Does the use of rotational atherectomy procedure during percutaneous coronary interventions influence the frequency of procedure-related myocardial injury assessed by cardiac magnetic resonance?

The usage of gadolinium-enhanced cardiac magnetic resonance (CMR) in the differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease has been demonstrated in previously published studies. It currently remains one of the basic methods for assessing myocardial ischemia, which has been reflected in many international guidelines, including those of the European Society of Cardiology (1-3). Also, T2 mapping for myocardial edema, cine CMR for regional wall motion abnormalities, rest first pass and adenosine stress perfusion are well sanctioned methods of myocardial ischemia assessment, also used in patients with acute coronary syndromes (4-6)

Comparison of the usefulness of selected formulas for GFR estimation in patients with diagnosed chronic kidney disease

Introduction: The diagnosis and classification of chronic kidney disease (CKD) are based on the glomerular filtration rate value. The simplest way to evaluate glomerular filtration rate is to estimate it based on serum creatinine concentration using one of many specific mathematical formulas. None of the formulas created for this purpose are perfect. Differences in eGFR values are frequently observed in specific stages of chronic kidney disease by KDIGO classification based on different formulas. Aim: The aim of the study is to compare the eGFR value in patients previously diagnosed with CKD treated in the Outpatient Nephrology Unit of the University Hospital in Krakow using the selected formulas. Material/Methods: The study was performed in a group of 882 patients (392 women, 490 men) aged 65.0 ± 14.8 years. GFR values were estimated using Bjornsson, the abbreviated MDRD, and CKD-EPI formulas. These values were then compared according to chronic kidney disease stage and age groups: above and below 60 years. Results: The mean eGFR value was for Bjornsson formula- 47.2 ± 21.1 ml/min/1.73m2, abbreviated MDRD formula- 38.8 ± 15.2 ml/min/1.73m2, and CKD-EPI formula- 37.7 ± 15.9 ml/min/1.73m2. There was a large concordance in eGFR values obtained using the CKD-EPI and abbreviated MDRD formulas in every stage of chronic kidney disease and in both age groups. The Bjornsson formula significantly increased the number of patients in early stages of CKD, G1 - 33 vs 2 (abbreviated MDRD) and 6 (CKD-EPI), G2- 186 vs 70 (abbreviated MDRD) and 69 (CKD-EPI). Conclusions: CKD-EPI and abbreviated MDRD formulas have a similar usefulness in GFR value estimation in patients with diagnosed chronic kidney disease. Lower eGFR values achieved using abbreviated MDRD formula and CKD-EPI equation in comparison with Bjornsson’s formula may result in an increased number of patients diagnosed with CKD

Fibrinolytic therapy of arterial thrombosis in patients with peripheral arterial disease previously treated with endovascular interventions with stent placement

Background. Acute in-stent thrombosis can occur in patients with peripheral arterial disease previously treated with endovascular interventions with stent implantation. Local fibrinolysis is an alternative treatment to endarterectomy. This study aims to determine the outcomes of local fibrinolysis in patients with arterial instent thrombosis. Material and methods. We retrospectively reviewed 27 cases following procedures of local fibrinolysis in patients with diagnosed recent thrombosis of peripheral arteries previously treated with endovascular interventions with stent placement. In 2 patients, in-stent thrombosis was diagnosed within 1 day of stent implantation, while in the other patients thrombosis was observed several or even a dozen months after endovascular procedure. As a fibrinolytic agent we used t-PA (Actylise), which was administered by fibrinolytic catheter localised in the occluded artery. Initial treatment was 5mg bolus of t-PA followed by infusion at a rate of 1–1.5 mg/h. Continuous infusion of therapeutic dose of heparin was maintained. Blood parameters, such as coagulation, blood count, renal function parameters, and electrolytes, were monitored. Duration of infusion ranged from 12 to 120 hours. Angiography was used to assess the final effect of fibrinolysis. We analysed the type and frequency of adverse events and their appearance according to duration of t-PA infusion. Results. We obtained satisfactory reocclusion of the arteries in 24 patients (88.8%). No complications were noted in 14 patients (48%). We did not observe any severe adverse events such as intracranial bleeding, intestinal bleeding, myocardial infarction, or death. Most of the complications were noted within 24 hours of fibrinolysis. Conclusions. Local fibrinolytic therapy of in-stent thrombosis with intraarterial infusion of fibrinolytic catheter localised under angiographic control is an effective method of patency restoration. The longer the fibrinolysis, the higher the possibility of adverse events. According to the analysis it is questionable whether or not strict monitoring of blood parameters can decrease the number of potential adverse events.Wstęp. U pacjentów z miażdżycą zarostową tętnic kończyn dolnych poddanych leczeniu wewnątrznaczyniowemu może nagle wystąpić ostre niedokrwienie z powodu zakrzepicy w obrębie wszczepionych stentów. Alternatywnie do embolektomii chirurgicznej można wykonać miejscową trombolizę. Celem pracy była ocena leczenia trombolitycznego zakrzepicy tętnic kończyn dolnych w obrębie uprzednio wszczepionych stentów. Materiał i metody. Ocenie poddano 27 kolejnych zabiegów trombolizy u pacjentów z miażdżycą zarostową tętnic kończyn dolnych, u których stwierdzono zakrzepicę w obrębie wszczepionych stentów. W wypadku 2 chorych trombolizę rozpoczęto w przeciągu 1. dnia od wszczepienia stentu, a u pozostałych pacjentów od kilku do kilkunastu miesięcy po wszepieniu stentu. Do leczenia fibrynolitycznego stosowano tkankowy inhibitor plazminogenu (Actylise) w dawce 1–1,5 mg/godzinę we wlewie ciągłym, który podawano przez cewnik fibrynolityczny umieszczony w obrębie niedrożności. Wlew poprzedzano bolusem 5 mg i.a. Równocześnie prowadzono ciągły wlew heparyny niefrakcjonowanej w dawce terapeutycznej. W trakcie trombolizy monitorowano parametry biochemiczne, morfologii oraz krzepnięcie krwi. Wlew kontynuowano przez 12–120 godzin. Ostateczny efekt oceniano angiograficznie. Analizowano rodzaj i częstość powikłań oraz ich występowanie w zależności od czasu trwania trombolizy. Wyniki. W 24 przypadkach na 27 (88,8%) uzyskano udrożnienie światła naczyń. Zabieg przebiegł bez powikłań w 14 przypadkach (48%). Nie odnotowano istotnego krwawienia do przewodu pokarmowego, zawału serca, udaru mózgu ani zgonu chorego. Stwierdzone powikłania w znaczącym odsetku wystąpiły po upływie 24 godzin od rozpoczęcia fibrolizy. Wnioski. Miejscowe leczenie trombolityczne zakrzepicy występującej u chorych po angioplastyce wewnątrznaczyniowej i implantacji stentu jest skuteczną metodą udrażniania tętnic. Czas prowadzonej trombolizy zwiększa ryzyko powikłań. Istnieją wątpliwości odnośnie możliwości zmniejszenia liczby powikłań dzięki monitorowaniu parametrów biochemicznych, morfologicznych oraz krzepnięcia krwi