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AIM: To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. METHODS: This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP?≤?21 mm Hg without medications indicated complete success while IOP?≤?21 mm Hg with medications indicated qualified success; and IOP

Mechanical thrombectomy is currently the gold standard treatment of large vessel occlusions, especially in anterior circulation acute ischemic stroke. At the same time, the problem of tandem occlusions seems especially important since most of the major clinical mechanical thrombectomy studies did not specifically evaluate patients with concomitant extracranial occlusions or critical stenoses. To date, there is no universally accepted optimal treatment strategy for such tandem lesions in acute ischemic stroke: it remains unclear which lesion - intracranial or extracranial - should be treated first. The selected reperfusion method should be based on the patients' individual characteristics, data from non-invasive radiologic studies, and the stroke team experience. We present a case of successful reperfusion therapy of acute tandem occlusion of the right internal carotid artery, followed by contralateral carotid artery stenting in a patient with stenosing extracranial atherosclerosis.

Posthemorrhagic hydrocephalus in newborns with ventricular occlusion leads to decompensation of CSF dynamics with a high risk of neurological disorders and child disability.Objective. To improve the effectiveness of treatment of hydrocephalus in newborns.Characteristics of children and research methods. The authors analyzed the treatment of hydrocephalus in 327 newborns in 2000– 2018. 184children (Group 1)underwent standard treatment with lumbar and ventricular punctures with 20-22G needles, and with progression of hydrocephalus – ventriculo-subgaleal drainage and ventriculo-peritoneal shunting. 143 children (Group 2) with ventricular occlusion underwentcomplex treatment with coronary-transluminal subarachnoventriculostomy (RF patent No. 2715535) and ventricular drainage with a ventriculo-subarachnoid stenting system (RF patent No. 2721455).Results. The effectiveness of treatment with the inclusion of the proposed options is improvedby eliminatingocclusion, restoring circulation and absorption of cerebrospinal fluid, prolonged sanitation of cerebrospinal fluid with isotonic sodium chloridesolution. A positive result with compensation for hydrocephalus was achievedin 75,4% of cases versus 28,2% with the «standard» protocol (p Conclusion. The data obtained allowus to consider the effectiveness of the inclusion of the proposed options in the modern algorithm for the treatment of hydrocephalus in newborns, to expand the possibilities for early rehabilitation and restorative treatment together with pediatricneurologists and doctors of related specialties.

Background Ductal stenting is the preferred method of securing adequate pulmonary blood flow in patients with duct-dependent pulmonary circulation. The main limitation in most centers is the difficult vertical tubular or convoluted ducts that represent real challenges to interventional pediatric cardiologists. We present our experience in patent ductus arteriosus (PDA) stenting with some technical tips to overcome difficulties, especially in stenting tortuous or long tubular ducts. This study was conducted on all patients with cyanotic congenital heart disease who underwent PDA stenting between January 2011 and December 2018. Results We attempted to stent the PDA in 43 patients, with a success rate of 93% (40 patients) and only one procedural mortality. There was also one stent migration that needed to be treated with urgent surgery. Three-fourths of the patients had difficult ductal morphology and origin. One stent was used to cover the PDA in 27 patients (62.8%), two stents were used in 13 (30.2%), and three stents were used in 2 patients (4.6%). In-stent stenosis rate was 12.5% (5 patients) and the development of progressive left pulmonary artery stenosis was seen in two patients (5%). Pulmonary artery growth was adequate in all patients. Conclusions PDA stenting is an effective method of palliation for patients with duct-dependent pulmonary circulation. It has low morbidity and mortality rates. Stenting difficult ducts have become more feasible with evolving materials and techniques.

IntroductionThere is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the short-term outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease.Material and methodsWe retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single- or double-vessel carotid disease.ResultsThere was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38–54%) vs. 55% (95% CI: 47–63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01).ConclusionsPatients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.

Funder: British Society of Interventional Radiology, PURPOSE: The purpose of this study was to evaluate the predictive value of a 'Modified Karnofsky Scoring System' on outcomes and provide real-world data regarding the UK practice of biliary interventions. MATERIALS AND METHODS: A prospective multi-centred cohort study was performed. The pre-procedure modified Karnofsky score, the incidence of sepsis, complications, biochemical improvement and mortality were recorded out to 30 days post procedure. RESULTS: A total of 292 patients (248 with malignant lesions) were suitable for inclusion in the study. The overall 7 and 30 day mortality was 3.1% and 16.1%, respectively. The 30 day sepsis rate was 10.3%. In the modified Karnofsky 'high risk' group the 7 day mortality was 9.7% versus 0% for the 'low risk' group (p = 0.002), whereas the 30 day mortality was 28.8% versus 13.3% (p = 0.003). The incidence of sepsis at 30 days was 19% in the high risk group versus 3.3% at the low risk group (p = 0.001) CONCLUSION: Percutaneous biliary interventions in the UK are safe and effective. Scoring systems such as the Karnofsky or the modified Karnofsky score hold promise in allowing us to identify high risk groups that will need more careful consideration and enhanced patient informed consent but further research with larger studies is warranted in order to identify their true impact on patient selection and outcomes post biliary interventions.

In this article it will be discussed actual issues and modern problems of the ischemic disease of the heart, antiplatelet therapy, its effects, hypolipidemic therapy, indications, counter indications, potential side effects as well as, successful management strategies after percutaneous coronary intervention following with drug eluted stents.

Objective With the development of endovascular technique and devices, large and giant intracranial aneurysms are increasingly being managed by this less invasive method. Here we discuss our experience on managing such aneurysms via endovascular technique. Methods Retrospective data on 42 patients with large and giant intracranial aneurysms managed by endovascular techniques between September 2015 to December 2017 at our neurosurgery institute were included in this analysis. Results There were a total 42 patients with 9 giant and 33 large aneurysms in this study. Eight aneurysms were treated by parent vessel occlusion, 22 aneurysms with coils and rest 12 aneurysms were treated with stent assisted coiling. Following the procedure, Raymond class I occlusion was accomplished in 31 (73.8%) patients while class Ⅱ in 9 (21.4%) and class Ⅲ in 2 (4.8%) patients. Overall morbidity and mortality were 9.5% and 14.3% respectively and favorable outcome was seen in 80.9% patients. Significant correlation was observed with clinical outcome and initial neurological status. Conclusions The study indicates that endovascular intervention is a safe and effective method in managing large and giant intracranial aneurysms with lesser morbidity and mortality.

