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Possibilities of transcatheter treatment of patients after extensive ischemic stroke

World Journal of Neuroscience 2013年第3期3卷 171-185页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases named after Most Holy John Tobolsky Moscow Russia

The research investigates the efficacy of brain transcatheter laser revascularization in patients who have had extensive ischemic stroke. 1125 patients aged 29 - 81 (average age 75) with cerebral atherosclerosis were examined. The examination plan included: CT brain scan, magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA), laboratory tests, assessment of severity of dementia (CDR), cognitive impairment (MMSE) and activities of daily living (IB). 93 patients suffered extensive ischemic stroke of whom 7 (7.53%) had 10 - 15 IB points, 25 (26.88%)—20 - 30 IB points, 61 (65.59%)—35 - 45 IB points. 69 patients underwent transcatheter treatment (Test Group). 24 patients underwent conservative treatment (Control Group). High-energy laser systems were used for revascularization of major intracranial arteries;lowenergy laser systems were used for revascularization of distal intracranial branches. Test Group: 67 (97.10%) patients had good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization. 12 - 24 months later the following positive trend was observed: 14 (20.59%) patients demonstrated good clinical outcome (IB 90 - 100);26 (38.24%) patients had satisfactory clinical outcome (IB 75 - 85);28 (41.18%) patients showed relatively satisfactory clinical outcome (IB 60 - 70);relatively positive clinical outcome (IB revascularization of cerebral blood vessels is an effective one for the treatment of extensive ischemic strokes. The effect is maintained for a long time;it causes regression of mental, intellectual and motor disorders, promotes regression of post-strok

关键词： Extensive Ischemic Stroke Neurological Deficits Post-Stroke Dementia Transcatheter Treatment Laser revascularization

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Clinical Outcomes in Patients Undergoing Triple-Vessel Angioplasty for Symptomatic Coronary Artery Disease

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International Journal of Clinical Medicine 2015年第10期6卷 746-752页

作者： Ashraf Safiya Manzil Jithu Sam Rajan Venkatesh Radhakrishnan Department of Cardiology Pariyaram Medical College Pariyaram India

Current treatment strategies for multi-vessel coronary artery disease include either coronary artery bypass surgery or percutaneous coronary intervention with stenting. The present study evaluates the morbidity and mortality among coronary artery disease patients undergoing triple-vessel angioplasty. This prospective record based descriptive study was carried out in Medical College, Pariyaram, Kannur, Kerala;a tertiary care cardiac centre in South India. Fifty consecutive patients who underwent angioplasty of one or more lesions in each of the three major coronary arteries from May 2010 to July 2012 were included in the study. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Event-free survival rate was 94% at a mean follow-up of 20 months. Overall 98% continued success was obtained with triple-vessel angioplasty. Triple-vessel angioplasty is a safe and effective therapy as an alternative to surgical revascularization in selected patients with triple-vessel coronary artery disease.

关键词： Coronary Artery Disease revascularization Stents Triple-Vessel Angioplasty

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The Use of Transcatheter Laser Exposure in the Treatment of Cerebral Vessels Hypoplasia Accompanied by Migraine

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Journal of Behavioral and Brain Science 2014年第10期4卷 443-452页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases Named after Most Holy John Tobolsky Moscow Russia

The research is dedicated to the possibility of restoring cerebral blood supply in patients with brain vessels hypoplasia accompanied by migraine. The research involved 67 patients aged 29 - 58 (average age 42) with severe migraine. The examination plan included laboratory diagnostics, assessment of dementia severity (CDR), assessment of cognitive impairment (MMSE), cerebral computed tomography (CT), cerebral magnetic resonance imaging (MRI), cerebral scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA). Hypoplasia symptoms were detected in 56 (83.58%) patients. To improve cerebral blood supply, the method of transcateter laser revascularization by means of low-energy CW lasers was used. Good immediate angiographic outcome manifested in persistent improvement of the intracranial vascular bed and marked collateral vascularization was obtained in 53 (94.64%) patients. Good clinical outcome— almost complete regression of migraine and vestibular disorders—was obtained in 49 (87.50%) patients. Satisfactory clinical outcome—partial regression of migraine and vestibular disorders— was observed in 7 (12.50%) patients. The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from cerebral vessels hypoplasia accompanied by migraine. This method has virtually no alternative;it stimulates natural angiogenesis causing collateral and capillary vascularization steadily improving the blood supply of the brain. The effect obtained after the treatment persists for a long time (9 years and longer), it causes regression of migraine, reduces mental disorders, and can improve the patients’ quality of life.

