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Biomedical subjects

D G Ioseliani

Publications and source records attributed to D G Ioseliani.

At least 19 recordsLinked to original sources
PubMed2006

[The results of direct myocardial revascularization in patients with various forms of coronary heart disease].

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.

Adult↗
PubMed2006

[The effects of cholesterol-lowering therapy on the results of coronary arterial stenting in patients with chronic forms of coronary heart disease].

The paper presents an analysis of correlations between long-term results of coronary arterial stenting and anticholesterol therapy with statins in 131 patients with chronic forms of coronary heart disease. The study revealed that anticholesterol therapy, when administered regardless the initial cholesterol level, improved the clinical condition of patients with initial hypercholesterolemia, and lowered the necessity of repeated endovascular procedures for restenosis and the progression of atherosclerotic changes. The necessity of repeated interventions is lowered by statin application rather than by normal levels of total cholesterol and low-density lipoproteins.

Adult↗
PubMed2005

[Combination of prehospital systemic thrombolytic therapy with endovascular procedures in the treatment of patients with acute myocardial infarction].

Since July 2002 we have been conducting a study of efficacy of prehospital thrombolytic therapy combined with subsequent endovascular procedures in the treatment of patients with acute myocardial infarction. Fifty nine patients received prehospital fibrinolysis with tissue-type plasminogen activator (TPA, n=28) or streptokinase (n=31) within 6 hours after onset of symptoms. TPA infusion compared with that of streptokinase was associated with smaller ischemic myocardial damage and lower frequency of side effects (3.6 and 38.7%, respectively). Angioplasty or stenting of infarct related arteries were carried out in 47 of these patients. The group of patients subjected to endovascular interventions was characterized by a low rate of in-hospital cardiac events and zero mortality.

Angioplasty, Balloon, Coronary↗
PubMed2004

[Development of transmural myocardial infarction in young persons with intact coronary arteries during methadone use for the treatment of heroine addiction].

Linkage between acute coronary syndrome and narcotic drug (cocaine) intake was first described by D. Colleman in 1982. However risk of development of acute myocardial infarction during replacement therapy after opioid withdrawal has not been elucidated. The paper contains description of two cases of development of myocardial infarction in young persons with intact coronary arteries who received synthetic opioid methadone for facilitation of heroine discontinuation. These clinical cases should draw attention of physicians to side effects of the use of methadone for the treatment of heroine addiction.

Adult↗
PubMed2004

[Endovascular treatments in coronary heart disease patients with restenosis after primary ballon angioplasty].

The study was undertaken to comparatively assess the results of stenting and transluminal balloon angioplasty (TBAP) of coronary arteries in patients with chronic forms of coronary heart disease concurrent with restenosis of primary TBAP. The data on 77 patients undergone endovascular procedures for restenosis of prior primary TBAP of coronary arteries at the Moscow Research and Practical Center of Interventional Cardioangiology in March 1997 to May 2003 were analyzed. Group 1 comprised 35 patients with a stent implanted at the site of coronary restenosis; Group 2 included 42 patients undergone repeated TBAP. These groups did not significantly differ in main clinical and functional characteristics, the extent coronary bed lesion, the number of diseased arteries and the morphological type of a coronary lesion (p < 0.05). The angiographic success of secondary TBAP, as well as coronary stenting was 100%. Survival was 100% in the late period. A control examination revealed the clinical picture of angina on exertion in 57.1% and 76.2% of the patients in Groups 1 and 2, respectively (p = 0.039). In the late period, a satisfactory angiographic result of coronary stenting was revealed in most cases (74.3 and 35.7% in Groups 1 and 2, respectively); restenosis was detected in 20 and 59.5% of cases, respectively (p < 0.01); occlusion in 5.7 and 4.8% (p > 0.05). Need for repeated interventional and surgical (aortocoronary bypass surgery) procedures was significantly less after coronary stenting than that after repeated TBAP (20 and 40.5%, respectively). In the late period, the factors significantly increasing a risk for in-stent restenosis were hypercholesterolemia (cholesterol > or = 5.5 mmol/l); the length of restenosis of an operated segment was > or = 18 mm and that of a stent > or = 20 mm. It is expedient to use coronary endroprosthesis to reduce the incidence of repeated restenosis and needs for repeated procedures for myocardial revascularization in the late period.

