging (TDI) is a new
technique that allows assessing quantitatively the global and regional
ventricular systolic and diastolic functions. The aim of the present study
was to determine the effects of elective and successful PCI on left
ventricular functions by using TDI method.
Forty-one patients who
underwent elective PCI were studied. Patients were divided into three groups
accor-ding to coronary artery PCI performed; left anterior descending artery
(Group 1), circumflex artery (Group 2) and right coronary artery (Group 3).
Routine echocardiographic examination and TDI were performed in all patients.
The peak myocardial systolic (S wave) and diastolic (E and A waves)
velocities were recorded. All examinations were done before PCI and 24th
hour and 3rd month after PCI.
There was no significant
difference in global systolic and diastolic function at 24th hour and 3rd
month in all groups. Regional S wave velocity increased at 24th hour only in
Group 1 (p=0.004). But there was no significant S wave velocity change at
3rd month in all groups. Although, there was no significant improvement of
regional diastolic function at 24th hour, regional diastolic function
improved at 3rd month in Group 1 and 2.
Only regional diastolic
function is improved at 3rd month after elective and successful PCI. Global
systolic and diastolic functions and regional systolic function are not
changed at 3rd month.
Does low serum paraoxonase-1 actIvIty become
a rIsk factor for coronary atherosclerosIs In postmenopausal
women?
Gündoğdu F, Erol M.K, Polat F, Sevimli
S, Arslan Ş, Gürlertop Y, Karakelleoğlu Ş.
Atherosclerosis is a
multifactorial disease, and hyperlipidemia is a major risk
factor for the development of cardiovascular disease.
Paraoxonase 1 (PON 1) plays role on lipid metabolism. This
study was performed with the aim to determine whether serum
PON 1 activity might be a factor development of
atheroscleros in postmenopausal women.
We conducted
a case-control study on 50 unrelated subjects who referred
to the cardiology department of the university hospital for
coronary angiography because of suspected ischemic heart
disease. The subjects were evaluated on their angiographic
findings in two groups. The patients group (n=25) composed
of subjects with angio-graphy cally documented coronary
artery disease (CAD) and the control group without
angiographically documented CAD (CAD-free subjects). PON 1
activity was measured either by spectrophotometer.
When
compared with age and mean time after menopause were similar
both group (p>0.05). The patients with CAD had significantly
higher total cholesterol (p<0.001), LDL cholesterol
(p<0.001) and triglyceride (p<0.01) levels when compared
with the controls but HDL cholesterol (p<0.05) level was
found significantly low. Serum basal PON 1 activity had
lower in CAD group but the difference did not statistically
significant when compared with the controls (p>0.05). On the
other hand, salt-stimulated with 1 M NACL PON-1 activity had
significantly lower in CAD group when compared with the
controls (p<0.005).
The results
of this study suggest that low serum PON 1 activity may also
be a risk factor in patients with postmenopausal women for
the CAD.
Invasive cardiology
techniques, which are commonly used nowadays, progressively
used in this field. Intracoronary stent techniques which are
used in invasive cardiology have become a common method and
the usage of balloon angioplasty has decreased the
complications such as acute collapse, dissection which are
seen during the surgery and also decreased the ratios of
restenosis. By the way the usage of stent prevents early
elastic recoil and they do not change late vascular
remodeling. Intracoroner ultrasound studies eliminate
elastic recoil and negative remodeling on the stent and in-stent
restenosis is basicly responsible for the increase of
intimal. Recently the stent's late oscillation
antirestenosis agents has draw great attention and
experiments on animals have shown that the agents which are
oscillatory from polymer plated dercreases neointima
thickness. Drug eluting stents which are compared to
standard stents decrease stent restenosis. However the
restrictions in usage of stents still continues. The
problems such as hipersensitivite reactions, late trombosis,
late endothelialization are seen in drug covered stents.
Nowadays newly developing technologies and drug covered
stents, polymer technology, gene added stents and absorbable
polymer stents found usage in the area.
In this
collected work stents which are used with polymer technology
and bioabsorbable stents are studied.
Coronary In-stent restenosIs and drug
elutIng stents
Batyraliev T, Avşar Ö.
