Direct coronary arterial stenting without predilatation in patients with coronary heart disease

The study was undertaken to evaluate the safety and efficiency of direct stenting versus routine stenting with predilation. It included 133 patients. By the decision of operators, direct stenting was conducted in 66 patients (71 stenoses) (Group 1). The remaining 67 patients (73 stenoses) underwent routine stenting with predilation (Group 2). The initial angiographic success of stenting was 100% in Group 1 and 98 in Group 2. Complications were absent. In the direct stenting group, technical problems occurred during a session in 9 (12%) cases. In this group the mean duration of fluoroscopy and the total duration of a session were much less than in the routine stenting group. The mean number of balloons used at dilation per stenosis and the number of dilation sessions per stenosis were much lower in Group 1 than in Group 2. The results of quantitative angiogram analysis before and after a session were similar in both patient groups. Six months following stenting, angiographic restenosis occurred in 7 (10%) patients in Group 1 and in 9 (12%) in Group 2. Direct stenting is a safe and effective treatment for non-occlusive coronary lesions without marked kinks and calcinosis. Direct stenting reduces the duration of fluoroscopy and the total duration of an operation by 50 and 22%, respectively, as compared to predilation stenting.     

Use of "Cypher" sirolimus-eluting stents in coronary heart disease patients with different types of coronary arterial lesions

The purpose of our study was to assess the immediate and late results of treatment with Cypher drug-eluting stents (Cordis, Johnson & Johnson, USA) in patients with coronary heart disease (CHD). This was a prospective study that included 738 patients who had been implanted Cypher stents in May 2002 to March 2006. The patients' mean age was 56 +/- 9 years; there were 87% of males. The patients were randomly included into the study and they underwent coronary stenting in the routine laboratory setting. A control group comprised 162 patients who had undergone Velocity or Sonic nondrug-eluting stents of the same firm, which had the similar structure. The groups did not differ in clinical characteristics. 827 stenoses in the eluting stent group and 225 stenoses in the control group were subject to revascularization. The immediate cure rate was 95 and 94%, respectively. The total number of events (myocardial infarction, emergency coronary bypass surgery, subacute occlusion of a stented segment) was 2.3% in the eluting stent group and 2.4% in the control group. A repeated examination 1 year after surgery was made in 482 and 119 patients in the drug-eluting and nondrug-eluting groups, respectively. During the follow-up, one patient died of a extracardiac cause and 3 (0.6%) patients underwent coronary bypass surgery in the nondrug-eluting stent group; there were no deaths and 2 (1.6%) patients had coronary bypass surgery in the control group. In the eluting stent group, there were fewer cases of repeated endovascular procedures of target stenosis revascularization than in the control group (3.7% versus 11.7%; p < 0.0005). In the eluting stent group, the total number of unfavorable cardiovascular events was significantly less than that in the control group and it amounted to 3.3% as compared with 15.9% in the non-eluting stent group; p < 0.0005. Cardiovascular event-free survival was significantly higher in the eluting stent group: 92% versus 77% in the non-eluting stent group (p < 0.0005).     

X-ray morphology of coronary arteries in patients with arterial hypertension in late periods after endovascular treatment

An association of arterial hypertension (AH) and late angiographic outcomes of endovascular interventions was studied in coronary heart disease. Forty two patients with or without AH underwent repeated coronary angiography within 2 months after the procedure. The total number of restenoses was found to be significantly greater in patients with AH than in those without it. The diameter of restenoses was significantly smaller (70.2 +/- 24.7 vs 48.2 +/- 29.2%) and their area is significantly larger (82.6 +/- 19.6 vs 66.9 +/- 28.8). Absence probability of restenosis was significantly smaller in patients with AH (7 vs 27%); at the same time there was the greatest reduction in this probability in the first 8 months following the intervention.     

Results of intracoronary stenting made in different periods after diagnostic coronary angiography

