Przezcewnikowe leczenie udaru niedokrwiennego o wysokim ryzyku powikłań krwotocznych

A case of acute ischemic stroke following pacemaker implantation treated via endovascular intervention together with intra-arterial thrombolysis has been presented. Through right radial access, proximal thrombotic occlusion of the left M1 segment of the middle cerebral artery was confirmed within 2.5 hours of symptoms onset. The Sion Blue wire was placed through the thrombus in the distal region of the artery and then the thrombus was aspirated with Finecross microcatheter. At the end of the procedure through the microcatheter two selective intra-arterial boluses of 5 mg of Alteplase were injected. The patient was discharged 6 days after the intervention with Rankin score 2, without bleeding events.Przedstawiono przypadek ostrego udaru niedokrwiennego po implantacji kardiostymulatora, leczony za pomocą interwencji wewnątrznaczyniowej z jednoczesnym lokalnym podaniem trombolizy. Po wprowadzeniu cewnika przez prawą tętnicę promieniową uwidoczniono proksymalne zamknięcie segmentu M1 lewej tętnicy środkowej mózgu w ciągu 2,5 godziny po wystąpieniu objawów. Następnie umieszczono prowadnik Sion Blue dystalnie do miejsca zakrzepu, a zakrzep zaaspirowano mikrocewnikiem Finecross. Po zakończeniu procedury poprzez mikrocewnik wstrzyknięto dotętniczo dwa bolusy Alteplazy po 5 mg. Pacjent został wypisany do domu 6 dni po interwencji w stopniu według Rankina 2, bez zdarzeń krwotocznych

Intracoronary ECG guided PCI in the contemporary catheterization laboratory. Part 1

Intracoronary ECG was invented in 1974 and in 1985 it was shown for the first time that intracoronary wire could be used as an ECG unipolar lead to detect ongoing ischemia in humans. Intracoronary ECG still remains highly underused technique for guiding percutaneous coronary interventions. This article summarizes studies dating from 1974 through 2016 showing intracoronary ECG usefulness in finding zones of ischemia, predicting myocardial necrosis, exploring vital myocardium, predicting myocardial recovery during primary PCI and finding new possibilities for developing better strategies for PCI. Still very cheap and easy to perform, it however requires additional time and deserves better integration in the catheterizationlaboratory.Wewnątrzwieńcowe EKG zarejestrowane za pomocą jednobiegunowego prowadnika wprowadzonego do tętnicy wieńcowej w celu oceny niedokrwienia wynaleziono w 1974 roku, a po raz pierwszy zostało wykonane u człowieka w 1985 roku. Wewnątrzwieńcowe EKG wciąż jest bardzo rzadko stosowaną techniką diagnostyczną podczas przezskórnej interwencji wieńcowej (PCI). Artykuł ten podsumowuje badania z okresu 1974–2016, pokazując że wewnątrzwieńcowe EKG może być przydatne w znalezieniu strefy niedokrwienia, przewidywaniu martwicy mięśnia sercowego, detekcji żywotnego miokardium, prognozowaniu zdrowienia mięśnia sercowego po pierwotnej PCI, jak również w poszukiwaniu nowych strategii podczas PCI. Nadal bardzo tanie i łatwe do wykonania, mimo iż wymaga dodatkowego czasu, to zasługuje na większe zainteresowanie przez pracujących w pracowniach hemodynamiki

Intracoronary ECG guided PCI in the contemporary catheterization laboratory. Part 2

Intracoronary ECG, which was created with unipolar guide introduced into coronary artery to analyze ischemia, was invented in 1974, and firstly performed in human body in 1985, Intracoronary ECG still remains rarely used technique for percutaneous coronary interventions (PCI). The article sums up studies dating from 1974 to 2016 which show that intracoronary ECG is useful for discovering the zones of ischemia, predicting myocardial necrosis, exploring vital myocardium, predicting myocardial recovery during primary PCI and finding new possibilities for the development of PCI. Intracoronary ECG is still very cheap and easily performed, even though it requires additional time and deserves much more interest among the staff incatheterization laboratories.Wewnątrzwieńcowe EKG zarejestrowane za pomocą jednobiegunowego prowadnika wprowadzonego do tętnicy wieńcowej w celu oceny niedokrwienia zostało wynalezione w 1974 roku, a po raz pierwszy zostało wykonane u człowieka w 1985 roku. Wewnątrzwieńcowe EKG wciąż jest bardzo rzadko stosowaną techniką diagnostyczną podczas przezskórnej interwencji wieńcowej (PCI). Artykuł ten podsumowuje badania z lat 1974–2016, pokazując, że wewnątrzwieńcowe EKG może być przydatne w znalezieniu strefy niedokrwienia, przewidywaniu martwicy mięśnia sercowego, detekcji żywotnego miokardium, prognozowaniu zdrowienia mięśnia sercowego po pierwotnej PCI, jak również w poszukiwaniu nowych strategii podczas PCI. Nadal bardzo tanie i łatwe do wykonania, mimo że wymaga dodatkowego czasu, to zasługuje na większe zainteresowanie pracujących w pracowniach hemodynamiki

