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Vassilev D, Mileva N, Panayotov P, Nikolov P, Dosev L, Karamfiloff K, Rigatelli G, Gil RJ, Stankovic G, Louvard Y. Side branch predilatation during percutaneous coronary bifurcation intervention: Long-term mortality analysis. Kardiol Pol 2024; 82:398-406. [PMID: 38638095 DOI: 10.33963/v.phj.100213] [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] [Received: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Side branch predilatation (SBPD) during coronary bifurcation interventions is a technique that is not recommended by the latest guidelines. However, the data about the clinical outcomes after SBPD are surprisingly few. AIMS The current study aimed to explore the association between SBPD and mortality in long-term follow-up. METHODS All patients with coronary bifurcation stenoses revascularized with percutaneous coronary intervention were included in a prospective registry. Patients with stable angina and a bifurcation lesion with ≥50% diameter stenosis were included in the current analysis. Patients were assigned to two groups - those with SBPD(+) and those without SBPD(-). Propensity score matching was performed to equalize the risk factors and severity of coronary artery disease between the groups. A Kaplan-Meier analysis with a log-rank test for between-group differences was also performed. RESULTS From January 2013 to June 2021, 813 patients were included in the final study population. The mean age was 67 (10) years. After propensity score matching, 648 patients remained for analysis - 324 in each group. At a median follow-up of 57 months patients in the SBPD(+) group had a higher all-cause mortality (n = 107 (33%) vs. n = 98 [30.2%]; P = 0.045) and cardiovascular mortality (n = 82 [25.3%] vs. n = 70 [21.6%]; P = 0.03) when compared with SBPD(-) patients. SBPD was independently associated with all-cause and cardiovascular mortality. CONCLUSION SBPD treatment of coronary bifurcation stenoses is associated with worse patient survival in the follow-up of up to 8 years. SBPD treatment gives better angiographic results, but this did not translate into better clinical outcomes.
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Affiliation(s)
- Dobrin Vassilev
- Medica Cor Hospital, Ruse, Bulgaria
- Ruse University "Angel Kanchev", Ruse, Bulgaria
| | - Niya Mileva
- Medica Cor Hospital, Ruse, Bulgaria
- Medical Faculty, Medical University, Sofia, Bulgaria
| | - Panayot Panayotov
- Medica Cor Hospital, Ruse, Bulgaria
- Department of Cardiology, Pulmology and Endocrinology, Medical Faculty, Medical University of Pleven, Pleven, Bulgaria
| | | | | | | | | | - Robert J Gil
- National Medical Institute of Internal Affairs and Administration Ministry, Warszawa, Poland
| | - Goran Stankovic
- Department of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
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Yaneva-Sirakova T, Zlatancheva G, Karamfiloff K, Traykov L, Petrov I, Vassilev D. The role of periprocedural hemodynamic variables during carotid stenting for the mid-term general mortality in advanced age patients. Folia Med (Plovdiv) 2023; 65:902-908. [PMID: 38351778 DOI: 10.3897/folmed.65.e100100] [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] [Received: 01/09/2023] [Accepted: 05/15/2023] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
| | - Galina Zlatancheva
- Acibadem City Clinic Cardiovascular Center, Sofia University, Sofia, Bulgaria
| | | | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia University, Sofia, Bulgaria
| | - Dobrin Vassilev
- Medica Cor University Hospital, University of Ruse, Ruse, Bulgaria
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Yaneva-Sirakova T, Traykov L, Karamfiloff K, Petrov I, Hristova J, Vassilev D. Neurotrophins in carotid atherosclerosis and stenting. Ann Med 2023; 55:335-341. [PMID: 36625566 PMCID: PMC9851235 DOI: 10.1080/07853890.2022.2163052] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Carotid stenting is used with an expanding indications. The neurotrophins are a family of proteins that induce the survival, development, and function of neurons. Carotid stenting alters cerebral blood flow and can affect neurotrophins' levels. MATERIAL AND METHODS We included 78 people: 39 with significant carotid stenoses (CS) referred for carotid stenting (mean age 67.79 ± 10.53 years) and relatively healthy control group of 39 people without carotid and vertebral artery disease (mean age 57.42 ± 15.77 years). Brain derived reurotrophic factor (BDNF) and neuronal growth factor (NGF) concentrations were evaluated with ELISA method from venous blood - once for the control group; and for the carotid stenting group: before (n33), 24 h after (n22) and at least 1 month after (n18) carotid stenting. RESULTS There was a difference between the mean neurotrophins' concentration of patients with significant carotid stenoses and the group without: BDNF p = 0.001, CI (-5.11 to -1.44) (3.10 ± 3.10 ng/ml in CS vs. 6.37 ± 4.67 ng/ml in