Muharrem Nasifov

Our initial experience with stent implantation for aortic coarctation in adults

OBJECTIVES We evaluated the procedural success and short-mid term results of stent implantation for aortic coarctation in adults. STUDY DESIGN The study included 15 consecutive patients (9 women, 6 men; mean age 27±7 years; range 17 to 45 years) treated with stent implantation for aortic coarctation. Fourteen patients had native, one patient had recurrent coarctation. Nine patients received bare metal and six patients received covered Cheatham-Platinum stents. Covered stents were used in patients with accompanying patent ductus arteriosus (n=2), severe coarctation (n=3), and recurrent coarctation (n=1). Procedural success was defined as the reduction in the pressure gradient across the coarctation site to less than 20 mmHg. The mean follow-up period was 10.4±4.6 months (range 3 to 18 months). RESULTS Stent implantation was successful in all the patients. Compared to the preprocedure figures, systolic gradient across the aortic coarctation decreased from 37.2±11.3 mmHg to 3.5±2.9 mmHg, the diameter of the coarcted aortic segment increased from 5.4±1.5 mm to 17.2±1.4 mm, and systolic blood pressure declined from 154±9.7 mmHg to 130±7.3 mmHg following stenting (for all, p<0.001). There were no procedure-related major complications. CONCLUSION Stent implantation for aortic coarctation in adults is a safe and effective alternative to surgical correction.

Asystole induced by radiofrequency catheter ablation of slow pathway

Radiofrequency (RF) catheter ablation is a treatment of choice widely used for a variety of supraventricular tachycardia. Transient sinus and atrioventricular (AV) node dysfunctions may occur during RF application to sites remote from the sinus and AV nodes, but they generally resolve quickly after cessation of RF current. We present a case of two episodes of asystole in a 43-year-old man induced by RF catheter ablation of an AV nodal slow pathway. A Bezold-Jarisch-like reflex, direct stimulation of parasympathetic fibers traveling to the sinus and AV nodes, RF-induced myocardial injury or pain could be responsible for this situation.

A Case of Spontaneous Multivessel Coronary Artery Spasm That Underwent Stent Implantation Accompanying ST Segment Elevation on Inferior Electrocardiographic Leads

Coronary artery spasm is usually defined as a focal constriction of a coronary artery segment, which is reversible, and causes myocardial ischaemia by restricting coronary blood flow. A coronary spasm may rarely compromise all three epicardial arteries simultaneously. We present a case of severe coronary spasm afflicting all coronary arteries accompanying an ST segment elevation in leads D2-D3 and aVF.

İlaç kaplı stent implantasyonunda intravasküler ultrason kullanımının akut tıkanma ve restenoz oranına etkisi

Objective: Major setbacks with the use of stents, which are widely used in the treatment of coronary artery disease, are development of acute thrombosis during early term and restenosis during the long term. No procedures have been able to completely prevent formation of early stent thrombosis (ST) and in-stent restenosis (ISR) up to now. The aim of the present study was to investigate the impact of intravascular ultrasonography (IVUS) guidance on angiographic outcomes of drug eluting stent (DES) implantation. Methods: In this study, we included 23 patients who received DES with the guidance of IVUS and 23 patients receiving the DES without IVUS. The patients were scrutinized for their sixth month control angiographies. The angiographic results were compared between the groups. Results: The basic angiographic and clinical features were similar between the groups (p>0.05). The minimal luminal diameter after the percutaneous intervention was higher in Group I than Group 2 (3.2±0.3. 2.9±0.4, p=0.03). Acute ST, late lumen loss and stent restenosis rates were comparable between the groups (p>0.05). On the other hand, among the patients that did not receive IVUS three patients were presented with stent restenosis (SR) and one patient developed acute ST. Conclusion: The present results indicate that the use of IVUS for the implantation of DES can increase the success rate of the intervention. Consequently, IVUS can be considered as a complementary method during DES implantation. J Clin Exp Invest 2013; 4 (1): 84-89 OZET

Çıplak stent implantasyonu sonrası gelişen koroner arter psödoanevrizmasının greft stent ile başarılı tedavisi

Although coronary artery pseudoaneurysm which could occur following percutaneous coronary interventions is a rare complication, it can be mortal. As soon as the pseudoaneurysm is diagnosed, it should be treated by percutaneous intervention or surgery. Graft stent implantation is a preferred treatment for appropriate patients. In this case report, we presented a successful treatment of coronary artery pseudoaneurysm by graft stent; which developed after the implantation of bare metal stent into the left anterior descending coronary artery. J Clin Exp Invest 2013; 4 (1): 126-129 OZET