In-stent restenosis (ISR) is a
novel pathobiologic process, histological distinct from
restenosis after balloon angioplasty and comprised largely
of neointima formation. As percutaneous coronary
intervention increasingly involves the use of stents, ISR is
also becoming correspondingly more frequent. In this review,
we examine the available stu-dies of the histology and
pathogenesis of ISR. An overview of mechanical treatments is
then provided, which includes drug eluting stents. Drug
eluting stent based therapies are discussed, including a
summary of current problems associated with this modality of
treatment. Finally, novel strategies for the prevention of
ISR are addressed, including novel developments in stents
and stent coatings. Until recently, limited pharmacologic
and mechanical treatment options have been available for
both treatment and prevention of ISR. However, recent
advances in local stent-based drug delivery systems make it
conceivable that the incidence of ISR will now be seriously
challenged.
Key Words:
In-stent restenosis, Drug eluting stents, Restenosis, Stent
ObstructIve sleep apnea syndrome and
cardIovascular dIsease
Batyraliev T, Avşar Ö,
Ekinci E.
States predicts that
obstructive sleep apnea syndrome (OSAS) may become even more
common. In many studies, the estimated prevalence of sleep-disordered
breathing, defined as an apnea-hypopnea index (AHI) of 5 or
higher, was 24 percent for men and percent for women. Among
state employees in Wisconsin 30 to 60 yr of age, Young and
colleagues estimated that 4% of men and 2% of women meet the
criteria for the clinical syndrome of OSAS. In adults, that
the prevalence of sleep apnea is much higher than the asthma
and diabetes mellitus. The sleep apnea in the United States
was being responsible from 38.000 yearly of deaths for
cardiovascular and 42 billion dollars hospitalizations.
Founded that those with an apnea- hypopnea index (AHI)
greater than 20 had a much greater mortality than those with
AHI less than 20. Although many investigators have reported
that there is a significant link between OSAS and the
cardiovascular events i.e. hypertension, cardiac arrhythmia,
myocardial infarcts, pulmonary hypertension, stroke. It has
been reported that OSAS is associated with hypertension,
independent of the confounding factors of age, sex, body
muscle index (BMI), alcohol and cigarettes.
Cardiac
failure was occurred in consequence of all heart disease.
Cardiac failure was consisting of systolic and diastolic
dysfunction of heart. Mortality of systolic heart failure is
% 18,9 and diastolic heart failure is % 8,7. OUAS patient
with in left ventricular systolic and diastolic heart
failure was existing study. These conditions could be an
early describe very important, because OSAS patients with
cardiac failure should be followed-up progression and
prevent from complications.
Left maIn coronary artery arIsIng from
the rIght sInus of valsalva wIth bIcuspId aortIc valve rare
coronary artery anomaly; a case report
Yavuzkır M, Karaca I.
The bicuspid aortic
valves accompany with coronary anomalies are not common
malformation. A female patient who has both these anomalies
was presented here. The patient underwent to successful
aortic valve replacement surgery.
StentIng of anomalous cIrcumflex artery
of a metabolIc syndrome patIent wIth a prevIous CABG (anomalous
cIrcumflex stentIng)
Temamoğulları A,
Batyraliev T.
Coronary artery
anomalies are found in approximately 1.3 percent of patients
undergoing coronary angiography. Although clinical course of
coronary anomalies is silent in general, a wide range of
clinical sequelae is noted. Currently besides reviewed the
literature we presented here a rare case of deployment of a
drug eluting stent to congenitally anomalous circumflex
coronary artery of a patient with metabolic syndrome who had
underwent to a conventional graft operation five years ago.
SIngle coronary artery from the rIght sInus
of valsalva, assocIated wIth myocardIal IschemIa
Kılıç H, Akdemir R, Biçer
A.
We present the case of
a patient in anomalous origin of the left coronary artery
that caused myocardial ischemia. Coronary angiography showed
that the left coronary artery arose from the right coronary
ostiuman anomaly that has been associated with chest
discomfort without atherosclerotic lesions.
Key Words:
Single coronary artery, Coronary angiography, Coronary
artery disease