关键词： Headache Migraine Hypoplasia of Cerebral Vessels Cerebrovascular Lesions Angiogenesis Transcatheter Laser revascularization

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Dementia and Cognitive Impairment Reduction after Laser Transcatheter Treatment of Alzheimer’s Disease

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World Journal of Neuroscience 2015年第3期5卷 189-203页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases Named after Most Holy John Tobolsky Moscow Russia

Reduced cerebral perfusion and microcirculation are found among AD causes, which should be considered in the development of new treatments for the disease. 165 patients with AD were examined. The examination plan included clinical assessment of dementia severity (CDR), cognitive function assessment (MMSE), laboratory examination, cerebral scintigraphy (SG), rheoencephalography (REG), cerebral CT and MRI, morphometric AD stages assessment (TDR) and cerebral multi-gated angiography (MUGA). 89 patients aged 34 - 79 (average age 67) were selected for the treatment: 31 (34.83%) male, 58 (65.17%) female patients. According to their AD stage, the patients were divided into: TDR-0 (preclinical stage)—10 (11.24%) patients, TDR-1 (early stage with mild dementia, mild cognitive impairment)—28 (31.46%) patients, TDR-2 (medium stage with moderate dementia, cognitive impairment sufficiently persistent)—34 (38.20%) patients, TDR-3 (late stage with sufficiently severe dementia and cognitive impairment)—17 (19.10%) patients. Test Group—46 (51.68%) patients—had transcatheter treatment with low-energy lasers. Control Group—43 (48.31%)—had conservative treatment with Memantin and Rivastigmine. The Test Group had cerebral microcirculation improvement leading to permanent dementia reduction and cognitive recovery which allowed transferring the patients to a lighter TDR group or withdrawing them from the scale. Control Group patients with earlier AD stages (TDR-0, TDR-1, TDR-2) obtained stabilization for a period of 6 months-3 years, with subsequent growth of dementia and cognitive impairment;patients with late AD stage (TDR-3) showed further increase of cognitive impairment and dementia. Transcatheter treatment allows reducing the effects of dyscirculatory angiopathy of Alzheimer’s type (DAAT) improving cerebral microcirculation and metabolism, which leads to permanent dementia regression and cognitive impairment reduction. These data show that AD treatment should be comprehensive and aimed at both the recovery of cerebral microcircul

关键词： Alzheimer’s Disease Dementia Vascular Dysfunction Dyscirculatory Angiopathy of Alzheimer’s Type DAAT TDR Temporal Lobes Atrophy Laser revascularization

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Transcatheter treatment of atherosclerotic lesions of the brain complicated by vascular dementia development

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World Journal of Neuroscience 2012年第4期2卷 200-209页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases named after Most Holy John Tobolsky Moscow Russia

The research focuses on the effectiveness of transluminal laser revascularization of the brain in the treatment of atherosclerotic lesions accompanied by vascular dementia development. 1125 patients aged from 29 to 81 (average age 75) suffering from various kinds of atherosclerotic lesions of cerebral vessels were examined during the research. The examination plan included: computed tomography of the brain (CT), magnetic resonance imaging (MRI), scintigraphy of the brain (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA). 665 (59.11%) patients suffered from diseases accompanied by the development of vascular dementia. To perform transcatheter treatment, 639 patients were selected: Group 1 (CDR-1)—352 patients, Group 2 (CDR-2)—184 patients, Group 3 (CDR-3)—103 patients. To conduct revascularization of main intracranial arteries high-energy laser systems were used;for revascularization of the distal intracranial branches low-energy laser systems were used. The clinical outcome depended on the severity of dementia and the timing of the intervention. A good clinical outcome in Group 1 was obtained in 281 (79.82%) cases, in Group 2 in 81 (44.02%) cases, in Group 3 in 9 (8.73%) cases. A satisfactory clinical outcome in Group 1 was obtained in 53 (15.34%) cases, in Group 2 in 62 (33.70%) cases, in Group 3 in 31 (30.09%) cases. A relatively satisfactory clinical outcome in Group 1 was obtained in 17 (4.83%) cases, in Group 2 in 41 (22.28%) cases, in Group 3 in 63 (61.16%) cases. No negative effect was observed after the intervention. Evaluating the data obtained it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of atherosclerotic lesions of the brain accompanied by dementia.