The high cost of tools and expendable materials and its associated necessity of solving organizational issues force to delay the implementation of stenting for nonmedical reasons in many cases. This gives a convenient way to evaluate how much effective and safe stenting would be made just after coronary angiography or delayed intervention would be performed and at the same time to consider the way delay in stenting may affect its clinical and angiographic results. The study covered 136 patients with coronary heart disease who had been implanted an intracoronary stent. All this patients were divided into 3 groups. Group 1 included 16 patients who had undergone stent implantation just after diagnostic coronary angiography, Group 2 comprised 42 patients who had the similar procedure no later than a month after coronary angiography, and Group 3 consisted of 78 patients who had it a month or later following angiography. The angiographic success rates of stenting was 100% in Group 1, 97.6% in Group 2, and 92.3% in Group 3. The causes of poor results were evolving myocardial infarction (2.4%) and technical failure (2.4%) in Group 2; evolving myocardial infarction (2.6%), emergency aortocoronary bypass surgery (1.3%), and technical failure (3.8%) in Group 3. In Group 2, 4.8% cases of those undergone delayed stenting showed more significant stenosis than those having diagnostic intervention. In Group 3, there was more progressive stenosis in 16.7% and a transition of stenosis to occlusion in 7.8%. There were no complications (such as hemorrhage, retroperitoneal hematoma, etc.) at the site of puncture in Group 1, but in Group 2 and 3 they were 3.8 and 6.5%, respectively. Delayed stenting frequently adversely affects the outcomes of endovascular treatment due to the higher incidence of complication and to the increasing technical sophistication of the procedure no late than a month after diagnostic coronary angiography.     

Quantitative and qualitative assessment of X-ray morphology of coronary restenosis after balloon angioplasty and stenting

The study was undertaken to compare the data of quantitative angiographic analysis of early and late outcomes of intracoronary stenting (ICS) and balloon coronary angioplasty (BCA) with the X-Ray morphology of restenosis. The prospective study enrolled 67 patients undergone repeated coronary angiography 2-10 months after successful BCA. Group I included 34 patients with coronary restenosis. Group II comprised 33 patients without restenosis signs. Each group was divided into 2 subgroups: A--patients undergone BCA; B--patients undergone ICS. Subgroups IA and IB included 22 and 12 patients, respectively, and subgroups IIA and IIB consisted of 24 and 19. The X-ray morphology of the underlying versus restenosis lesions in the subgroups was quantitatively and qualitatively assessed. The findings have led to the following conclusions that ICS yields more optimal early and late angiographic results than does BCA; according to the site of restenosis against the underlying lesion, the following types of restenosis following BCA and ICS are identified: diffuse, localized, marginal, and mixed; restenosis after ICS is characterized by for concentric morphology while that following BCA preserves the morphology of a primary lesion.     

Coronary angiography via femoral and radial accesses in patients with extensive atherosclerosis

The incidence of complications and the comparative results of endovascular interventions made via femoral and radial accesses are analyzed. The study included 142 patients with coronary atherosclerosis and coronary heart disease showing a hemodynamically significant atherosclerotic lesion of at least three vascular beds. Angiography was made via femoral and radial accesses in 86 and 56 patients, respectively. In patients with multifocal atherosclerosis, the number of cardiac events (myocardial infarction, death) did not differ significantly when coronarography was made by applying different accesses. There were a significantly larger number of peripheral thrombotic events in the femoral access group (p < 0.05). Aneurysm of the abdominal aorta with its thrombosis was found to be a risk factor of the occurrence of thrombotic complications when coronary angiography was made via the femoral access. Coronary angiography performed through the radial artery allows the risk of thrombotic complications to be substantially reduced in patients with multifocal atherosclerosis: such complications were not observed in the radial access group, they were in 5 (5.8%) cases in the femoral access group.     

An fMRI Study of Audiovisual Speech Perception Reveals Multisensory Interactions in Auditory Cortex

Research on the neural basis of speech-reading implicates a network of auditory language regions involving inferior frontal cortex, premotor cortex and sites along superior temporal cortex. In audiovisual speech studies, neural activity is consistently reported in posterior superior temporal Sulcus (pSTS) and this site has been implicated in multimodal integration. Traditionally, multisensory interactions are considered high-level processing that engages heteromodal association cortices (such as STS). Recent work, however, challenges this notion and suggests that multisensory interactions may occur in low-level unimodal sensory cortices. While previous audiovisual speech studies demonstrate that high-level multisensory interactions occur in pSTS, what remains unclear is how early in the processing hierarchy these multisensory interactions may occur. The goal of the present fMRI experiment is to investigate how visual speech can influence activity in auditory cortex above and beyond its response to auditory speech. In an audiovisual speech experiment, subjects were presented with auditory speech with and without congruent visual input. Holding the auditory stimulus constant across the experiment, we investigated how the addition of visual speech influences activity in auditory cortex. We demonstrate that congruent visual speech increases the activity in auditory cortex.     

Specific features of the clinical course and angiographic pattern in chronic coronary artery occlusion

Particular features of coronary angiography and clinical presentation of coronary artery disease have been studied in patients with chronic total coronary occlusion. Chronic total coronary occlusion is defined as TIMI 0 or TIMI I type flow in the artery for more than three days. Patients with coronary occlusion have more severe course of coronary artery disease: they more often suffer myocardial infarction and high gradations of angina. Myocardial function is much more affected if there is occlusion of left descending artery, or there are no signs of intercoronary collaterals.