High Risk Of Restenosis Research Articles

Surgical management and outcomes of chronic mesenteric ischemia

Chronic mesenteric ischemia (CMI) is a vascular condition resulting from atherosclerotic blockage of the mesenteric arteries, which reduces blood flow to the intestines. Though rare, CMI is critical to diagnose due to the risk of progression to acute mesenteric ischemia, which can be life-threatening. This review discusses the pathophysiology, clinical presentation, and diagnostic challenges of CMI, emphasizing the need for timely revascularization to improve patient outcomes. Both endovascular and open-surgical techniques are examined, with a focus on patient selection and procedural outcomes. Endovascular interventions, preferred for their lower morbidity, have shown promising results despite a higher risk of restenosis. Comprehensive management, including aggressive medical therapy and lifestyle modifications, remains essential to address the underlying atherosclerosis. Given the complexity of CMI, a multidisciplinary approach is recommended to ensure accurate diagnosis and optimal treatment. This review emphasizes the significance of early diagnosis and customized treatments to improve the quality of life and survival rates in patients with CMI.

How to decide appropriate percutaneous coronary intervention (PCI) technique for managing heavy calcified coronary lesions: serial case-report

Background: Coronary artery calcification (CAC) is still challenging for interventional cardiologists. Their contribution to major adverse cardiac events occurs from the high risk of stent thrombosis or in-stent restenosis and target lesion revascularization. Optimal preparation, such as coronary plaque modification before stenting, is required to reduce the risk of periprocedural adverse events. This case presentation aimed to describe the appropriate management of heavy calcified coronary lesions. Case Presentation: Two cases of heavy calcified coronary lesions with different baselines as Acute Coronary Syndromes (ACS) and elective PCI were presented. In our ACS patients, the Primary PCI was done by coronary angioplasty without stenting because of the complexity of the heavily calcified lesion. A referral to tertiary health care was made for further PCI procedures using a combination of calcium-ablation and balloon-based techniques. A treatable complication occurred after the orbital atherectomy was performed with good results. The second case was an elective PCI patient with heavy calcified lesions findings from coronary angiography. The balloon-based technique was performed using non-compliant and scoring balloons without complication and showed good results. Conclusion: The challenging points in managing heavy calcified coronary lesions are procedure complexity and the higher stent failure rate. Many modifying coronary calcification algorithms using advanced modalities have been proposed, which could be used to select the appropriate technique as experienced and increase the success rate. Keyword: balloon-based technique, calcium-ablation technique, heavy calcified coronary lesion, orbital atherectomy

In-Depth Review of the Influence of Renal Insuficiency on Major Adverse Cardiovascular Event (MACE) and Mortality in Patients with Acute St-Segment Elevation Myocardial In- farction (STEMI)

The widespread implementation of invasive procedures such as coronary angiography and primary percutaneous coronary intervention (PCI) into the routine management of patients with acute ST-segment elevation myocardial infarction (STEMI) in the last 10 years has led to a significant improvement in patient prognosis. At the same time, this also raises new problems and questions, mostly related to the fact that there are many elderly patients and/or patients with comorbidities who need to undergo this invasive procedure. One of the most important comorbidities is renal insufficiency. STEMI patients with renal insufficiency typically present with more extensive atherosclerotic lesions, including diffuse coronary calcification, which poses a challenge to the interventional cardiologist due to a higher risk of periprocedural complications, higher risk of restenosis, major adverse cardiovascular event (MACE) , and patient mortality. This review discusses in depth the influence of renal insufficiency on MACE and mortality in STEMI patients. Keywords: renal insufficiency, STEMI, MACE, mortality.

