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ANALYSIS OF CORONAROGRAM IN CORONARY ATHEROSCLEROSIS

Despite the fact that selective coronary angiography has been used in cardiological practice for more than 30 years, the methods of coronarogram analysis continue to develop and improve. This process is inextricably linked with the introduction of fundamentally new ways of treating patients with coronary atherosclerosis. The intravital imaging of the coronary bed allowed first of all to reliably ascertain the very fact of atherosclerotic lesion of the coronary arteries and thus differentiated approach to the treatment of patients with different forms of IHD. With the development of cardiac surgery (the introduction of coronary artery bypass graft surgery), a more thorough analysis of coronary arteriograms appeared: without the knowledge of the localization of atherosclerotic obstructions, the degree of arterial damage and the prevalence of the process, it is impossible to perform shunt operations. The introduction and wide dissemination of invasive intracoronary methods of treatment of coronary atherosclerosis stimulated the development of new methods of coronarogram analysis. So, if information about the degree, localization and prevalence of the atherosclerotic process is sufficient for carrying out shunting operations, additional information is required to perform intracoronary interventions. This is due to the fact that the point of application of intracoronary interventions is not the entire affected coronary vessel, but directly that morphological substrate that caused a critical decrease in the artery lumen. After the introduction of the PTCA method, this operation was performed in patients with only a chronic clinical form of coronary atherosclerosis and only in those cases when they had a single atherosclerotic lesion of the coronary artery in the form of concentric discrete stenosis narrowing the arterial lumen by 50-95% in coronary angiography. Now this operation is performed in both chronic and acute forms of coronary disease; as with single-vessel, and with two-, three-vessel lesions of the coronary bed; As with stenosis, and with occlusions of the coronary arteries. It is not surprising that the number of unsuccessful attempts and complications of PTCA

Analyzing the primary (performed before PTCA) coronarograms of patients who had complications after angioplasty, the researchers drew attention to the fact that atherosclerotic plaques that underwent dilatation have an atypical coronarographic configuration. This fact gave reason to think that the "wrong" stenosis configuration, determined on coronarograms, reflects the morphological changes taking place in these plaques, namely, the processes of their destruction and intraluminal thrombus formation.
A study by Levin and Fallon comparing the postmortem coronary and coronary angiography of the same patients who died of complications of coronary atherosclerosis confirmed the validity of these assumptions. This study, as well as a number of others, initiated the introduction of the method of qualitative analysis of coronarograms. This method, now improved, allows to determine with a high degree of reliability the intravital morphological state of atherosclerotic obstructions of the coronary arteries of patients with coronary atherosclerosis. In vivo information about the morphological state of atherosclerotic lesions is important both for predicting the course of coronary atherosclerosis (it is known that the destruction of atherosclerotic plaques is the main condition for the transition of the chronic form of coronary atherosclerosis to acute - unstable angina and MI), and to determine indications for PTCA and predict possible complications of this operation.

Thus, in order to choose the right treatment tactics for patients with coronary atherosclerosis and to determine the indications for this or that kind of surgical intervention, several methods of coronarogram analysis should be used. First, it is necessary to establish common coronarographic characteristics of atherosclerotic lesions of the coronary arteries (the number of atherosclerotic obstructions and their segmented localization in the coronary bed). Second, to conduct a quantitative coronary analysis of each of the obstructions (determine the degree of narrowing of the lumen and the length of obstruction). Third, to analyze the qualitative coronarographic characteristics of obstructions (determine the signs of destruction of atherosclerotic plaques and intraluminal thrombus formation, as well as the severity of these processes). In addition, the results of interventional procedures are affected by some anatomical features of obstruction localization (location of obstruction in the place of significant artery bend, distal to several bends, in the place of artery bifurcation, etc.). These features also need to be considered when determining indications for operations.
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ANALYSIS OF CORONAROGRAM IN CORONARY ATHEROSCLEROSIS

