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Korotkikh AV, Kashtanov MG. Overview of the distal radial access from the radial artery occlusion perspective. J Vasc Access 2024:11297298241250376. [PMID: 38708831 DOI: 10.1177/11297298241250376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Conventional radial access in endovascular surgery has certain limitations, primarily associated with the presence of local complications and radial artery occlusion. Over the past 7 years, distal radial access has exploded into all areas of endovascular procedures, from interventional cardiology to vascular surgery and interventional oncology. However, puncture of the distal radial artery has its own nuances and features: a learning curve, the use of ultrasound navigation in the initial stages of mastering the access, limitations in patients with acute conditions (acute coronary syndrome and stroke). This review aims to analyze on important aspects of the procedure of distal radial access from preparation for it to hemostasis and to explore all data about the new roles of distal radial access in avoiding but also treating radial artery occlusion, as the first thing to begin with the development and implementation of new access.
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Affiliation(s)
| | - Maksim Gennadievich Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Catheterization Laboratory, Tomsk, Russia
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. Distal Radial Access: Is There a Clinical Benefit? Cardiol Rev 2024; 32:110-113. [PMID: 36538417 DOI: 10.1097/crd.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For decades, the femoral artery has been the most common vascular access for diagnostic and therapeutic endovascular procedures. However, over the past 20 years, radial access has been gaining popularity, as it is a safer and allows practical access with more benefits. Recently, the new distal radial access has proven to be an equal or perhaps even safer vascular access for diagnostic and therapeutic coronary and noncoronary interventions. Today, this access should be in the arsenal of every interventional surgeon.
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Affiliation(s)
- A V Korotkikh
- From the Cardiac Surgery Clinic, Amur State Medic al Academy, Blagoveshchensk, Russian Federation
| | - A M Babunashvili
- Interventional Cardiology Department, Sechenov University, Moscow, Russian Federation
| | - A N Kazantsev
- Surgery Department, City Alexandrovskaya Hospital, St. Petersburg, Russian Federation
| | - Z S Annaev
- Neurosurgery Department, Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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Kazantsev AN, Abdullaev IA, Danilchuk LB, Shramko VA, Korotkikh AV, Chernykh KP, Bagdavadze G, Zharova AS, Kharchilava EU, Lider R, Kazantseva Y, Zakeryayev AB, Shmatov DV, Kravchuk VN, Zakharova KL, Artyukhov SV, Bhand HK, Chernyavtsev IA, Erofeev AA, Khorkova SM, Kulikov KA, Lutsenko VA, Matusevich VV, Morozov D, Peshekhonov KS, Sultanov RV, Zarkua NE, Khasanova DD, Serova NY, Shaikhutdinova RA, Gavrilova OO, Alekseeva EO, Kleschenogov AS, Sukhoruchkin PV, Taits DB, Taits BM, Palagin PD, Lebedev OV, Alekseev MV, Belov Y. CAROTIDSCORE.RU-The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy. Vascular 2024; 32:132-142. [PMID: 36056591 DOI: 10.1177/17085381221124709] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
GOAL Presentation of the first Russian computer program (www.carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CEE). MATERIAL AND METHODS The present study is based on the analysis of a multicenter Russian database that includes 25,812 patients after CEE operated on from 01/01/2010 to 04/01/2022. The following types of CEE were implemented: 6814 classical CEE with plastic reconstruction of the reconstruction zone with a patch; 18,998 eversion CEE. RESULTS In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14%-myocardial infarction, 0.35%-stroke. The combined endpoint was 0.68%. For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. Based on this formula, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. On the basis of the obtained calculations, a computer program CarotidSCORE was created. Its graphical interface is based on the QT framework (https://www.qt.io), which has established itself as one of the best solutions for desktop applications. It is possible not only to calculate the probability of developing a complication, but also to save all data about the patient in JSON format (for the patient's personal card and his anamnesis). The CarotidSCORE program contains 47 patient parameters, including clinical-demographic, anamnestic and angiographic characteristics. It allows you to choose one of the four types of CEE, which will provide an accurate stratification of the risk of complications for each of them in person. CONCLUSION CarotidSCORE (www.carotidscore.ru) is able to determine the likelihood of postoperative complications in patients undergoing CEE.