ULTRASOUND DIAGNOSIS OF THE RENAL ARTERY STENOSIS IN A TRANSPLANTED KIDNEY IN THE EARLY POSTOPERATIVE PERIOD

In this clinical case, stenosis of a renal artery of transplant was detected in time by angiography using dynamic Doppler ultrasound control. The chosen treatment method allowed the restoration of arterial patency and thus renal graft function in the shortest possible time and with minimal trauma. However, due to the high risk of restenosis in the plastic area, continuous dynamic ultrasound monitoring and monitoring of the patient's creatinine level are required. The purpose of this presentation is to present a case of early detection of a postoperative complication by Doppler ultrasound, which made it possible to prevent vascular dysfunction, often leading to loss of the renal graft. Materials and Methods. In this article, we report a case of timely detection of renal artery stenosis by ultrasound in a patient, followed by confirmation by angiography and restoration of renal artery and graft function by endovascular balloon angioplasty. All major hemodynamic changes in Doppler ultrasound parameters characteristic of renal artery stenosis are described in this article. Results. Dynamic Doppler ultrasound monitoring and angiography allowed early detection of the described complication of renal transplantation. The optimal choice of treatment tactics allowed the restoration of arterial patency and renal graft function in the shortest possible time, thus preventing graft rejection. Conclusion. Our clinical case demonstrates the importance of the monitor in the assessment of renal perfusion. The outcome of kidney transplantation largely depends on the successful resolution of these issues, which determines the relevance.

Assessment of Sonographic Parameters for Predicting Primary Patency Rate in Hemodialysis Patients With Venous Valve-Related Stenosis.

Ultrasonography is more frequently used in patients with arteriovenous fistula (AVF) stenosis. The aim of this study is to use sonographic parameters for predicting primary patency in hemodialysis patients with venous valve-related stenosis (VVRS) who are treated by ultrasound-guided percutaneous transluminal angioplasty (PTA). A total of 229 VVRS patients who underwent PTA between January 2017 and December 2021 were enrolled. Clinical characteristics were retrospectively collected. Sonographic parameters were measured both before and after PTA. Univariate and multivariate Cox analyses were performed to identify independent factors associated with primary patency rate. All measured sonographic parameters improved after PTA compared to before PTA. Before PTA, the diameter of VVRS > 1.0 mm, age ≤ 57 years, and body mass index (BMI) > 21.57 kg/m2 were associated with better outcomes. While the diameter of radial artery, proximal radial artery close to the anastomosis, brachial artery, the flow volume of brachial artery, the length and peak velocity (PV) of the VVRS, and the diameter and PV after the VVRS had no association with the primary patency rate. After PTA, only patients with a diameter of VVRS > 4.0 mm had favorable outcome. In addition, patients with a gain of diameter of VVRS > 2.4 mm after PTA had a trend of better outcomes. The diameter of VVRS before and after PTA could be served as markers to predict primary patency rate and second patency rate in AVF patients with VVRS. The gain of diameter of VVRS could also be a potential marker. Using simple markers of sonographic parameters, we could quickly identify patients with a higher risk of restenosis. These patients should be followed more closely in case of restenosis at early. It is also beneficial to the prevention of thrombosis. These measures help to preserve more valuable vascular for a long-term dialysis. Additionally, the physician should pay more attention on the dialysis-related complications in these risky patients, such as hemodialysis-related hypotension.

Benefits and Challenges of Drug-Coated Balloons in Peripheral Artery Disease: From Molecular Mechanisms to Clinical Practice.

Multiple clinical trials have reported favorable outcomes after drug-coated balloon therapy for peripheral artery disease in above-the-knee and below-the-knee lesions and in both de novo and in-stent restenosis. However, there are still insufficient data to identify and tackle the risk factors associated with a higher risk of restenosis, which is the primary concern for patients who are treated with an endovascular approach. A modern armamentarium, which includes improved lesion preparation techniques such as plaque modification balloons, mechanical atherectomy, intravascular lithotripsy, and imaging, is crucial for obtaining better long-term clinical outcomes. Moreover, a better understanding of the molecular properties of drug-coated balloons has led to improved devices that could tackle the shortcomings of previous generations. This comprehensive review focuses on drug-coated balloon technology as a tool to treat peripheral artery disease and the effects of the molecular mechanisms involved in preventing vascular restenosis.

The Relationship Between Achilles Tendon Thickness and Instent Restenosis in Patients with Carotid Stents

