Distal Arterial Bed Research Articles

ENDOVASCULAR ANGIOPLASTY FOR REPEATED REVASCULARIZATION OF THE ARTERIAL BED IN PATIENTS WITH RECURRENT CHRONIC ARTERIAL INSUFFICIENCY

Aim. To improve the results of repeated reconstruction of the great vessels in case of relapse of chronic arterial insufficiency by differentiated use of popliteal tibial autovenous bypass grafting and endovascular angioplasty for revascularization of the arteries of the leg. Materials and methods. The long-term results of surgical treatment of 522 patients were examined, including 353 patients with bilateral atherosclerotic occlusion of the aortic-femoral zone and 159 patients with unilateral occlusion of the ileo-femoral segment. At the primary surgical intervention, 98 patients were diagnosed with chronic arterial insufficiency (CAI) of stage II B, in 228 – CAI of stage III, in 196 – chronic critical ischemia of the lower extremities, stage III – IV. In the long-term postoperative period, 146 (27.97 %) late complications were diagnosed, of which 78 (56.1 %) had a relapse of chronic arterial insufficiency. In 36 patients, CAI stage II B was established, and in 42 – CAI stage III. Patients were re-operated in the period of 5.4 ± 1.9 years after primary revascularization. All men were 64.4 ± 3.1 years old. Results. The multilevel atherosclerotic lesions of the reconstructed arterial bed, cicatricial changes after the initial surgical intervention, progressive atherosclerotic lesions of the outflow tract required multi-story shunting operations. The success of shunting surgery depends on sufficient revascularization of the outflow paths – the arterial bed of the ankle segment. Revascularization of the distal arterial bed was achieved using popliteal-tibial autovenous bypass grafting (19 cases) and endovascular angioplasty (30 observations). To reduce peripheral vascular resistance and increase the volume of the peripheral vascular bed in 19 (63.3%) cases, endovascular balloon angioplasty of two tibial arteries was performed simultaneously. The postoperative period in 10 (12.8%) patients was complicated by the development of thrombosis of the reconstruction segment. In 7 cases, thrombosis of the reconstruction segment was eliminated. The using of popliteal-tibial autogenous bypass grafting and endovascular angioplasty during revascularization of the ankle segment provided satisfactory results in repeated reconstructive operations in 87.2 % of cases. Conclusions. For the revascularization of the lower leg arteries, the use of popliteal autovenous shunting and endovascular angioplasty provides 87.2% satisfactory results in repeated reconstructive operations for chronic arterial insufficiency relapse.

Use of Trapping Techniques and a GooseNeck Snare to Retrieve a Fractured Balloon Catheter.

Percutaneous transluminal coronary angioplasty balloon fracture, retention, and embolization are rare complications of percutaneous coronary intervention. The incidence has historically been estimated at <0.8%, which is likely an underestimate given the increasing quantity and complexity of percutaneous procedures. We demonstrate how to avoid emergency surgery by using basic balloon trapping techniques and a snare in the more distal arterial bed.

Endocrine Disorders and Peripheral Arterial Disease - A Series of Reviews Cushing Syndrome-Cortisol Excess.

Cushing syndrome (CS), characterised by endogenous or exogenous glucocorticoid hormone excess, is associated with several systemic complications, including impaired glucose metabolism, which often becomes clinically manifest as diabetes mellitus (DM). In addition, CS can harm the arterial wall because of hyperglycaemia, dyslipidaemia, hepatic steatosis, and central obesity. These metabolic disorders promote atherosclerosis by synthesising adipokines, leptin, and proinflammatory cytokines. Lower limb arterial complications in CS are common and significantly impact morbidity and mortality. Furthermore, CS, in combination with DM, is likely to cause more diffuse vascular disease that predominantly affects distal arterial beds. In conclusion, CS promotes atherosclerosis, including peripheral artery disease, by causing functional and morphological deterioration of the arterial vessel wall and increasing the presence of classical risk factors of atherosclerosis.