controls); NGF p = 0.049, CI (0.64-347.75), 195.67 ± 495.34 pg/ml in CS vs. 21.48 ± 52.81 pg/ml in controls. BDNF levels before carotid stenting (3.10 ± 3.10 ng/ml) were significantly lower than the postprocedural (4.99 ± 2.57 ng/ml) - p < 0.0001, CI (-2.86 to -0.99). For NGF there was a tendency for lower values after stenting: 195.67 ± 495.34 pg/ml before vs. 94.92 ± 120.06 pg/ml after, but the result did not reach statistical significance. The neurotrophins levels one month after carotid stenting and controls' were not significantly different p < 0.01 (BDNF 5.03 ± 4.75 ng/ml vs. 6.37 ± 4.67 ng/min; NGF 47.89 ± 54.68 pg/ml vs. 21.48 pg/ml). DISCUSSION AND CONCLUSION Periprocedural and mid-term concentrations of neurotrophins after carotid stenting change in non-linear model. This may be due to changes in cerebral perfusion and also might be involved in neuronal recovery and reparation after reperfusion.KEY MESSAGESPeriprocedural and mid-term concentrations of neurotrophins after carotid stenting change in non-linear model.As the majority of them are not specific, their periprocedural change can be used as a clinical correlate to guide changes or even success in carotid stenting.Changes in neutrophins' concentrations may be due to changes in cerebral perfusion and also might be involved in neuronal recovery and reparation after reperfusion.This goes in analogy with cardiac high-sensitive troponin, used as procedural guidance in coronary interventions.
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Affiliation(s)
| | - Latchezar Traykov
- Department of Neurology, UMHAT “Alexandrovska”, Neurology Clinic, Medical University Sofia, Sofia, Bulgaria
- Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Kiril Karamfiloff
- Department of Internal medicine, UMHAT “Alexandrovska”, Cardiology Clinic, Medical University Sofia, Sofia, Bulgaria
| | - Ivo Petrov
- Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | - Julieta Hristova
- Department of Clinical Laboratory and Drug Toxicity, UMHAT “Alexandrovska” Clinical laboratory, Medical University Sofia, Sofia, Bulgaria
| | - Dobrin Vassilev
- Department of Health Care, UMHAT “Medica Cor”, Ruse, University of Ruse “Angel Kanchev”, Ruse, Bulgaria
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Yaneva-Sirakova T, Vassilev D, Karamfiloff K, Hristova J, Shumkova M, Traykov L. Clinical effect of carotid stenting on cognitive abilities - possible evaluation using candidates for biomarkers. Folia Med (Plovdiv) 2023; 65:193-198. [PMID: 37144302 DOI: 10.3897/folmed.65.e79996] [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] [Received: 12/31/2021] [Accepted: 03/17/2022] [Indexed: 05/06/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Latchezar Traykov
- Medical University of Sofia, Bulgarian Academy of Sciences, Sofia, Bulgaria
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Kostova-Lefterova D, Stanev S, Ivanova D, Rashev MG, Nikolov N, Cheshmedzhieva B, Aleksandrov A, Karamfiloff K, Martinov I, Dineva S. PATIENT EXPOSURE DURING LOWER EXTREMITY ENDOVASCULAR AND HYBRID PROCEDURES – A MULTICENTER STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Vassilev D, Mileva N, Collet C, Nikolov P, Karamfiloff K, Naunov V, Sonck J, Hristova I, Georgieva D, Rigatelli G, Kassab GS, Gil RJ. Determinants of functional significance of coronary bifurcation lesions and clinical outcomes after physiology-guided treatment. Int J Cardiol Heart Vasc 2022; 38:100929. [PMID: 35024426 PMCID: PMC8728425 DOI: 10.1016/j.ijcha.2021.100929] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the rate of functionally significant (fractional flow reserve, FFR ≤ 0.80) coronary bifurcation stenoses that are considered anatomically significant based on angiographic estimation and to define predictors of functional significance of stenoses in main vessel and side branch. BACKGROUND To date, the rate of functionally significant stenoses in angiographic significant coronary bifurcation stenoses has not been specifically determined. METHODS Patients with significant angiographic bifurcation lesions defined as diameter stenosis >50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). The protocol was approved by the local ethics committee. RESULTS Overall, 171 patients with bifurcation lesions were included. Mean FFR in MV was 0.80 ± 0.01 and 0.84 ± 0.09 in SB. 46% (n = 78) of bifurcation lesions were functionally significant when assessed with FFR. Diameter stenosis in main vessel, lesion length, side branch territory and SYNTAX score (SS) were found as predictors for lesion functional severity (main vessel FFR ≤ 0.80). At the time of follow-up, there were no differences between the treated and deferred group regarding rates of all-cause death, cardio-vascular death, MACEs and POCE. CONCLUSION Less than half of all angiographic significant bifurcation lesions were functionally significant when assessed with FFR. There was no difference in clinical outcomes at mean time of three years follow-up in treated and deferred lesion.