Objective: Considering that atherosclerosis and Achilles tendon thickening share common mechanisms, the aim of this study to reveal the relationship between Achilles tendon thickness (ATT) and carotid in-stent restenosis (ISR). Methods: In this study, 89 patients who had carotid stenting for carotid artery disease at our institute between 2016 and 2020 were included. Subjects were divided into two groups as restenosis (+) and restenosis (-) based on the ultrasonographic and/or angiographic findings. The development of 50% or more restenosis in the carotid stent was defined as ISR. Bilateral ATT was measured for all patients who satisfied the inclusion criteria. Results: In our study, 16 (17.9%) patients constituted the restenosis group and 73 (82%) the no-restenosis group. ATT values were similar between groups (4.90.8 vs 4.70.6, p=.27). However, in the marginal effect graphic, it has been demonstrated that the probability of carotid stent restenosis increases with the increase in the mean ATT. The probability of restenosis was 14% when the mean ATT value was 4.16 mm (mean -1 SD) and the probability of restenosis was 22% when the mean ATT value was 5.36 mm (mean +1 SD). Conclusion: No significant difference was found in ATT between the restenosis and no-restenosis group, however, the probability of restenosis increased with increasing ATT. In addition, ultrasonographic measurement of ATT is an easy, inexpensive and safe method that can be used to identify patients at high risk for carotid stent restenosis.

Long-term results of endovascular treatment of patients with coronary heart disease using various PCI technologies

Objective: the effectiveness and safety of endovascular treatment of coronary artery disease in coronary artery disease using various technologies of percutaneous coronary intervention (PCI) was evaluated — implantation of drug-coated metal stents, implantation of bioresorbable stenting scaffolds, the use of drug-coated coronary balloon catheters in the long- term period, 10 years after PCI.Materials and methods: data obtained from 324 patients with coronary heart disease after PCI using the previously mentioned treatment methods. The endpoint was the loss of the target vessel lumen (TLF), a combination of cardiac death, myocardial infarction, and revascularization associated with the target vessel.Results: the treatment of patients with coronary heart disease using implantation of drug-coated metal stents, bioresorbable stenting scaffolds or drug-coated coronary balloon catheters is safe and has low rates of cardiac mortality, myocardial infarction and revascularization of the target vessel in the long term. In cases where implantation of stents or scaffolds was contraindicated or impossible due to the small diameter of the artery, diffuse extended lesion and high risk of restenosis, angioplasty with a coronary balloon catheter with an antiproliferative drug coating takes place, showing positive long-term results.

Nanotexture and crystal phase regulation for synergistic enhancement in re-endothelialization on medical pure titanium surface

Re-endothelialization has been recognized as a promising strategy to address the tissue hyperplasia and subsequent restenosis which are major complications associated with vascular implant/interventional titanium devices. However, the uncontrollable over-proliferation of smooth muscle cells (SMCs) limits the clinical application of numerous modified strategies. Herein, a novel modified strategy involving with a two-step anodic oxidation and annealing treatment was proposed to achieve rapid re-endothelialization function regulated by regular honeycomb nanotexture and specific anatase phase on the titanium surface. Theoretical calculation revealed that the presence of nanotexture reduced the polar component of surface energy, while the generation of anatase significantly enhanced the polar component and total surface energy. Meanwhile, the modified surface with regular nanotexture and anatase phase produced positive effect on the expression of CD31, VE-Cadherin and down-regulated α-SMA proteins expression, indicating excellent capacity of pro-endothelial regeneration and inhibition of SMCs proliferation and migration. One-month in vivo implantation in rabbit carotid arteries further confirmed that modified tube implant surface effectively accelerated confluent endothelial monolayer formation and promoted native-like endothelium tissue regeneration. By contrast, original titanium tube implant induced a disorganized tissue proliferation in the lumen with a high risk of restenosis. Collectively, this study opens us an alternative route to achieve the function that selectively promotes endothelial cells (ECs) growth and suppresses SMCs on the medical titanium surface, which has a great potential in facilitating re-endothelialization on the surface of blood-contacting titanium implant.

Prediction value of pericoronary fat attenuation index for coronary in-stent restenosis.