  1. ANATOMY OF CORONARY ARTERIES. COMPLEX ANALYSIS OF CORONAROGRAM
    The human heart is supplied with the left and right coronary arteries, which move away from the ascending aortic arch in the left and right coronary sinuses (Figure 1.60-1.62). The most reliable method of intravital coronary artery imaging is coronary angiography. Analysis of atherosclerotic lesions, revealed on coronarograms, determines the tactics of treatment of patients with
  2. Sudden death in coronary artery atherosclerosis
    Sudden death is primarily a complication of severe coronary artery atherosclerosis, which affects several coronary vessels. In pathoanatomical research, the frequency of detection of fresh coronary thrombosis ranges from 25 to 75%. A rupture of an atherosclerotic plaque that caused vessel obstruction was found in a number of patients without thrombosis. Thus, there is an impression,
  3. Complex analysis of coronarograms
    In Table. 1.11 presents the criteria for the complex analysis of coronary angiograms, which should be reflected in the coronary protocol taking into account the general, quantitative, qualitative and anatomical characteristics of atherosclerotic lesion of the coronary arteries. Based on these criteria determine the probability of unsuccessful attempts and complications of intracoronary interventions. In addition, the protocol
  4. Percutaneous coronary interventions for single discrete lesions of the coronary arteries, diffuse stenoses, multivessel lesions in coronary artery disease
    Percutaneous coronary interventions for single discrete lesions of the coronary arteries, diffuse stenoses, multivessel lesions with
  5. The tactics of performing percutaneous coronary intervention in acute coronary syndrome without ST segment elevation
    Recently published reviews suggest that percutaneous coronary interventions are performed in less than 50% of patients with acute coronary syndrome without ST elevation (GRACE (Global Registry of Acute Coronary Events), CRUSADE (Coronary Revascularization UltraSound Angioplasty DEvice trial)). Proponents of drug treatment for patients with unstable angina and MI without ST segment elevation
  6. Percutaneous coronary interventions in acute coronary syndrome without ST segmental aneurysm
    Percutaneous coronary interventions in acute coronary syndrome without segmentation
  7. Analysis of anatomical features of localization of atherosclerotic lesions in the coronary canal
    Experience in the implementation of intracoronary treatment interventions in coronary atherosclerosis has shown that their results are significantly influenced by the anatomical features of the localization of atherosclerotic obstructions: damage distal to the significant tortuosity of the coronary artery (2 bends and more) (Figure 1.75); localization in the place of significant bending of the vessel (Figure 1.76); in the place of bifurcation
  8. Lecture the eleventh. Atherosclerosis, hypertension, myocardial infarction, ischemic and coronary heart disease
    Lecture the eleventh. Atherosclerosis, hypertension, myocardial infarction, ischemic and coronary disease
  9. Percutaneous coronary interventions for multivessel lesions in CHD
    One of the debatable problems of modern interventional cardiology is the issue of multivessel angioplasty in patients with advanced coronary atherosclerosis. Solving this issue requires an analysis of many factors: the definition of multivessel lesion, the possibility and feasibility of complete and incomplete revascularization of the myocardium, the analysis of long-term results
  10. Nutrition for atherosclerosis
    Correct medical nutrition with atherosclerosis with damage to the blood vessels of the heart, brain or other organs helps to slow the progression of the disease, reduce metabolic disorders, improve blood circulation, reduce body weight, if necessary, provide nutrition without overloading the cardiovascular and central nervous system, liver, kidney. Atherosclerosis is a chronic disease that
  11. Percutaneous coronary interventions for single-vessel lesions in IHD and single discrete stenoses
    Since the first coronary angioplasty, the main coronarographic indications for this intervention have been determined. The lesions suitable for balloon angioplasty include single proximal hemodynamically significant discrete uncalcified stenoses in patients with preserved LV function. Similar lesions, according to modern research, and
  12. Percutaneous coronary interventions in the presence of bends in the coronary artery bed, lesions of the mouth, calcified lesions, long lesions
    Percutaneous coronary interventions in the presence of bends in the coronary artery bed, lesions of the mouth, calcified lesions, long
  13. ATHEROSCLEROSIS WITH SUGAR DIABETES
    ATHEROSCLEROSIS WITH SUGAR
  14. INSTRUMENTATION USED IN PERCUTANE CORONARY INTERVENTIONS
    Diagnostic tools For diagnostic coronary angiography, performed in coronary atherosclerosis, a relatively small number of instruments are required: arterial puncture needles, wire conductors, perforators, introducers and angiographic catheters. Now in connection with a wide spread of methods of endovascular reconstruction of coronary arteries under their
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