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Affiliation(s)
- Dobrin Vassilev
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Niya Mileva
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Pavel Nikolov
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Kiril Karamfiloff
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Vladimir Naunov
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Irinka Hristova
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Despina Georgieva
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | | | - Robert J. Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
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Vassilev D, Mileva N, Collet C, Nikolov P, Sokolova K, Karamfiloff K, Naunov V, Sonck J, Rigatelli G, Kassab GS, Gil RJ. Bifurcation functional significance score as predictor of mortality: a validating study. Sci Rep 2021; 11:24308. [PMID: 34934122 PMCID: PMC8692595 DOI: 10.1038/s41598-021-03815-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes. Patients with significant angiographic bifurcation lesions defined as diameter stenosis > 50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). 169 patients from Fiesta study (derivation cohort) and 555 patients from prospective bifurcation registry (clinical effect cohort) were analyzed to validate angiographic prediction score (BFSS) used to determine the potentially functional significance of coronary bifurcation stenosis. Bifurcation functional significance score (including the following parameters-SYNTAX ≥ 11, SB/MB BARI score, MV %DS ≥ 55%, main branch (MB) %DS ≥ 65%, lesion length ≥ 25 mm) with a maximum value of 11 was developed. A cut-off value of 6.0 was shown to give the best discriminatory ability-with accuracy 87% (sensitivity 77%, specificity 96%, p < 0.001). There was also a significant difference in all-cause mortality between patients with BFSS ≥ 6.0 vs. BFSS < 6.0-25.5% vs. 18.4%, log-rank p = 0.001 as well as cardiac mortality: BFSS ≥ 6.0 vs. BFSS < 6.0-17.7% vs. 14.5%, log-rank (p = 0.016). The cardiac mortality was significantly lower in patients with smaller absolute SB territory, p = 0.023. An angiographic score (BFSS) with good discriminatory ability to determine the functional significance of coronary bifurcation stenosis was developed. The value for BFSS ≥ 6.0 can be used as a discriminator to define groups with higher risk for all-cause and cardiac mortality. Also, we found that the smaller side branches pose greater mortality risk.
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Affiliation(s)
- Dobrin Vassilev
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria.
| | - Niya Mileva
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria.
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Carlos Collet
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
| | - Pavel Nikolov
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Katerina Sokolova
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Kiril Karamfiloff
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Vladimir Naunov
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | | | - Robert J Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
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Dobrin Vassilev, Mileva N, Panayotov P, Sokolova K, Nikolov P, Naunov V, Collet C, Karamfiloff K, Rigatelli G, Gil R. TCT-503 Survival of Patients With Chronic Coronary Total Occlusions With Normal, Midrange, and Low Ejection Fractions: The Role of Percutaneous Revascularization. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vassilev D, Mileva N, Collet C, Sokolova K, Nikolov P, Karamfiloff K, Rigatelli G, Gil R. Baseline troponin-T is powerful predictor of mortality after coronary bifurcation stenting. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the lesion, however, fail to give information about the functional significance of the bifurcation stenosis. There is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes.