The role of periprocedural hemodynamic variables during carotid stenting for the mid-term general mortality in advanced age patients

Introduction: Carotid stenting may produce significant bradycardia and/or hypotension. This may have negative short- and long-term effects for the elderly high-risk patients. Their cerebral hemodynamics is with exhausted adaptive capacity because of the multiple cardiovascular risk factors, advanced age, and significant stenosis. Aim: This was a retrospective study aimed at finding whether periprocedural hypoperfusion or hypotension at the time of carotid stenting had any significance for the acute neurological outcome and mid-term general mortality in advanced-age patients who were at high risk for surgical endarterectomy. Materials and methods: We studied 138 consecutive patients with significant carotid stenosis from January 2015 to July 2019. The mean (SD) age was 67.41 (10.70) years. The mean follow-up period was 31 months (922 days). The patients were hemodynamically monitored periprocedurally according to a local protocol. Vasopressors were added if a prolonged hypotension was measured. Statistical data were analyzed using SPSS IBM v. 19 (p=0.05, CI 95%). Results: The male patients were 94 (68%). The number of patients with hypotension periprocedurally or in the first 6 hours post-procedure was 55 (42%). The mean blood pressures were 135/83 mmHg before, 116/76 mmHg during, and 121/73 mmHg after the procedure. Kaplan-Maier analysis showed no significant differences in the mid-term general mortality rate between patients with and patients without transitory hypotension. There wasn’t any difference in the postprocedural neurological outcome either. Conclusions: The presence of hypotension during carotid stenting was not linked to a negative neurological outcome. It also did not increase mid-term all-cause mortality in elderly patients (mean age, 67 years). The finding could be attributed to the relatively brief period of hypotension, the prompt administration of vasopressors, or the prevention of brain edema and hyper-reperfusion during carotid stenting in terms of elevated blood pressure; however, this remains to be determined

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encourage

Invasive hemodynamic assessment of patients with cardiomyopathies

Инвазивната хемодинамична оценка на сърдечните заболявания придобива все по-голяма роля през последни- те десетилетия. Поради по-широката си достъпност и безопасност неинвазивните техники са основните методи, използващи се за оценка на сърдечната функция. Хемодинамичната оценка чрез сърдечна катетеризация се при- лага за решаване на диагностични проблеми, които не могат да бъдат решени чрез рутинните методики. Този тип изследване трябва да бъде индивидуализирано спрямо конкретните проблеми на всеки пациент и базирано на получените от неинвазивните изследвания резултати. Инвазивната диагностика се използва широко при оценка- та на пациентите с различни сърдечно-съдови заболявания, включително и кардиомиопатии. В настоящия обзор разглеждаме ролята на сърдечната катетеризация, нейните предимства и недостатъци като част от цялостната оценка на пациентите с кардиомиопатии.  Invasive hemodynamic assessment of cardiac diseases has become an important diagnostic tool in recent decades. Non-invasive methods are the main techniques used to assess cardiac function, due to their wider availability. Cardiac catheterization is useful when there are diagnostic problems that cannot be solved with routine methods. Cardiac catheterization should be individualized according to the specific problems of the patient and based on the results from non-invasive methods. Invasive diagnostics is used in the assessment of patients with various cardiovascular diseases, including cardiomyopathies. In this review, we consider the role of cardiac catheterization, its advantages and disadvantages as part of the overall assessment of patients with cardiomyopathies.