As a novel imaging marker, pericoronary fat attenuation index (FAI) reflects the local coronary inflammation which is one of the major mechanisms for in-stent restenosis (ISR). We aimed to validate the ability of pericoronary FAI to predict ISR in patients undergoing percutaneous coronary intervention (PCI). Patients who underwent coronary CT angiography (CCTA) before PCI within 1week between January 2017 and December 2019 at our hospital and had follow-up invasive coronary angiography (ICA) or CCTA were enrolled. Pericoronary FAI was measured at the site where stents would be placed. ISR was defined as ≥ 50% diameter stenosis at follow-up ICA or CCTA in the in-stent area. Multivariable analysis using mixed effects logistic regression models was performed to test the association between pericoronary FAI and ISR at lesion level. A total of 126 patients with 180 target lesions were included in the study. During 22.5months of mean interval time from index PCI to follow-up ICA or CCTA, ISR occurred in 40 (22.2%, 40/180) stents. Pericoronary FAI was associated with a higher risk of ISR (adjusted OR = 1.12, p = 0.028). The optimum cutoff was - 69.6 HU. Integrating the dichotomous pericoronary FAI into current state of the art prediction model for ISR improved the prediction ability of the model significantly (△area under the curve = + 0.064; p = 0.001). Pericoronary FAI around lesions with subsequent stent placement is independently associated with ISR and could improve the ability of current prediction model for ISR. Pericoronary fat attenuation index can be used to identify the lesions with high risk for in-stent restenosis. These lesions may benefit from extra anti-inflammation treatment to avoid in-stent restenosis. • Pericoronary fat attenuation index reflects the local coronary inflammation. • Pericoronary fat attenuation index around lesions with subsequent stents placement can predict in-stent restenosis. • Pericoronary fat attenuation index can be used as a marker for future in-stent restenosis.

Fasting blood glucose predicts high risk of in-stent restenosis in patients undergoing primary percutaneous coronary intervention: a cohort study

Objectives. Studies have shown that fasting blood glucose (FBG) is closely associated with poor prognosis in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI), but its association with in-stent restenosis (ISR) is still unclear. Therefore, this study was to explore the association between FBG with ISR in patients with CHD after PCI. Design. In this cohort study, we included 531 patients with CHD who underwent PCI. Logistic regression, receiver operating characteristic (ROC), subgroup analysis and restricted cubic spline (RCS) were used to assess the association between FBG with ISR. Results. A total of 124 (23.4%) patients had ISR. Patients with higher levels of FBG had higher incidence of ISR compared to those with lower levels of FBG (p = 0.002). In multivariable logistic regression analyses, higher levels of FBG remained strongly associated with higher risk of ISR (as a categorical variable, OR: 1.89, 95% CI: 1.21–2.94, p = 0.005; as a continuous variable, OR: 1.12, 95% CI: 1.03–1.23, p = 0.011). ROC analysis also showed that FBG might be associated with the occurrence of ISR (AUC = 0.577, 95% CI: 0.52–0.64, p = 0.013). Subgroup analyses showed the association of FBG with ISR was also stable in several subgroups (< 60 years or ≥ 60 years, male, with or without smoking, without diabetes and without hypertension). And RCS analysis showed that FBG was linearly and positively associated with the risk of ISR. Conclusions. Higher levels of FBG were closely associated with higher risk of ISR in patients with CHD after PCI.

Prognostic Impact of Drug-Coated Balloons in Patients With Diabetes Mellitus: A Propensity-Matched Study

Patients with diabetes mellitus (DM) are at higher risk of restenosis and stent thrombosis after percutaneous coronary intervention (PCI) and drug-eluting stent (DES) positioning. Whether drug-coated balloons (DCB) can offer any benefit in this subset of patients has been seldom cleared out and was the aim of the present propensity-matched cohort study, that compared the prognostic impact of DCB versus DES in patients with DM who underwent PCI. Patients with DM enrolled in the NOvara-BIella-TREnto (NOBITRE) Registry were identified and matched according to propensity score, to a control population of patients with DM treated with DES. The primary study end point was the occurrence of major adverse cardiovascular events (MACEs). A total of 150 patients were identified in the DCB group and matched with 150 DES-treated patients. Patients treated with DCB displayed more often a previous cardiovascular history and received a more complete pharmacological therapy. Target vessel diameter and the percentage of stenosis were lower in patients with DCB, whereas binary in-stent restenosis was more common (p<0.001, p=0.003, and p<0.001, respectively). Paclitaxel-eluting balloon represented the most common strategy in the DCB group, whereas Zotarolimus-eluting stents were used in half of the DES population. At a median follow-up of 545.5days, MACE occurred in 54 (19.4%) of patients, with no difference according to the PCI strategy (21.6% vs 17.3%, adjusted hazard ratio [95% confidence interval]1.51 [0.46 to 4.93], p=0.50). Major ischemic end points were slightly increased in patients treated with DCB, whereas overall death was significantly reduced (3.6% vs 10.9%; adjusted hazard ratio [95% confidence interval]0.27 [0.08 to 0.91], p=0.03). In conclusion, the present propensity-matched study shows that, in patients with DM who underwent PCI for in-stent restenosis or de novo lesions, the use of DCB is associated with a similar rate of MACE and a modest increase in target lesion failure, but a significantly improved survival as compared with DES.