关键词： Cerebrovascular Disease Vascular Dementia Cognitive Impairment Stroke Transcatheter Treatment Laser revascularization Regeneration

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Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type

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Journal of Behavioral and Brain Science 2012年第1期2卷 67-81页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases Named after Most Holy John Tobolsky Moscow Russia

Purpose: We propose an analysis of dyscirculatory angiopathy of Alzheimer’s type (DAAT) endovascular treatment method based on transcatheter revascularization and recovery of collateral and microvascular bed of the brain by means of low-energy transluminal laser irradiation as well as its comparison with traditional Alzheimer’s disease (AD) treatment methods. Methods: The research involved 81 patients aged 34 - 79 (average age 67). 46 (46.8%) patients were treated using endovascular method—Test Group. 35 (43.2%) patients were given conventional treatment—Control Group. Patients were subdivided: Group (CDR-0): 9 (11.1%), pre-clinical stage or increased AD risk;Group (CDR-1): 24 (29.6%), mild dementia and cognitive impairment;Group (CDR-2): 31 (38.3%), moderate dementia and persistent cognitive impairment;Group (CDR-3): 17 (21.0%), severe dementia and cognitive impairment. Research plan included CT or MRI with subsequent temporal lobes volume calculation, brain scintigraphy (SG), rheoencephalography (REG), and cerebral MUGA. There were indications and contraindications for treatment in Test Group. In Group CDR-0, endovascular intervention was prophylactic, against the background of increasing memory impairment;in Groups CDR-1, CDR-2, CDR-3, it was conducted in 1 to 12 years period from AD symptoms appear-ance. Conservative treatment with Memantin and Rivastigmine was carried out in Control Group. Results: In Test Group, positive outcome accompanied by prolonged dementia decline, cognitive impairment decrease, and patients’ transition to CDR group of an earlier stage, was obtained in all cases. In Control Group, patients’ temporary stabilization in their own CDR group was achieved. Conclusions: Endovascular treatment of patients with AD different stages can not only reduce DAAT phenomena but can also cause AD regression possibly accompanied by regenerative processes in the cerebral tissue. Conservative treatment only allows stabilizing the patient’s condition for a while.

关键词： Alzheimer’s Disease Dementia Dyscirculatory Angiopathy of Alzheimer’s Type DAAT Hippocampus Temporal Lobes Atrophy Hypovascular Zone Laser revascularization Brain Tissue Regeneration

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Transcatheter Technologies in Treating Brain Atherosclerosis Complicated by Chronic Cerebrovascular Insufficiency

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Neuroscience & Medicine 2014年第4期5卷 161-176页

作者： Ivan V. Maksimovich Clinic of Cardiovascular Diseases Named after Most Holy John Tobolsky Moscow Russia

