Bora Demircelik

Pharmacomechanical Thrombectomy in the Management of Deep Vein Thrombosis Using the Cleaner Device: An Initial Single-Center Experience

BACKGROUND Pharmacomechanical thrombectomy (PMT) has appeared as an effective treatment modality for deep venous thrombosis (DVT). The study aimed to assess the efficacy of the Cleaner™ thrombectomy device for acute DVT. METHODS Sixteen consecutive patients presenting with extensive iliofemoral and/or femoropopliteal acute DVT and managed at our institution between February 2013 and May 2014 were retrospectively reviewed. The patients underwent PMT with the Cleaner device after insertion of vena caval filters. For underlying stenotic lesions, balloon angioplasty and/or stent placement was performed. RESULTS PMT with the Cleaner device was successful in 14 patients with complete restoration of flow. No clinical signs of pulmonary thromboembolism was recorded after the procedure. Thrombectomy failed in 2 patients. For the rest of the patients, balloon angioplasty was performed to relieve underlying stenotic lesions. Nine of them underwent additional stenting. CONCLUSIONS Our initial experience suggests that the Cleaner device can be used in acute DVT. However, further studies involving larger patient populations are warranted to determine long-term results.

Coronary stenting for acute myocardial infarction in a patient with an anomalous origin of the left main coronary artery.

The angiographical incidence of coronary anomalies was 1.3%. Anomalous origin of the left main coronary artery arising from the right sinus of Valsalva is extremely rare occurring in approximately 0.019% of angiographic series. Most of these anomalies are not clinically important. Percutaneous coronary intervention plays an important role in the management of acute myocardial infarction, and coronary anomalies may determine a lower success rate of this intervention. We report here the unusual case of a patient with single coronary ostium and acute inferior myocardial infarction who underwent successful coronary stenting.

A coronary proatherosclerotic marker: Pregnancy-associated plasma protein A and its association with coronary calcium score and carotid intima-media thickness

BACKGROUND Atherosclerosis, a chronic inflammatory disorder of the arteries, is responsible for the greatest number of deaths in westernized societies, with numbers increasing at a marked rate in developing countries. Coronary calcium score (CCS), carotid intima-media thickness (CIMT) and pregnancy-associated plasma protein A (PAPP-A) are predictors for the development of atherosclerosis. OBJECTIVES This study was aimed to investigate the relationship between CCS, CIMT and PAPP-A for earlier diagnosis of atherosclerosis. MATERIAL AND METHODS A total of 99 patients were included in the study. Coronary computerized tomography (CT) angiography was performed on all patients. The calcium scoring technique was performed using a sequential scanning mode. CIMT measurement was done through the area 1 cm distal of the bulbus arteriosus with carotid Doppler ultrasound. PAPP-A values were analyzed by double immunoenzymatic technique. RESULTS Out of 99 patients, 63 were found with coronary atherosclerosis using multislice computed tomography (MSCT) coronary angiography. When the cut-off point for CCS was taken to be 0.40, the sensitivity of this parameter was 97% and its specificity was 68.3%. When the cut-off point for CIMT was taken to be 0.60, the sensitivity and the specificity of these parameters were 75.0% and 87.3%, respectively, for the right measurements and 75.0% and 79.4%, respectively, for the left measurements. CONCLUSIONS This data support the conclusion that PAPP-A, like CCS and CIMT, is a parameter that can be used to detect subclinical atherosclerosis.

Antiplatelet Effect of Sequential Administration of Cilostazol in Patients with Acetylsalycilic Acid Resistance.

BACKGROUND Acetylsalicylic acid (ASA) resistance in patients with coronary artery disease is an important medical problem that can affect treatment decision-making and outcomes. Cilostazol has been investigated to determine its effectiveness in patients with acetylsalicylic acid resistance. The aim of this study was to evaluate the antiplatelet efficacy of sequential administration of CLZ in patients with ASA resistance. METHODS A total of 180 patients were enrolled in our study. Patients with stable coronary artery disease were first given orally ASA 100 for 10 days, followed by collagen/epinephrine induced closure time (CTCEPI) measurements. Those who were found to be resistant to orally 100 mg of ASA were given orally 300 mg of ASA for an additional 10 days after which we repeated CTCEPI measurements. Those patients with resistance to orally 300 mg ASA were then given CLZ at a daily dose of orally 200 mg for 10 days followed by a final CTCEPI measurement. RESULTS The rate of resistance to 100 mg ASA was 81/180 (45%) compared to a rate of 35/81 (43.2%) with 300 mg ASA. Of the 35 patients found to be resistant to 300 mg ASA, 22 (62.9%) also failed to respond to CLZ treatment. Overall, sequential administration of 300 mg ASA and 200 mg CLZ resulted in a reduction in the number of non-responders from 45% to 12.2%. CONCLUSIONS Initiation of CLZ could be of benefit in some patients with ASA-resistance for whom an effective anti-aggregant effect is of clinical importance.

A Case Report of Three Dimensional Transthoracic Echocardiographic View of Acute Proximal Type Aortic Dissection

A 67 year-old female patient was admitted to our emergency room with the complaint of severe and sudden onset tearing like chest pain lasting for an hour. Immediately performing twodimensional transthoracic echocardiography (2DTTE), pericardial effusion and an undulating intimal flap within the aortic lumen starting from the non-coronary cuspid were visualized. Ascending aorta was 7.6 cm in diameter. Real-time three-dimensional (RT 3D) TTE confirmed the diagnosis. Once the diagnosis of acute proximal type aortic dissection is suspected which modality to be chosen depends on clinical status of the patient and technical availability of the hospital. Non-invasive diagnostic modalities like contrast enhanced computed tomography (CECT), magnetic resonance imaging (MRI) may be preferred over invasive aortography. As transesophageal echocardiography (TEE) is a semi-invasive procedure and is mostly used intraoperatively, TTE may be preferred instead of TEE. RT 3DTTE is a helpful equipment in confirming the diagnosis of aortic dissection by 2DTTE. RT 3DTTE is advantageous in terms of accessibility and applicability at bedside and being a non-invasive procedure.

Arrhythmic Side Effect of Itraconazole Monotherapy: A Case Report

A 39-year-old woman treated with itraconazole for onychomycosis developed palpitation and dizziness during her treatment. Premature ventricular contractions (PVC) were detected during monitoring in the emergency room. Twenty-four hour holter electrocardiogram revealed aberrant premature atrial contractions (PACs) and PVCs. Corrected QT interval was in normal limits. After discontinuing the therapy, her complaints disappeared couple of days later. Her 24-h holter ECG displayed no PACs or PVCs. In this case the etiology of extra systoles is not wellknown. She did not have any other infection or used any other medication which may interfere with the metabolism of itraconazole. Enhanced cardiac automaticity may be a probable mechanism instead of more commonly encountered QT prolongation. Cardiac side-effects of itraconazole is rare but may be life threatening. Arrhythmic side effects should be monitored carefully even in otherwise healthy patients.