Средне-отдаленные результаты применения биоабсорбируемых скаффолдов у пациентов с острым коронарным синдромом

Patients with acute coronary syndrome need the earliest possible revascularization of the coronary arteries, which is the key to successful treatment. The introduction of endovascular myocardial revascularization has significantly improved the results of treatment of patients with ACS. More than half of these patients come with lesions of several vessels and, as a rule, this is the most severe contingent with a high incidence of complications of AMI, disability, mortality [1]. The current European and American recommendations for the treatment of these patients play a leading role in reducing reperfusion time. At the same time, there is no consensus regarding the volume of revascularization, the sequence and volume of procedures are not clearly defined, questions remain about the stages of treatment of these patients [1]. The use of BVS in patients with ACS, subject to the rules of implantation, is accompanied by good immediate and medium-long-term results [2, 3].Пациенты с острым коронарным синдромом нуждаются в максимально ранней реваскуляризации коронарных артерий, что является залогом успешного лечения. Внедрение эндоваскулярной реваскуляризации миокарда позволило существенно улучшить результаты лечения пациентов с ОКС. Более половины таких пациентов поступают с поражением нескольких сосудов и, как правило, это наиболее тяжелый контингент с высокой частотой развития осложнений ОИМ, инвалидизации, смертности [1]. Актуальные европейские и американские рекомендации по лечению этих пациентов ведущую роль отводят сокращению времени реперфузии. В то же время нет единого мнения относительно объема реваскуляризации, чётко не определена очередность и объем выполнения процедур, остаются открытыми вопросы относительно этапности лечения данных пациентов [1]. Использование BVS у пациентов с ОКС при соблюдении правил имплантации сопровождается хорошими непосредственными и среднеотдаленными результатами [2, 3]

Эмболизация вен простатического сплетения в лечении веногенной эректильной дисфункции (клинические случаи)

In the structure of reason of erectile dysfunction venous insufficiency of the penis is prevails. These patients are most often offered for prosthesis of penis. X-ray surgical embolization of the veins of the prostatic plexus began to be used since 1984. According to the literature, it is effective on average in 85% of cases. The operation is performed antegradely through incision or puncture of the dorsal vein of the penis or retrograde through transfemoral X-ray surgical access. In 2018 A.A. Kapto et al. for the first time performed retrograde X-ray surgical embolization of the veins of the prostatic plexus from the transbasilar access. The cause of venous insufficiency of the penis is most often due to the varicose disease of the veins of the pelvic organs because of arteriovenous conflicts (nutcracker phenomenon, posterior nutcracker phenomenon, May-Thurner syndrome). A new direction is the implementation of combined operations, allowing to influence both the causes of venous plethora of the pelvic organs, and pathological venous drainage. In 2018 A.A. Kapto et al. performed the first operations: 1) X-ray endovascular occlusion of the veins of the prostatic plexus in combination with X-ray endovascular angioplasty and stenting of the left common iliac vein; 2) retrograde transfemoral X-ray surgical embolization of the veins of the prostatic plexus in combination with angioplasty and stenting of the left common iliac vein; 3) embolization of the left testicular vein, retrograde transfemoral X-ray surgical embolization of the veins of the prostatic plexus in combination with angioplasty and stenting of the left common iliac vein; 4) retrograde x-ray surgical embolization of the veins of the prostatic plexus from the transbasilar access in combination with angioplasty and stenting of the left common iliac vein. The use of new high-tech X-ray surgical techniques allows us to solve the problem of venogenic erectile dysfunction without performing endofalloprothesis. Authors declare lack of the possible conflicts of interests.В структуре причин эректильной дисфункции превалирует венозная недостаточность полового члена. Этим пациентам чаще всего предлагают протезирование полового члена. Рентгенохирургическая эмболизация вен простатического сплетения начала применяться с 1984 г. По данным литературы она эффективна в среднем в 85% случаев. Операцию проводят антеградно через инцизию или пункцию дорзальной вены полового члена или ретроградно через трансфеморальный рентгенохирургический доступ. В 2018 г. А.А. Капто и соавт. впервые выполнена ретроградная рентгенохирургическая эмболизация вен простатического сплетения из трансбазилярного доступа. Причиной венозной недостаточности полового члена чаще всего является варикозная болезнь вен органов малого таза вследствие артериовенозных конфликтов (Nutcracker phenomenon, posterior nutcracker phenomenon, May-Thurner syndrome). Новым направлением является выполнение комбинированных операций, позволяющих воздействовать как на причины венозного полнокровия органов малого таза, так и на патологический венозный дренаж. В 2018 г. А.А. Капто и соавт. выполнены первые операции: 1) рентгенэндоваскулярная окклюзия вен простатического сплетения в сочетании с рентгенэндоваскулярной ангиопластикой и стентированием левой общей подвздошной вены; 2) ретроградная трансфеморальная рентгенохирургическая эмболизация вен простатического сплетения в сочетании с ангиопластикой и стентированием левой общей подвздошной вены; 3) эмболизация левой яичковой вены, ретроградная трансфеморальная рентгенохирургическая эмболизация вен простатического сплетения в сочетании с ангиопластикой и стентированием левой общей подвздошной вены; 4) ретроградная рентгенохирургическая эмболизация вен простатического сплетения из трансбазилярного доступа в сочетании с ангиопластикой и стентированием левой общей подвздошной вены. Применение новых высоко технологичных рентгенохирургических методик позволяет решать проблему веногенной эректильной дисфункции без выполнения эндофаллопротезирования. Авторы заявляют об отсутствии конфликта интересов