Background/aim Popliteal artery aneurysms (PAAs) are abnormal bulgings, which account for 70% of all peripheral artery aneurysms. They are usually asymptomatic. In this study, we present our long-term results of endovascular stent grafts in the treatment of PAA in the light of literature data. Material and methods A total of 63 legs of 63 patients with PAA, who were treated with endovascular techniques in our clinic between July 2010 and July 2019, were retrospectively analyzed. All patients underwent color Doppler ultrasound (DUS), magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to identify the diameter and length of PAAs, vessel tortuosity, the presence and degree of thrombus, and diameter in the healthy landing zone and to visualize tibioperoneal vascular structures. A Viabahn stent graft was inserted in all patients. Results 57 patients (90.5%) were males with a mean age of 76.35 ± 7 years. 24 patients (38.1%) were symptomatic, while 11 patients (17.5%) had a concomitant abdominal aortic aneurysm (AAA). The mean follow-up period was 46.05 ± 25.01 months. The primary patency rate was 79.3%. A graft thrombosis was observed in 13 patients (20.6%) during a mean follow-up period of 8.31 ± 5.91 months. The number of distal arteries was significantly lower in the patients with thrombosis than those without. Conclusions Endovascular treatment of PAA using stentgrafts is safe in selected cases. However, it is reasonable to avoid endovascular treatment due to an increased risk for thrombosis in patients with a low number of patent distal arteries or impaired distal flow.

Background Mycotic aneurysms are rare vascular lesions, occurring in 0.6–2% of arterial aneurysms but with no reported venous cases. Venous aneurysms unrelated to an underlying infectious process have been previously described and are typically surgically repaired due to risk of thromboembolic events. Case presentation This case reports a bleeding external iliac vein mycotic aneurysm secondary to erosion of a chronic pelvic abscess, successfully treated with endovascular stenting, in an oncologic patient without alternative therapeutic options. Conclusion Venous aneurysms are uncommon vascular lesions which have historically been treated with open surgical repair. Given the lower degree of procedural morbidity, endovascular management of these lesions may be an effective option in the appropriate setting, particularly as a last resort in patients without surgical treatment options.

With the advent of endovascular therapy, conventional angiography has replaced histology as a diagnostic gold standard for fibromuscular dysplasia (FMD). However, angiographic findings are not precisely diagnostic in isolated focal renal artery stenosis (RAS) in FMD. Optical coherence tomography (OCT) imaging by reflecting in vivo histology may improve the diagnostic accuracy in such cases. Restenosis following balloon angioplasty of RAS in FMD occurs frequently and often requires optimized reintervention. However, the role of OCT in the diagnostic evaluation of focal RAS in FMD and in optimizing the intervention is not well studied. We present a young female with resistant secondary hypertension due to bilateral focal RAS on angiography. In the absence of an angiographic string of beads appearance, the diagnoses remained uncertain. However, OCT imaging diagnosed a multifocal disease with characteristic changes of fibro-medial dysplasia, akin to its histological description in the literature. The patient underwent bilateral balloon angioplasty with good angiographic results. After one year on follow-up, relapse of uncontrolled systemic hypertension occurred due to bilateral restenosis. Despite a satisfactory repeat balloon angioplasty of the left-sided re-stenotic lesion, a significant residual pressure gradient persisted. Usage of OCT guided oversized balloon and stent safely achieved good results with complete resolution of the pressure gradient. Right renal artery stenosis required balloon angioplasty alone. She had complete resolution of hypertension without any medications at six months of follow-up. In conclusion, OCT can supplement other diagnostic modalities in providing a proper diagnosis in an angiographically ambiguous focal RAS in FMD. A persistent residual pressure gradient across the lesion despite good angiographic results may be optimized with OCT guidance during the intervention.

Background Abnormal hypoperfusion on the surgical side after carotid artery stenting is rare. Neurological deterioration caused by it is deceptive, which can easily lead to misdiagnosis. The mechanism of hypoperfusion has rarely been demonstrated. We present here a fully studied case with a high probability of intracerebral steal phenomenon. Case presentation A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Restlessness and left limb hemiplegia occurred within 24 h after the procedure, which was similar to hyperperfusion syndrome. However, postoperative computerized tomography perfusion (CTP) revealed abnormal hypoperfusion in the right hemisphere. Transcranial Doppler (TCD) also showed decreased flow velocity in the right middle cerebral artery, and increased flow velocity in the right anterior cerebral artery. We considered that intracerebral steal phenomenon might be the cause, then hypervolemic therapy was accepted and the symptoms completely resolved after 3 days. Conclusions Ipsilateral hypoperfusion is rarely seen after carotid artery stenting. Intracerebral steal phenomenon may be the underlying mechanism. CTP or TCD is helpful for the early detection of this adverse event.

Background. Carotid artery restenosis is a rare complication of carotid stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reveals an in-stent restenosis rate of 0–6 %, a fairly low value given an extensive study sampling of patients. Restenosis still lacks an adequate explanation in endovascular carotid surgery. Intravascular ultrasound visualisation, drug-coated balloons, stent reimplantation or reconstructive surgery have actively been used since relatively recently to tackle restenosis. Drug-coated balloons may fail in certain cases due to hampered restenosis angioplasty in a markedly rigid neointimal hyperplasia. Surgical reconstruction also possessed drawbacks, mostly due to obstacles in the stent removal and the procedure infeasibility in high-risk surgical patients.Materials and methods. The article describes a clinical case of stent-in-stent restenosis correction with drug-coated balloon-expandable re-stenting of right internal carotid artery and a long-term prognosis estimation with optical coherence tomography.Results and discussions. This tactic was adopted due to haemodynamically and clinically significant internal carotid artery restenosis, the patient’s denial of carotid endarterectomy and insufficiently effective balloon angioplasty. The choice of the correction technique was conclusive basing on a negative stent deformation testing that showed the lack of deforming stress factors at internal carotid artery restenosis. Intravascular imaging greatly enhances our ability to understand and assess endovascular processes.Conclusion. We consider clinically significant restenoses in previously stented carotid arteries as requiring further research effort, with the clinical case presented describing an individual solution.