Methods
Patients with significant angiographically bifurcation lesions defined as diameter stenosis >50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). If FFR was ≤0.80 the lesion was considered functionally significant, and patients underwent PCI. For the group with FFR >0.80 – intervention was deferred. All patients were followed-up for vital status every 3 months. Cox regression analysis was performed to identify independent predictors of all-cause and cardiovascular death. The local ethics committee approved the study and patients signed informed consent for participation into registry.
Results
For mean follow-up of 38±18 months (median 40, IQR 23–55 months) all-cause mortality was numerically lower: 8.5% (n=7/82) in deferred group and 12.6% in stented group (n=11/76, p=0.387). The cardiac mortality was also numerically lower, but statistically not significant (9.8%, n=8/82 vs. 11.5%, n=10/88, p=0.714). On multivariate model, independent predictors were mitral regurgitation >1st degree – HR=1.778 (CI 1.100–2.874, p=0.019); dyslipidemia HR=0.765 (CI 0.594–0.985, p=0.038); hemoglobin concentration – HR=0.976 (CI 0.964–0.988, p<0.001); pre-PCI serum troponin ≥0.010 ng/ml – HR=2.702 (CI 1.451–5.032, p=0.002). On multivariate analysis, the following factors were identified as independent predictors of cardiac mortality: age – HR=1.035 (CI 1.009–1.062, p=0.009); diabetes – HR=1.789 (CI 1.089–2.962, p=0.024); dyslipidemia treated with statin – HR=0.667 (CI 0.515–0.863, p=0.002); LV posterior wall thickness – HR=1.230 (CI 1.062–1.424, p=0.006); mitral regurgitation more than 1st degree – HR=1.763 (CI 1.065–2.917, p=0.027); troponin pre-PCI ≥0.010 ng/ml – HR=2.498 (CI 1.228–5.081, p=0.011); true bifurcation lesion – HR=1.820 (CI 1.026–3.229, p=0.040); SBBARI score <10% – HR=1.715 (CI 1.049–2.804, p-0.031).
Conclusion
Baseline high-sensitive troponin T value is a strong predictor for both all cause and cardiac mortality in patients undergoing coronary bifurcation lesion PCI.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Alexandrovska University Hospital
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Affiliation(s)
- D Vassilev
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - N Mileva
- Olv Hospital Aalst, Aalst, Belgium
| | - C Collet
- Olv Hospital Aalst, Aalst, Belgium
| | - K Sokolova
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - P Nikolov
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - K Karamfiloff
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | | | - R Gil
- Mossakowski Medical Research Centre, Warsaw, Poland
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Shumkova M, Vassilev D, Karamfiloff K, Ivanova R, Stoyanova K, Yaneva-Sirakova T, Gil RJ. Acute myocarditis associated with Pfizer/BioNTech vaccine. Kardiol Pol 2021; 79:1282-1283. [PMID: 34424994 DOI: 10.33963/kp.a2021.0095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Monika Shumkova
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria.
| | - Dobrin Vassilev
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Kiril Karamfiloff
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Raya Ivanova
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Kristina Stoyanova
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Teodora Yaneva-Sirakova
- Department of Cardiology, Alexandrovska University Hospital, Faculty of Medicine, Medical University of Sofia, Bulgaria
| | - Robert J Gil
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Poland Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of the Interior, Warszawa, Poland
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Shumkova M, Vassilev D, Karamfiloff K, Ivanova R, Yaneva-Sirakova T, Stoyanova K, Boneva T, Kaneva R, Gil RJ. Left ventricle non-compaction with a dilative phenotype and novel genetic mutations. Kardiol Pol 2021; 79:716-717. [PMID: 33890751 DOI: 10.33963/kp.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Monika Shumkova
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Dobrin Vassilev
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Kiril Karamfiloff
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Raya Ivanova
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Teodora Yaneva-Sirakova
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Kristina Stoyanova
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Tsenka Boneva
- Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Radka Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Robert J Gil
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Poland Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of the Interior, Warszawa, Poland
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Vassilev D, Mileva N, Collet C, Nikolov P, Dimitrov G, Karamfiloff K, Naunov V, Rigatelli G, Gil R, Serruys P. TCT CONNECT-203 Prediction of Functional Severity of Coronary Bifurcation Lesions by Means of Angiographically Derived Score (Results From FIESTA Registry, NCT01724957). J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vassilev D, Mileva N, Collet C, Nikolov P, Dimitrov G, Karamfiloff K, Naunov V, Rigatelli G, Gil R, Serruys P. TCT CONNECT-154 Cardiovascular Mortality After Functionally Guided Treatment of Coronary Bifurcation Lesions: Insights From FIESTA Registry. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mileva N, Vassilev D, Nikolov P, Dimitrov G, Karamfiloff K, Collet C. TCT CONNECT-241 Rates of Periprocedural Complications in Patients With Percutaneous Coronary Intervention of Chronic Total Occlusions and Impact on Mortality. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vassilev D, Nikolov P, Mileva N, Zlatancheva G, Dimitrov G, Ivanov V, Karamfiloff K, Collet C, Gil R. P1963The determinants of functional significance of coronary bifurcation lesions and its implications on clinical follow up to 48 months (insights from FIESTA registry). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is no study up-to-now to determine the rate of functionally significant coronary bifurcation lesions, which have to be intervened and what are the clinical consequences of the FFR case selection strategy.