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Affiliation(s)
- A N Kazantsev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - I A Abdullaev
- St. Petersburg State Pediatric Medical University, Russian Federation
| | - L B Danilchuk
- First St. Petersburg State Medical University Named After Academician I. P. Pavlov, Russian Federation
| | - V A Shramko
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | | | - Gsh Bagdavadze
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A S Zharova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - E U Kharchilava
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - Ryu Lider
- Kemerovo State Medical University, Russian Federation
| | | | - A B Zakeryayev
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - D V Shmatov
- Clinic of High Medical Technologies. N.I. Pirogov St. Petersburg State University, Russian Federation
| | - V N Kravchuk
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | | | - H K Bhand
- Kemerovo State Medical University, Russian Federation
| | - I A Chernyavtsev
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A A Erofeev
- City Multidisciplinary Hospital No. 2, Russian Federation
| | - S M Khorkova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - K A Kulikov
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - V A Lutsenko
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaeva, Russian Federation
| | - V V Matusevich
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - Dyu Morozov
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | - R V Sultanov
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaeva, Russian Federation
| | - N E Zarkua
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - D D Khasanova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - N Y Serova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | - O O Gavrilova
- Yaroslav-the-Wise Novgorod State University, Russian Federation
| | - E O Alekseeva
- Yaroslav-the-Wise Novgorod State University, Russian Federation
| | | | - P V Sukhoruchkin
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - D B Taits
- St. Petersburg State Pediatric Medical University, Russian Federation
| | - B M Taits
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - P D Palagin
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - O V Lebedev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - M V Alekseev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - YuV Belov
- Federal State Budgetary Scientific Institution "Russian Scientific Center of Surgery Named B.V. Petrovsky", Moscow, Russian Federation
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Korotkikh AV, Vakhnenko YV, Kashtanov MG. Some Topical Aspects of the "Sports Heart" Problem. Literature Review. Part 2. Curr Probl Cardiol 2023; 48:101921. [PMID: 37394208 DOI: 10.1016/j.cpcardiol.2023.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
Electrocardiography occupies a special place among a significant list of other methods for diagnosing the pathology of the cardiovascular system of athletes. Often its results differ significantly from those in the general population, being a consequence of the adaptation of the heart to economical functioning at rest and super-intensive work in training and competitions. This review focuses on the features of the "athlete's electrocardiogram (ECG)." In particular, those changes that are not a reason for removing athletes from physical activity, but in combination with known factors can lead to more serious changes up to sudden cardiac death. Fatal rhythm disorders in athletes are described, possible in Wolff-Parkinson-White syndrome, syndrome of ion channel pathology, arrhythmogenic dysplasia of the right ventricle, etc. Particular attention is paid to arrhythmia due to connective tissue dysplasia syndrome. Knowledge of these issues is necessary to choose the right tactics for an athlete with changes to the electrocardiogram and in the protocol of daily Holter monitoring of the electrocardiogram, and a doctor related to sports medicine should be aware of the features of "electrophysiological remodeling" of the athlete's heart, normal and pathological "sports electrocardiogram," about conditions accompanied with the development of serious rhythm disorders and algorithms for examining the cardiovascular system of the athlete.
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Affiliation(s)
| | | | - Maksim Gennadievich Kashtanov
- Ural Federal University, Experimental Laboratory, Ekaterinburg, Russia; Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Catheterization Laboratory, Tomsk, Russia; Sverdlovsk Regional Hospital No.1, Catheterization Laboratory, Ekaterinburg, Russia
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6
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Abstract
This review of the literature analyzes publications over the past five years on various problems associated with carotid endarterectomy: 1. Is the eversion or classical technique of surgery with plastic repair of the reconstruction area with a patch more effective? 2. Carotid endarterectomy or carotid angioplasty with stenting is more optimal? 3. When should brain revascularization be performed after the development of ischemic stroke? 4. Should a temporary shunt be used to protect the brain during carotid endarterectomy? 5. How to prevent and treat different types of intraoperative ischemic strokes? 6. What tactics of treatment of patients with combined lesions of the carotid and coronary arteries is more effective? 7. What are the causes and methods of elimination of restenosis of the internal carotid artery known? 8. Is carotid endarterectomy safe in old age?