The article presents the results of stenting of the left renal vein in 35 patients with proven hemodynamically significant compression of the vein in “aorto-mesenteric tweezers”. Clinical manifestations of lesions of the left renal vein are very diverse, and pathogenetic mechanisms remain not fully understood. Therefore, the determination of indications for stenting and perfect technical performance are predictors of success in the near and long-term periods of postoperative follow-up. Our experience in stenting the left renal vein demonstrates the possibility of achieving intraoperative technical success in 100 % of cases, as well as a significant improvement in the quality of life in most patients after endovascular intervention, due to a significant reduction in the clinical manifestations of the pathological phenomenon.

Introduction: Subclavian artery stenosis is a potential cause of serious morbidity, endangering the upper extremities, brain and the heart. It is a relatively rare form of peripheral arterial disease, usually present in patients who already suffer from peripheral arterial disease on other vessels, most often lower extremity arteries. Atherosclerosis is considered to be the primary underlying cause. The current treatment of choice is endovascular approach which combines percutaneous transluminal angioplasty and stenting as its noninvasive nature yields faster recovery and less complications. Aim: The aim of this study was to examine the characteristics of subclavian atherosclerotic lesions in patients who underwent endovascular procedure and their relationship with known risk factors. Additional aim was to assess clinical and procedure characteristics of patients and compare them with similar experiences from other centers. Patients and methods: We conducted a retrospective single center review of patients treated with endovascular procedure for SA stenosis and/or occlusion. A total of 53 patients were detected. Three patients were excluded due to the arteritis origin of the stenosis, leaving 50 patients suitable for analysis. Participants’ characteristics were analyzed using descriptive statistics. Normal distribution was assessed using Shapiro-Wilk test. Categorical variables were analyzed using the Chi-square test. Univariate logistic regression was used to calculate unadjusted odds ratios of factors associated with level of stenosis. Results: The mean age at the time of the first intervention was 62±8 years. All except 8 patients were symptomatic. The most common symptoms were paresthesia (32%), vertigo (30%), muscle fatigue (24%) and rest pain (22%). 58% of patients presented with Subclavian steal syndrome. The most common comorbidities and risk factors present in selected patients were hypertension 76%, smoking 60%, hyperlipidemia 60% and coronary artery disease 22%. A total of 50 lesions were treated with 59 endovascular procedures, 9 reinterventions among them. Technical success was achieved in 85% of procedures. After univariate analysis 3 items were detected suitable for multivariate logistic regression. The multivariate regression model was statistically significant χ2 (4, N = 50) = 17.94, p

Introduction: Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited. Aim: This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients. Material and methods: We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During longterm follow-up we assessed new neurological events and stenoses of implanted stents. Results: The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During longterm follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events. Conclusions: Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

Stenosis of the iliac veins is common in patients with chronic venous insufficiency. The article describes the methods for the diagnosis and treatment of iliac vein stenosis. The causes of iliac vein stenosis include extravasal compression or the consequences of ileofemoral thrombosis. Stenosis of the iliac veins exists in 1/4 of the entire adult population, but clinical manifestations do not occur in all patients. Stenosis of the iliac veins should be considered in case of an unknown edema, more often in the left lower extremity, since venous duplex ultrasound of lower extremities is not sensitive and specific enough when examining the veins above the inguinal ligament. The most accurate diagnostic method is intravascular ultrasound (IVUS) but the appeared computed tomography angiography (CTA) and magnetic resonance angiography (MRA) with high-quality images have become a good replacement for IVUS. The main method of treatment of iliac vein stenosis, besides stenting, isindispensable drug therapy consisting of antithrombotic and phlebotonic drugs.

The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.

Internal stenting of the upper urinary tract is a widespread urological surgery. Its frequency in modern practice is high and continues to grow due to the widespread use of endourological, percutaneous, and laparoscopic interventions. The presence of a stent in the patient's body often leads to a decrease in the quality of life due to the occurrence of stent-dependent symptoms, which often requires urgent hospitalization. According to various data, they are registered in at least 80% of patients. The most common stent-dependent symptoms are frequent and / or painful urination, urge to mix (up to imperative), nocturia, pain in the lumbar region, macrohematuria. According to existing data, a fair share of responsibility for the development of these symptoms lies with the distal (vesicular) curl of the internal stent, especially if the technology of its installation is not followed or the length of the drainage is incorrectly selected. The review describes methods for correct installation of internal ureteral stents by transurethral retrograde, antegrade, and laparoscopic approaches, as well as a method for installing and removing mono-pigtail drains. The internal drainage procedure is standard, so the focus is on the nuances and details of this widespread manipulation. The given cohort of patients and the range of surgical interventions indicate a significant experience of the authors in this issue. All illustrations are author's own and taken from the daily workflow. It should be noted that the modern understanding of the process and technological equipment ensure correct stenting when performing any interventions with any access. An adequate choice of installation method and correct positioning of the stent, knowledge of simple details and "secrets" allow not only to restore urodynamics, but also to effectively prevent the development of stent-dependent symptoms, thereby preserving patients quality of life.

Objective ‒ to develop a technique for endovascular treatment of symptomatic ostial stenosis of the vertebral arteries, which allows to minimize risks of delayed stent breakage and restenosis. Materials and methods. This is analysis of prospectively collected data from patients presenting from 2016 to 2019 in the endovascular center of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. One hundred four stents were placed in 99 patients using the author’s complex method, which is based on our modification of Szabo technique. The principles of the method were developed based on a literature review and in vitro tests using 7 silicone models of the initial segments of the subclavian and vertebral arteries with different angles of divergence of the vertebral arteries (30, 45, 60, 90, 120, 135, 150°) and 9 balloon mounted drug-eluting stents with open-cell design Resolute (Medtronic).Results. There were no cases of displacement of the stent proximally or distally during implantation. In all cases, stents were implanted in the affected segment exactly and did not prolapse more than 1 mm beyond the ostium of the vertebral artery into the subclavian artery. There were no «clinical» ischemic complications in the early postoperative period. In 5 cases, isolated subclinical ischemic lessions in the carotid circulation were revealed during one-session stenting of ostial stenosis of the vertebral arteries and carotid stenting. In the posterior circulation, ischemic lessions on MRI in the early postoperative period were not detected in any observations.Conclusions. Developed complex stenting method based on our modification of Szabo technique allows us to achieve optimal long-term results of stenting of symptomatic ostial stenosis of the vertebral arteries.

