Oleg Viktorovich Krestyaninov

Endovascular embolization coils are a key tool for minimally invasive vessel occlusion; however, their widespread use in Russian practice is limited by high cost and dependence on imported supplies. The development of Russian analogues requires a comprehensive assessment of the biocompatibility of designs that combine a metal frame with polymer fibers. Aim. To evaluate the biocompatibility of experimental prototypes of embolization coils made of stainless steel with polymer fibers (silk, poly(glycolide-co-lactide), polypropylene, polyethylene terephthalate, polyvinyl chloride with barium sulfate). Materials and Methods. Coil samples were fabricated by mechanical winding of stainless steel wire followed by manual fixation of polymer fibers in the inter-coil spaces. Hemolytic activity was assessed by the degree of hemolysis of human red blood cells upon contact with sample extracts. Cytotoxicity of the experimental coil samples with fibers was evaluated using human fibroblasts of the FEC-16-2 line by direct (co-culture) and indirect (cultivation in material extracts) methods. Results. All studied samples met standard biocompatibility criteria: the hemolysis level did not exceed acceptable values (less than 2 %), and no cytotoxic effect was detected. The lowest hemolysis values were recorded for coils with silk fibers (0.005 ± 0.004 %). Samples with poly(glycolide-co-lactide) showed a somewhat higher hemolysis level (1.184 ± 0.212 %), which may be attributed to hydrolytic degradation of the polymer with a local decrease in pH. Conclusion. Silk, polypropylene, polyethylene terephthalate, and radiopaque fibers based on polyvinyl chloride with barium sulfate are promising materials for the development of Russian embolization coils, offering a combination of hemocompatibility and functionality. The use of poly(glycolide-co-lactide) requires additional evaluation of long-term safety. The obtained results justify further preclinical studies, including the assessment of thrombogenicity and stability of fiber fixation under simulated blood flow conditions.

Highlights We present a clinical case demonstrating the feasibility of transcatheter mitral valve repair using the MitraClip system as an effective bridging therapy to orthotopic heart transplantation in a high-surgical-risk patient with severe functional mitral regurgitation secondary to acute myocardial infarction.   Abstract While the impact of percutaneous mitral valve repair (MitraClip) on outcomes in chronic, severe, symptomatic mitral regurgitation has been extensively studied for many years, data on the use of this edge-to-edge percutaneous mitral valve repair in patients with severe, acute mitral regurgitation are scarce and limited to isolated reports or small registries. In some patients, the MitraClip procedure may serve as a bridge to surgical correction of mitral regurgitation, and in some cases, to orthotopic heart transplantation. In this paper, we describe a clinical case of the use of the MitraClip technology in acute post-infarction mitral regurgitation as a bridge to subsequent orthotopic heart transplantation.

Aim . To compare the procedural, inhospital, and mid-term outcomes of two stra­tegies for preparing coronary artery calcification. Material and methods . A clinical analysis of treatment outcomes was performed in 88 patients with severe coronary artery calcification who underwent surgery between 2022 and 2024. Percutaneous coronary intervention with stenting was performed. Patients were randomized 1:1 to calcification preparation using a combining rotational atherectomy with cutting balloon angioplasty or rotational athe­rectomy with high-pressure balloon angioplasty. Two patients (2,2%) underwent surgery for unstable angina, and 86 (97,8%) patients had stable angina. We assessed the procedure technical success, the need to modify the lesion pre­paration strategy, periprocedural complications, and the inhospital and 30-day postoperative periods. Results . Technical success was achieved in 100% of cases in both study groups. However, in 8 patients (18%) who did not achieve optimal calcification preparation criteria, rotational atherectomy and a high-pressure balloon preparation were switched to combining rotational atherectomy with cutting balloon angioplasty. The radial artery was the most common access for endovascular intervention (78,4% of cases). Periprocedural myocardial infarction was not recorded. In all cases, patients were managed conservatively in the postoperative period, and repeat intervention was not required. Conclusion . Combining rotational atherectomy with cutting balloon angioplasty demonstrates comparable safety and efficacy to rotational atherectomy combined with a high-pressure balloon angioplasty. Intravascular ultrasound is a key factor in optimizing treatment strategy and deciding whether to switch strategies. This method can be used as a primary strategy for calcification modification, as well as when high-pressure balloon angioplasty is ineffective.