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Affiliation(s)
- Anton Nikolaevich Kazantsev
- Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma, Russian Federation; Kostroma oncological dispensary, Kostroma, Russian Federation.
| | - Alexander Vladimirovich Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | | | - Yuriy Vladimirovich Belov
- First Moscow State Medical University named after Sechenov, Moscow, Russian Federation; Federal State Budgetary Scientific Institution Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russian Federation
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Golets KO, Gaganova TS, Kokaya RV, Golokhvastov SV, Zarkua NE, Zharova AS, Korotkikh AV, Kazantsev AN. [Long-term results conventional and eversion carotid endarterectomy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:70-76. [PMID: 37682098 DOI: 10.17116/jnevro202312308270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To analyze immediate and long-term results of conventional and eversion carotid endarterectomy (CEA) within a multicenter registry. MATERIAL AND METHODS This retrospective, multi-center, comparative study included 375 patients who underwent CEA between February 1, 2018 and February 1, 2022. Depending on the type of operation, the sample was stratified into the eversion CEA (group 1, n=218) and conventional CEA with plasty of the reconstruction area with a diepoxy-treated xenopericardium patch (group 2, n=157). The long-term follow-up period was 26.5±18.3 months. Information about the condition of patients and the development of complications was obtained by telephone questioning and calling patients to the clinic for a follow-up examination. RESULTS No myocardial infarction was diagnosed in the hospital postoperative period. There were no statistically significant differences in the frequency of acute cerebrovascular accident. The only cause of death after conventional CEA was hemorrhagic stroke. According to the section study, the cause of death was edema with dislocation of the brain stem. The remaining strokes in both groups (1 case each) were of the ischemic type. The probable cause was a distal embolism following the use of a temporary shunt. During conservative treatment, the neurological deficit completely regressed on days 21 and 26, respectively. In the late postoperative period, significant differences were obtained in the incidence of stroke (group 1: n=2; 0.91%; group 2: n=6; 3.8%; p=0.05; OR - 0.23; 95% CI=0.04-1.17) and restenosis of the internal carotid artery (ICA) more than 60% (group 1: n=0; group 2: n=11; 7.0%; p<0.0001; OR - 0.03, 95% CI=0.001-0.49). CONCLUSION The eversion CEA technique demonstrated a lower risk of developing hemodynamically significant restenosis of the internal carotid artery in the long-term follow-up period. To obtain convincing evidence of the effectiveness of eversion or conventional CEA, additional randomized multicenter trials with the inclusion of results in clinical guidelines are required.
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Affiliation(s)
- K O Golets
- North-Western State Medical University I.I. Mechnikov, St. Petersburg, Russia
| | - T S Gaganova
- North-Western State Medical University I.I. Mechnikov, St. Petersburg, Russia
| | - R V Kokaya
- North-Western State Medical University I.I. Mechnikov, St. Petersburg, Russia
| | | | - N E Zarkua
- North-Western State Medical University I.I. Mechnikov, St. Petersburg, Russia
| | - A S Zharova
- North-Western State Medical University I.I. Mechnikov, St. Petersburg, Russia
| | | | - A N Kazantsev
- Korolev Regional Clinical Hospital, Kostroma, Russia
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Kazantsev AN, Karkayeva MR, Tritenko AP, Korotkikh AV, Zharova AS, Chernykh KP, Bagdavadze GS, Lider RY, Kazantseva YG, Zakharova KL, Shmatov DV, Kravchuk VN, Peshekhonov KS, Zarkua NE, Lutsenko VA, Sultanov RV, Artyukhov SV, Kharchilava EU, Solotenkova KN, Zakeryayev AB. CAROTID ENADRTERECTOMY FOR INTERNAL CAROTID THROMBOSIS IN PATIENTS WITH COVID-19. Curr Probl Cardiol 2022:101252. [PMID: 35577077 PMCID: PMC9109971 DOI: 10.1016/j.cpcardiol.2022.101252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/12/2022]
Abstract
Analysis of the results of emergency carotid endarterectomy (CEE) against the background of internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVA) in patients with COVID-19. During the COVID-19 pandemic (April 1, 2020-May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019-March 1, 2020). According to laboratory parameters, patients with COVID-19 had severe coagulopathy (with an increase in D-dimer: 3832 ± 627.2 ng/mL, fibrinogen: 12.6 ± 3.1 g/L, prothrombin: 155.7 ± 10, 2%), inflammatory syndrome (increased ferritin: 646.2 ± 56.1 ng/mL, C-reactive protein: 161.3 ± 17.2 mg/L, interleukin-6: 183.3 ± 51.7 pg/mL, leukocytosis: 27.3 ± 1.7 10E9/L). In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n = 1; group 2: 1.1%, n = 1; P= 0.81; OR=2.09; 95 % CI = 0.12-34.3) myocardial infarction (group 1: 2.3%, n = 1; group 2: 0%; P= 0.7; OR = 6.3; 95% CI = 0.25-158.5), CVA (group 1: 2.3%, n = 1; group 2: 2.2%, n = 2; P= 0.55; OR = 1.03; 95% CI = 0,.09-11.7). ICA thrombosis and hemorrhagic transformations were not recorded. However, due to severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n = 5; group 2: 1.1%, n = 1; P= 0.02; OR = 11.5; 95% CI = 1.3-102.5). In all cases, the flow of hemorrhagic discharge came from the drainage localized in the subcutaneous fat. This made it possible to remove skin sutures in a dressing room, suturing the source of bleeding and applying secondary sutures under local anesthesia. Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.