Background Disconnected branch pulmonary arteries with a systemic arterial origin of the disconnected vessel is a rare, but well-described entity. Most will have ductal tissue connecting the pulmonary artery to the aorta. Case summary We describe in this paper the haemodynamic result in three neonates presenting with ductal origin of a single branch pulmonary artery in the context of trans-catheter stenting procedures to maintain or re-recruit vessel patency. All were faced with potential or actual ductal closure and proceeded to trans-catheter stenting to re-cannalate the duct-dependent pulmonary artery. Two patients with otherwise normal anatomy struggled post-procedure with pulmonary hypertension and right ventricular dilatation. Both required surgical re-anastomosis of the disconnected pulmonary artery during the same admission—one 26 days post-stenting following failure to wean from high-flow respiratory support and the second 8 days post-stenting following failed extubation. In contrast, a patient with tetralogy of Fallot born at 2.5 kg underwent sequential stenting of the right ventricular outflow tract and then the left-sided ductus. He had a good post-procedural course and thrived for several months before complete repair. Discussion We describe the clinical courses and discuss the resultant haemodynamics, highlighting the importance of flow to each lung, the resulting haemodynamic implications and the compounding effects of additional lesions.

Introduction. Currently, there are more than 200 methods of surgical treatment of a megaureter, but none of the methods has achieved universal acceptance. Until now, the issues of differential diagnosis of organic and functional causes of ureteral dilatation in children under 3 years of age have not been sufficiently illuminated, there is no generally accepted algorithm for the management of patients with this pathology. Relevance. The relevance of obstructive uropathies is evidenced by the fact that they occupy the third position in the list of the most common causes of chronic kidney disease in children, and account for 15% of cases. The prognosis of the outcome of obstructive uropathy is determined by the nature of the lesion and the degree of involvement in the pathological process of the kidneys, one of the main homeostatic and endocrine organs in humans. The degree of involvement of various markers in the development and progression of kidney damage in children is still insufficiently understood. All this prompts the search for screening, highly sensitive and specific methods for the diagnosis and prediction of nephrosclerotic changes in children against the background of urinary tract obstruction. Objective: The study of the clinical and laboratory diagnostic methods, allowing to differentiate functional or organic urodynamic disorders, to determine the tactics of managing patients with obstructive uropathy. Materials and methods. Since 2016, a study has been conducted of 174 children aged 0 to 18 years. 3 groups of children were identified: 1) with endoscopic treatment (main group); 2) treated with an open surgical method (control group); and 3) a group of children without urinary tract obstruction (reference group). Results. In the course of the study, it was found that the most optimal values of serum cystatin C, close to the reference group (0.048-0.831 mg/ml) were obtained in children treated with endoscopic correction of the intramural ureter (0.217-0.798 mg/ml). Conclusions. The tactics of endoscopic treatment of obstructive uropathies in children has advantages in terms of open surgical methods in technical simplicity, minimally invasiveness, maximum physiology, and a decrease in the frequency of postoperative complications. These theses are confirmed by the obtained results of the study of serum cystatin C as a marker of the state of renal filtration. It should be remembered that the effectiveness of endoscopic stenting of the lower ureter depends on the age of the child.

Objective: classical methods of determining arterial blood supply of the graft following orthotopic liver transplantation (OLT) reflect the presence of blood flow in the trunk and large branches of the A. hepatica, without the characteristic of completeness of blood filling of peripheral sections, which is very important for objective evaluation of function. The aim of this study is to establish the diagnostic value of a direct perfusion study (IFlow) of the graft. Materials and methods. From 1998 to 2019, 245 OLTs were conducted. From 2015 to 2019, arterial changes were detected in 24 (23%) patients after 104 OLTs. A perfusion study was performed in 9 patients with suspected arterial graft failure. According to the IFlow study, liver hypoperfusion due to stenosis and/or splenic steal syndrome was detected in 8 cases and became an indication for therapeutic intervention. Results. Hepatic stenting and/or splenic artery embolization was performed to improve arterial blood supply to the liver. Endovascular procedures performed restored the perfusion index from 0.24 (0.01–0.89) to 0.61 (0.35–0.98). Conclusion. Absence of ultrasound and multispiral computed tomography signs of arterial complications does not rule out the need for perfusion angiography. Perfusion angiography allows to objectify the angiography data and perform corrective intervention in good time.

The rate of heart failure and subsequent placement of left ventricular assistive devices (LVADs) has been increasing. The extra-anatomic placement of the LVAD and outflow graft presents a challenging problem for repair when complications arise. The present report describes a case of a 63-year-old man who had presented with acute pseudoaneurysm of the outflow graft of his recently placed LVAD. Percutaneous access of the left subclavian artery and percutaneous, transthoracic access of the outflow graft was obtained to allow for sheath placement and stent deployment within the outflow graft. The patient underwent successful endovascular repair of the defect without complications.

Venous occlusion that affects the subclavian or innominate vein is a common problem in cardiac implantable electronic device (CIED) patients, with a reported range between 3% and 5%.1 In contrast, occlusion of the superior vena cava (SVC) not associated with malignancy (thus termed “benign”) is a rare condition (incidence 0.03%–0.15%) that causes a clinical syndrome of upper extremity and face swelling, pleural effusions, orthostatic hypotension, and collateral circulation and might even give rise to life-threatening complications if undetected, as illustrated by this case report.2,3

The number of cases of superior vena cava syndrome (SVCS) increased due to increased cardiac devices and central venous catheters. Management of benign SVCS is still controversial. A 51-year-old male known to have ischemic cardiomyopathy and chronic renal failure on regular hemodialysis. In the last 12 months, he had progressive shortness of breath and swelling of his upper part of the body. Examination revealed engorgement of the neck veins, facial puffiness, and pitting edema of both upper limbs. Venography showed occluded SVC. We applied a 50 Watt of energy via electrocautery pen to a Hi-Torque 0.014 Astato guidewire to cross the occluded segment retrogradely. We used 2 stents 39 mm, mounted on BIB 20/40 mm. Final angiography revealed full restoration of SVC flow. Diathermy use to cross a chronic total SVC obstruction is feasible and safe. Endovascular techniques are suitable as initial management of benign SVC syndrome.

