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In this manual, the authors focused on the principal methods for diagnosis of peripheral artery disease in cardiological patients, from the interview and physical examination to functional tests and vascular visualization. Diagnostic and prognostic value of each method, its potentialities for reducing the risk of cardiovascular events (CVE), including myocardial infarction (MI), ischemic stroke (IS) or extremity amputation in critical ischemia, and overall mortality are discussed. The authors provided current information about a possibility of reducing the risk of CVE by intensifying the antithrombotic therapy according to results of the COMPASS study.

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Thrombosis traditionally considered as a complication of cardiovascular disease, however, this problem until recently was rarely taken into account in the presence of cancer. Although the association between cancer and thrombosis has been known almost 150 years ago, awareness of the impact of thrombotic complications have increased only now. Cancer is an independent major risk factor for venous thromboembolism (VTE), which is the leading cause of death of cancer patient. The incidence of VTE is steadily increasing in these patients. Thrombotic events have a significant impact on the quality of life of patients, and are associated with worsening of their short-term and long-term survival. The objective of this review is to summarize modern views on pathophysiology, as well as to outline new approaches to risk assessment, prevention and treatment of thrombosis in cancer patients.

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AIM: to assess immediate and long-term results of coronary angioplasty and stenting in patients older than 80 years - a high risk group in view of the severity of concomitant pathology and extent of coronary atherosclerosis. MATERIAL AND METHODS: We conducted retrospective analysis of data from 167 patients older than 80 years (mean age 81.43+/-2.14 years) subjected to percutaneous coronary intervention from 2006 to 2013 (3.2% from total number of patients). Multivessel involvement was present in 128 patients (76.6%) including 20 (12.4%) with stenosis in left main coronary artery. In 215 out of 270 stenotic lesions complicated stenoses type B2, C were detected . Number of chronic occlusions was 31 (10.3%) out of 301 treated lesions. There were 46 patients (27.5%) with diabetes, 16 (9.6%) with chronic anemia, 35 (21%) with chronic renal failure. Concomitant multifocal lesions in other arterial beds were found in 67 patients (40.1%). Radial, femoral, and combined femoral-radial accesses was used in 157 (94%), 5 (3%), and 5 (3%) patients, respectively. Results were studied with the help of automated system of digital computer angiography and intracoronary ultrasound. Long-term results were assessed with the help of questioning, control angiography, and echocardiography. RESULTS: Immediate angiographic and clinical success was achieved in 97 and 94% of cases, respectively. Revascularization was complete in 62.2% of cases. Hospital mortality was 0.7%. Major adverse cardiac events (MACE) were registered in 4.6 and 22.4% of patients during periods of 30 days and >24 months, respectively. Stent thrombosis was diagnosed in 3 cases (1.79%) in 6-18 months after intervention. Repeat revascularization in remote period was performed in 20 patients (12.8%), in 8 of them because of appearance of new lesion. Survival after 40 months was 91%, survival without MACE after 60 months was 74.8%. Complications related to access artery was 4.2% (1.9% in 157 transradial Interventions). According of logistic regression analysis, the following predictors of MACE in remote period were determined: initial depressed left ventricular function, diabetes mellitus, and lesion length >35 mm. CONCLUSION: Coronary angioplasty and stenting is an effective method of treatment of coronary atherosclerosis in patients older than 80 years with acceptable rate of MACE. Radial access lowers rate of access related vascular complications.

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Aim of the study was to compare efficacy of sirolimus covered (116 patients, group 1) and bare (117 patients, group 2) stents. Groups were comparable according to main characteristics. Proportion of patients with diabetes was 19 and 13.7%, with multivessel lesions--87.1 and 80.4%, with arterial diameter <2.75 mm--46.5 and 23.9% in group 1 and 2, respectively. Lesion length was 25.9+/-6.6 mm (28-93 mm) in group 1 and 22.1+/-7.8 mm (26-102 mm) in group 2. Overall 473 stents were implanted into 232 arteries (2.1 per artery). In group 1 184 stents were implanted in 116 arteries, in group 2--289 stents in 117 arteries. Immediate success rate was 97.4 and 99.1% in groups 1 and 2, respectively (p=0.74). There were no cases of acute stent thrombosis. Subacute thrombosis (after 1-3 weeks) occurred in 2 patients (1.7%) of group 1 and in 1 patient (0.85%) of group 2 (p=0.47). Angiographic restenosis was observed in 12 (10.6%) and 66 (56.9%) patients in groups 1 and 2, respectively (p<0.0025). In 47 of 66 patients (71.2%) in group 2 restenosis was diffuse. There was no case of diffuse restenosis in group 1. Twelve months survival without angina and major coronary events was 79.8% in group 1 and 31%--in group 2.

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Clinical case of implantation in anterior interventricular artery (AIA ) of the first coronary stent in Russia is presented. Control angiogram obtained 7 years after stenting showed stent patency without restenosis with maximal 15.68% in-stent stenosis. Angiogram obtained after 13 years revealed good patency of previously stented segment of AIA. However a new stenosis appeared in left main coronary artery as a result of natural progression of atherosclerotic process. A drug eluting stent (Cypher) was implanted into left main coronary artery with good immediate result. This clinical observation demonstrates possibility of maintenance of effect of coronary artery stenting for long period of time as well as possibility of repetitive use of endovascular methods of treatment of ischemic heart disease despite newly developed complex lesions.

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Immediate and long term results of 2 methods of coronary angioplasty (balloon dilatation and stenting) were analyzed retrospectively. During 10 years proportion of stent implantations increased 30-fold reaching 95-97% of coronary interventions. This was associated with improvement of immediate results of angioplasty: lowered rates of myocardial infarctions, urgent coronary artery bypass graftings and acute coronary artery occlusions (from 2.7% after balloon angioplasty to 0.6% after stenting). Improved long-term prognosis after stenting manifested in lower frequency of cardiovascular events. Five year survival was 98,8 and 92.7% after stenting and balloon angioplasty, respectively (p=0.004). However effect of stenting on rates of angiographic restenosis and repeat revascularizations was less pronounced (27.1 and 30.4%, respectively, after stenting vs. 30.1 and 34.5%, respectively, after balloon angioplasty).

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The examination of 80 patients with acute myocardial infarction has revealed that prehospital thrombolytic therapy (TT) allows it to be initiated significantly earlier by 2.9 hours, resulting in coronary reperfusion and ensuring more complete blood flow recovery than hospital therapy. The natural history of the disease is also more favourable when TT is used in the prehospital period. It is concluded that with strict observance of indications and contraindications, TT used by an emergency team in the prehospital period is no more dangerous than in the hospital period.

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