EFFICACY OF DISTAL REVASCULARIZATION IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Critical limb ischemia (CLI) leads to an increase in the above-the-knee amputations and mortality, which can reach 40 %.&#x0D; The aim of the study is to improve the results of treatment in patients with CLI by including endovasal revascularization methods in complex therapy.&#x0D; Materials and Methods. The results of surgeries on lower limb arteries in 189 patients were analyzed; among them 110 patients were diagnosed with CLI. The study enrolled 74 men (67.3 %), and 36 women (32.7 %). The average age was 68 years old. Patients underwent color duplex ultrasound scanning (CDUS) and CT angiography. Along with surgical revascularization, patients were prescribed antibacterial, anticoagulant, antiplatelet and insulin therapy (those with diabetes mellitus).&#x0D; Results. 110 patients with CLI underwent endovascular revascularization: balloon angioplasty – 110 (100 %), stenting – 54 (49.1 %), hybrid surgeries – 9 (8.2 %), atherectomy and mechanical aspiration – 9 (8.2 %). 88 patients with CLI (80 %) were also diagnosed with multilevel lower extremity arterial disease, and only 22 patients (20 %) had segmental lesions. Above-the-knee amputation was performed in 4 patients, below-the-knee amputation was conducted in 2 patients. Out of 110 patients, 7 people died (6 %). Out of 103 patients, 97 people (94 %) preserved foot balancing function.&#x0D; Conclusion. In patients with CLI and distal arterial bed, endovascular revascularization prevented above-the-knee amputation in 94%. Thus, it allowed us to maintain foot balancing function in patients.

Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia.

Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p&lt; 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p &lt; 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

EMBOLIZATION OF THE INTERNAL ILIAC ARTERY USING LIQUID EMBOLYZING SYSTEMS

Among the complications of endovascular abdominal aortic aneurysm repair the most common are the so–called endoleaks - the preservation of blood flow inside an isolated aneurysmal sac. This complication occurs in almost every fourth patient and is the main cause of reinterventions, which makes the late development of this complication one of the urgent problems under discussions. The report presents a clinical case of treatment of a patient with an aneurysm of the infrarenal abdominal aorta with its spread to the common iliac artery using the technique of preventive embolization of the internal iliac artery with application of a liquid tantalum-containing ethylene vinyl alcohol copolymer. All stages of the operation were performed in the catheterization laboratory using a stationary angiographic system. The embolizing material was introduced after implantation of the stent-graft into the target position, through a microcatheter pre-installed at the ostium of the embolizing internal iliac artery. The introduction of a tantalum-containing ethylene vinyl alcohol copolymer after the installation of the stentgraft, under conditions of significant reduction of arterial antegrade blood flow in the lumen of the internal iliac artery, allowed to create a reliable occlusion of the ostium segment of the artery, reduced the risk of migration of embolizing substance into the distal arterial bed.

SURGICAL TREATMENT OF EARLY POSTOPERATIVE COMPLICATIONS OF ENDOVASCULAR REVASCULARIZATION OF A MULTI-LEVEL STENOTIC-OCCLUSIVE ATHEROSCLEROTIC LESION OF THE FEMORAL-DISTAL ARTERIAL BED