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Affiliation(s)
- A N Kazantsev
- Alexander Hospital, St. Petersburg, Russian Federation.
| | - M R Karkayeva
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation
| | - A P Tritenko
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - A V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - A S Zharova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - K P Chernykh
- Alexander Hospital, St. Petersburg, Russian Federation
| | - G Sh Bagdavadze
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - Ye G Kazantseva
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - K L Zakharova
- Alexander Hospital, St. Petersburg, Russian Federation
| | - D V Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | - V N Kravchuk
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | | | - N E Zarkua
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - V A Lutsenko
- Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation
| | - R V Sultanov
- Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation
| | - S V Artyukhov
- Alexander Hospital, St. Petersburg, Russian Federation
| | - E U Kharchilava
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - K N Solotenkova
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation
| | - A B Zakeryayev
- Research Institute - Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Tarasyuk ES, Annaev ZS. Distal radial artery access in noncoronary procedures. Curr Probl Cardiol 2022:101207. [PMID: 35460683 DOI: 10.1016/j.cpcardiol.2022.101207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.
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Affiliation(s)
- A V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | | | | | - E S Tarasyuk
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - Z S Annaev
- Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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10
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Belov YV, Kazantsev AN, Vinogradov RA, Korotkikh AV, Chernykh KP, Matusevich VV, Kachesov EY, Shmatov DV, Zakeryaev AB, Erofeev AA, Dzhanelidze MO, Karmokov IA, Kuklev AP, Andreeva AI, Taits BM, Taits DB, Bagdavadze GS, Kokaya RV, Zharova AS, Radzhabov IM, Lutsenko VA, Sultanov RV, Alizada FR, Abdullaev AD, Povtoreyko AV, Kapran TI, Lider RY, Vayman EF, Meleshin EO, Ginzburg ER, Makoeva MM, Klimova AI, Vinogradova ER, Zakharova KL, Pachkoriya MG, Alekseeva EO. [Long-term results of carotid endarterectomy and carotid artery stenting in patients with high bifurcation of common carotid artery: a multiple-center study]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:6-16. [PMID: 35758073 DOI: 10.17116/neiro2022860316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE), carotid endarterectomy with patch repair and carotid artery stenting (CAS) in patients with high bifurcation of common carotid artery. MATERIAL AND METHODS A retrospective multiple-center open study included 1983 patients who underwent internal carotid artery (ICA) repair for severe stenosis between 2010 and 2021. Three groups of patients were distinguished depending on revascularization option: group 1 (n=638) - eversion CEE; group 2 (n=351) - CEE with patch repair; group 3 (n=994) - CAS. RESULTS In-hospital postoperative mortality and incidence of stroke and myocardial infarction were similar. All bleedings (n=39) occurred after CEE. ICA thrombosis was diagnosed in groups 1 and 2 due to intimal detachment after insertion of temporary bypass tube. Incidence of laryngeal paresis, neuropathy of hypoglossal and glossopharyngeal nerves, Horner syndrome, damage to salivary glands was comparable in groups 1 and 2. Long-term mortality was the highest (n=10; 2.8%) after CEE with patch repair due to fatal stroke. In turn, the highest incidence of ICA restenosis and restenosis-induced ischemic stroke was observed after CEE with patch repair and CAS. CONCLUSION 1. Classical and eversion CEE in patients with high CCA bifurcation is followed by high in-hospital incidence of damage to cranial nerves and salivary glands, laryngeal paresis, Horner syndrome, bleeding and risk of ICA thrombosis. 2. In patients with high CCA bifurcation, CAS and CEE with patch repair are accompanied by high incidence of ICA restenosis, restenosis-induced stroke and mortality in long-term postoperative period. 3. Eversion CEE demonstrates the lowest rates of all adverse cardiovascular events in long-term follow-up period.