May–Thurner and Paget–Schroetter syndromes are rare conditions encountered by vascular surgeons. An updated knowledge about these conditions is crucial for the effective management of patients with these syndromes who are mostly young. May–Thurner syndrome (MTS) is caused by the compression of the left common iliac vein by the right common iliac artery, and it is a risk factor for left leg deep venous thrombosis (DVT). Imaging (conventional venogram, computed tomography venography (CTV), magnetic resonance imaging (MRV)) can reveal the stenotic venous segment where the artery crosses. Stenting in symptomatic patients yields good results with minimal recurrence. Paget–Schroetter syndrome (PSS) is an idiopathic axillary-subclavian vein thrombosis mostly affecting the young population, particularly those who have repeated overhead arm activities. Narrower costoclavicular space along with other anatomical and coagulation factors can possibly lead to this condition. Patients can present with acute DVT, post-thrombotic syndrome or subclinical syndromes. Venogram, CTV or MRV with provocative maneuvres can confirm the dynamic obstruction. Thrombolysis followed by early bony decompression is advocated in patients presenting with acute arm DVT, as this approach is associated with limited residual disability and recurrence. This review discusses the current concepts and treatment options of both conditions.

Purpose In the absence of literature data, we aimed to determine the long-term patency rates of middle/distal common carotid artery (CCA) stenting and to investigate predisposing factors in the development of in-stent restenosis (ISR). Materials and Methods Fifty-one patients (30 males, median age 63.5 years), who underwent stenting with 51 self-expandable stents for significant (≥ 60%) stenosis of the middle/distal CCA, were analyzed retrospectively. Patient (atherosclerotic risk factors, comorbidities, medications), vessel (elongation), lesion (stenosis grade, length, calcification, location), and stent characteristics (material, diameter, length, fracture) were examined. Duplex ultrasonography was used to monitor stent patency. The Mann–Whitney U and Fisher’s exact tests, Kaplan–Meier analyses, and a log-rank test were used statistically. Results The median follow-up time was 35 months (interquartile range, 20–102 months). Significant (≥ 70%) ISR developed in 14 patients (27.5%; stenosis, N = 10; entire CCA occlusion, N = 4). Primary patency rates were 98%, 92%, 83%, 73%, and 61% at 6, 12, 24, 60, and 96 months, respectively. Reintervention was performed in six patients (11.8%) with nonocclusive ISR. Secondary patency rates were 100% at 6 and 12 months and 96% at 24, 60, and 96 months. In-stent restenosis developed more frequently (P P Conclusion Stenting of the middle/distal CCA can be performed with acceptable patency rates. If intervention is unequivocally needed, patients with hyperlipidemia will require closer follow-up care. Level of Evidence Level 3, Local non-random sample.

Background Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs. Case summary We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography–computed tomography (PET–CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients’ functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal. Discussion Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET–CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.

Background T4 esophageal cancer portends a poor prognosis, particularly when it is complicated by a tracheoesophageal fistula (TEF) either resulting from disease or occurring as a complication of treatment. Patients with TEF that occurs during treatment are commonly treated with palliative intent because fistula-associated treatment complications such as aspiration pneumonia and mediastinitis are associated with high morbidity and mortality. To date, there is no clear evidence on the optimal treatment of T4 esophageal cancer, particularly when a TEF formation occurs. Case summary A 67-year-old gentleman who presented with dysphagia and weight loss. Endoscopy and imaging revealed a T4N1M0 cervical esophageal squamous cell carcinoma. He received image-guided intensity-modulated radiation therapy, with concurrent weekly carboplatin (area under curve 2 mg/mL per minute) and paclitaxel (50 mg/m2 of body surface area). One week after treatment initiation (16.2 Gy thus far), he developed cough on swallowing. A TEF was detected on image-guided radiation therapy using cone-beam computed tomography during the treatment course, for which a tracheal stent was inserted. After discussing the risks and morbidity of continuing treatment, he resumed chemoradiotherapy with an additional radiation dose of 45 Gy in 25 fractions. Three months after completion of chemoradiotherapy, he developed an esophageal stricture that required esophageal stenting and dilatation. The patient remains cancer-free at two year on follow-up. Complete response of esophageal cancer was evident on post-treatment endoscopy and computed tomography imaging, with successful closure of TEF. Conclusion This case highlights that successful curative treatment for esophageal cancer complicated by a TEF is possible using novel chemotherapeutic regimens and modern radiation technologies.

The formation of neointimal hyperplasia after stent implantation and the occurrence of in-stent chronic coronary occlusion is considered a gradual process with possible formation of stable angina pectoris. Materials and methods. Our registry included 131 patients with restenotic changes in a previously implanted stent, which amounted 3.75 % of the total number of interventions during corresponding period. Among these, 36 (1.02 %) patients had chronic coronary occlusion in a previously implanted stent. In most cases, a multivessel disease occurred, the time after stenting was more than 78 months, and the course of the disease was symptomatic in all patients. Most often (38.2 %), stent occlusion was recorded in the left anterior descending artery. Results. Our results indicate that in the presence of conical (typed) proximal and distal occlusion cups, the recanalization efficiency was the greatest (86.6 %), providing intraluminal guidewire advancement both with antegrade access and in the case of a retrograde approach for recanalization of chronic occlusions in the stent. The most commonly used technique was using wires with increasing «load» on the tip until an effect is obtained (AWE – antegrade wire escalation). Conclusions. In contemporary conditions, recanalization of the in-stent chronic coronary occlusion is characterized by significant success (85–90 %). It is necessary to use coronary guidewire with a significant load on the tip, microcatheters with increased penetrating ability, as well as specialized microcatheters. High efficiency was demonstrated by tapped guidewires with a composite structure. Repeated stenting requires optimization using intravascular imaging techniques.

