SummaryBackgroundStents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.MethodsThe International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470.FindingsThe trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4·0%) events of disabling stroke or death in the stenting group compared with 27 (3·2%) events in the endarterectomy group (hazard ratio [HR] 1·28, 95% CI 0·77–2·11). The incidence of stroke, death, or procedural myocardial infarction was 8·5% in the stenting group compared with 5·2% in the endarterectomy group (72 vs 44 events; HR 1·69, 1·16–2·45, p=0·006). Risks of any stroke (65 vs 35 events; HR 1·92, 1·27–2·89) and all-cause death (19 vs seven events; HR 2·76, 1·16–6·56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0·0197).InterpretationCompletion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.FundingMedical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union.

The aim: To estimate the dynamics of echocardiographic parameters in patients with CAD within 5 years after revascularization. Material and methods: 50 persons (males/females 39/11; mean age 59.9±9.3 years; STEMI 76%, non-STEMI 24%) were divided into two groups: n=38 after PCI with stenting (PCIwS); n=12 after CABG. Observation included regular echocardiography with LV myocardial mass (LVMM) and geometry estimation. Results: Groups were comparable by age, co-morbidity, BP, heart rate and BMI. Significantly severe baseline LV hypertrophy (LVH) and left atrial enlargement (LAE) in group 2 explained by spread coronary atherosclerosis. Later progressive LAE (4.37±0.22 cm, P0-60<0.05) in group 1, and aortic/LV dilatation (+0.4/+1.0 cm, respectively, both P0-60<0.05) in group 2 developed. In two years LVMM index increased by 13.4/17.5% in groups 1/2, respectively. Normal geometry and concentric remodeling completely disappeared in 3/1.5 years after PCIwS/CABG, respectively. Conclusions: Within the 1st year after revascularization, patients with CABG had more severe LVH. In 5 years after PCIwS the ratio between concentric/eccentric LVH was 2:1, whereas after CABG – 1:2.

The aim of the study is to assess the prognostic value of the structural and functional echocardiographic indicators in IHD patients, depending on acute coronary syndrome management (revascularization vs medical therapy), during 60 months. Materials and methods:Thetotal of 101 IHD patients were examined on the clinical bases of the Internal Medicine Department 2. Prior to the study. The 84 males and 17 females aged 58.6±4.2were split into the experimental group after myocardial revascularization (EG, n = 71) and control group with standard medical therapy (CG, n = 30). In addition to the protocol-prescribed clinical lab tests, during five years, the dynamics of the echocardiographic cardiac parameters has been assessed. The digital data was processed by the Kaplan-Meier estimator; the 60-month cumulative survival rate (%) was estimated and significance of the difference was assessed by Cox's F-test (p<0.05).

Introduction. For a patient with coronary heart disease, recovery from myocardial revascularization is a complex process. Cardiac remodeling involves, after myocardial infarction, hypertrophy and dilation, resulting in impaired systolic-diastolic cardiac function, which is an additional risk factor for events. Prospective studies have shown a relationship between left ventricular size and the risk of cardiovascular events. Given this, there was a need to conduct our research. Purpose: To determine the prevalence of types of left ventricular geometry in patients with coronary heart disease, post-infarction cardiosclerosis, depending on therapeutic tactics: revascularization or conservative therapy for 60 months. Material and Methods: We examined 101 patients aged 58.6±4.2 years after myocardial revascularization (n = 71) and with conservative treatment only (n = 30), in whom the dynamics of echocardiographic parameters of the heart were evaluated for 5 years. The values ​​of remodeling myocardial mass index of the left ventricle and the relative thickness of the left ventricle were determined. Results and Discussion. At baseline, patients with concentric left ventricular hypertrophy (50.0%) and concentric remodeling (24.1%) predominated in the main group. Normal geometry in 14.8% and eccentric left ventricular hypertrophy were observed in 11.1%. In the comparison group, eccentric hypertrophy and concentric left ventricular remodeling were most commonly observed, 29.6% each, slightly less than 25.9% concentric hypertrophy, and the least was normal geometry (14.8%). After 60 months, patients with both groups did not experience normal left ventricular geometry and concentric remodeling. The concentric type (80.0%) was predominant in the main group, and the eccentric type (55.6%) in the comparison group. Conclusions. In patients with ischemic heart disease, postinfarction cardiosclerosis progresses in 5 year follow-up myocardial hypertrophy regardless of treatment. After revascularization, concentric left ventricular hypertrophy develops more often, whereas under conservative treatment, left ventricular eccentric hypertrophy is combined with systolic dysfunction and left atrial dilatation. After revascularization, an increase in the index was associated with an increase not only in body weight but also in changes in lipid profile and diastolic hypertension.

Львівський національний медичний університет імені Данила Галицького, м. Львів, Україна Ключові слова: ішемічна хвороба серця, реваскуляризація міокарда, ліпідограма.Мета роботи -проаналізувати 5-річну динаміку ліпідограми у хворих на ішемічну хворобую серця після реваскуляризації міокарда з приводу інфаркту міокарда. Матеріал і методи. Оцінено параметри ліпідограми у 40 хворих (9 жінок і 31 чоловік) на ішемічну хворобу серця після реваскуляризації міокарда віком 59,9±9,4 р. Результати. Рівень холестерину (ХС) істотно знизився впродовж перших трьох та шести місяців після реваскуляризації, тоді як з 9-го місяця почалось підвищення його вмісту і через 4,5 року рівень ХС став навіть вищим за початковий. Вміст β-ліпопротеїдів істотно знижувався через три і шість місяців до норми (35-55 ОД), проте надалі збільшувався з максимумом через 48 та 54 місяці. На момент включення у дослідження було дещо більше пацієнтів із гіперхолестеринемією і цільовим рівнем ХС (по 37,5%), тоді як оптимальні і пограничні значення траплялися з частотою 12,5%. Через 60 місяців спостереження кількість хворих, в яких утримувався цільовий рівень ХС, зменшився до 28,6%. Середнє значення холестерину ліпопротеїдів високої щільності (ХС-ЛПВЩ) (1,03 ммоль/л) знаходилось у межах цільового рівня і зразу після операції поширеність цільового рівня становила 64,3%. Через три місяці спостерігалось незначне зниження поширеності цільового рівня ХС-ЛПВЩ до 55,5%. Найнижчий уміст ХС-ЛПВЩ ми спостерігали через три роки (0,89±0,10 ммоль/л). Тільки впродовж першого півріччя вдалось досягнути цільового рівня холестерину ліпопротеїдів низької щільності (ХС-ЛПНЩ) (3 міс. -77,8%, 6 міс. -72,7%). Однак через 12 місяців середнє значення ХС-ЛПНЩ повернулось до вихсідного значення і через чотири роки перевищувало його. Висновок. Зменшення загального ХС, β-ліпопротеїдів та ХС-ЛПНЩ спостерігається тільки впродовж перших шести місяців після операції реваскуляризації, а потім показники поступово зростають та через 4-4,5 року перевищують висхідний рівень та норму, що вимагає вивчення прихильності до лікування та, ймовірно, більш агресивної ліпідознижувальної терапії. Буковинський медичний вісник. Т.22, № 2 (86). С. 24-29.