Sakir Arslan

Usefulness of mean platelet volume for predicting stroke risk in paroxysmal atrial fibrillation patients.

Atrial fibrillation is the most common sustained arrhythmia in clinical practice. It is important to specify patients with a high risk of thromboembolus due to elevated procoagulant and prothrombotic state. The aim of this study is to assess the relation of stroke/transient ischaemic attack (TIA) with mean platelet volume (MPV), which is an indicator of platelet activation in patients with paroxysmal atrial fibrillation (PAF). Patients with PAF were enrolled in this study during years of 2012–2014. Patients were divided into two groups according to the presence or absence of stroke/TIA. Demographic data were registered and CHA2DS2VASc scores of patients were calculated. It was investigated whether there was a difference among groups regarding MPV levels. Ninety patients, 31 of whom had history of stroke/TIA (symptomatic group), were enrolled to study. CHA2DS2VASc score of symptomatic group was 4.77 ± 1.26, while CHA2DS2VASc score of asymptomatic group was 2.63 ± 1.41. Nevertheless, there was not any difference regarding CHA2DS2VASc score among two groups when 2 points due to stroke/TIA were subtracted in symptomatic patients. MPV was detected higher in symptomatic patients than asymptomatic patients (11.1 ± 1.3 vs. 9.1 ± 1.0 fL, P < 0.001, respectively). A value of 9.85 for the MPV ascertained with receiver operating characteristic (ROC) curve analysis to predict stroke/TIA was found to have a sensitivity of 87% and specificity of 78%. Elevated MPV levels were ascertained to be related with stroke/TIA in patients with PAF. Assessment of MPV apart from CHA2DS2VASc score in patients with PAF might be subsidiary to specify patients with an enhanced risk of stroke/TIA.

Predictors of Symptom Development in Intermediate Carotid Artery Stenosis Mean Platelet Volume and Platelet Distribution Width

Platelets play an important role in the pathogenesis of atherothrombosis. Platelet activation is associated with increased mean platelet volume (MPV) and platelet distribution width (PDW). In this study, we investigated the relation of MPV and PDW with the risk of stroke in patients with intermediate (50%-70%) carotid artery stenosis. A total of 254 patients (115 symptomatic and 139 asymptomatic) with intermediate carotid artery stenosis were enrolled in this study. Symptomatic and asymptomatic patients were compared in regard to MPV and PDW. Mean platelet volume was significantly greater in the symptomatic group compared with the asymptomatic group (11.1 and 9.4 fL, respectively; P < .001). Platelet distribution width was significantly greater in the symptomatic group compared with the asymptomatic group (15.0% and 11.9%, respectively; P < .001). Multivariate regression analysis showed that an MPV ≥10.2 fL and a PDW ≥14.3% were independent predictors of developing symptomatic carotid artery stenosis. Mean platelet volume and PDW are increased in the presence of symptomatic intermediate carotid artery stenosis. Increased MPV and PDW may be independent predictors of developing symptomatic carotid artery plaque.

Clinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases

Introduction Patients with peripheral arterial disease (PAD) are at increased risk for all-cause mortality and cardiovascular mortality. Aim To present anatomical and morphological characteristics of patients who underwent endovascular stenting with laboratory and our mid-term results. Material and methods One hundred fifty-three patients (mean age: 62.8, 86% male) who underwent percutaneous intervention of lower extremity arteries were included in the study. Demographic characteristics, medical history, physical examination and laboratory findings of patients were analyzed. Patients’ lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC). Clinical outcomes included complications and mortality, 6-minute walking distance, functional class (NYHA) and patency rates. Results Seventy percent of patients had hypertension, 42% were smokers, 78% had coronary artery disease, 20% had coronary artery bypass grafting, 55% had diabetes mellitus and 71% had dyslipidemia. Six patients with diabetes mellitus and poor wound healing despite medical therapy were treated with stenting leading to alleviation of pain and avoidance of amputation. The initial technical success rate of revascularization was 95.6% (153/160). Our mid-term results show that percutaneous procedures in lower extremity arterial diseases can be performed with low complication and high success rates. Patients’ 6-minute walk distance, ankle/brachial index values, functional class and the status of foot ulcers were evaluated. Conclusions Especially in patients with distal vascular disease, poor wound healing and no chance of surgical revascularization, percutaneous endovascular revascularization may provide good blood flow and prevent amputation.

An Unusual Pattern of All Three Coronary Arteries Originating from a Single Coronary Artery Arising from the Right Sinus of Valsalva

Anomalous origin of coronary arteries is generally asymptomatic and a rare disease. However, some cases can cause severe life-threatening events such as myocardial ischemia, arrhythmia, and acute myocardial infarction. We describe a case of a single coronary artery arising from the right sinus of Valsalva in a 48-year-old female patient with a complaint of stable angina pectoris and palpitations. Coronary angiography revealed that all three coronary arteries arose from the right sinus. Coronary CT angiography confirmed that there was an anomalous origin of the left coronary artery arising from the right sinus of Valsalva. The patient was managed with conservative treatment.

A Case of Thrombus Formation in a Patient with Preserved Left Ventricle Ejection Fraction and Development of Peripheral Embolization

Echocardiography is a substantial imaging modality for evaluating intracardiac masses. Thrombi and primary or metastatic cardiac tumors should be considered in the differential diagnosis of left ventricle (LV) masses. Thrombus formation in the LV generally occurs because of diseases that cause LV systolic dysfunction. Some cases have been reported to be related to thrombus formation in patients with a normal LV ejection fraction. Physicians should consider that a thrombus might develop in patients with a normal ejection fraction.

