Aim: Central nervous system may be affected after coronary artery by-pass graft (CABG) and carotid artery stenosis is an important risk factor. Near infrared spectroscopy (NIRS) is used to measure the regional cerebral oxygen concentration (rScO2). The aim of this study is to determine the relationship of rScO2 in patients with carotid artery lesion and to determine the relation of stroke with rScO2 changes. Material and Method: The patients who had cardiac bypass surgery were involved in the study. Demographic characteristics and presence of carotid artery stenosis, were collected from the files. Bilateral rSO2 measurements performed by 2 sensors. RScO2 values are detected in 5 minutes of cross-clamp (XCL5), XCL30, XCL60, XCL90, XCL120 and after the by-pass. Results: 57 patients were involved in the study (40 male and mean age 62.54±13.08). 17 (29%) patients had carotid stenosis. rScO2 levels are statistically significantly decreased in the patients with stenosis after post-clamp 30 minutes. Three patients had stroke after surgery (5.2%). Two of the patients had carotid stenosis while one patient did not have. Conclusion: RScO2 decreased in carotid artery stenosis irrespective of the degree of the stenosis after 30 minutes of cross-clamp. Cerebral perfusion follow-up is important during the CPB and NIRS is a method that can be used for this purpose.
Objectives: This study aimed to examine the mid-term results of patients who underwent directional atherectomy (DA) for vascular preparation before drug-coated balloon (DCB) angioplasty with superficial femoral artery lesions longer than 150 mm and severe calcification and compare these patients with those treated with DCB angioplasty alone. Patients and methods: This prospective study enrolled 76 patients (66 males, 10 females; mean age: 63.3+9.8 years; range 44 to 105 years) with calcific superficial femoral artery lesions longer than 150 mm treated with DA before DCB angioplasty or DCB angioplasty alone between May 2019 and November 2020. The patients were evaluated in two groups according to DA use: the DA+DCB group with 46 patients and the DCB group consisting of 30 patients. The results of these two methods were compared, and the outcomes were followed up for one year after the treatment. Primary outcomes were patency, freedom from target lesion revascularization, and unplanned amputation. Results: There was no statistically significant difference between the two groups in demographic features, risk factors, comorbidity, and functional capacity assessment tests. At the 12th month, the primary patency of the DCB and DA+DCB group was 66.6% and 82.6%, respectively (p<0.05). Although the bail-out stent requirement rate for the treatment of the flow-limiting dissection (type C-F) was lower in the DA+DCB group (8.6% vs. 10.0%), there was no statistically significant difference (p=0.46). Conclusion: The DA prior to DCB in long segment severe calcific superficial femoral artery lesions may provide better patency and may decrease rate of flow-limiting and non-flow limiting dissections.
Introduction: Worldwide, >200 million patients are affected by peripheral arterial disease (PAD) and endovascular interventional treatments are increasingly being applied. Contrast-induced nephropathy (CIN) is the third most common cause of renal failure in hospitals. However, factors such as renal vasoconstriction, decrease in renal blood flow, endothelial dysfunction, and oxidative stress have been suggested in the etiology of CIN. Studies are showing that inflammatory markers increase in CIN. Systemic immune inflammation index (SII), a newly defined parameter, is calculated by multiplying the platelet and lymphocyte counts and dividing by the neutrophil count. Studies are showing that this parameter influences prognosis in various cancer types. Considering that inflammation may play a role in CIN, we planned this study to investigate the role of SII in patients undergoing percutaneous peripheral vascular interventions. Material and Method: 300 patients who underwent percutaneous peripheral vascular interventions between August 2018-December 2021 due to peripheral arterial disease were included in the study. The data of the patients were scanned retrospectively from the patient files. The neutrophil-lymphocyte ratio (NLR) was calculated by dividing the neutrophil count by the lymphocyte count. SII was found by multiplying NLR with platelet count Results: Contrast-induced nephropathy developed in 41 (12.3%) patients. CIN(+) patients also, had higher CRP levels (5.1±0.7vs 2.4±0.4,P<0.05), NLR (4.07±1.07vs 2.65±0.84, P<.005), SII score (1778±627.57vs 867.14±491.88, P<.005.) the contrast media used was also higher in CIN(+) patients (176.19±48.44 vs 128.72±48.44;P<0.05) Multivariate logistic regression analysis demonstrated that a high SII score was an independent predictor of development of CIN (odds ratio [OR]: 1.002, 95% confidence interval [CI]: 1.001-1.002, P<.0005) together with high NLR (OR: 3.56, 95% CI: 1.905-6.675, P<.005) and CRP (OR: 1.002, 95% CI: 1.001-1.002, P<.005 Receiver operating characteristic curve analysis demonstrated that the best cutoff value of 1224 for SII to predict the development of CIN with 85% sensitivity and 72% specificity (area under ROC curve 0.904 [95% CI: 0.866-0.942], P<.005). Conclusion: Imbalance in inflammatory cells, the increase in neutrophils, and the decrease in lymphocytes play a role in developing kidney damage. Impaired immune functions due to lymphocytopenia contribute to the development of acute kidney injury. Oxidative stress exacerbates the inflammatory state by increasing inflammatory cell infiltration. AS a result, SII may be a powerful predictor of inflammation and can be used to determine the risk before interventional procedures.
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