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Affiliation(s)
- Yu V Belov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A N Kazantsev
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - R A Vinogradov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | | | - K P Chernykh
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - V V Matusevich
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - E Yu Kachesov
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - D V Shmatov
- St. Petersburg State University, St. Petersburg, Russia
| | - A B Zakeryaev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A A Erofeev
- City Multidisciplinary Hospital No. 2, St. Petersburg, Russia
| | - M O Dzhanelidze
- Western Regional Center for Modern Medical Technologies, Kutaisi, Georgia
| | - I A Karmokov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A P Kuklev
- St. Petersburg State University, St. Petersburg, Russia
| | - A I Andreeva
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - B M Taits
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - D B Taits
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - G Sh Bagdavadze
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - R V Kokaya
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A S Zharova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I M Radzhabov
- Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - V A Lutsenko
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - R V Sultanov
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - F R Alizada
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - A D Abdullaev
- Pskov Regional Infectious Clinical Hospital, Pskov, Russia
| | - A V Povtoreyko
- Pskov Regional Infectious Clinical Hospital, Pskov, Russia
| | - T I Kapran
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
| | - E F Vayman
- Kemerovo State Medical University, Kemerovo, Russia
| | - E O Meleshin
- Podgorbunsky Kuzbass Clinical Hospital for Emergency Care, Kemerovo, Russia
| | - E R Ginzburg
- Podgorbunsky Kuzbass Clinical Hospital for Emergency Care, Kemerovo, Russia
| | - M M Makoeva
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A I Klimova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | | | - K L Zakharova
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - M G Pachkoriya
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - E O Alekseeva
- Yaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
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11
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Kazantsev AN, Chernykh KP, Bagdavadze GS, Dzhanelidze MO, Lider RY, Korotkikh AV, Zharova AS, Kazantseva EG. [Subclavian-carotid transposition and subclavian artery stenting for steal-syndrome]. Khirurgiia (Mosk) 2022:77-84. [PMID: 36073587 DOI: 10.17116/hirurgia202209177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze in-hospital results of subclavian-carotid transposition and subclavian artery stenting in patients with steal-syndrome. MATERIAL AND METHODS A retrospective open study included 137 patients with occlusion or severe stenosis of the first segment of subclavian artery and steal-syndrome. The 1st group included 50 patients who underwent stenting or recanalization with stenting of the first segment of subclavian artery between January 2010 and March 2020. The 2nd group included 87 patients who underwent subclavian-carotid transposition between January 2010 and March 2020. RESULTS There were no in-hospital mortality, myocardial infarction, ischemic stroke or bleeding. In the second group, damage to recurrent laryngeal nerve with irreversible laryngeal paresis occurred in 6.9% of patients, and one patient had brachial plexus neuropathy. One patient developed lymphorrhea with chylothorax accompanied by shortness of breath on exertion. Conservative management with repeated pleural punctures was not accompanied by clinical compensation. The patient was discharged for outpatient treatment. Thromboembolism of the left branch of the aorto-femoral prosthesis and deep femoral artery on the left was diagnosed in the endovascular correction group after implantation of Protege GPS stent (10´60 mm) and post-dilation with a PowerFlex PRO balloon catheter (9´4 mm). Acute ischemia of the left lower limb required thrombectomy with patch repair of deep femoral artery. The patient was discharged after 5 days. In another case, vertebral artery dissection occurred after implantation of Protege GPS stent (10×40 mm) and post-dilatation with a PowerFlex PRO balloon catheter (8´20 mm). In this regard, the patient underwent stenting of the fourth segment of vertebral artery (Endeavor Resolute 4.0´24 mm stent) with post-dilation (Boston Scientific Samurai balloon catheter 0.014´190 cm). The patient was discharged after 3 days. CONCLUSION Subclavian-carotid transposition and subclavian artery stenting are safe methods of revascularization that are not accompanied by myocardial infarction, ischemic stroke or mortality. However, subclavian-carotid transposition is characterized by higher risk of neurological disorders (laryngeal paresis, phrenic nerve paresis, brachial plexus neuropathy) and wound complications (lymphorrhea, chylothorax). In turn, subclavian artery stenting is associated with the risk of dissection and embolism. Therefore, the choice of treatment strategy in patients with occlusive-stenotic lesions of the first segment of subclavian artery should be personalized and carried out by a multidisciplinary team.