Bernard-Soulier syndrome, a congenital bleeding disorder, can rarely present with atherosclerosis and thrombosis. Acute coronary syndrome in such patients present a unique challenge as no standard set of guidelines exist for successful treatment. (Level of Difficulty: Intermediate.), Graphical abstract, Bernard-Soulier syndrome, a congenital bleeding disorder, can rarely present with atherosclerosis and thrombosis. Acute coronary syndrome in such…

Bingyan Wang,1,* Siyi Lu,1,* Zhiqiang Song,2 Fei Li,1 Junren Ma,1 Yanpeng Ma,1 Xin Zhou,1 Wei Fu1 1Department of General Surgery, Peking University Third Hospital, Beijing, People’s Republic of China; 2Department of Gastroenterology, Peking University Third Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei FuDepartment of General Surgery, Peking University Third Hospital, Beijing 100191, People’s Republic of ChinaEmail fuwei@bjmu.edu.cn zhouxinasd@sina.cnAim: Obstructive colon cancer can be treated by self-expanding metal stents (SEMS) prior to definitive surgery. However, the oncological outcome remains controversial, especially regarding whether stent placement or obstruction results in more perineural invasion (PNI) or lymphovascular invasion (LVI). This study aimed to compare clinical outcomes of emergency surgery (ES) and stent as bridge to surgery (SBTS) in patients with obstructive colon cancer. The pathological characteristics were also compared between obstructive and nonobstructive cancer.Methods: This study included 880 patients (including 47 ES and 45 SBTS) admitted to Peking University Third Hospital from January 2010 to December 2018. Short-term and long-term outcomes were compared. The pathological differences between an equal number of obstructive and nonobstructive patients matched using propensity scores were investigated.Results: SBTS patients had less intraoperative blood loss (P < 0.001), shorter ICU stay time (P = 0.007), lower incidence of colostomy (P < 0.001), and higher laparoscopic achievement (P < 0.001) than did ES patients. No pathological difference was found between the two groups. SBTS patients showed better overall survival (86.7% vs 68.1%, P = 0.029), but not disease-free survival (68.9% vs 59.6%, P = 0.211) than did ES patients. PNI was significantly higher in obstructive cancer than in nonobstructive cancer (29.3% vs 16.3%, P = 0.035).Conclusion: SBTS had a lower incidence of short-term complications and did not affect long-term prognosis compared with that of ES, indicating that SBTS is a safe and effective treatment. Further, PNI may be associated with obstruction, but not with stent insertion.Keywords: colon obstruction, stenting, bridge to surgery, perineural invasion

At the present time, left main (LM) stenting is an alternative to coronary artery bypass grafting in patients with coronary artery disease (CAD) and haemodynamically significant LM lesion. Despite of long history of LM interventions, long-term results are still poorly understood. Presented data are still conflicting and need further affirmation. Aim. To investigate long-term outcomes of percutaneous coronary intervention (PCI) in patients with LM lesions. Materials and methods. The study included 27 patients with CAD with haemodynamically significant LM lesion who underwent PCI. The risk was calculated using the SYNTAX Score and the SYNTAX Score II in all the patients. According to the results of the calculation, patients were divided into 3 groups: the low risk group (SYNTAX Score = 0-22) included 16 (59.3%) patients, the medium risk group (SYNTAX Score = 23-32) included 8 (29.6%) patients, and the high-risk group (SYNTAX Score > 32) included 3 (11.1%) patients. Results. The incidence of major adverse cardiovascular events during the mean follow-up period of 30.9 months was 11.1%, while 89.9% of patients had good immediate and long-term results of the procedure. Fatal cases were reported only in groups of patients with intermediate and high risk according to evaluation by the SYNTAX score. No fatal cases were observed in low risk group of patients according to the SYNTAX score. Thus, patient affiliation with one of the risk groups based on the SYNTAX Score scale affected the long-term LM PCI outcomes. Conclusions. In patients with LM lesion, PCI can be performed with good long-term results in 89.9% of cases. The main criterion for the selection of patients for LM PCI is the risk calculation data based on the SYNTAX Score scale, taking into account the decision of the Heart Team.

Objective – to study the result of light transmission aggregometry with ADP for platelet reactivity before and after clopidogrel administration before extra-intracranial stenting.Materials and methods. Between January and October 2019 36 patients (19 males and 17 females, the average age was 41 years (25–69 years)) who underwent extra or intracranial stenting for atherosclerotic stenosis, endovascular aneurysm coiling with stent-assistance, or implantation of flow diverter were examined. Determination of the aggregation curve with ADP (concentration – 5 mmol/L) was performed before antiplatelet therapy and 5–7 days after before the procedure. Clopidogrel resistance was determined with a maximum aggregation > 50 % on the aggregation curve. In case of clopidogrel resistance, the daily and loading doses were increased to 150 and 450 mg respectively.Results. The maximum ADP-induced aggregation before clopidogrel admission was 77.50 % [63.0–99.0] and 43 % [33.0–61.0] after admission (p < 0.0001). Clopidogrel resistance was detected in 6 (16.7 %) patients. All patients with low sensitivity to clopidogrel underwent extra or intracranial stenting without peri-procedural complications. Thromboembolic complications occurred in 2 patients with a normal response in the early postoperative period after stent implantation, and in 1 case there was a hemorrhagic complication on standard dual antiplatelet therapy in the form of recurrent bleeding from the femoral artery puncture site.Conclusions. Light transmission aggregatometry with ADP is an effective and relatively cheap method of determination the clopidogrel response before neurovascular stenting. Platelet response to clopidogrel therapy significantly varies among patients. Maximum ADP-induced aggregation on the standard dose of clopidogrel before stenting is an important prognostic factor for deciding the optimal clopidogrel dosage. Therapeutic approaches to reduce platelet aggregation in patients with low response on a standard clopidogrel therapy require further study with the aim to determine the optimal drug and its dose for reducing thrombembolic complications rate, without additional risk of hemorrhagic ones.