Restenosis Following Bronchoscopic Airway Stenting for Complex Tracheal Stenosis.

Nonsurgical patients with complex postintubation tracheal stenosis (PITS) and tracheostomy-associated tracheal stenosis (PTTS) often require airway stenting. However, the optimal approach is unknown. Identifying patients at higher risk for restenosis after stent removal may allow the treating physician to individualize the vigilance and duration of airway stenting, and help optimize outcomes. This was a single-center retrospective analysis of prospectively collected data on all patients with complex PITS and/or PTTS treated with protocolized bronchoscopic airway stenting over a consecutive 16-year period. The primary outcome analyzed was restenosis rate at 1 year after stent removal. Predictors for restenosis and factors influencing risk for death during stent therapy were also assessed. Of the 181 subjects treated with silicone airway stenting, 128 were available for analysis of the primary outcome. Restenosis by 1 year after stent removal occurred in 58%. Independent predictors for restenosis were coexisting diabetes [odd ratio (OR)=3.10, 95% confidence interval (CI)=1.04-9.24; P=0.04], morbid obesity (OR=3.13, 95% CI=1.20-8.17; P=0.02), and occurrence of stent-associated complications requiring bronchoscopic management (OR=2.13, 95% CI=1.12-4.03; P=0.02). The overall mortality during the initial stenting period was 14%, and a silicone Y-stent was associated with a higher risk of death (OR=3.58, 95% CI=1.40-9.14; P=0.008). Tracheal restenosis after silicone stent therapy for complex PITS and PTTS is common and more likely to occur in patients with diabetes, morbid obesity, and frequent stent-associated complications. Mortality risk during stent therapy is not negligible, and a Y-stent should be utilized only after careful consideration. These findings may be incorporated into the approach to bronchoscopic airway stenting in these patients.

P201 DRUG–COATED BALLOON AND DIABETES MELLITUS: A MATTER OF SURVIVAL

Abstract Background Patients with diabetes mellitus (DM) are at higher risk of restenosis and stent thrombosis after percutaneous coronary intervention and drug eluting stent (DES) positioning. Limited although interesting data are available on prognosis after revascularization with drug–coated balloon (DCB) in this group of patients. The aim of this study is to evaluate the prognostic impact of DCB use in patients affected by DM. Methods Patients with DM enrolled in a retrospective multicenter registry were identified and matched to a control population of diabetic patients treated with DES enrolled in another retrospective registry, according to a propensity score calculated on the independent predictors of main adverse cardiac events (MACE). The primary study endpoint was the occurrence of MACE, a composite of death, myocardial infarction, and target vessel revascularization. Secondary endpoints were the independent components of the primary endpoint, or target lesion failure (TLF). Results 150 patients were identified in the DCB group and matched with 150 DES–treated patients. However, patients treated with DCB displayed more often a previous cardiovascular history and received a more complete pharmacological therapy. Target vessel diameter and the percentage of stenosis were lower in DCB patients, whereas binary in–stent restenosis was more common. At a median follow–up of 545.5 days, MACE occurred in 54 (19.4%) of the patients, with no difference according to the PCI strategy. Although a trend toward higher TLF was found (p=0.06), overall death was significantly reduced in diabetic patients (3.6% vs 10.9%; adjusted HR[95%CI]= 0.27[0.08–0.91], p=0.03). Conclusion Although limited by some differences among the groups, the present propensity–matched study shows that, among patients with DM undergoing PCI for in–stent restenosis or de novo lesions, the use of DCB is associated to a similar rate of MACE and a possible increase in TLF, but a significantly improved survival as compared to use of DES.

Machine Learning Identifies New Predictors on Restenosis Risk after Coronary Artery Stenting in 10,004 Patients with Surveillance Angiography.

