The Highway Technique: a new stenting technique to treat coronary bifurcation lesions

WOS: 000294133900012PubMed ID: 20142197Aims: We report a new stenting technique which was employed in 12 patients to treat coronary bifurcation lesions. Methods and results: A stent is positioned in the main vessel together with a balloon in the side branch, which is positioned slightly proximal to the main vessel stent that also has enough length to cover the side branch ostium. Both the stent in the main vessel and the balloon in the side branch are inflated simultaneously. Following deflation, a double lumen is created in the main vessel, proximal to the bifurcation. The stent balloon is removed with the side branch balloon left deflated in its initial position. The main vessel is rewired with a third guidewire. The side branch balloon and guidewire are removed. The initial guidewire in the main vessel is directed to the side branch. A balloon is advanced and inflated in the side branch to dilate the struts of the main vessel stent that will provide the side branch entrance. The side branch balloon is left in place. A size matched balloon is advanced on the third guidewire that was advanced in the main vessel and inflated inside the stent with high pressure. Finally, kissing balloon inflation is performed at the bifurcation. Provisional stenting of the side branch can be performed when necessary. Final kissing balloon inflation is recommended after stenting of the side branch. Conclusions: As a new coronary bifurcation stenting method, the Highway Technique has some advantages in side branch protection, with favourable immediate and 30-day clinical outcomes

How to estimate left ventricular hypertrophy in hypertensive patients

Left ventricular hypertrophy (LVH) is a structural remodeling of the heart developing as a response to volume and/or pressure overload. Previous studies have shown that hypertension is not an independent factor in the development of LVH and occurrence does not depend on the length and severity of hypertension, but the role played by other comorbidities such as triglycerides, age, gender, genetics, insulin resistance, obesity, physical inactivity, increased salt intake and chronic stress. LVH develops through three phases: adaptive, compensatory, and pathological phase. Contractile dysfunction is reversible in the first two phases and irreversible in the third. According to the Framingham study, LVH develops in 15-20% of patients with mild arterial hypertension, and in 50% of patients with severe hypertension. The pathophysiology of LVH includes hypertrophy of cardiomyocytes, interstitial and perivascular fibrosis, coronary microangiopathy and macroangiopathy. Individuals with LVH have 2-4 times higher risk of having adverse CV events compared to patients without LVH

How to estimate left ventricular hypertrophy in hypertensive patients

Left ventricular hypertrophy (LVH) is a structural remodeling of the heart developing as a response to volume and/or pressure overload. Previous studies have shown that hypertension is not an independent factor in the development of LVH and occurrence does not depend on the length and severity of hypertension, but the role played by other comorbidities such as triglycerides, age, gender, genetics, insulin resistance, obesity, physical inactivity, increased salt intake and chronic stress. LVH develops through three phases: adaptive, compensatory, and pathological phase. Contractile dysfunction is reversible in the first two phases and irreversible in the third. According to the Framingham study, LVH develops in 15-20% of patients with mild arterial hypertension, and in 50% of patients with severe hypertension. The pathophysiology of LVH includes hypertrophy of cardiomyocytes, interstitial and perivascular fibrosis, coronary microangiopathy and macroangiopathy. Individuals with LVH have 2-4 times higher risk of having adverse CV events compared to patients without LVH

The interaction between endothelin-1 and C-reactive protein and their impact on long-term prognosis after percutaneous coronary interventions

WOS: 000267405600008Introduction: Previous studies have demonstrated unfavourable outcomes in coronary artery disease and percutaneous coronary intervention (PCI) patients with high endothelin-1 (ET-1) or high sensitivity C-reactive protein (hs-CRP) levels. The aim of our study was to investigate the impact of pre-procedural ET-1 and hs-CRP levels on major adverse coronary events (MACE) after PCI and to analyse a possible correlation between ET-1 and hs-CRP in this study population. Material and methods: Eighty consecutive PCI patients with a single de novo, non-occlusive coronary lesion were included. Blood samples were obtained immediately before the procedure. The study endpoint was the occurrence of MACE, which was defined as death (all causes), non-fatal myocardial infarction or repeat coronary revascularization (PCI or surgery). Results: At the end of the 24 months' follow-up, 28 patients (35%) reached an end-point. We could not observe any correlation between ET-1 and hs-CRP in the overall patient group (r = 0.141, p = 0.213). Neither ET-1 nor hs-CRP levels were found to be predictive for MACE after PCI in multivariate analyses (p = 0.605 and 0.757 respectively). Conclusions: We could not demonstrate a relationship between pre-procedural ET-1 or hs-CRP levels and MACE at 24 months after successful PCI with single stent implantation to single de novo lesions. This study also could not show any correlation between ET-1 and hs-CRP levels in PCI patients