Objective Approximately 30% of lung cancer patients develop central airway obstruction (CAO) that remarkably shortens survival. There is little data about the benefits of stenting within this heterogeneous patient group. Our objective was to review their overall survival (OS) and their risk of hospitalization versus patients who did not have lesions requiring stent placement. Methods We retrospectively reviewed charts of 171 non-small cell lung cancer (NSCLC) patients who underwent bronchoscopy in the University of Cincinnati Cancer Center from the year 2011 to 2013. Twenty-five patients with advanced lung cancer were evaluated by interventional pulmonology service for endobronchial stent placement for CAO. Eight patients did not require placement of a stent and 17 had obstructive lesions that required stenting by interventional pulmonology. Results Demographical parameters such as age and gender did not have a significant impact on the risk of hospitalization or OS of both groups of patients, however, those whose lesions did not mandate stent placement had significantly lower odds of hospitalization compared to patients with CAO requiring a stent (OR: 15.913, 95% CI: 1.211-209.068, P = 0.0352). Patients with advanced NSCLC and CAO that required stent placement had an OS of 13.9 m [3.9-19.9 m] compared to an OS of 23.9 m for patients with CAO not requiring a stent. We found out that patients with less severe CAO have lower odds of hospitalization and better OS compared to patients with CAO mandating stent placement. Conclusion CAO patients with interventional pulmonology (IP) evaluation and management in addition, may have improved OS suggesting that IP consultation might offer both improvement in quality of life and overall survival to patients with advanced NSCLC and CAO. .

This article is a technical review of the common techniques used in the treatment of lower-limb occlusive arterial disease associated with diabetes. The techniques described here reflect the author’s own practice and are methods that the author finds helpful in avoiding complications and in making the technical aspects of the procedures easier. Keywords: Diabetes, Foot ulcer, Ischemia, Endovascular treatment, Angioplasty, Stenting, Retrograde access, Subintimal, Intraluminal, Pedal arch, Perfusion

Background The objective of this retrospective single-center study was to report the initial and the long-term outcome after stent-assisted angioplasty of occlusive disease at the common femoral artery. Materials and Methods Between 1995 and 2015, 94 limbs in 79 consecutive patients (54 men; mean age 70 ± 8.6 years) underwent angioplasty with self-expanding stent implantation in 94 common femoral arteries. Critical limb ischemia was present in 15 limbs (16%); the other patients had claudication. Results Technical success was 99%. Complications occurred in 5/94 interventions (5.3%): puncture site hematomas (2), arteriovenous fistula (1), cholesterol embolism (1), and dissection of the access site artery (1). The intervention was outpatient-based in 98%. Median follow-up was 53 months. Ankle–brachial index (ABI) rose from 0.71 ± 0.17 to 1.0 ± 0.2 (p p Conclusions SAA of the CFA resulted in high immediate success and a low complication rate. Restenosis rate was moderate, and target lesions could easily be retreated by angioplasty. The main hazard was not restenosis, but death during follow-up.

SUMMARY OBJECTIVE: The objective of this study was to compare the interventions of percutaneous transluminal drug-coated balloon angioplasty (DCB PTA) and standard PTA in the treatment of patients with the below-the-knee peripheral artery disease (BTK PAD). METHODS: Overall, 196 patients (113 males and 83 females; mean age: 63.56±11.94 years; 45–83 years) were treated with PTA for BTK PAD between June 2014 and March 2019. RESULT: Standard PTA (group 1; 96 patients) and DCB PTA (group 2; 100 patients) results were analyzed and compared retrospectively. No statistically significant difference was found between the mean ages of group 1 and 2 patients (p=0.371, p>0.05). Demographic and clinical data were compared and no any statistically significant differences was found between the two groups. Comparing in terms of the iliac lesion, there was no statistically significant difference between the two groups. However, a statistically significant difference was found between the two groups in terms of frequency of popliteal lesions (p=0.001; p

Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide and is associated with high risk of stroke recurrence. While the most common clinical presentation is acute–subacute transient ischemic attack or ischemic stroke, occasionally, patients with underlying ICAS present with acute occlusion of the affected vessel. Diagnosis and endovascular management of ICAS-related emergent large vessel occlusion (ELVO) can be challenging. Herein, we review the current evidence supporting endovascular management of ICAS-related ELVO and discuss future directions.

Gadodiamide is a gadolinium-based chemical element that is considered safe and well tolerated in patients without renal dysfunction and is therefore routinely used as a contrast agent in magnetic resonance imaging. Although radio-opaque, it is not frequently used for coronary angiography due to its less than optimal image quality and prohibitive cost. Our center’s previous experience was less than satisfactory but the addition of a power injection system yielded good quality diagnostic images. We report a case of 63 years old male with a known history of severe, life-threatening anaphylactic reaction to previous iodinated dye presenting with persistent angina despite optimal medical therapy. Coronary and bypass graft angiography was performed using 24 cc of undiluted Gadodiamide (OMNISCAN) with a power injector (ACIST®) without any incidents or premedication with an interpretable angiogram.

An Arnold-Chiari malformation is a congenital central nervous system defect. Raised intracranial pressure is commonly observed, and posterior decompression neurosurgery is the treatment of choice. We describe a patient with iatrogenic occlusion of bilateral jugular veins, subclavian vein, and superior vena cava resulting from repeated central venous cannulations. Because of venous hypertension, the patient suffered from neurologic symptoms: headaches, vision disturbances, and marked head edema. Two stents were used to recanalize the right internal jugular vein and superior vena cava. Symptoms subsided, and the patient returned to work. During 24-month follow-up, stents were patent. The patient remains symptom free and continues working. Keywords: Vena cava obstruction, Endovascular treatment, Stenting

The type and etiology of stroke in young patients are known to differ from those in elderly patients, that influences the diagnosis and treatment. Dissection of cerebral arteries holds the top position in the structure of the causes of ischemic stroke in children and young people below 45 years. Currently no clear guideline on the proper treatment of this pathology exists. The article presents the case of acute ischemic stroke in a young patient (the stroke was caused by the occlusion due to dissection of the internal carotid artery) successfully treated with radiosurgical method - stenting of the cervical part of the artery with the transition to petrous segment of the left carotid artery using combined proximal and distal protection of cerebral vessels. The control of patient's state and results of angiography and ultrasound demonstrate the favourable immediate and medium-term prognosis for the patient.

