Analysis of radial artery occlusion causes and methods of its prevention after interventions using radial access. Results of the APRIORI study

Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p<0,001). Predictors of RAO were type 2 diabetes (odds ratio (OR), 1,9, 95% confidence interval (CI), 1,1-3,4, p=0,03) and an increase in hemostasis duration by 1 hour (OR, 1,2, 95% CI, 1,1-1,3, p<0,001). When analyzing the retrospective part, the predictors of RAO were body mass index (OR, 1,06, 95% CI, 1,02-1,09, p=0,002), female sex (OR, 0,6, 95% CI, 0,4-0,9, p=0,02), smoking (OR, 1,38, 95% CI, 1-1,91, p=0,047). The administration of statins in different dosages, as well as antihypertensive and anti-ischemic agents, did not have a significant effect on the RAO rate.Conclusion. The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate

DEEP GUIDE WIRE PENETRATION TECHNIQUE IN COMPLEX CORONARY ANATOMY

The presented literature analysis is focused on the heart microvasculature and finding new ways to perform the method of deep coronary penetration technique. Also, new data reflecting the technique’s efficacy and safety are published on regular basis

Immediate and Long-term Results of Stenting of the Unprotected Left Coronary Artery Trunk in Patients with Stable Coronary Heart Disease

Objective. To assess the immediate and long-term results of stenting of the unprotected left coronary artery (LCA) trunk in patients, by using different types of drug-eluting stents.Material and methods. The follow-up covered 282 patients who had undergone stenting of the unprotected LCA trunk. The mean follow-up was 34.6 [33.9; 35.3] months. The patients were divided into groups according to the type of a first-, second-, and third-generation implanted stent.Results. The incidence of adverse cardiovascular events in the patients of Group 1 was significantly higher than in those in Groups 2 and 3 (29 and 7.6%, p<0.0001). The incidence of thrombosis of first-generation stents (7.0%) was significantly higher than that of second- and third-generation ones (1.6%) (p=0.02). The incidence of adverse cardiovascular events was comparable between Groups 2 and 3, despite a shorter duration of dual antiplatelet therapy in the third-generation stent group. The absence of stent postdilatation in the LCA trunk is an independent risk factor for adverse prognosis.Conclusion. The use of second- and third-generation stents along with changes in the technical aspects of stenting of the unprotected LCA trunk leads to a substantial reduction in the risk of adverse cardiovascular events and allows the indications for intervention to be expanded in this patient category

Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism