The effects of carotid artery stenting on short-term clinical outcomes and evaluation of restenosis

Objectives: Data on restenosis and long-term outcomes of carotid stenting are limited. The aim of this study was to investigate cardiovascular effects of carotid stenting on clinical outcome and restenosis in patients with symptomatic severe carotid artery stenosis.Materials and methods: Twenty patients (mean age: 68±7 years, 11 male) who have been decided to perform stenting in joint Committee of Cardiology, Cardiovascular Surgery and Neurology Clinics were included.Patients were evaluated both clinically and Doppler ultrasonographically for frequency of cardiovascular events and restenosis. Restenosis is defined as the reapperance of stenosis with a diameter reduction of ≥%50 with peak systolic velocity higher than 224 cm/s.Results: Comorbidities in patients were; coronary artery disease in 14, peripheral artery disease in three, and both chronic renal failure and congestive heart failure in two. Stent diameters were ranged from 6 to 8 mm, and stent lengths were 30 and 40 mm. During the procedure 5 patients had predilatation and 19 had postdilatation. None of the patients had >%30 resudial stenosis after the procedure. All procedures were technically successful. After the procedure only one transient ischemic attack was seen. There were no restenosis, myocardial infarction, death or stroke at 30th day end of the first year of follow up. Diabetes and heart failure were found as predictors for restenosis.Conclusion: In highly selected cases, carotid artery stenting is an effective and safe method in the short term. Restenosis did not seem to be a restricting problem for the success of carotid artery stentin

Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism

The Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

Background: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) is a prospective,multicenter study designed with the aim of describing the prevalence and epidemiology ofAF practice in Turkey. This study aims to evaluate stroke risk in non-valvular atrial fi brillation(AF) and anticoagulant drug utilization within conformity to AF guidelines.Methods: Patients were recruited in 17 referral hospitals refl ecting all the population of7 geographical regions of Turkey. 2242 consecutive patients who had been admitted with AFon ECG were included in the study. 1745 of these patients, who had non-valvular AF, wereincluded in the statistical evaluation. Stroke risk was evaluated with the CHA2DS2-VASc score.Results: The average age of participants was determined to be 69.2 ± 11.5 years (56%female). Persistent-permanent AF was found to be the most common type of non-valvularAF (78%). The most common comorbid disorder was hypertension (73%). It was found thatoral anticoagulant therapy was used by 40% of all patients, 37% of whom had effective INR(2.0–3.0). Upon multivariate analysis, age was found to be the only independent predictorof stroke among the variables’ effects on thromboembolic events that created CHA2DS2-VAScabbreviations (OR 1.026, p < 0.001).Conclusions: These results suggest that stroke risk scores should be thoroughly heededbased on guidelines, and that anticoagulation must be applied according to their guidance

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study.Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treatedat 13 major hospitals in Turkey from 2005 to 2012.Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14–6.13), poor functional status (OR 24.5; 95% CI 3.1–196.5) and high CRP (OR 1.02; 95% CI1.00–1.03) measured on admission were independent risk associates for in-hospital mortality.Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class ofIII/IV and high CRP reflected independent risk for stroke/mortality end point

Obstruction of superior vena cava flow during transcatheter atrial septal defect closure with the Atriasept ASD occluder

In this paper, we describe a patient with a large secundum atrial septal defect ASD (26 mm) with adequate rims that were suitable for percutaneous closure. While closing this ASD, the superior vena cava (SVC) was occluded with the right atrial disc of the Atriasept ASD occluder (Cardia) and thus the device was retrieved before its release. After retrieval of this device, an Amplatzer ASD occluder was successfully implanted without disturbing the caval flow

The effect of perindopril on echocardiographic parameters, NYHA functional class and serum NT-proBNP values in patients with diastolic heart failure

Introduction: Growing evidence has demonstrated that diastolic heart failure occurs in about half of heart failure (HF) patients. We investigated thee effects of perindopril on echocardiographic parameters, New York Heart Association (NYHA) functional class and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in patients with diastolic heart failure

Hemodynamic deterioration and ST-segment elevation developed in a patient during transcatheter aortic valve implantation

Transcatheter aortic valve implantation is becoming increasingly popular as an alternative treatment technique for symptomatic patients with severe aortic stenosis, who are at high risk for surgery. However, with this revolutionary treatment modality, some fatal complications have also emerged. One of these fatal complications is the occlusion of the left main coronary artery at the time of procedure. In this case report, we presented a case of a transcatheter aortic valve implantation complicated by acute left main trunk subtotal oc-clusion and hemodynamic collapse, which was successfully resolved by balloon angioplasty and stent implantation

Percutaneous closure of perimembranous ventricular septal defects associated with septal aneurysm in adults.

Objective: Percutaneous closure of perimembranous ventricular septal defects (pmVSD) has become an accepted alternative to surgical closure in selected cases. However, closure of pmVSDs associated with septal aneurysm is more challenging. We report our experience of device closure of pmVSDs associated with septal aneurysm