Machine learning (ML) approaches have the potential to uncover regular patterns in multi-layered data. Here we applied self-organizing maps (SOMs) to detect such patterns with the aim to better predict in-stent restenosis (ISR) at surveillance angiography 6 to 8 months after percutaneous coronary intervention with stenting. In prospectively collected data from 10,004 patients receiving percutaneous coronary intervention (PCI) for 15,004 lesions, we applied SOMs to predict ISR angiographically 6-8 months after index procedure. SOM findings were compared with results of conventional uni- and multivariate analyses. The predictive value of both approaches was assessed after random splitting of patients into training and test sets (50:50). Conventional multivariate analyses revealed 10, mostly known, predictors for restenosis after coronary stenting: balloon-to-vessel ratio, complex lesion morphology, diabetes mellitus, left main stenting, stent type (bare metal vs. first vs. second generation drug eluting stent), stent length, stenosis severity, vessel size reduction, and prior bypass surgery. The SOM approach identified all these and nine further predictors, including chronic vessel occlusion, lesion length, and prior PCI. Moreover, the SOM-based model performed well in predicting ISR (AUC under ROC: 0.728); however, there was no meaningful advantage in predicting ISR at surveillance angiography in comparison with the conventional multivariable model (0.726, p = 0.3). The agnostic SOM-based approach identified-without clinical knowledge-even more contributors to restenosis risk. In fact, SOMs applied to a large prospectively sampled cohort identified several novel predictors of restenosis after PCI. However, as compared with established covariates, ML technologies did not improve identification of patients at high risk for restenosis after PCI in a clinically relevant fashion.

"Burying" covered coronary stents under drug-eluting stents: A novel approach to ensure long-term stent patency.

Covered coronary stent (CS) implantation is associated with a high risk for in-stent restenosis (ISR) and stent thrombosis (ST). We describe the outcomes after overstenting ("burying") CS using contemporary drug-eluting stents (DES). We analyzed short- and long-term outcomes of consecutive patients who had had a CS implanted, which was consecutively covered ("buried") with a third-generation DES. CSs were primarily post-dilated and then covered with a longer DES overlapping the proximal and distal edges of the CS. To ensure optimal stent expansion and appositions, all lesions were post-dilated using adequately sized non-compliant balloons. Between 2015 and 2020, 23 patients (mean age 67 ± 14 years, 74% males) were treated using this novel approach. Reasons for implanting CS included treatment of coronary aneurysms (n = 7; 30%), coronary perforations (n = 13; 57%), and aorto-ostial dissections (n = 3; 13%). All CSs were successfully deployed, and no peri-procedural complications occurred. The median time of follow-up was 24.5 (interquartile range [IQR] 11.7-37.9) months. All patients had a 1-month follow-up (FU) and 19/23 (83%) patients had 12-month FU (FU range 1-60 months). No probable or definite STs occurred, and no cardiovascular deaths were observed. Among patients undergoing angiographic FU (11/23 [48%]), 1/23 showed angiographically significant ISR 6 months post CS implantation. Burying a coronary CS under a DES appears to be a safe and promising strategy to overcome the limitations of the currently available CS devices, including a relatively high risk for target lesion failure due to ISR and ST.

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events.

CASP1 Gene Polymorphisms and BAT1-NFKBIL-LTA-CASP1 Gene-Gene Interactions Are Associated with Restenosis after Coronary Stenting.

In the present study, we evaluated the association of the BAT1, NFKBIL, LTA, and CASP1 single nucleotide polymorphisms and the gene–gene interactions with risk of developing restenosis after coronary stenting. The allele and genotype determination of the polymorphisms (BAT1 rs2239527 C/G, NFKBIL1 rs2071592 T/A, LTA rs1800683 G/A, CASP1 rs501192 A/G, and CASP1 rs580253 A/G) were performed by 5’exonuclease TaqMan assays in 219 patients: 66 patients with restenosis and 153 without restenosis. The distribution of rs2239527 C/G, rs2071592 T/A, and rs1800683 G/A polymorphisms was similar in patients with and without restenosis. Nonetheless, under recessive (OR = 2.73, pCRes = 0.031) and additive models (OR = 1.65, pCAdd = 0.039), the AA genotype of the rs501192 A/G polymorphism increased the restenosis risk. Under co-dominant, dominant, recessive, and additive models, the AA genotype of the rs580253 A/G was associated with a high restenosis risk (OR = 5.38, pCCo-Dom = 0.003; OR = 2.12, pCDom = 0.031; OR = 4.32, pCRes = 0.001; and OR = 2.16, 95%CI: 1.33–3.52, pCAdd = 0.001, respectively). In addition, we identified an interaction associated with restenosis susceptibility: BAT1-NFKBIL1-LTA-CASP1 (OR = 9.92, p < 0.001). In summary, our findings demonstrate that the rs501192 A/G and rs580253 A/G polymorphisms, as well as the gene–gene interactions between BAT1-NFKBIL1-LTA-CASP1, are associated with an increased restenosis risk after coronary stenting.