Angioplasty, Balloon, Coronary↗
PubMed2004

[A clinical case of successful combination of endovascular and surgical correction of multifocal atherosclerotic signs in an elderly patient].

Combination of the methods of interventional cardioangiology with current techniques of vascular surgery allows a considerable broadening of the potential for the treatment of different signs of multifocal atherosclerosis in "high risk" patients. For instance, a 70-year-old patient (height 152 cm, weight 32 kg; initial concentration of serum creatinine 174 mumol/l) with the clinical evidence of progressing angina pectoris and critical ischemia of the lower extremities underwent angioplasty (the first stage) using a transradial access and stenting of the critically narrowed circumflex branch of the left coronary artery and angioplasty of the proximal segment of the right coronary artery. Good angiographic and clinical results were obtained. This provided a possibility of accomplishing aortofemoral bifurcation bypass grafting. So, the staged combined treatment made it possible to eliminate the life- threatening signs of multifocal atherosclerosis and to improve disease prognosis in an elderly patient classified with a group of inoperable subjects.

Aged↗
PubMed2002

[Immediate results of direct coronary artery stenting].

Stent implantation is as a rule preceded by balloon angioplasty (predilation). This increases duration and cost of the procedure. Low profile stents with improved design allow to perform direct (i.e. without predilation) stenting. Immediate results of our series of direct coronary artery stenting procedures evidence for high efficacy and safety of the technique.

Angioplasty, Balloon↗
PubMed2002

[C-reactive protein as possible early prognostic marker of restenosis development in coronary artery stents].

AIM: To study possible link between inflammatory response of the body to stent implantation and development of instent restenosis. METHODS: C-reactive protein (CRP) was determined in 24 patients subjected to coronary stenting. Coronary angiography was repeated in 7.1-/+0.68 months after initial procedure. RESULTS: At repeat angiography positive results of stenting persisted in 18 while restenosis developed in 6 patients. All patients had increased CRP levels on days 2-3 after stenting. Day 2 CRP levels were higher in patients with than without restenosis (28-/+4.22 mg/l and 14.17-/+2.14 mg/l, respectively, p<0.05). CRP levels tended to normalize by day 5. CONCLUSION: Coronary artery stenting in patients with angina pectoris is associated with transitory elevation of CRP level. Day 2 CRP >or=24 mg/l with high degree of probability predicts restenosis in remote period.

Adult↗
PubMed2002

[Comparative long-term outcomes of balloon angioplasty of uni- or multi-vessel lesions in coronary disease].

A study has been carried out on long-term results of transluminal balloon angioplasty (TLBAP) in case of mono- and multivascular lesion of coronary bed (CB). During long-term follow-up (16.3 +/- 3.8 months) a high survival rate was observed after treatment procedure both in mono- (97.1%) and multivascular (98.75%) lesion. However, patients with monovascular lesion had lesser probability of being subjected to additional revascularization procedure and greater probability of avoiding angina pectoris in long-term follow-up unlike patients with multivascular lesion of coronary arteries (85.7% vs 63.8%). At the same time a good angiographic angioplastic effect of dilated vessel remained in equal number of patients: 66.7% with monovascular lesion and 68.6% with multivascular lesion. Therefore, it is advantageous to use TLBAP both in mono- and multivascular CB lesion.

Angina Pectoris↗
PubMed1992

[X syndrome: does left ventricular myocardial perfusion suffer during exercise?].

