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    Early and late outcomes of carotid artery stenting [Karotis arter stentlerinin erken ve geç sonuçlari]
    (2007) Aydiner O.; Boztosun B.; Şirvanci M.; Akçakoyun M.; Karaman K.; Aksoy T.; Onat L.
    Objective: Carotid artery stenting is a new approach alternative to surgical carotid endarterectomy. Cerebral protection devices improved the applicability of this technique. In this study, we evaluated applicability, safety and late clinical outcomes of percutaneous interventions for carotid artery stenosis. Methods: A prospective study included 26 patients (15 female, 11 male, mean age 70±16 years) undergoing percutaneous transluminal angioplasty and stenting with different sizes of balloons and stents for 28 internal carotid artery stenoses at Kadir Has University Department of Interventional Radiology between March 2002 and December 2004. Ten patients were asymptomatic, one had amaurosis fugax, four had transient ischemic attack within last four months, one had drop attacks, one had headache, seven had the findings of hemiparesis and three had hemiplegia. Results: Stenosis rates were calculated according to North America Symptomatic Carotid Endarterectomy Trial. Median stenosis rate was 85% (range: 60%-95%). All of the 28 internal carotid artery stenoses were managed with balloon dilatation and stenting (technical success rate 100%). Median residual stenosis rate after procedure was 14% (range: 0%-30%). Asystole developed in five patients and bradycardia in eight patients. Ipsilateral middle cerebral artery infarction occurred in two patients. One patient had intracranial reperfusion bleeding four hours after the procedure. No procedural death was observed within one month of follow-up. One patient died of myocardial infarction four months after the procedure. Cranial computed tomography revealed multiple metastases in one patient complaining of intractable headache and primary source was found to be pulmonary carcinoma. No stent restenosis was defined at Doppler ultrasonographic examinations performed 6 and 12 months after procedures with normal flow patterns and velocities. Two patients underwent control angiography at 12th month and myointimal proliferations with insignificant obstruction (25% and 30%) were detected. Conclusion: Carotid artery stenting seems to be applicable and safe procedure but it is associated with infrequent major complications. Results of studies comparing surgery and angioplasty will be helpful in defining role of stenting in the treatment of carotid occlusive disease.
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    Effects of different cardioplegic solutions on nitric oxide release from coronary vasculature in diabetic patients undergoing coronary artery bypass surgery
    (2006) Karaca P.; Yurtseven N.; Enç Y.; Aksoy T.; Sokullu O.; Bilgen F.; Canik S.
    Objective: The aim of this study was to compare the effects of two different cardioplegic solutions on nitric oxide (NO) release from coronary vasculature in patients with type II diabetes mellitus undergoing coronary artery bypass grafting (CABG) surgery. Methods: Forty patients undergoing elective CABG surgery were randomized to be given crystalloid (Group 1) or blood (Group 2) cardioplegia. Aortic and coronary sinus blood samples were taken at three different time periods and the release of NO from the coronary vasculature was determined by measuring its stable end-products, nitrite and nitrate. The difference between the aortic and coronary sinus concentrations of nitrite and nitrate represents the amount of NO released by coronary vascular bed. Results: Before application of aortic cross-clamp, at T1 period, the levels of nitrite/nitrate from the coronary vasculature were similar in both groups (6.53±1.21 µM vs 6.07±1.24 µM, p> 0.05). However after the removal of cross-clamp, a significant decrease in NO was observed in Group 1 as compared with Group 2 (4.21±0.73 µM vs 4.92±1.02 µM, p< 0.01). This decrease persisted at T3 period, after 30 minutes of reperfusion in group 1 being significantly different from group 2 (3.86±0.49 vs 4.37±0.72 µM, p<0.05). Conclusion: This study has shown that in patients with type II diabetes mellitus crystalloid cardioplegia causes a decrease in the release of NO from coronary vascular bed during aortic cross-clamp and reperfusion period whereas more physiologic blood cardioplegia did not Our findings indicate that blood cardioplegia protects endothelial function better than crystalloid cardioplegia in diabetic patients.