Miokardo revaskuliarizacijos efektyvumo įvertinimas vyraujant difuziniam ateroskleroziniam širdies vainikinių arterijų pažeidimui

There is still a controversy in the treatment of long coronary lesions. In case of diffuse coronary artery disease the optimal extent of revascularization is not well established and is usually operator dependent. The aim of this study was to evaluate functional, angiographic and clinical results of fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) on long coronary lesions using 2nd or newer generation drug eluting stents (DES). Patients were included if they had a lesion in a major coronary vessel where FFR value was ≤ 0.8 and it was envisaged that a stent ≥ 30 mm in length would be necessary. Achieving an optimal post PCI FFR result in patients with long diffuse coronary artery disease was only possible in a limited number of cases equating to 12.2%. An optimal FFR result could not be achieved in any patient who was treated with >50 mm of stent. The use of long and ultra-long stents resulted in a high proportion of patents with residual hemodynamically significant ischemia (10.8% of cases with post PCI FFR ≤ 0.80). The rate of functional restenosis at 9 months follow up was shown to be approximately 3 times higher than angiographic restenosis. In the majority of cases diffuse coronary artery disease cannot be functionally effectively treated using long and ultra-long drug eluting stents. PCI on long coronary lesions could be used as an option in the high CABG risk patients with diffuse coronary artery disease

The effectiveness of myocardial revascularization in patients with diffuse coronary atherosclerosis

There is still a controversy in the treatment of long coronary lesions. In case of diffuse coronary artery disease the optimal extent of revascularization is not well established and is usually operator dependent. The aim of this study was to evaluate functional, angiographic and clinical results of fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) on long coronary lesions using 2nd or newer generation drug eluting stents (DES). Patients were included if they had a lesion in a major coronary vessel where FFR value was ≤ 0.8 and it was envisaged that a stent ≥ 30 mm in length would be necessary. Achieving an optimal post PCI FFR result in patients with long diffuse coronary artery disease was only possible in a limited number of cases equating to 12.2%. An optimal FFR result could not be achieved in any patient who was treated with >50 mm of stent. The use of long and ultra-long stents resulted in a high proportion of patents with residual hemodynamically significant ischemia (10.8% of cases with post PCI FFR ≤ 0.80). The rate of functional restenosis at 9 months follow up was shown to be approximately 3 times higher than angiographic restenosis. In the majority of cases diffuse coronary artery disease cannot be functionally effectively treated using long and ultra-long drug eluting stents. PCI on long coronary lesions could be used as an option in the high CABG risk patients with diffuse coronary artery disease

Intravascular Ultrasound Guidance Is Associated with a Favorable One-Year Target Vessel Failure Rate and No Residual Myocardial Ischemia after the Percutaneous Treatment of Very Long Coronary Artery Lesions

Background: Studies have shown that percutaneous coronary intervention (PCI) in long coronary artery lesions (≥30 mm) is associated with more frequent target vessel failure (TVF), and a significant proportion of patients have lesions that continue to induce ischemia after PCI (FFR ≤ 0.8). We investigated the impact of intravascular ultrasound (IVUS) on the functional PCI result and one-year TVF rate after the percutaneous treatment of long coronary artery lesions. Methods: A total of 80 patients underwent IVUS-guided PCI in long coronary artery lesions. The PCI results were validated with IVUS and FFR. Procedural outcomes were the proportion of patients with: (1) optimal physiology result (post PCI FFR value ≥ 0.9); (2) optimal anatomy result (all IVUS PCI optimization criteria met); and (3) optimal physiology and anatomy result. The clinical outcome was TVF during a one-year follow-up (target vessel (TV)-related death, TV myocardial infarction, ischemia-driven TV revascularization). Results: The mean stented segment length was 62 mm. The target vessel (TV) was the left anterior descending artery in 82.5% of cases. There were no patients with residual ischemia (FFR ≤ 0.8) after PCI. Optimal coronary flow (FFR ≥ 0.9) was achieved in 37.5%; optimal anatomy, as assessed by IVUS, was achieved in 68.4%; and both optimal flow and anatomy were achieved in 25% of patients. Target vessel failure during the 12-month follow-up was 2.5%. Conclusions: In the percutaneous treatment of very long coronary artery lesions, the use of IVUS guidance is associated with a low TVF rate during a one-year follow-up and no residual myocardial ischemia, as assessed by FFR

Intravascular Ultrasound vs. Fractional Flow Reserve for Percutaneous Coronary Intervention Optimization in Long Coronary Artery Lesions