Sixteen patients with the X syndrome underwent thallium-201 myocardial scintigraphy. Eleven patients with one-coronary artery disease served as a control group. During bicycle ergometry all the 16 patients showed various degrees of local myocardial perfusion impairments. The foci were located in the basins of various coronary vessels. Impaired myocardial perfusion in patients with the X syndrome was similar to that in patients with moderate, but hemodynamically significant stenosis of a coronary artery. At the same time the impairments were significantly less pronounced than in those with critical stenosis of a coronary artery. Thus, patients with the X syndrome have not only clinical signs of coronary heart disease (anginal episodes), but they also have marked myocardial perfusion impairments during exercise.

Adult↗
PubMed1992

[Role of coronary collateral circulation in the compensation of disorders of myocardial perfusion and left ventricular function in patients with newly appearing angina pectoris].

The myocardial perfusion and left ventricular function were evaluated by bicycle ergometry and myocardial scintigraphy in 23 patients with primary angina taking into account the status of coronary collateral circulation in response to stenotic and occlusive atherosclerosis. In addition to severe occlusive disease of the coronary bed, most patients had significant disturbances of myocardial perfusion and left ventricular function, which were detected during exercise tests. In patients with compensatory collateral circulation in the coronary bed, such disturbances were less marked than in those without anastomoses. However collateral coronary circulation cannot be regarded to be of real value as it compensates impaired perfusion incompletely, but in some cases it can result in impaired myocardial vascularization apparently due to the steal syndrome.

Adult↗
PubMed1991

[Prognostic significance of "silent" myocardial ischemia in patients with unstable stenocardia].

A 24-hour ECG monitoring was performed in 30 patients with unstable angina. Ten patients had episodes of transient ST-segment displacement only in the presence of anginal attacks (Group 1), 10 had ST-segment displacement episodes in the presence of both anginal attacks and silent myocardial ischemia (Group 2), and 10 with the displacements concurrent with only silent ischemia (Group 3). The patients from the groups were not significantly different in terms of major clinical, history, and angiographic data. Following an average of 1 year, death and acute myocardial infarction were observed in 1 (10%) and 2 (22.2%) in Group 1; 1 (10%) and 3 (33.3%) in Group 2; and 2 (20%) and 5 (62.5%) patients, respectively. It was concluded that episodes of silent myocardial ischemia are prognostically more hazardous than those of transient hypoxic ECG changes concomitant with anginal attacks.

Angina, Unstable↗
PubMed1991

[New-onset angina pectoris: clinical aspects, diagnosis, prognosis and treatment tactics].

NOA patients are not a homogeneous population in relation to impairment of coronary circulation, clinical symptoms and prognosis. Early hospitalization and treatment of the disease result in more favourable hospital and long-term responses than in the overall population of coronary patients. Conservative and surgical treatment in them produce almost similar results as regards survival and incidence of acute myocardial infarction. Hence, it is thought justifiable to use drugs in the majority of NOA patients leaving surgery only for patients with grave multiple coronary lesions and resistance to chemotherapy.

Angina Pectoris↗
PubMed1991

[The necessity for a differentiated approach to the treatment of acute disorders of the coronary circulation].

The article discusses problems of the tactics of treatment of acute disorders of coronary circulation with the use of radiologically-guided intravascular and surgical methods along with drug therapy. The authors conclude on the basis of accumulated experience that in most patients, both in unstable angina pectoris and in acute myocardial infarction, there is no need for emergency procedures and operations for direct revascularization of the myocardium, which should be resorted to only in patients with complete irresponsiveness to drug therapy. After stabilization of the condition, however, the tactics of diagnostic and therapeutic measures must be differentiated according to the patients' clinical condition and a series of laboratory indices. In particular, treatment should be limited to drugs in patients with an uneventful clinical course and high tolerance to physical exertion (bicycle ergometry test). Patients who are relatively irresponsive to drug therapy or have a low tolerance to physical exercises should be subjected to planned selective coronarography and, if indicated, treated by transluminal angioplasty of the coronary arteries or by an operation for direct revascularization of the myocardium. The authors emphasize in particular that the methods of drug, radiologically-guided intravascular, and surgical treatment should not be regarded as alternatives but as methods mutually complementing one another in different stages of the disease.

Angina, Unstable↗