In-hospital outcomes of treatment of patients with acute coronary syndrome using distal radial access [Госпитальные результаты лечения пациентов с острым коронарным синдромом с применением дистального лучевого доступа]

Endovascular methods are leading in the treatment of patients with acute coronary syndrome (ACS). Transradial access (TRA) is traditionally used, but there are some disadvantages. Distal transradial access (dTRA) is an alternative to conventional TRA, but its outcomes in patients with ACS are controversial. Aim. To evaluate the safety and efficacy of vascular accesses, as well as in-hospital outcomes of treatment of patients with ACS using conventional TRA versus dTRA. Material and methods. This single-center, prospective, randomized study included 264 patients with ACS, which were divided into 2 groups: group 1 (n=132) - dTRA, group 2 (n=132) - TRA. The groups were comparable in the initial clinical, laboratory and angiographic characteristics. Results. During percutaneous coronary intervention, 240 drug-eluting stents were implanted in 184 patients. In 10 patients, access was converted: from dTRA to TRA in 2,3% (n=3), from dTRA to femoral -3,0% (n=4), from dTRA to femoral in 2,3% (n=3). The mean puncture time was 125,1±11,9 s in group 1 and 58,8±8,2 s in group 2 (p<0,00005). There was no difference in the total intervention duration as follows: 30,5±7,1 min and 29,4±4,6 min (p=0,1428), respectively. The time to hemostasis was significantly higher in the TRA group: 354,2±28,1 vs 125,4±15,3 min in group 1 (p<0,00005). When using dTRA, a lower incidence of hematomas (0,8 (n=1) vs 7,0% (n=9) (p=0,019)), spasm (5,6 (n=7) vs 13,2% (n=17) (p=0,039)) and radial artery occlusion (0,8 (n=1) vs 6,2% (n=8) (p=0,036)). The number of major adverse cardiac events (MACE) in both groups was comparable: 10,4% (n=13) and 10,1% (n=13) in group 1 and 2, respectively (p=0,932). Conclusion. The use of dTRA does not increase the total procedure duration compared to conventional TRA. The complication rate was comparable in both study groups. When dTRA was used, the incidence of local complications was significantly lower compared to conventional TRA. Thus, dTRA can be an alternative to conventional TRA, but large randomized trials are required for final conclusions. © 2021 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Combined endovascular treatment of acute coronary syndrome with bioresorbable scaffolds and angioplasty in patient with critical lower limb ischemia – Hybrid treatment in multidisciplinary hospital

The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome. © 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved

REMOTE CLINICAL QUALITY MANAGEMENT OF ENDOVASCULAR CARE

To assess the effectiveness of remote clinical quality management of endovascular Aim care. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The Methods system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In April-December 2020 it increased up to 71.6% (p<0.001). The frequency of performing Results PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005). Remote clinical management based on telemedicine and mentoring process Conclusion technologies contributes to improving the quality of endovascular care in MI. © 2021 Angles. All rights reserved