The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting.

OBJECTIVES: Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. METHODS: A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. RESULTS: CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset (p < 0.001). CONCLUSIONS: The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

The role of multislice computed tomography in the diagnosis of coronary artery fistulas.

BACKGROUND: This study aims to investigate the frequency and the anatomical features of coronary artery fistulas in patients undergoing multislice computed tomographic angiography for various reasons. METHODS: Between January 2009 and July 2015, a total of 40 coronary artery fistulas of 26 patients were retrospectively analyzed using multislice computed tomographic angiography in our clinic. The affected arteries and localizations of the fistulas were evaluated. RESULTS: Of the fistulas, 11 (27.5%) were originating from the circumflex artery, 10 (25%) from the left anterior descending artery, four (10%) from the diagonal arteries, three (7.5%) from the left main coronary artery, three (7.5%) from the right main coronary artery, three (7.5%) from the septal artery, three (7.5%) from the conus artery, one (2.5%) from the obtuse marginal artery, one (2.5%) from left anterior descending artery proper (dual LAD), and one (2.5%) from the ramus intermedius. One of the conus arteries was directly originating from the right coronary sinus. Twelve (30%) of the fistulas were draining into the pulmonary trunk, eight (20%) into the left ventricle, seven (17.5%) into the right ventricle, five (12.5%) into the superior vena cava, three (7.5%) into the right main pulmonary artery, two (5%) into the right atrium, one (2.5%) into the left atrium, one (2.5%) into the right internal thoracic artery, and one (2.5%) into the sinus coronarius. CONCLUSION: Compared to conventional angiography, multislice computed tomographic angiography is a non-invasive modality which allows enhancing coronary artery fistulas at a higher rate and visualizing the cardiac anatomy in detail.

A Late Sequela of the David Procedure: Left Main Coronary Artery Compression and Myocardial Infarction due to Pseudoaneurysm Formation.

Valve-sparing root replacement (the David procedure) is a valuable alternative to conventional aortic root replacement with a composite graft, especially in patients whose aortic valve leaflets have not been altered. However, reintervention rates are higher than are those associated with composite graft implantation. In this report, we present the case of a patient who had undergone valve-sparing root replacement 2 years earlier and was admitted to our hospital with myocardial infarction and cardiogenic shock secondary to coronary ostial button dissection, aortic pseudoaneurysm formation, and severe left main coronary artery compression. To our knowledge, this case is exceedingly rare. Rather than attempt local reconstruction of the mouth of the pseudoaneurysm, we excised the lesion, the aortic valve, and the graft, and we successfully implanted a composite aortic graft with a mechanical aortic valve.