The research investigates the possibility of restoring the blood supply in patients with atherosclerosis of the brain, as well as the treatment of chronic cerebrovascular insufficiency. The research involves 946 patients aged 29 - 81 (average age 74) suffering from various types of cerebral atherosclerosis. 568 (60.04%) patients underwent transcatheter treatment—Test Group. 378 (39.96%) patients underwent conservative treatment—Control Group. The examination plan included laboratory diagnostics, assessment of dementia severity (CDR), assessment of cognitive impairment (MMSE), evaluation of the activities of daily living (IB), cerebral computed tomography (CT), cerebral magnetic resonance imaging (MRI), cerebral scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA). To restore the blood supply, the method of transcatheter laser revascularization was applied;high-energy pulsed lasers were used for major intracranial arteries treatment, and low energy CW lasers—for distal intracranial branches treatment. Test Group: 459 (80.81%) patients had good clinical outcome, 91 (16.02%)—satisfactory clinical outcome, 18 (3.17%)—relatively satisfactory clinical outcome;relatively positive clinical outcome was not obtained in any case. Control Group: good clinical outcome was not obtained in any case;65 (17.20%) patients had satisfactory clinical outcome, 121 (23.26%)—relatively satisfactory clinical outcome, 192 (50.79%)—relatively positive clinical outcome. The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from atherosclerosis of the brain. The obtained results last up to 10 years and more;it causes regression of mental and motor disorders, promotes regression of dementia and largely improves the patients’ quality of life;it has virtually no alternative—which makes the proposed method significantly different from conservative treatment methods.

关键词： Cerebrovascular Disease Cerebrovascular Insufficiency Cognitive Impairment Transcatheter Laser revascularization Regeneration Ischemic Stroke

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Early Percutaneous Coronary Intervention for Unprotected Left Main Disease in Patient with Cardiogenic Shock: A Case-Report

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World Journal of Cardiovascular Diseases 2016年第6期6卷 175-178页

作者： Krupal Reddy Department of Cardiology SevenHills Hospital Mumbai-400059 Maharashtra India

The prognosis of left main coronary artery disease is largely affected by the appropriate selection of the treatment strategy. A 45-year-old male presented with severe chest pain and two episodes of ventricular tachycardia, which was reverted after DC shock. Coronary angiography revealed critical stenotic lesion in the left main coronary artery. The patient successfully underwent urgent angioplasty with stent deployment in the left main coronary artery.

关键词： Left Main Disease revascularization Percutaneous Coronary Intervention

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Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease

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Journal of Nanjing Medical University 2006年第6期20卷 351-354页

作者： Xin Chen Ming Xu Zhibing Qiu Yinshuo Jiang Liming Wang Liqiong Xiao Department of Thoractic ＆ cardiovascular surgery the First Hospital Afficiated to Nanjing Medicul University Nanjing Heart Institue Nanjing 210006 China

Objective： To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods ： The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results： The mean number of the distal anastomosis was 3.78＋ 1.11 in CCABG group, and 3.83 ＋ 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 ＋ 0.08, and 1.10＋ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion： OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.

关键词： off-pump coronary artery bypass grafting flow of grafts revascularization

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Myocardial Ischemia Following Shrapnel Epicardiac Injury 16 Years Earlier: Case Report

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Case Reports in Clinical Medicine 2014年第3期3卷 110-113页

作者： Jaffar S. Shehatha Dara M. Mohialdeen Abdulsalam Y. Taha Abdulsalam Y. Taha Cardiac Surgery Department PAR Hospital Irbil Iraq School of Surgery Western Australia University Perth Australia Department of Cardiology Sulaimania Centre for Heart Disease Sulaimania Iraq Department of Cardiothoracic and Vascular Sur-gery School of Medicine and Sulaimania Teaching Hospital Sulaimania Iraq

Coronary artery injuries are uncommon. Acute injuries of major coronary vessels, particularly the left anterior descending artery (LAD), are life-threatening because of the significant cardiac dysfunction that ensues and usually requires repair or bypass. In contrast, late presentation of missile coronary artery injuries has been sporadically reported in the literature. Herein we present a 32-year-old lady from Sulaimania, Iraq with multiple shrapnel injuries 16 years earlier presented recently with severe anterolateral myocardial ischemia unresponsive to medical treatment. Coronary angiography and surgical exploration revealed shrapnel compressing the LAD. The patient responded very well to shrapnel extraction and coronary artery revascularization (off pump left internal mammary artery—LIMA—to LAD anastomosis). The management of this patient is discussed with review of relevant literature. It is concluded that long-standing shrapnel close to a major coronary artery may incur an external trauma initiating a localized arteriosclerosis with an extremely long time interval from injury to the onset of symptoms of myocardial ischemia.

关键词： Coronary Artery Late Injuries Epicardiac Myocardial Ischemia Repair revascularization

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