Аortic regurgitation – hemodynamic changes and evaluation

Клапните сърдечни заболявания са водеща причина за нарушения в качеството и продължителността на живот. Епидемиологията им варира значително в целия свят. От изключително важно значение е познаването на хемо- динамичните промени, до които водят. Това позволява правилно изработване на статегия относно бъдещи интер- венции върху клапния апарат. През последните години се отбелязва изключителен напредък в разработването  на различни методики в сферата на оперативно и интервенционалното лечение на клапните заболявания. В този раздел ние се спираме основно на аортната регургитация и нейната значимост. Valvular diseases are a leading cause of morbidity, mortality and impaired quality of life in all over the world with different epidemiology. It is extremely important to know the hemodynamic changes for the proper development of a strategy for future interventions. The recent years shows progress in various methodologies of the field of surgery and interventional treatments of valvular diseases. In this section, we focus mainly on aortic regurgitation and its clinical significance

Survival of patients with cardiomyopathies

Кардиомиопатиите са хетерогенна група заболявания. Основният патогенетичен механизъм е миокардна увреда, резултат най-често на генетични мутации. Те са една от водещите причини за развитие на сърдечна недостатъч- ност, внезапна сърдечна смърт и животозастрашаващи аритмии. Прогнозата при пациентите с кардиомиопатии се определя основно от наличието или липсата на определени фактори, асоциирани с неблагоприятно протичане, както и от етапа на диагностицирането им. Преживяемостта при отделните видове кардиомиопатии е различна, като водеща причина за повишена смъртност е късното откриване на заболяването и съответно забавеното за- почване на лечение. Основните кардиомиопатии, разгледани в настоящия обзор, са хипертрофична, дилативна, рестриктивна, ЛК некомпактност и аритмогенна деснокамерна кардиомиопатия. Cardiomyopathies are a heterogeneous group of diseases. The main pathogenetic mechanism is myocardial damage due to genetic mutations. Cardiomyopathies are one of the leading causes of heart failure, sudden cardiac death, and life-threatening arrhythmias. Certain factors associated with poor prognosis determined the prognosis in this group of patients. Survival in different types of cardiomyopathies depends on the time of diagnosis and initial treatment. The types of cardiomyopathies discussed in this review are hypertrophic cardiomyopathy, dilative cardiomyopathy, restrictive cardiomyopathy, left ventricle non-compaction, and arrhythmogenic right ventricular cardiomyopathy

Serum biomarkers for pulmonary hypertension

Налице са значими изследвания и научни разработки, свързани с патофизиологията на пулмоналната хипертония (ПХ), вследствие на което се увеличават възможностите за терапевтичното и повлияване. Традиционните методи за диагностика и мониториране на ПХ включват ехокардиография и дясна сърдечна катетеризация, допълнени от оценка на функционалния клас по NYHA и 6-минутен тест с ходене (6 MWT). Нарастващият брой циркулаторни биомаркери, които се повишават при ПХ може да подпомогне клиницистите както в диагностиката, така и при оценка тежестта на заболяването и отговора от лечението. In the fi eld of development of pathophysiology of pulmonary hypertension, there are growing number of signifi cant recent advances, which leads to new therapeutic agents. Traditional methods of diagnosing and monitoring this condition have comprised echocardiography and right heart catheterization, in addition to functional measures, such as estimation of functional class and the 6-min walk test. An increasing number of biomarkers have been described that are elevated in pulmonary hypertension and which may assist the clinician in diagnosis and in the assessment of disease severity and response to treatment.

Clinical effect of carotid stenting on cognitive abilities – possible evaluation using candidates for biomarkers

Micro- and macrovascular consequences of atherosclerosis, arterial hypertension, dyslipidemia, and smoking can affect neurotransmission and markers for neuronal activity. The potential direction and specifics are under study. It is also known that optimal control of hypertension, diabetes, and dyslipidemia in midlife may positively affect cognitive functioning later in life. However, the role of hemodynamically significant carotid stenoses in neuronal activity markers and cognitive functioning is still being debated. With the increased use of interventional treatment for extracranial carotid disease, the question of whether it might affect neuronal activity indicators and whether we can stop or even reverse the path of cognitive deterioration in patients with hemodynamically severe carotid stenoses naturally emerges. The existing state of knowledge provides us with ambiguous answers. We sought the literature for possible markers of neuronal activity that can explain any potential difference in cognitive outcomes and guide us in the assessment of patients throughout carotid stenting. The combination of biochemical markers for neuronal activity with neuropsychological assessment and neuroimaging may be important from practical point of view and may provide the answer to the question for the consequences of carotid stenting for long-term cognitive prognosis