Background: Early and accelerated atherosclerosis is a major cause of cardiovascular disease and often causes premature death in T1DM patients. In T1DM, atherosclerosis can be detected since adolescence. The initial association between urinary albumin to creatinine ratio (ACR) and c-reactive protein (hs-CRP) with subclinical cardiovascular disease in children and adolescents with T1DM supported findings from previous studies. Imaging tests using ultrasound can detect subclinical atherosclerosis in this patient population. Carotid artery intima-me- dia thickness (cIMT) and flow-mediated dilatation response (FMD) have been frequently used to detect subclini- cal atherosclerosis. Objectives: To find correlation between ACR and hsCRP on the thickness values of cIMT and FMD in children and adolescent T1DM patients at Dr Saiful Anwar Hospital Malang Methods: This is a cross-sectional study with 82 subjects of T1DM patients who routinely control the pediatric outpatient clinic of RSUD Dr. Saiful Anwar Malang, with the research period January – July 2019 and December 2021 – March 2022. Subjects were undergone valcuras ultrasound examination for measurements of cIMT and FMD. Blood sample from subjects were also collected to detect level of ACR and hsCRP. Associations between the study variables were estimated by calculating the Pearson’s rank correlation. Result: There was correlation between ACR with FMD and cIMT (r=-0.593; p=0.000 and r=0.339; p=0.002, respectively). ACR was negatively correlated with FMD and positively correlated with cIMT. There was also correlation between hsCRP with FMD and cIMT (p=-0.375; p=0.001 and r= 0.414; p=0.023, respectively). hsCRP was negatively correlated with FMD and positively correlated with cIMT. Conclusion: ACR and hsCRP have a correlation with increasing CIMT values and decreasing FMD values in children and adolescents with T1DM patients. Preadolescent children with T1DM displayed evidence of increased low-intensity vascular inflammation, increased cIMT and attenuated FMD measurements. These data suggest that endothelial dysfunction and systemic inflammation are present even in preadolescent children with T1DM
Background : One in three patients undergoing percutaneous coronary intervention (PCI) exhibits moderate or severe coronary artery calcification. Coronary calcification remains a major independent predictor of PCI failure and adverse outcomes. PCI of calcified coronary lesions remains challenging, despite significant improvements in the available tools and techniques. Rotational Atherectomy (RA) is a critical component to improve PCI success in these situations by producing lumen enlargement by physical removal of plaque and reduction in plaque rigidity, thus facilitating dilation Case Illustration: A 73-year-old man with exertional angina was referred to our hospital, with a history of hypertension, diabetes mellitus, ex-smoker and dyslipidemia. Physical exam, electrocardiogram, chest x-rays, and laboratory findings were unremarkable, but transthoracic echocardiogram revealed anterior wall hypokinesis. History of cardiac catheterization outside of our center with angiographic result of left anterior descending (LAD) lesion, highly calcified, non-dilatable on first several POBA attempts. Coronary angiography at our center, revealed diffuse calcification from proximal to distal of the LAD artery with about 90% maximum stenosis in mid LAD. RA (Rotablator, Boston) was then performed with A 1.50 mm burr gradually advanced at 150,000 rpm to passed the lesion. After deployments of stents, final angiogram showed well positioned stents with good distal run-off flow. The patient was uneventful during the procedure and was discharged following day. Discussion: In experienced hands, RA is as safe as standard PCI. RA is as a tool to make PCI possible in complex lesions with moderate or severe calcification when clinical variables make PCI appropriate. Rotablator is a catheter-based interventional cardiology procedure using a high-speed rotational device designed to ablate atherosclerotic plaque and restore luminal patency. This help to facilitate stent delivery, avoiding the barotrauma caused by repeated high-pressure balloon inflations that can lead to vessel dissection or perforation. Atherectomy can be performed safely with optimal burr selection and proper ablation techniques, and as a result, complication rates have been significantly minimized, with few changes in the acute complications reported in contemporary studies.
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