Aortic embolization of an Edwards SAPIEN prosthesis due to sigmoid left ventricular hypertrophy: Case report

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis. Although a minimally invasive procedure, it is not free from complications, one of which is valve embolization at the time of TAVI. We present a case of embolization of a balloon-expandable aortic valve due to sigmoid left ventricular hypertrophy and managed with a second valve without surgery. The embolized valve was repositioned in the aortic arch between the left common carotid artery and the brachiocephalic trunk.

Endovascular Treatment of IliacArtery Stenosis in Patients withRenal Transplant and PelvicEctopic Kidney: Rare TwoCases

Endovascular Treatment of Iliac Artery Stenosis in Patients with Renal Transplant and Pelvic Ectopic Kidney: Rare Two Cases Management of iliac stenosis in an ectopic pelvic kidney and renal transplantation is challenging. The stent implantation of iliac arteries in patients with functioning renal transplant and ectopic pelvic kidneys is critical because it is important to avoid ischemic and reperfusion injury to the kidney. Endovascular intervention avoids aortic cross clamping and can prevent renal ischemia. Here we report the endovascular management of iliac stenosis in two patients with renal transplant and pelvic ectopic kidney. Two patients underwent balloon expandable iliac stenting using a small amount of contrast due to decreased renal function

High prevalence of severe vitamin D deficiency in patients with acute myocardial infarction

Abstract Background: Vitamin D deficiency is associated with acute coronary syndrome (ACS). We aimed to evaluate calcidiol status and its relationship with coronary angiography findings in two selected groups of ACS patients. Methods: We investigated two groups of patients with ACS: 75 patients with ST-segment-elevation myocardial infarction (STEMI) and 68 patients with unstable angina pectoris (USAP). The ACS diagnosis was confirmed by coronary angiography findings. Biochemical parameters were studied at the first visit of the patients with automated instruments and ready-to-use kits. Results: Calcidiol levels were significantly lower in the STEMI group compared to the USAP group (p<0.001), while the prevalence of calcidiol deficiency in the STEMI group was significantly higher (p<0.001). Serious calcidiol deficiency (<4 ng/mL) was present in 17% of the STEMI group and in 7% of the USAP group. We did not observe any significant relationship between calcidiol status and coronary angiography findings. Conclusions: Our results support the previously described associations between ACS and calcidiol deficiency. Besides, we report a more severe calcidiol deficiency and an extraordinarily high prevalence of vitamin D deficiency or insufficiency in these patients.

Successful percutaneous closure of a tortuous coronary artery to pulmonary artery fistula using the anchor technique: a different approach.

Coronary artery fistula (CAF) is described as an anomalous connection between a coronary artery and a major vessel or cardiac chamber. It can result in myocardial ischemia, heart failure, pulmonary hypertension, bacterial endocarditis, and rupture of aneurysmal vessels [1]. The majority of these fistulae originate from the left anterior descending artery or from the right coronary artery [2]. Symptomatic coronary artery fistulae are usually treated with percutaneous intervention or surgical correction [3]. We report herein a case of successfully performed percutaneous coil embolization of a tortuous coronary artery fistula using the anchor technique.

Early and Midterm Outcomes of Percutaneous Treatment of Symtomatic Stenosis of Lower Extremity and Chronic Limb Ischemia

Objectives: Our goal is to evaluate the effectiveness, reliability, advantages and the results of early-to-mid-term of percutaneous treatment of lower extremity strictures. Background: Technological advances in the past decade have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments for patients with lower extremity peripheral arterial disease (PAD). The role of endovascular interventions is also expanding in the treatment of limb-threatening ischemia. Especially in chronic limb ischemia and foot ulcers, diabetic patients with inoperable, there is growing interest below the knee interventions. Methods: Between May 2011 and May 2013, 85 patients with stenosis of the lower limb arteries (iliac-femoral-popliteal-below the knee) and treated percutaneously, enrolled in the study. Although medical therapy, patients with intermittent claudication and have >70% stenosis in iliac or femoral artery, stenting procedure was performed after primary stenting or balloon angioplasty. Symptomatic patients with >70% stenosis of popliteal or below-knee artery, balloon angioplasty was performed. After the patients were followed up clinically. Results: Tecnical success was achieved in 84 patients (98,8%). Predilatation before stent placement, 33,3% of cases performed. Post dilation procedure was performed in 66,6% of patients with used the self-expanding stent. 84 patients with iliac-femoral artery stenosis, stenting procedure is applied and concomitantly 6 patients with popliteal artery and distal to the stenosis, the balloon angioplasty was performed. Average follow-up time was 10,0 6,3 months. (1 – 25 Months). Including death, myocardial infarction, major bleeding complications were not observed depending on percutaneous procedures. Iliac stent in a patient as a complication inferior vena cava fistula formation, this complication was treated using a stent-graft. 7 patients with diabetes and foot wounds that never heal, healed wounds were observed during follow-up after the procedure. In the clinical follow-up, claudication complaints decreased and increased walking distances observed. Conclusion: Technical success rate and early-midterm outcomes of percutaneous treatment for PAD are magnificent. We believe that percutaneous treatment methods in lower extremity arterial stenosis, will be more widespread with percutaneous treatment techniques and operator experience increases.