Objective: to analyze the angiographic results of endovascular treatment for chronic coronary occlusions in patients with coronary heart disease.Material and methods. In 2009 to 2013 attempted endovascular recanalization of chronic coronary occlusions in 854 patients with coronary heart disease. The patients’ age ranged from 36 to 68 years (mean 52 years). The estimated duration of occlusion was 1 month to more than 3 years. There were 193 (22.6%) females and 661 (77.4%) males. 462 (54.1%) patients had a history of myocardial infarction. 738 (86.4%) and 116 (13.6%) patients had true (TIMI grade 0) and functional (TIMI grade 1) occlusions, respectively. Multi- and univascular lesions were found in 683 (79.9%) and 171 (20.1%) patients, respectively. Silent occlusions with preserved myocardial contractility were identified in 165 (19.3%) patients.Results. Blood flow could be successfully restored in 616 (72.1%) patients. Recanalization of chronic coronary occlusion failed in 238 (27.9%) patients.Conclusion. Recanalization of chronic coronary occlusions is a highly effective and relatively safe technique. The efficiency of the procedure largely depends on the duration of occlusion, its X-ray morphological characteristics, and the experience of a physician.

The use of the radial artery as an approach to percutaneous coronary interventions is becoming increasing popular now. The success of this approach depends on both the accumulated experience of an operator and a health care facility. The paper analyzes an investigation of the comparative characteristics of both a transradial approach and a transfemoral one and the impact of the former on the success of the procedure. It considers the role of the transradial approach in the present-day practice of X-ray endovascular diagnosis and treatment specialists and discusses the problems of education and choice of optimal clinical indications.

The paper describes the technical features of a transradial approach; indications and patient selection for this arterial approach; and stepwise patient preparation. It depicts the anatomic variants of the origin of the radial artery, which affect the success of this approach. The suitable instruments for this approach are described. The authors give their results of the performed study comparing different types of approaches.

OBJECTIVETo compare the long-term results of transluminal balloon coronary angioplasty in patients after implantation of drug-eluting coronary artery stents with permanent or biosoluble polymer coatings.MATERIAL AND METHODSThis was a prospective, comparative, single-center trial. It enrolled patients having at least 70% stenosis who had undergone intracoronary Cypher (SES) or EucaTAX (EUPES) stent implantation.RESULTSThe trial included 602 subjects, including 282 patients with a placed EUPES stent and 320 patients with an implanted SES stent. Two years later, there was a higher rate of repeat revascularization in the EUPES group than in the SES group (16.3% versus 6.25%; p = 0.0001) and that of great unfavorable events in these groups (18.4% versus 7.8%; p = 0.001). According to the angiographic parameters of in-stent restenosis, the rate of repeat target-segment revascularization was significantly higher in the EUPES group than that in the EucaTAX group while stenting coronary arteries less than 3 mm in diameter, using stents more than 18 mm in length, as well as in residual stenosis of more than 12% as compared to the SES group.CONCLUSIONIn the SES group, the clinical outcomes were better than those in the EUPES group during 2-year follow-up; the rate of target lesion revascularization was significantly higher in the EUPES group.

Our aim was to examine correlations between polymorphisms in five antioxidant enzymes genes, activity of free-radical processes, and the risk of restenosis after coronary artery stenting with bare metal stents (BMS). A total of 101 male patients who underwent intracoronary stenting using BMS and coronary angiography follow-up of 6 months were enrolled in: group with in-stent restenosis (n = 44) and without restenosis (n = 57). The content of lipoperoxides and malondialdehyde (MDA) in Low-density lipoprotein (LDL), activity of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) in erythrocytes, and genotypes polymorphisms of the CAT gene (-262C/T), paraoxonase-1 (PON-1) gene (163T/A and 575A/G), endothelial nitric oxide synthase (eNOS) gene (298G/T (rs#1799983) and -786T/C), GPx-1 gene (599C/T (rs#1050450)), and glutathione-S-transferase (GSTP) gene (313A/G) were determined. In carriers of the minor allele of 599C/T polymorphism of the GPx-1 gene, activity of GPx in erythrocytes was lower by 17 % than in wild allele homozygotes, while the content of lipoperoxides in LDL was higher by 74 %. T-allele of 599C/T polymorphism of the GPx-1 gene (OR = 2.9; 95 % CI: 1.23-6.82) and T-allele of 298G/T polymorphism of the eNOS gene (OR = 2.79; 95 % CI: 1.17-6.66) were associated with the risk of in-stent restenosis. Minor alleles of polymorphisms 298G/T of the eNOS gene and 599C/T of the GPx-1 gene are associated with an increased risk of in-stent restenosis. Minor allele of the GPx-1 gene 599C/T polymorphism leads to a decrease of the GPx activity and increase of the activity of free-radical processes.

