Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries.

BACKGROUND: The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries. METHODS: The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment. RESULTS: The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables. CONCLUSIONS: Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.

Safety of bivalirudin versus unfractionated heparin in endovascular revascularization of peripheral arteries in short- and long-term follow-up.

INTRODUCTION: Patients with peripheral artery disease (PAD) are considered as a high-risk group for hemorrhagic events. AIM: To assess the safety of bivalirudin vs. unfractionated heparin (UFH) in percutaneous peripheral interventions (PPI) in short- and long-term follow-up. MATERIAL AND METHODS: The retrospective single-center, observational study included 160 patients, undergoing PPI. Patients were divided into 2 groups based on the use of anticoagulation - unfractionated heparin (UFH group) or bivalirudin (Biv. group) - and observed up to 5 years. RESULTS: The UFH group consisted of 101 patients and the Biv. group consisted of 59. We registered the following end points during in-hospital observation: 1 death (0.63% Biv, p = 0.18), 12 hematomas at puncture site (0.63% Biv. vs. 7.05% UFH, p = 0.04), 2 pseudoaneurysms (1.27% UFH, p = 0.29), thrombosis (0.63% UFH, p = 0.45), 1 bleeding from puncture site (0.63% UFH, p = 0.45). The total number of hemorrhagic complications was 1.24% in the Biv. group and 8.07% in the UFH group (p = 0.04). During long-term follow-up of 65.7 ±36.4 months the all-cause mortality rate was higher in the Biv. group (8.59% Biv vs. 0% in UFH group, p = 0.009). Regression analysis showed that bivalirudin administration is a risk factor for increased mortality risk (p = 0.003, OR = 15, 95% CI: 3.3-107.8). CONCLUSIONS: Usage of UFH was associated with a higher number of hemorrhagic complications, especially hematomas at the puncture site in comparison to patients receiving bivalirudin.

Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion.

INTRODUCTION: Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten-fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. AIM: To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. MATERIAL AND METHODS: We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. RESULTS: The study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%. CONCLUSIONS: The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications.

Impact of coronary artery disease presence on the long-term follow-up of carotid artery stenting.

BACKGROUND: Carotid artery stenting (CAS) has become an alternative for carotid endarterectomy in the treatment of carotid artery atherosclerosis, due to limited injury and comparable periprocedural risk. The impact of coronary artery disease (CAD) on long-term follow-up after CAS needs to be reconsidered due to the intensification of aggressive pharmacotherapy in CAD in recent years. AIM: To assess the impact of CAD presence on the long-term follow-up of patients after CAS. METHODS: Data of 130 symptomatic and asymptomatic patients undergoing CAS with cerebral protection systems from December 2002 to December 2010 were divided into two groups: those with and those without CAD. Major adverse cardio- and cerebrovascular events (MACCE) during follow-up were defined as the combination of death (cardiac and non-cardiac), myocardial infarction (MI) and stroke or transient ischaemic attack (TIA). Long-term outcomes of patients were stratified based on the history of CAD. RESULTS: The mean age of patients was 66 ± 9 years, and the majority of patients were male (80.2%). Long-term follow-up data were available in 86.2% of patients. During mean follow-up of 71.9 ± 31.7 months the all-cause mortality rate was 19.3%. The rates of MI, stroke/TIA, and MACCE were 16.7%, 12.3%, and 36.3%, respectively. The frequency of MACCE during long-term follow-up was higher in patients with CAD vs. without CAD (40.8% vs. 6.7%, p = 0.01), and the mortality rate in the two groups was 22.2% vs. 0%, (p = 0.07), respectively. CONCLUSIONS: Patients with symptomatic or asymptomatic carotid stenosis are high-risk individuals. The presence of CAD increases the risk of MACCE in such patients during long-term follow-up.

Comparison of radiation dose exposure in patients undergoing percutaneous coronary intervention vs. peripheral intervention.

INTRODUCTION: Most endovascular techniques are associated with patient and personal exposure to radiation during the procedure. Ionising radiation can cause deterministic effects, such as skin injury, as well as stochastic effects, which increase the long-term risk of malignancy. Endovascular operators need to be aware of radiation danger and take all necessary steps to minimise the risk to patients and staff. Some procedures, especially percutaneous peripheral artery revascularisation, are associated with increased radiation dose due to time-consuming operations. There is limited data comparing radiation dose during percutaneous coronary intervention (PCI) with percutaneous transluminal angioplasty (PTA) of peripheral arteries. AIM: To compare the radiation dose in percutaneous coronary vs. peripheral interventions in one centre with a uniform system of protection methods. MATERIAL AND METHODS: A total of 352 patients were included in the study. This included 217 patients undergoing PCI (single and multiple stenting) and 135 patients undergoing PTA (in lower extremities, carotid artery, renal artery, and subclavian artery). Radiation dose, fluoroscopy time, and total procedural time were reviewed. Cumulative radiation dose was measured in gray (Gy) units. RESULTS: The total procedural time was significantly higher in PTA (PCI vs. PTA: 60 (45-85) min vs. 75 (50-100) min), p < 0.001. The radiation dose for PCI procedures was significantly higher in comparison to PTA (PCI vs. PTA: 1.36 (0.83-2.23) Gy vs. 0.27 (0.13-0.46) Gy), p < 0.001. There was no significant difference in the fluoroscopy time (PCI vs. PTA: 12.9 (8.2-21.5) min vs. 14.4 (8.0-22.6) min), p = 0.6. The analysis of correlation between radiation dose and fluoroscopy time in PCI and PTA interventions separately shows a strong correlation in PCI group (r = 0.785). However, a weak correlation was found in PTA group (r = 0.317). CONCLUSIONS: The radiation dose was significantly higher during PCI in comparison to PTA procedures despite comparable fluoroscopy time and longer total procedure time in PTA. Fluoroscopy time is a reliable parameter to control the radiation dose exposure in coronary procedures. The increasing complexity of endovascular interventions has resulted in the increase of radiation dose exposure during PCI procedures.

[Mild induced hypothermia in patient with acute myocardial infarction after cardiac arrest]. / Zastosowanie lagodnej hipotermii terapeutycznej u pacjenta z zawalem serca powiklanym naglym zatrzymaniem krazenia.

Mild induced hypothermia is recommended by both European and American cardiological associations as well as European and Polish Recuscitation Council as a standard therapy in comatose patients resuscitated from cardiac arrest. We report a case of a 60 year-old male patient resuscitated from out-of-hospital cardiac arrest treated with mild hypothermia. The use of hypothermia improved patient's neurological prognosis and outcome by preventing severe brain injury.