Background: intravascular ultrasound (IVUS) and fractional flow reserve (FFR) have both been shown to be superior to angiography in optimizing percutaneous coronary intervention (PCI). However, there is still a lack of comparative studies between PCI optimization using physiology and intravascular imaging head-to-head. The aim of this study was to compare the effectiveness of FFR and IVUS PCI optimization strategies on the functional PCI result (assessed with FFR) immediately post-PCI and at 9–12 months after the treatment of long coronary lesions. Methods: This was a single-center study comparing post-PCI FFR between two different PCI optimization strategies (FFR and IVUS). The study included 154 patients who had hemodynamically significant long lesions, necessitating a stent length of 30 mm or more. The procedural outcomes were functional PCI result immediately post-PCI and at 9–12 months after treatment. Clinical outcomes included target vessel failure (TVF) and functional target vessel restenosis rate during follow-up. Results: Baseline clinical characteristics and FFR (0.65 [0.55–0.71]) did not differ significantly between the two groups and the left anterior descending artery was treated in 82% of cases. The FFR optimization strategy resulted in a significantly shorter stented segment (49 mm vs. 63 mm, p = 0.001) compared to the IVUS optimization strategy. Although the rates of optimal functional PCI result (FFR > 0.9) did not significantly differ between the FFR and IVUS optimization strategies, a proportion of patients in the FFR group (12%) experienced poor post-PCI functional outcome with FFR values ≤ 0.8, which was not observed in the IVUS group. At the 9–12 month follow-up, 20% of patients in the FFR group had target-vessel-related myocardial ischemia, compared to 6% in the IVUS group. The rates of TVF and functional target vessel restenosis during follow-up were also numerically higher in the FFR optimization group. Conclusions: The use of FFR PCI optimization strategy in the treatment of long coronary artery lesions is associated with a higher incidence of poor functional PCI result and larger myocardial ischemia burden at follow-up compared to the IVUS optimization strategy. However, this discrepancy did not translate into a statistically significant difference in clinical outcomes. This study highlights the importance of using IVUS to optimize long lesions functional PCI outcomes

Ilgų vainikinių arterijų susiaurėjimų PKI vadovaujantis frakcijinio tėkmės rezervo tyrimu: dvejų metų klinikiniai rezultatai naudojant antros ir naujesnės kartos vaistais dengtus stentus

Background. Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions. Materials and methods. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints – target vessel revascularization (TVR) and major adverse cardiac events (MACE) – were recorded at 1 and 2 years. Results. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, p = 0.6). On regression analysis, the total stent length had no influence on the TVR rate. Conclusions. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes

Use strontium-89 in the anaalgesic treatment of cancer patients witch bone metastases

The aim of this article was to review the available literature regarding to the use of strontium-89 in the palliation of osteoblastic bone pain. The data of many researches showed that approximately 80% of patients witch pain from osteoblastic lesions resulting from prostate or breast cancer experience significant pain relief by administration of strontium-89, witch only mild levels of hematotoxicity. The duration of pain relief in some cases exceeded 3-6 months. Indications for administration of strontium-89, effectiveness and duration of the treatment, side effects are reviewed in this article

Evaluation of atrial fibrillation management and cardiovascular risk profile in atrial fibrillation patients: A cross-sectional survey

Objective The aim of this study to investigate the most frequent risk factors of atrial fibrillation (AF), co-morbidities, complications associated with AF and the use of anticoagulants and other medications in patients who were referred to university hospitals in Lithuania. Materials and methods This cross-sectional study enrolled consecutive inpatients and outpatients with AF presenting to cardiologists in the two biggest Lithuanian university hospitals from November 2013 to May 2014. AF diagnosis was confirmed by a 12-lead ECG or 24-h Holter with an episode duration of >30 s. Results A total number of 575 patients were recruited, and complete data on clinical subtype were available for 515 patients (mean age of 70.7 years; 48.5% of women). Permanent AF was the most frequent type of AF (46.6%). Common comorbidities were hypertension (85.8%), heart failure (77.9%) and coronary artery disease (51.8%). Amiodarone was the most common antiarrhythmic agent used in 14.6% of the patients, while beta-blockers and digoxin were the most often used rate control drugs (59.6% and 10.7%, respectively). Oral anticoagulants were used by 53.3% of the patients; of them, 95.6% used vitamin K antagonists, while non-vitamin K antagonist were used by only 4.4%. The INR within a therapeutic range (2.0–3.0) was documented in 19.2% of the patients. Other antithrombotic drugs such as aspirin and clopidogrel were used in 13.7% and 2.0% of the patients, respectively; dual antiplatelet treatment was administered in 6.2% of the patients. Of the entire cohort, the mean CHA2DS2-VASc score was 3.97 ± 1.6 and the mean HAS-BLED score was 2.25 ± 1.0. Conclusions Compliance with the treatment guidelines remains suboptimal and further patient education is needed