AIM:To investigate possibility of effect of antioxidant status on severity of restenosis of coronary arteries after transluminal coronary angioplasty with stenting.MATERIAL AND METHODS:Men with ischemic heart disease and coronary angiography performed in 6 months after coronary artery stenting with bare stents were included in this study. Coronary angiograms were subjected to quantitative computer analysis. Samples of venous blood were obtained before control angiography. We assessed duration of lag phase of copper induced free radical oxidation of low density lipoproteins (LDL), and measured level of lipoperoxides in LDL, content of malone dialdehyde (MDA) in LDL, activity of superoxide dismutase (SOD), glutathione peroxidase (GP), and erythrocyte catalase.RESULTS:We revealed positive correlations of lag phase duration and activity of GP with minimal artery diameter 6 months after stenting (r=0.41, p < 0.002 and r=0.24, p < 0.05, respectively), of lipoperoxide level in LDL and MDA content in LDL with degree of stenosis (r=0.32, p < 0.009, and r=0.37, p < 0002, respectively). We also found negative correlations between lag phase duration and GP activity with degree of restenosis (r= - 0.38, p < 0.04, and r= - 0.39, p < 0.001, respectively), level of lipoperoxides in LDL and MDA content in LDL with artery minimal diameter (r= - 0.33, p < 0.007, and r=0.32, p < 0.008, respectively).CONCLUSION:Our study confirms possibility of influence of antioxidant status on degree of coronary artery restenosis in patients after coronary artery stenting.

Aim. To study the links between four polymorphisms of three antioxidant enzymes (catalase, paraoxonase, endothelial NO synthase) and restenosis risk after coronary artery stenting (CAS). Material and methods. The study included male patients with coronary heart disease (CHD), stable angina and angiographically verified stenosis of one or two main CA ≥70%, after intracoronary CAS with non-eluting stents and control coronary angiography 6 months later. Angiographical stenosis was determined as local reduction in CA diameter ≥50%. In all participants, -262 C/T polymorphism of CAT gene, L55M and Q192R polymorphisms of PON gene, and E298D polymorphism of eNOS gene were identified. Results. The study included 101 patients, and restenosis was diagnosed in 44%. E298D polymorphism of eNOS gene was associated with stent restenosis. In D allele carriers, restenosis risk was higher (p=0,008). The combination of LM/QQ genotypes for L55M and Q192R polymorphisms of PON gene was twice as prevalent in restenosis group: 41% vs. 21% (p=0,044). Conclusion. Genotyping on E298D polymorphism of eNOS gene and L55M and Q192R polymorphisms of PON gene could be used for post-CAS restenosis risk stratification in Russian patients.

Aim. To study the links between four polymorphisms of three antioxidant enzymes (catalase, paraoxonase, endothelial NO synthase) and restenosis risk after coronary artery stenting (CAS). Material and methods. The study included male patients with coronary heart disease (CHD), stable angina and angiographically verified stenosis of one or two main CA >= 70%, after intracoronary CAS with non-eluting stents and control coronary angiography 6 months later. Angiographical stenosis was determined as local reduction in CA diameter >= 50%. In all participants, -262 C/T polymorphism of CAT gene, L55M and Q192R polymorphisms of PON gene, and E298D polymorphism of eNOS gene were identified. Results. The study included 101 patients, and restenosis was diagnosed in 44%. E298D polymorphism of eNOS gene was associated with stent restenosis. In D allele carriers, restenosis risk was higher (p=0,008). The combination of LM/QQ genotypes for L55M and Q192R polymorphisms of PON gene was twice as prevalent in restenosis group: 41% vs. 21% (p=0,044). Conclusion. Genotyping on E298D polymorphism of eNOS gene and L55M and Q192R polymorphisms of PON gene could be used for post-CAS restenosis risk stratification in Russian patients.

The present study has evaluated the immediate angiographic results of primary percutaneous interventions (PCI) in patients with acute myocardial infarction, as well as hospital and 6-month clinical outcomes. The analysis covered a total of 265 patients (females (23%) and males (77%)); their mean age was 57+/-11 years. The mean time before the first balloon dilatation during PCI was 278+/-135 minutes after the development of the pain syndrome or 109+/-94 minutes after hospital admission. PCI proved to be effective in 96% of the patients, as evidenced by angiography. TIMI 3 blood flow was achieved in 83% of cases during PCI. After primary PCI, hospital mortality was 98.9% and 95% survived 6 months. At 6-month follow-up, 22% patients had positive exercise tests, recurrent angina pectoris and/or more than 50% luminal stenosis of the infarct-related artery. Control angiography made less than 6 months later showed 11% restenosis. This prospective study has demonstrated the high immediate and long effectiveness and safety of primary interventions in acute myocardial infarction.