The use of endovascular techniques remains the only chance to restore blood flow under the conditions of a distal stenotic-occlusive process. Nevertheless, under the conditions of endovascular reconstructive surgery of the distal arterial bed, unsatisfactory results occur in 6-32% of cases in the form of thrombosis or restenosis of the reconstruction segment due to the progression of signs of limb ischemia.&#x0D; The aim is to improve the results of endovascular revascularization of multilevel atherosclerotic stenotic-occlusive femoral-distal arterial bed by surgical treatment of postoperative complicated forms of revascularized infrainguinal arterial bed.&#x0D; Materials and methods. 164 patients with multilevel stenotic-occlusive lesions of the femoral-distal arterial bed were under observation. Ultrasound dopplerography was used to select the volume of reconstructive intervention. Endovascular angioplasty of the femoral-popliteal segment (I stage) was performed with Pan Medical (PEKICO), OPTA PRO (Cordis) balloon catheters. In 41.10% of observations, balloon angioplasty of the femoral segment was continued with the placement of a stent - a self-expanding Smart ControL stent (Cordis), a self-expanding Carbostent stent (Flype), a self-expanding stent - Vascular stent (BARD) was used. Endovascular angioplasty of the arteries of the tibial segment (II stage) was performed using long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific). 76 intraluminal and 33 subintimal angioplasty were performed. When performing subintimal angioplasty, CompleteSE (Medtronic), Smart (Cordis) and CompleteSE (Medtronic) stents were used. In 40 patients, angioplasty was performed on two arteries of the leg, in 33 - on one of the tibial arteries. At the first stage, an open reconstruction of the femoral-popliteal segment was performed - the formation of a femoral-popliteal autovenous shunt. In 20 (21.98%) observations, the proximal anastomosis was formed at the level of the bifurcation of the thoracic cavity during simultaneous deep fundoplasty. In 36 (39.51%) observations, the distal anastomosis of the autovenous shunt was formed at the level of the PCA by the end-to-end type. A 6F Check-Flo Performer (USA), Balton (EU) introducer was used to ensure the change of the balloon catheter. Long balloons (80-150 mm) Armada 35 LL manufactured by Abbott Vascular (USA) and Amphirion Deep (Medtronic) Coyote (Boston Scientific) were used, CompleteSE stents (Medtronic) – 23 cases, Smart (Cordis) – 24 observations.&#x0D; Conclusions. The early postoperative period of endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed is complicated by thrombosis of the popliteal-tibial segment in 15.9% of observations. Thrombosis of the popliteal segment is detected 2.7 times more often after endovascular angioplasty of one of the tibial arteries during endovascular revascularization of a multilevel stenotic-occlusive lesion of the femoral-distal arterial bed than during endovascular angioplasty of two tibial arteries. The effectiveness of the use of rheological thrombus extraction by the Angiojet system in the surgical treatment of postoperative thrombosis of the popliteal segment, which is formed in 15.9% of observations after endovascular revascularization of a stenotic-occlusive lesion of the femoral-distal arterial bed, is equal to 84.6%.

Real world single center experience with saphenous vein grafts interventions: should filters be filtered out?

Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) can be challenging due to no reflow phenomenon from distal embolization of debris and microvascular vasoconstriction, resulting in myocardial injury post-procedure. Guidelines promote the use of distal embolic protection devices (EPD) to protect the distal arterial bed during SVG PCI. However, this approach has shown less-than-optimal results in many studies. We report our data using the Borgess protocol [prophylactic intracoronary (IC) nicardipine injection and direct stenting], as an alternative to EPDs in a large series of SVG interventions. This is a retrospective, cohort study of our single center experience with SVG interventions between 2017 and 2021. The primary outcome of the study was major adverse cardiovascular events (MACE) [a composite of death, emergent coronary artery bypass graft surgery (CABG), myocardial infarction (MI), and target vessel revascularization (TVR)] at 30 days post-procedure. There were 424 consecutive SVG interventions performed during the study period, and 76% of cases presented with acute coronary syndrome. Full adherence to the Borgess protocol was observed in 36% of cases; IC nicardipine was utilized in 72% of cases. MACE rate was 3.5% at 30 days driven primarily by MI (2.6%). The Borgess protocol approach to vein graft interventions proved good outcomes when compared to SVG PCI in randomized trials utilizing EPDs. Our study is limited by the retrospective nature and single center experience.

POS-562 ISCHEMIC DISTAL HAND STEAL SYNDROME : A RARE COMPLICATION OF AVF

Ischemic steal syndrome is a rare complication of arteriovenous fistula creation due to high blood flow in a low resistance vein and reversal of flow away from the higher resistance distal arterial bed into the vein. Several options including ligation of arteriovenous fistula, banding, proximalization of arterial inflow and distal revascularization and interval ligation (DRIL).