Anemia as a risk factor for restenosis in femoropopliteal arterial disease after drug-coated balloon angioplasty.

This study aimed to investigate the relationship between anemia and restenosis in patients with femoropopliteal arterial disease following drug-coated balloon (DCB) angioplasty. 194 patients treated with DCB for femoropopliteal lesions were retrospectively analyzed for up to 12 months of follow-up between January 2017 and September 2020. Baseline clinical and procedural characteristics were compared between the anemia and non-anemia patients, and predictors of restenosis were identified using logistic regression. 32.5% of the patients undergoing DCB angioplasty had anemia. Patients with anemia were significantly older, with higher rates of hypertension, coronary artery disease, chronic renal insufficiency, and diabetes, and with lower rates of smoking and male gender. In the multivariate analysis, anemia was independently and significantly associated with a higher risk of restenosis (OR, 3.872; 95% CI, 1.556-9.638; P = 0.004). Anemia is independently associated with restenosis in patients treated with DCB for femoropopliteal arterial disease. Patients with lower baseline hemoglobin might have more chances to develop restenosis at follow-up.

ПРОГНОСТИЧЕСКИЕ МАРКЕРЫ РЕСТЕНОЗА У ПАЦИЕНТОВ С ПЕРИФЕРИЧЕСКИМ АТЕРОСКЛЕРОЗОМ ПРИ ЭНДОВАСКУЛЯРНЫХ ВМЕШАТЕЛЬСТВАХ

Objective. To study the role of hemostatic parameters as potential markers of restenosis in patients with peripheral artery disease (PAD) after endovascular procedures. Methods. An open prospective study involved 55 PAD patients aged 63 (57; 69) with the stage IIb-IV Fontaine chronic lower limb ischemia; 48 (87.3%) subjects were male; 18 (32.73%) patients had type 2 diabetes mellitus (T2D). Before angioplasty or stenting of the arteries of the lower extremities, the activity of protein C (PrC), the levels of soluble endothelial receptors for protein C (sEPCR), the activity of coagulation factors FVIII, FIX, FXI were determined in the peripheral blood. Within a year every three months Duplex ultrasound or angiography for follow-up examination have been performed to detect restenosis. Results. Within one year restenosis was detected in 13 (23.6%) patients. Binary regression analysis revealed T2D, FVIII activity and sEPCR as prognostic markers of restenosis. sEPCR level lower than 46.8 ng/ml was associated with a 4.263 higher risk for restenosis after endovascular procedures (odds ratio 4.263, CI 95% 1.509-12.042); absolute risk 47±11% (CI 95% 25-69 %). The patients with T2D had a 2.6 higher risk for restenosis as compared to subjects without diabetes mellitus (odds ratio 2.6, CI 95% 1.031-6.599); absolute risk 41.18±12% (CI 95% 17.78-64.58%). The probability of developing restenosis was inversely related to the initial indicators of FVIII activity and the level of sEPCR: the lower the absolute values of FVIII and sEPCR, the higher the likelihood of developing restenosis in the postoperative period. Conclusion. Patientswith diabetes mellitus (type 2), reduced activity of coagulation factor FVIII and level of soluble endothelial protein C receptors are at particularlyhigh riskforrestenosis What this paper adds The study of hemostasis parameters in patients with the peripheral atherosclerosis revealed that the sEPCR level below 46.8 ng/ml corresponded to an elevateion of restenosis risk after endovascular interventions by 4.263 folds (odds ratio 4.263, 95% CI 1.509-12.042), the presence of type 2 diabetes mellitus - in 2.6 folds (odds ratio 2.6, 95% CI 1.031-6.599). The likelihood of developing restenosis was inversely related to baseline FVIII activity and sEPCR levels. The authors proposed a method for calculating the individual probability of developing restenosis using the abovementional indicators.