Aneurysm of the membranous septum detected during left ventriculography and demonstrated by cardiac magnetic resonance imaging

WOS: 000268628100029PubMed ID: 18674835

Response to the Letter to the Editor: "The correct number of double right coronary artery reported in the literature"

WOS: 000269156200015PubMed ID: 19073355

Evaluation of Graft Patency After Coronary Artery Bypass Grafting by Using Stress Echocardiography Combined With Strain Imaging

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400113…Turkish Soc Cardio

Treatment of saphetious vein graft lesions with paclilaxel- and sirolimus-eluting stews: comparison of short- and long-term clinical outcomes

WOS: 000262178300007PubMed ID: 19103539Objective: The purpose of this study was to compare treatment of saphenous vein graft (SVG) lesions with paclitaxel-eluting (PES) and sirolimus-eluting stents (SES) in daily practice with regard to short- and long-term clinical outcomes. Methods: Between August 2002 and September 2006, a total of 71 patients with SVG lesions who were implanted PES or SES with percutaneous coronary intervention in our center were evaluated retrospectively. Forty-six patients with PES (PES group) were compared to twenty-five patients treated with SES (SES group) in terms of in-hospital, 30-day, six-months and 1-year clinical outcomes. Statistical analyses were performed using Chi-Square statistics or Fisher's exact and independent sample t test. Survival analysis was done using Kaplan-Meier method and log-rank test. Results: Baseline clinical characteristics were similar in both groups except for a tendency toward a lower age in the SES group. No statistically significant difference was found between two groups by means of lesion and procedural characteristics. All clinical outcomes at 30-day, 6-month and 1-year after the interventions were similar in both groups. Early stent thrombosis was detected in one patient (2.2%) of PES group (p=0.65). Late stent thrombosis was not observed in both groups. The rate of major adverse cardiac events at 1-year was 8.7% in the PES group and 16% in the SES group (p=0.44). Conclusion: Short- and long-term clinical outcomes of PIES and SES in the treatment of SVG lesions are similar. The results of our study showed that both drug-eluting stents are effective and safe in real-world patient with diseased SVGs. (Anadolu Kardiyol Derg 2008; 8: 437-6

Comparison of intracoronary versus intravenous administration of tirofiban in primary percutaneous coronary intervention

WOS: 000281309900009PubMed ID: 20693130Objective: The purpose of this study was to compare the intravenous bolus dose of tirofiban with intracoronary bolus dose in primary percutaneous coronary intervention (PCI) with regard to in hospital and six months clinical outcomes and peak cardiac enzyme levels. Methods: We retrospectively examined 84 ST elevation myocardial infarction (STEMI) patients who underwent primary PCI from March 2006 to February 2007. All patients received the systemic bolus dose of tirofiban 10 mcg/kg either via intracoronary (IC) or intravenous (IV) route, followed by a 36 hours of IV infusion at 0.15 mcg/kg/min. Thirty six patients in IC group were compared with 48 patients in IV group in terms of peak cardiac enzyme levels, in-hospital and six months major adverse cardiac events (MACE) rates (death, myocardial infarction and repeat revascularization). Fisher's exact test, Yates Chi-square, unpaired Student's t-test and Mann-Whitney U test were used for statistical analysis. Results: There was no difference in cardiovascular risk profile or cardiac history between two groups. At six months the incidence of MACE was 6.25% in IV group and 11.1% in IC group (p=0.45). Peak cardiac phosphokinase (CPK) levels between IV and IC groups were also statistically non significant (2657 +/- 2181 U/L in IV group and 2529 +/- 1929 U/L in IC group) (p=0.92). Conclusion: Intracoronary bolus application of tirofiban was not associated with reduction in MACE rates compared to intravenous administration in patients with STEM! who underwent primary PCI. Future prospective trials with higher bolus doses of IC tirofiban should addressed to clarify this issue. (Anadolu Kardiyol Derg 2010;10:340-5