Use of the Orbital Atherectomy System in Isolated, Chronic Atherosclerotic Lesions of the Popliteal Artery

The treatment of isolated calcified lesions involving the popliteal artery are demanding and they often require stent placement to achieve acceptable luminal gain. This study evaluates the safety and performance of the orbital atherectomy system (Cardiovascular Systems Inc.) and percutaneous transluminal angioplasty with a drug-coated balloon (PTA-DCB) for the treatment of chronic atherosclerotic lesions within the popliteal artery segment. From November 2018 to November 2019, a series of six patients with Rutherford classification stage III peripheral arterial disease with isolated, focal, calcified occlusions of the popliteal artery were treated with orbital atherectomy followed by PTA-DCB. No embolic protection devices were used. The technical success rate was 100%, the primary patency rate was 100% at 7.0 (±4.2) months of follow-up. The Rutherford classification improved in all patients from stage III to stage II and the mean ankle brachial pressure index after the procedure was 0.97 (±0.08), with a preoperative mean ankle brachial pressure index of 0.69 (±0.21). In one instance, spasm was noted in a distal arterial bed and it was successfully treated with local nitroglycerine. No distal embolisation, perforation or aneurysmal degeneration was observed. During follow-up there were no deaths, major amputations or revascularisation of target lesions. The use of orbital atherectomy system in combination with PTA-DCB was found to be safe and effective in modifying focal, chronic, calcified plaques in the popliteal artery segment in these six cases.

Reversal of Vasospasm with Clazosentan After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Clazosentan, an endothelin-1 receptor antagonist, has been shown to prevent the development of large vessel angiographic vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). It has been hypothesized that clazosentan can also reverse established angiographic vasospasm. The REVERSE (resynchronization reverses remodeling in systolic left ventricular dysfunction) study was a prospective, multicenter, open-label, 2-stage pilot study of adult patients with aSAH who had received intravenous clazosentan (15 mg/hour) after developing moderate-to-severe angiographic vasospasm. The primary efficacy endpoint was the reversal of global cerebral vasospasm in large cerebral artery segments 3 hours after clazosentan initiation. The secondary endpoints included large artery vasospasm reversal at 24 hours and the maximum change in the angiographic cerebral circulation time. The change in vasospasm severity in the proximal and distal segments was investigated in an exploratory analysis. The primary efficacy endpoint was met in 3 of 11 evaluable patients (27.3%; 95% confidence interval, 6.0-61.0). However, recruitment was stopped after stage 1 in accordance with the predefined interim analysis criteria. In the exploratory analysis, 50.0% and 77.8% of the patients showed a significant reversal of vasospasm or improvement to the admission state in ≥2 distal segments at 3 and 24 hours and 28.6% and 77.8% in ≥2 proximal segments, respectively. Although the main analysis showed a reversal of large vessel vasospasm 3 hours after clazosentan initiation in a few patients, the exploratory analysis indicated a clear pharmacodynamic dilating effect on vasospastic cerebral vessels at 24 hours in most patients, in particular, in the distal arterial beds. This observation supported the inclusion of patients with established vasospasm in the ongoing REACT (prevention and treatment of vasospasm with clazosentan) trial.

Profundoplasty in treatment of patients with chronic lower limb ischaemia

The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV. Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years. Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.

The no-reflow phenomenon: mechanisms and therapeutic targets

The phenomenon of «no-reflow» refers to a state of myocardial tissue hypoperfusion or absence of perfusion after eliminating the cause of the occlusion of the coronary artery. Two main pathogenetic mechanisms may contribute to the development of no-reflow phenomenon after primary percutaneous coronary intervention in patients with myocardial infarction: ischemic-reperfusion injury of the microcirculatory vessels and embolization of the distal arterial bed with fragments of thrombus and atherosclerotic plaque. In this review, we describe the pathophysiological mechanisms of no-reflow, risk factors for no-reflow phenomenon, the principles of diagnosis and therapeutic targets.

Phylogenetic theory of general pathology. Pericytes, function of the distal arterial bed, metabolic arterial hypertension and hypovolemic shock.