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Affiliation(s)
- A N Kazantsev
- St. Petersburg City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - K P Chernykh
- St. Petersburg City Alexandrovskaya Hospital, St. Petersburg, Russia
| | - G Sh Bagdavadze
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - M O Dzhanelidze
- Western Regional Center of Modern Medical Technologies, Kutaisi, Georgia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
| | | | - A S Zharova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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12
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Korotkikh AV, Korotkikh DA, Nekrasov DA. [Suicidal neck injury without vital organ damage]. Khirurgiia (Mosk) 2021:70-72. [PMID: 33759472 DOI: 10.17116/hirurgia202104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a suicidal neck injury without vital organ damage. Trauma was made by scissors for suicidal purposes. Upon admission, the patient underwent X-ray examination in 2 planes, gastroscopy, bronchoscopy, Doppler ultrasound of the neck vessels. Extraction of scissors and wound drainage were carried out under endotracheal anesthesia. Postoperative period was uneventful.
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Affiliation(s)
| | | | - D A Nekrasov
- Regional Clinical Hospital No. 2, Tyumen, Russia
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13
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Vasil'ev AP, Strel'tsova NN, Bessonov IS, Korotkikh AV. [State of microcirculation in patients with atherosclerosis and diabetes mellitus after limb revascularization]. Angiol Sosud Khir 2020; 26:22-29. [PMID: 32240132 DOI: 10.33529/angio2020112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The study was aimed at comparatively assessing the dynamics of the parameters of the microcirculatory bed of the skin after endovascular revascularization of the lower limb in patients suffering from intermittent claudication (IC) with and without type 2 diabetes mellitus (DM). PATIENTS AND METHODS Microcirculation (MC) of the skin of lower extremities was examined in 88 male patients presenting with IC and without DM (Group One) and in 28 male patients with IC and DM (Group Two). 30 patients from Group One and 21 patients from Group Two were subjected to endovascular revascularization of lower limbs. MC was examined on the 2nd day after restoration of blood flow in the extremity by means of laser Doppler flowmetry with the assessment of the amplitude parameters of blood flow fluctuations, reflecting active and passive mechanisms of regulation of microcirculation, the intensity of blood flow through the arteriole-venule shunts and the nutritive blood flow. RESULTS At baseline, the main parameters of MC had no differences in the groups and were characterized by intensification of the blood shunted bypassing the nutritive bed, venous plethora, constriction of precapillaries and restriction of capillary blood flow. After endovascular angioplasty of the affected artery and restoration of blood flow therein the patients of the examined subgroups demonstrated an equal increase in the ankle-brachial index, thus approaching the normal values; the patients of both subgroups reported disappearance of pain in the legs during usual daily activities. In patients without DM, endovascular intervention was accompanied by a decrease in the intensity of the arteriole-venule shunts, venous plethora, and enhancement of capillary blood flow. The patients with DM at the early stage after restoration of blood flow in the limb were found to have no statistically significant shifts of the functional parameters of the microvascular bed. CONCLUSION From the point of view of microcirculatory transformations in patients with IC and DM, the effect of limb revascularization at early stages of follow-up turned out to be incomplete, which, probably, was due to irremovable events of latent diabetic microangiopathy and neuropathy.
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Affiliation(s)
- A P Vasil'ev
- Tyumen Cardiological Research Centre, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tyumen, Russia
| | - N N Strel'tsova
- Tyumen Cardiological Research Centre, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tyumen, Russia
| | - I S Bessonov
- Tyumen Cardiological Research Centre, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tyumen, Russia
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14
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Nekrasov DA, Korotkikh AV, Blagovisnaia VA. [Hibrid intervention for internal carotid artery stenosis and ipsilateral aneurysm of anterior communicating artery]. Angiol Sosud Khir 2019; 25:75-78. [PMID: 30994611 DOI: 10.33529/angio2019110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The presence of an ipsilateral aneurysm in stenosis of the internal carotid artery is determined by the findings of CT angiography in 1.8-3.2% of cases. The available literature has described a wide variety of treatment for this pathology: isolated or alternate, with a method of simultaneous endovascular treatment, i. e., carotid stenting and endovascular embolization of an aneurysm, currently gaining popularity. The major difficulties associated with therapeutic decision-making in this cohort of patients include stage-wise nature, temporal parameters, the need for removal of an intracranial aneurysm, and assessment of perioperative complications. A clinical case report presented herein is an example of a method of a hybrid approach, i. e., simultaneously performing carotid endarterectomy and endovascular embolization of an aneurysm. In certain cases (anatomical variants, structure of an atherosclerotic plaque, individual peculiarities), this approach is more justified than popularity-gaining simultaneous endovascular treatment.
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