Aim. To evaluate the efficacy and safety of a primary invasive strategy with coronary angiography followed by myocardial revascularization when indicated in patients with chronic limb-threatening ischemia (CLTI) compared with an inhospital conservative approach. Material and methods . This single-center retrospective study included 650 patients with CLTI combined with coronary artery disease between 2017 and 2022. The treatment strategy was determined by a multidisciplinary team. Based on the chosen strategy, patients were divided into invasive and conservative groups. Inhospital outcomes, major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute myocardial infarction, and major adverse limb events (MALEs) were assessed. Results. The mean patient age was 68 years, and 74,5% were men. In the invasive group, hemodynamically significant coronary artery disease (CAD) was detected in 60,4% of patients. Percutaneous coronary intervention was performed in 50,5% of patients, and coronary artery bypass grafting was performed in 11,3%. During hospitalization, the invasive group, which underwent selective coronary angiography followed by myocardial revascularization as indicated, demonstrated a significant reduction in the incidence of MACCE (2,91% vs 0%; p=0,01) and acute myocardial infarction (2,5% vs 0%; p=0,03) compared with the conservative group in patients with CLTI and underlying CAD. Independent predictors of hemodynamically significant CAD included age, a history of percutaneous coronary intervention, and femoropopliteal disease according to the TASC IIC classification. Conclusion . Selective coronary angiography plays a key role in the diagnosis of coronary atherosclerosis in patients with CLTI when noninvasive stress testing is limited. Myocardial revascularization performed before elective peripheral vascular surgery reduces the risk of MACCE during the perioperative (inhospital) period in this patient population. Endovascular revascularization of lower extremity arteries in patients with CLTI significantly reduces the MALE incidence. A multidisciplinary approach should be implemented in each specialized center to develop an optimal treatment algorithm for severe comorbid patients.

Aim. To evaluate the efficacy and safety of a primary invasive strategy with coronary angiography followed by myocardial revascularization when indicated in patients with chronic limb-threatening ischemia (CLTI) compared with an inhospital conservative approach. Material and methods . This single-center retrospective study included 650 patients with CLTI combined with coronary artery disease between 2017 and 2022. The treatment strategy was determined by a multidisciplinary team. Based on the chosen strategy, patients were divided into invasive and conservative groups. Inhospital outcomes, major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute myocardial infarction, and major adverse limb events (MALEs) were assessed. Results. The mean patient age was 68 years, and 74,5% were men. In the invasive group, hemodynamically significant coronary artery disease (CAD) was detected in 60,4% of patients. Percutaneous coronary intervention was performed in 50,5% of patients, and coronary artery bypass grafting was performed in 11,3%. During hospitalization, the invasive group, which underwent selective coronary angiography followed by myocardial revascularization as indicated, demonstrated a significant reduction in the incidence of MACCE (2,91% vs 0%; p=0,01) and acute myocardial infarction (2,5% vs 0%; p=0,03) compared with the conservative group in patients with CLTI and underlying CAD. Independent predictors of hemodynamically significant CAD included age, a history of percutaneous coronary intervention, and femoropopliteal disease according to the TASC IIC classification. Conclusion . Selective coronary angiography plays a key role in the diagnosis of coronary atherosclerosis in patients with CLTI when noninvasive stress testing is limited. Myocardial revascularization performed before elective peripheral vascular surgery reduces the risk of MACCE during the perioperative (inhospital) period in this patient population. Endovascular revascularization of lower extremity arteries in patients with CLTI significantly reduces the MALE incidence. A multidisciplinary approach should be implemented in each specialized center to develop an optimal treatment algorithm for severe comorbid patients.

Transcatheter aortic valve implantation (TAVI) is an effective minimally invasive treatment for patients with severe aortic stenosis and varying surgical risks. However, like any surgery, TAVI is associated with various complications, including periprocedural myocardial injury. This issue remains understudied, and numerous questions remain unresolved, including not only the diagnosis of periprocedural myocardial injury after TAVI but also the long-term prognosis for patients who experience this complication. This article highlights the following issues related to periprocedural myocardial injury after TAVI: definition, pathogenesis, diagnosis, and its impact on short-term and long-term treatment outcomes.

Background: Reverse crush and culotte are commonly used strategies in case of side branch (SB) compromise after main vessel (MV) stenting during provisional bifurcation percutaneous coronary intervention (PCI). Aim: The aim of this study is to compare the technical and procedural outcomes and safety of reverse crush versus (vs.) culotte technique in cases of SB compromise following MV stenting during provisional bifurcation PCI. Methods: We analyzed 43 PCIs (43 patients) with SB compromise after MV stenting during provisional strategy from the PROGRESS‐BIFURCATION registry that were treated with reverse crush or culotte. Results: Of 43 PCIs (43 patients) with SB compromise after MV stenting during the provisional strategy, 29 (67%) were treated with reverse crush and 14 (33%) with culotte. Reverse crush and culotte patients had similar baseline characteristics. Reverse crush was more likely to be used in the left anterior descending artery (LAD) and in smaller bifurcation angles (45° [37.50, 60.00] vs. 70° [45.00, 80.00], p = 0.017). Culotte was more frequently used in the left main coronary artery (LMCA). Reverse crush cases had smaller proximal (3.25 [3.00, 3.50] vs. 4.00 [3.00, 5.00] mm, p = 0.028) and distal (3.00 [2.50, 3.00] vs. 3.50 [3.00, 4.00] mm, p = 0.013) MV diameter, smaller SB diameter (2.50 [2.25, 2.50] vs. 3.00 [2.50, 3.50] mm, p < 0.001) and longer proximal MV (10.00 [5.00, 20.00] vs. 5.00 [0.00, 10.00] mm, p = 0.003) and SB (10.00 [8.00, 12.00] vs. 4.00 [0.00, 10.00] mm, p = 0.002) lesions. SB total occlusion was a more frequent trigger for escalation to a two‐stent strategy in the reverse crush group compared with the culotte group (42.3% vs. 0.0%, p = 0.016). Patients treated with the reverse crush technique were less likely to require escalation to a third stenting strategy compared with those treated with culotte (4.0% vs. 21.4%, p = 0.04), but had longer procedural time (102.00 [77.00, 144.00] vs. 60.00 [45.00, 110.00] min), p = 0.012). There was no difference in technical (100% vs. 100%, p = 1.00), procedural (96.6% vs 100%, p = 1.00) success, periprocedural major adverse cardiac events (MACE) (3.4% vs. 0.0%, p = 1.00) or long‐term MACE (HR 0.59, 95% CI 0.12–2.92, p = 0.50) between reverse crush and culotte cases. Conclusion: Most cases of SB compromise during provisional MV stenting were treated with reverse crush, but periprocedural and long‐term outcomes were similar between reverse crush and culotte.