The in vivo roles of pericyte contractile sphincters, smooth muscle cells, endothelial monolayer, precapillary muscle arterioles, exchange and volume capillaries in the physiological balance between peripheral blood pool and the blood pool volume in the distal arterial bed are not fully understood. However, it is highly probable that: 1. There is no primary arterial hypertension. The compensatory biological reaction of arterial pressure (AP) is always secondary, thus indicating the presence of symptomatic or metabolic arterial hypertension (AH). 2. Elevation of AP in proximal arterial bed is a compensatory response to metabolic disorders and impaired microcirculation and metabolism↔microcirculation biological reaction. The response develops locally in the distal arterial bed (muscle arterioles, functional sphincters, pericytes). 3. Metabolic AH is a pathology of the phylogenetically early distal arterial bed , endothelial monolayer, smooth muscle cell and pericyte function. 4. We believe that formation of acute hypovolemic shock is the condition of sphincter (pericyte) atonia in precapillary muscle arterioles with formation of a nonphysiological blood volume in the distal arterial bed when physiological volume of peripheral blood is insufficient to fill the bed. 5. When local disorder in the biological reaction metabolism↔microcirculation is not compensated by endothelium-dependent vasodilation, an efferent innervation signal from the vasomotor center at the entire organism level is sent to the heart and systemic AP increases first in the proximal then in the distal arterial bed. 6. Systemic AP elevation impairs function of the target organs: kidneys, brain and lungs. Each of these organs regulates hydrodynamics in the local pool of extracellular medium, their dysfunction inducing a compensatory response. 7. Metabolic arterial hypertension results from discoordinated systemic compensation of local disorders in the following biological functions: homeostasis, endoecology, trophology and adaptation. This discoordination occurs at the level of paracrine regulated cell communities of functionally different cells which are structural units of each internal organ.

Retrograde Pulmonary Embolectomy for Acute Pulmonary Embolism: A Simplified Technique

Surgical embolectomy in acute pulmonary embolism is usually reserved for patients with massive pulmonary embolism presenting with cardiogenic shock, or for whom thrombolysis is absolutely contraindicated or has failed. Incomplete removal of thrombotic material lodged in the distal pulmonary arterial bed is considered an important cause of persistent pulmonary hypertension. Retrograde pulmonary embolectomy is an adjunct to conventional pulmonary embolectomy, resulting in more complete embolectomy, specifically of material lodged in the distal pulmonary arterial bed. We describe our simplified technique of retrograde pulmonary embolectomy as a safe adjunct to conventional pulmonary embolectomy.

Experimental model for the study of retrograde flow.

BackgroundVenous arterialization has been adopted as a strategy for salvage of limbs in critical ischemia without the distal arterial bed, with successful outcomes, but the mechanisms by which irrigation of the extremities takes place are still unknown.ObjectivesTo develop an experimental model to test hypotheses that could explain the mechanisms of blood supply in venous arterialization.MethodsEleven pigs underwent a period of hind limb ischemia followed by reperfusion achieved by venous arterialization, after interposition of conduits filled with 10 ml (5 animals – group 1) or 1 ml (6 animals – group 2) of China Ink. After euthanasia, the limbs were amputated and underwent histological analysis.ResultsUnder optical microscopy, ink staining was observed in the arteriolar lumen of six (55%) of the eleven pigs used in the experiment; four (80%) out of five from group 1 and two (33%) out of six from group 2.ConclusionsThe experimental model was capable of testing the hypothesis. The presence of China Ink in the arteriolar lumen shows that it is possible to supply the arterial vessels by means of venous arterialization.