Methods
We analyzed patients from FIESTA registry, which was continuation of FIESTA study (Ffr vs. IcEcgSTA, ClinicalTrials.gov Identifier: NCT01724957). Patients with stable angina were included (if there were other coronary stenoses they were threated first after checking by FFR for functional significance). The inclusion criterions were angiographic bifurcation lesions in a native coronary artery with diameter ≥2.5 mm and ≤4.5 mm and SB diameter ≥2.0 mm. We excluded patients with ST-segment elevation myocardial infarction, left main, hemodynamic instability and those with non-cardiac co-morbidity conditions with a life expectancy of less than one year. PCI was performed according to the current guidelines. Provisional stenting was the default strategy in all patients. Two guidewires were inserted into both distal MB and SB. Initial FFR was performed using the PrimeWire or PrimeWire Prestige (Volcano Corp., USA). For all FFR measurements, intracoronary adenosine was given in increasing doses of 60 mcg, 120 mcg, and 240 mcg. The minimum value of FFR measurements was taken for analysis. All patients received double antiplatelet therapy with ADP-antagonist and aspirin for at least 12 months.
Results
A 130 consecutive patients with coronary bifurcation stenoses were included – 57 had positive FFR<.80 in main vessel of bifurcation lesion (44% functionally significant lesions). The mean age was 67±10 years, 66% males, 96% hypertensive, 39% diabetic, 96% dyslipidemic (or on treatment with statin), 55% smokers, 22% with previous myocardial infarction, 51% with previous PCI. The residual SYNTAX score before FFR bifurcation assessment was 13±4 (FFR<.80) vs. 8±3 (FFR≥0.80), p<0.001. Univariate predictors of bifurcation FFR<.80 were: proximal (MV%DS) or distal (MB%DS) main vessel stenosis ≥85% (derived from ROC analysis with overall accuracy 77% and 72%, accordingly), lesion length, SYNTAX score, triglyceride concentration, previous MI on lateral wall and carotid artery disease. On multivariate logistic analysis only MV%DS>85% (OR=8.929, CI 2.887–27.619, p<0.001), MB%DS>85% (OR=3.831, CI 1.349–10.883, p=0.012) and SYNTAX score≥12 (OR=16.466, CI 5.225–15.889, p<0.001). At median follow-up of 26 months (IQR 17–35) the all-cause mortality was 17.5% in FFR positive bifurcations vs. 4.1% in FFR negative lesions (log-rank =.067).
Conclusions
Less than a half of angiographically significant coronary bifurcation lesions are functionally significant and require stent implantation. The functional significance was related with higher degree stenosis in main vessel and overall disease severity estimated with SYNTAX score. A trend to lower mortality was noted in group with non-significant FFRs.
