[Oral spiramycin for prevention of restenosis in coronary arteries].

Restenosis is the main problem of percutaneous coronary intervention (PCI). We investigated influence of oral Spiramycin (oral 16- cyclic macrolide antibiotic) on restenosis rate after uncovered metal stents implantation. 73 patients with acute myocardial infarction (1month) and one vessel lesion were divided into two groups. The first group composed of 42 patients, were treated with 100 mg aspirin +75 mg clopidogrel per day. The second group composed of 31 patients (12 patients were diabetic and 14 had long stenosis) received aspirin+clopidogrel+ spiramycin (one tablet - 3.000.000 IU per day during 6 weeks). Mean vessel diameter in first group patients was 3,2+0,4 millimeters; in second group patients was 3,1+0,3 millimeters. Angiography was performed twice: after six months of stent implantation and after an year of stent implantation. At 12-month follow up there were no major adverse cardiac events in both groups. Restenosis rate was significantly higher in the first group of patients (14,3% vs 6,4%; p<0,001; 4,8% vs 3,2% p<0,01). Oral administration of spiramycin for prevention of restenosis is safe and cost-effective in case of uncovered metal stents.

[Comparison between bare metal stents and drug eluting stents for the treatment of chronic total occlusion].

Patients with chronic total occlusions (CTO) are under high risk of restenosis, repeat recanalization procedures and mortality after stent. In our study we evaluated the clinical and angiographic efficacy of bare metal stents (BMS) and drug eluting stents (DES) implantation for chronic total occlusion.107 patients were divided into two groups: who were successfully treated with BMS (n=60) 56,1% and those who had CTO lesions with Cypher implantation(n=47) 43,9%. Six-month angiographic restenosis rates and major adverse cardiac events (MACE) were compared between the groups. At 6-month angiographic follow up, the restenosis rate was significantly higher in the BMS group (21,8% vs. 4,7%; p<0,001), but there was no significant statistic difference in the rate of MACE (11,6% vs.13,3%; p>0,05). Therefore, the implantation of DES in the treatment of CTO lesions showed more favourable results regarding restenosis compared with BMS implantation, but there was not a trend towards lower MACE rates.

[Is always chronic total occlusion indication for recanalization in patients with multi-vessel disease].

The issue of recanalization chronic total occlusion (CTO) up today stays unsolved. Existence of viable myocardium in the CTO basin is regarded to be one of the proofs in cases of transitory ischemia or in the state of hibernation. But, the question of CTO opening in presence of acinetic segments is still under discussion. The aim of our study is testing assumption that CTO recanalization in the presence of other stenotic arteries, improves global and regional contractility of myocardium. One hundred and twenty patients with MI after one month were enrolled. To diagnose viability of myocardium 72% of patients went through stress-echocardiography with small dozes of dobutimin. After, all patients were divided into two groups: who have to undergo complete revascularization (Group I- 35,5%), and those who have to undergo only CTO revascularization (Group II- 64,5%). There were no significant statistic differences in hemodynamic parameters between groups. In case of multi-vessel disease restoration of antegrade flow in CTO caused to block of CAD attacks and symptoms of congestive heart failure. Therefore, results of the study let us state existence of CTO as indication for angioplasty of infarct-related artery.