DIFFERENCES IN PHYLOGENETIC FACTORS OF ETIOLOGY AND PATHOGENESIS UNITY OF METABOLIC PANDEMIAS - CIVILIZATION DISEASES

Regulation of metabolism in vivo can be understood when considering the formation in phylogenesis of the function of humoral, hormonal mediators, vegetative regulators separately: a) at the cell level; b) in paracrinally regulated cell communities (PC), organs and systems and c) at the body level. Each of regulation levels was formed at different stages of phylogenesis; the completion of levels occurred, we suppose, when reaching “relative biological perfection”. Formation of organs and organ systems was finished also, in our opinion, at the level of this perfection. When three levels reached sequentially were analyzed in Homo sapiens , it was revealed with systemic approach that through “relative biological perfection” at the level of the body, “regular mismatch” of metabolism is observed. Phylogenetic mismatch of the regulation of metabolism at three levels of “relative biological perfection” are etiological factors of “metabolic pandemias” of each of “civilization diseases”. All “metabolic pandemias” including atherosclerosis, metabolic arterial hypertension, IR status, obesity, metabolic syndrome and nonalcoholic fatty liver disease are disorders of one, late in phylogenesis, biological function of locomotion. Etiological basis for metabolic (essential) arterial hypertension is a regular mismatch: a local compensation of disturbances of the biological response metabolism ↔ microcirculation in the distal arterial bed with endothelium-dependent vasodilatation and only systemic compensation at the level of the body in the proximal part. For millions of years, there coexist two functionally connected and phylogenetically separated pools of fatty cells: the earlier visceral fatty cells (VFC) and the later subcutaneous adipocytes. Insulin blocks TG hydrolysis and release of nonetherified fatty acids (NEFA) into the blood plasma only from adipocytes; hormone cannot block lipolysis in phylogenetically early VFC and inhibit the effect of phylogenetically early hormones on them. Increase in blood plasma NEFA in the course of biological response of stress in vivo does not accompany proportional growth in albumin concentration. The function of phylogenetically early resident macrophages and monocytes ↔ macrophages, differentiated in intima of arteries in situ and ex tempore , is not identical. Biological response of fatty cells deposit into adipocytes occurs in the form of nonpolar triglycerides in lipoprotein composition, but their release - only in the form of polar NEFA.

INVERSION OF THE CONCEPT ABOUT BIOLOGICAL ROLE OF RENIN → ANGIOTENSIN-II → ALDOSTERONE SYSTEM AND FUNCTION OF ARTERIAL BLOOD PRESSURE AS A METABOLISM REGULATOR

The phylogenetic theory of general pathology postulates an inversion of the concept about the role of arterial blood pressure (AP) in physiology and pathology. Activation of the synthesis of the renin → angiotensin-II (AG-II) system components by nephron and increase in aldosterone secretion are not aimed at elevating AP., but at maintaining the volume of extracellular medium, part of the Third Word Ocean where all cells still live as millions of years ago. Phylogenetically early internal organs cannot regulate the effects of phylogenetically late AP., a physical factor of metabolism. AP is not increased by kidneys, but by the vasomotor center that attempts to reanimate nephronal function, the biological function of endoecology and biological reaction of excretion by increasing AP in proximal and, subsequently, hydrodynamic pressure in the distal region of arterial bed. In addition to the major role in the realization of the biological function of locomotion, AP is a physical factor involved in compensation of impaired functions of homeostasis, trophology, endoecology and adaptation. Levels of metabolism regulation have developed during phylogenesis. Biochemical reactions are specifically regulated at the autocrine level. In paracrine-regulated cell communities of distal arterial bed, metabolism is regulated by millions of local peristaltic pumps by compensating the biological reactions of endothelium-dependent vasodilation, microcirculation, effects of humoral messengers and hormones. In vivo metabolism is regulated nonspecifically from the vasomotor center level by a physical factor (AP) by sympathetic activation of the heart; AP in proximal and distal regions of arterial bed overcomes peripheral resistance and «squeezes through» the arterioles where microcirculation is impaired. AG-II acts as a vasoconstrictor only in the distal arterial bed. In essential (metabolic) arterial hypertension, paracrine cell communities of nephrons and kidneys are involved in realization of pathologic compensation in the second turn and often “suffer being innocent” , similar to other “target” organs”, such as brain, lungs and heart.

Update on Mechanical Thrombectomy

Intra-arterial stroke therapy aims to restore perfusion of the distal arterial bed by recanalizing the primary arterial occlusive lesion [1]. Successful recanalization positively correlates with improved longterm functional outcomes [2-4]. The PROACT II4 trial published in 1999 demonstrated a clear benefit from administering prourokinase via a catheter-based approach directly into the occlusive lesion.