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Affiliation(s)
- D Vassilev
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - P Nikolov
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - N Mileva
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - G Zlatancheva
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - G Dimitrov
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - V Ivanov
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - K Karamfiloff
- University Hospital Alexandrovska, Cardiology clinic, Sofia, Bulgaria
| | - C Collet
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - R Gil
- Mossakowski Medical Research Centre, Warsaw, Poland
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Vassilev D, Dosev L, Collet C, Karamfiloff K, Stoikova J, Pancheva R, Shumkova M, Zlatancheva G, Naunov V, Rigatelli G, Kassab GS, Gil RJ, Serruys PW. Intracoronary electrocardiogram to guide percutaneous interventions in coronary bifurcations - a proof of concept: the FIESTA (Ffr vs. IcEcgSTA) study. EUROINTERVENTION 2018; 14:e530-e537. [PMID: 28829743 DOI: 10.4244/eij-d-17-00189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to determine the accuracy of the intracoronary electrocardiogram (icECG) to detect ischaemia during bifurcation lesion percutaneous coronary intervention (PCI) with fractional flow reserve (FFR) as a reference. METHODS AND RESULTS Patients with significant bifurcation lesions defined as FFR ≤0.80 were included. FFR and icECG were performed in the main vessel (MV) and side branch (SB) before and after provisional stenting. icECG was recorded with an uninsulated proximal wire end connected to a unipolar lead. The diagnostic accuracy of the icECG for the detection of ischaemia in the SB after MV stenting was determined with FFR as a reference. Overall, 37 patients were included. Seventeen bifurcations had an SB FFR ≤0.80 after MV stenting and 20 patients had an ST-segment elevation on the icECG. There was significant correlation between SB FFR and ST-segment elevation on the icECG (r=-0.533, p<0.001). The diagnostic accuracy of icECG ST-elevation to detect functionally significant SB stenosis revealed an AUC of 0.71 (95% CI: 0.64-0.80) with a sensitivity of 88% and specificity of 75% with a positive predictive value of 75% and negative predictive value of 88%. Neither SB FFR nor icECG correlated with SB percent diameter stenosis after MV stenting. CONCLUSIONS Intracoronary ECG has a good ability to predict functionally significant stenosis at the SB after MV stenting during bifurcation PCI. This method provides a novel strategy to assess the significance of an SB lesion without the need of a pressure wire.
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Affiliation(s)
- Dobrin Vassilev
- "Alexandrovska" University Hospital, Cardiology Department, Medical University, Sofia, Bulgaria
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Vassilev D, Dosev L, Karamfiloff K, Shumkova M. TCT-823 Main vessel score - a simple tool to predict functional significant main vessel stenosis requiring treatment in coronary bifurcation lesions. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vassilev D, Dosev L, Karamfiloff K. TCT-293 Is it possible to predict fractional flow reserve in side branch after main vessel stenting in coronary bifurcation lesions by means of intracoronary electrocardiogram? A proof of concept FFRvs.icECG. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vassilev D, Dosev L, Karamfiloff K. TCT-535 Intracoronary electrocardiographic parameters predict mortality rates at mid-term follow-up (up to 60 months) after stenting coronary bifurcation lesions. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vassilev D, Dosev L, Karamfiloff K, Pancheva R, Shumkova M, Zlatancheva G, Dunev P, Stoykova Z, Naunov V, Rigatelli G, Gil R, Collet C, Serruys P. P6113Mortality prediction at five years after PCI of bifurcaton stenoses - intracoronary ECG mortality score (IEMS). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vassilev D, Dosev L, Karamfiloff K, Pancheva R, Shumkova M, Stoykova Z, Rigatelli G, Gil R, Collet C, Serruys P. P2386Main vessel score - a simple tool to predict functional significant main vessel stenosis requiring treatment in coronary bifurcation lesions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vassilev D, Karamfiloff K, Dosev L, Stoykova Z, Naunov V. P1743FFR guided treatment of bifurcation stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vassilev D, Dosev L, Karamfiloff K, Stoykova Z, Naunov V, Shumkova M, Pancheva R. P1741Is it possible to predict fractional flow reserve in side branch after main vessel stenting in coronary bifurcation lesions by means of intracoronary electrocardiogram? A proof of concept FFR vs. icECG. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vassilev D, Dosev L, Karamfiloff K, Naunov V, Stoykova Z, Shumkova M, Pancheva R. P1737Intracoronary electrocardiographic parameters predict mortality rates at mid-term follow-up (up to 60 months) after stenting coronary bifurcation lesions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vassilev D, Dosev L, Rigatelli G, Karamfiloff K, Popov H, Nikolov L, Ivanov K, Entcheva-Dimitrov P, Golebiewski S, Gil RJ, Kassab GS, Bil J. Prediction of troponin elevation by means of intracoronary electrocardiogram during percutaneous coronary intervention of coronary bifurcation lesions (from COronary SIde Branch Residual IschemiA and COllateralization Assessment Study; COSIBRIA & Co Study. Kardiol Pol 2016; 74:943-53. [PMID: 27112944 DOI: 10.5603/kp.a2016.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/14/2015] [Revised: 02/09/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influence of periprocedural ischaemia on coronary artery bifurcation stenting (percutaneous coronary intervention [PCI]) remains uncertain. AIM To determine the differences in rates of end procedural ischaemia after bifurcation lesion PCI detected with intracoronary electrocardiography (icECG). METHODS Unipolar icECGs were recorded before, during, and after stent placement and at the end of procedure in side branch (SB) and main branch (MB). Coronary wire was placed in all distal vessels with diameter > 1.5 mm to "map" the distal zones of ischaemia. The patient population consisted of patients with stable/unstable angina with troponin I evaluated before and after PCI. RESULTS We studied 147 patients (68% males) with mean age of 64 ± 9 years. One hundred and forty-two patients had icECG recordings at the end of PCI from all locations of the treated region; 36% of patients had MB ST segment elevation (STE) and 31% had icECG STE in the SB region (p = 0.378). The icECG had sensitivity of 82% and specificity of 81% to detect troponin I elevation, with positive predictive value of 81% and negative predictive value of 83%. The independent predictors of troponin increase (> 5 × N) were: sex (for female gender, OR = 0.130, CI 0.017-0.995, p = 0.049), previous myocardial infarction (OR = 33.23, CI 2.802-394.1, p = 0.005), and icECG STE in MB or SB or occlusion of secondary SB (OR = 7.877, CI 2.474-25.07, p < 0.001) and for any troponin elevation were double product - SBPxHR (OR = 0.999, CI 0.999-1.00, p = 0.022) and icECG STE in MB or SB or occlusion of secondary SB (OR = 9.762, CI 3.273-29.12, p < 0.001). CONCLUSIONS Intracoronary electrocardiography is a highly sensitive and specific method for determination of ischaemic regions and prediction of elevated troponin I.
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Affiliation(s)
- Dobrin Vassilev
- "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria.
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Vassilev D, Karamfiloff K, Gil R, Tu Quynh NN, Van Tran H, Rigatelli G. GW26-e5422 Patients with residual ischemia on intracoronary electrocardiogram after stenting coronary bifurcation lesions have more angina at 12 month follow-up – insights form intracoronary electrocardiography based strategy for treatment of coronary bifurcation lesions. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.06.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vassilev D, Karamfiloff K, Dosev L, Stoykova J, Stoimenov S, Jekova M, Naunov V, Pancheva R, Gil RJ. TCT-477 Normalized Troponin Increase to Area at Risk for Procedural Myonecrosis Assessment and Prognostication After Percutaneous Coronary Intervention in Coronary Bifurcation Lesions – Insights From Intracoronary Electrocardiography Based Strategy for the Treatment of Coronary Bifurcation Lesions. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vassilev D, Karamfiloff K, Gil R. Aneurysm formation after paclitaxel-eluting balloon angioplasty used to treat coronary artery restenosis after plain old balloon angioplasty - case report and review of the literature. Postepy Kardiol Interwencyjnej 2015; 11:250-1. [PMID: 26677372 PMCID: PMC4631746 DOI: 10.5114/pwki.2015.54027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/16/2015] [Accepted: 04/12/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Dobrin Vassilev
- Department of Cardiology, “Alexandrovska” University Hospital, Medical University, Sofia, Bulgaria
| | - Kiril Karamfiloff
- Department of Cardiology, “Alexandrovska” University Hospital, Medical University, Sofia, Bulgaria
| | - Robert Gil
- Central Clinical Hospital of the Internal Affairs and Administration Ministry, Warsaw, Poland
- Institute of Experimental and Clinical Medicine, Polish Academy of Science, Warsaw, Poland
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Vassilev D, Mateev H, Alexandrov A, Karamfiloff K, Gil RJ. Double bifurcation optimization stent system technique for left main stenosis. J Interv Cardiol 2014; 27:570-3. [PMID: 25224296 DOI: 10.1111/joic.12155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We present a first-in-man case with implantation in culottes' fashion of two dedicated coronary bifurcation stents (BiOSS Lim) in distal left main stenosis. The immediate procedural and very short-term result was excellent.
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Affiliation(s)
- D Vassilev
- National Heart Hospital, Sofia, Bulgaria
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