The review describes morbidity, mortality and possible complication rates for diabetic patients with peripheral arteries disease. The article demonstrates the modern tendency in the surgical treatment of peripheral arteries atherosclerosis, shows and compares worldwide results of endovascular and open revascularization. The authors have assessed the risk of amputation for patients with diffuse peripheral arteries disease and described basic treatment principals for better chronic ischemic ulcer healing.

In the review the authors analyzed the literature data on the state of knowledge of the problems of genetic polymorphisms CYP2C19 gene response to clopidogrel in patients with acute coronary syndrome. Despite on the technological advances and the widespread use of coronary stenting, restenosis at the site of angioplasty remains the main factor limiting its long-term effectiveness. We made the literature review of the state of the study of the genetic polymorphism of the CYP2C19 gene for a response to clopidogrel in patients with acute coronary syndrome and percutaneous coronary intervention. To achieve this goal, a systematic search and subsequent analysis of publications and online resources were carried out. All publications are indexed in the PubMed, Medline, e-Library, CoogleScholar.

Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report. Keywords: Angioplasty, Complete internal carotid artery occlusion, Endarterectomy, Endovascular, Hybrid, Stenting, Stroke, Total occlusion of carotid artery

Introduction. Aortal coarctation is one of the most studied conditions of heart congenital defects, which comprises from 7% to 10% of all congenital heart defects. During many years the various treatment strategies were used. Open surgical reconstructive intervention was first de-scribed in 1945, and this was, as a rule, resection of aortal narrowed portion. Although the treatment of coarctation is usually successful in a short-term perspective, there is a well-known fact of de-velopment of complications at the later stages, especially after surgical reconstruction, such as post-coarctation aneurysms. Objective. To analyze surgical methods of correction of coarctation. Materials and methods.in the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine during the period 1960–2017, 4245 patients were operated with native coarctation of aorta. Selective patients’ choice for this work was restricted only by such cases of aneurysm of descending aorta, for which the data were reliable. Considering the above, we will be limited by the period of observation, starting from 1995. Totally, 91 cases with aneurysm of descending aorta were included in this work, 85 (93.4%) of patients were re-operated, 6 (6.6%) of patients were not operated due to various reasons. The patient distribution by age and gender at the moment of correction of aortal coarctation showed that they included 68 (74.7%) males and 23 (25.3%) females in the ratio 2.9:1. The average patient age by that time was 14.7, ranging from 1 to 38 years. By the moment of discovery of post-coarctation aneurysm the patients’ age increased to an average 38.1, ranging from 21 to 60 years. The average time interval between the surgery of aortal coarctation and diagnosis of aneurysm of descending aorta was 22 years, ranging from 1 month to 45 years. The frequency of complications of aneurysm of descending aorta after surgery of aortal coarctation was different for various surgical methods. Among the aneurysms, which developed after coarctation correction, the most frequent were aneurysms after implantation of synthetic patch – 61(88.5%). The less frequent were aneurysms in 6 (8.7%) patients after implantation of tubular prostheses, and in 2 (2.8%) patients – after end-to-end anastomosis. Results and discussion. Till recent time the standard treatment practice was open surgical operation with direct access to proximal part of descending aorta by left-sided lateral. In our Department 85 surgical interventions were performed, including 69 surgeries by the traditional surgical method. From these patients, 7(10.1%) were operated two times, and 2(2.9%) – three times. In all 69(81.2%) cases, operated by open traditional surgical method, we performed vascular prosthesis implantation. Such operations require highly qualified anesthetic support with obligatory differential endobronchial intubation, cor-rection of disorders of respiratory and kidney functions, and compensation of present and possible blood loss [4]. Consider-ing high probability of uncontrolled hemorrhage at the stage of aneurysm mobilization, we installed temporary bypass graft – 75.3% or CPB pump – 24.7%, from ascending aorta or left atrium to descending aorta or femoral artery. Hospital mortality in this patient cohort was 5.9%.The use of endovascular treatment of thoracic aorta aneurysm increased considerably since Dake et al. in 1994 implanted the first stent-graft into thoracic aorta. In our Department, we performed 16(18.8%) of the procedures under general anesthesia with spinal drainage. For the patients, who require the covering of the zone of going of left subclavian artery or left common carotid artery, we perform extra-anatomic shunting 9(10.5%), or even subtotal debranching 2(0.2%), if there is no possibility to use individually pre-pared scalped stent-graft. The most common access is through common femoral artery by operative access 15(17.6%), or, more recently, by transcutaneous access 1(1.1%).

Background. Coronary artery vasospasm (CVS) is an important mechanism of myocardial ischemia which can produce any of the manifestations of coronary artery disease from silent myocardial ischemia to acute coronary syndrome including myocardial infarction or sudden cardiac death. One of the main markers of CVS is retrosternal pain not associated with increased myocardial oxygen requirement such as that due to exercise or emotional excitement with frequent attacks in the morning and temporary ST segment elevation. Some patients have variant angina caused by the spasm of coronary arteries (СА) coupled with stable angina provoked by emotional and physical stress. Such patients have decreased exercise tolerance. Aim. To determine the feasibility and subsequence of the appointment of diagnostic procedures such as electrocardiography (ECG), bicycle ergometry (BEM), provocative tests and coronary angiography and left ventriculography (CAG & LVG) in order to visualize СА, to make the choice of patient’s management and to assign an adequate therapeutic program. Materials and methods. The patient who was admitted with complaints about progression of angina and shortness of breath received the full complex of diagnostic manipulations. The purpose was to verify the diagnosis and to prescribe an adequate treatment. Results. This clinical case shows the subsequence of the appointment of diagnostic procedures to the patient who has normal ECG, ST segment elevation on BEM and progression of angina attacks, that is, the necessity of the widespread introduction of coronary angiography. Conclusion. This article shows the necessity of appointment of CAG & LVG. CAG & LVG revealed atherosclerotic lesion of CA which caused chest paint, ST segment elevation, and this result confounded the presence of CVS as a cause of complaints in this patient. The patient underwent stenting of the affected CA which helped to eliminate the cause of pain and is compatible with adequate therapeutic tactics for patients with CA stenosis.