Introduction. The study of the elastic properties of the arteries of the lower extremities is necessary for the development of methods for effective surgical treatment and the prediction of their complications. Objective. The aim of our study was to compare the radial deformation properties (stiffness and radial extensibility of the vascular wall) of various segments of native arteries of the femoropopliteal segment and arteries after various reconstructive interventions under physiological conditions using ultrasound imaging. Methods. A prospective cohort study (n = 40) was conducted. Four groups were formed: Group 1 (n = 10) – healthy volunteers; Group 2 – patients after semiclosed loop endarterectomy (n = 10); Group 3 – patients after endovascular recanalization of the superficial femoral artery using cut nitinol stents (n = 10); Group 4 – patients after endovascular recanalization of the superficial femoral artery using braided nitinol stents (n = 10). All participants underwent ultrasound measurement of the stiffness index and radial extensibility of the vascular wall at 5 points. Results. Radial extensibility of the femoropopliteal artery wall in the supine position averages 10 %, with the exception of the Hunter’s canal region, where it is almost 4 times lower (2.8 %, p < 0.001). In the supine position, the deobliterated superficial femoral artery after loop endarterectomy in the adductor canal of the femur has a 2-fold higher (5.6 %) radial extensibility of the vascular wall compared to the native artery. The stented superficial femoral artery demonstrates a significant decrease in radial distensibility of the vessel wall in both positions (0.6–0.7 %). Conclusion. Radial distensibility of the superficial femoral artery wall under physiological conditions is nonuniform, with the lowest distensibility observed in the Hunter’s canal. Semi-closed endarterectomy maintains acceptable arterial biomechanics, while stenting significantly increases wall stiffness, which may be one of the reasons for its unsatisfactory long-term results. The development of stents with properties similar to those of native arteries is necessary.

Aim To evaluate the efficacy and safety of a new 3D navigation-guided technique for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and a high risk of atrioventricular (AV) conduction disorder. Material and methods The study presents the results of a single-center prospective randomized pilot study. Sixty patients meeting inclusion and exclusion criteria with at least one criterion of a high risk for AV conduction disorder were enrolled in the study. All included patients were randomized 1:1 into two groups. In Group 1, TAVI was performed using a 3D navigation-guided technique, while in Group 2, the classical TAVI technique was used. The primary endpoint was the composite incidence of permanent pacemaker (PP) implantation and new-onset complete left bundle branch block (LBBB) at 6 months. Results In the early postoperative period, the 3D navigation-guided TAVI group had a lower incidence of new-onset LBBB (10.3% vs . 33.3%; p =0.03), better parameters of intraventricular conduction according to electrophysiology study (EPS) (H-V interval 79.1±13.5 ms vs . 96.0±39.9 ms; p =0.03) and electrocardiography (QRS complex duration 108.0±16.3 ms vs . 119.0±22.6 ms; p =0.04). The incidence of PP implantation during the hospital stage, A-H interval duration, and Wenckebach point in the AV junction according to EPS did not differ significantly between the groups. The incidence of the primary endpoint (PP implantation + new-onset LBBB) during the 6-month follow-up period was 43.3% in the classical technique group and 16.7% in the 3D navigation-guided TAVI group ( p =0.02). There were no statistically significant differences between the groups in the incidence of procedural complications or major adverse cardiovascular and cerebrovascular outcomes. Conclusion This study demonstrated the efficacy and safety of a new 3D navigation-guided TAVI technique in reducing the composite rate of implantation PP and LBBB at 6 months post-procedure, with comparable rates of procedural complications and major adverse cardiac and cerebrovascular events (MACCE) during long-term follow-up. Implementation of these findings into clinical practice will enable personalization and optimization of transcatheter treatment outcomes in patients with severe AS.