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Kateter aracılı intra-arteriyel tromboliz, alt akstremite arterlerinin akut / subakut ve hatta bazı kronik tıkanıklarında ve kurtarılabilir ekstremite iskemisi olan bypass greftlerinde kullanılabilecek rasyonel bir tedavi yöntemidir. Kabul edilebilir bir komplikasyon oranı ile özellikle taze trombüs veya embolisi olan bir çok hastada acil damar açıklığına ulaşılabilir. Aynı zamanda kronik tıkanıklarda endovaskuler girişimler için yardımcı tedavi yöntemi olabilir. Kateter aracılı uygulanan trombolitik ajan dozu ve tekniği ile ilgili standart tedavi yöntemi yoktur. Tedavi stratejisinin seçimi ekstremite canlılığı, lezyon özellikleri ve kanama riskleri temelinde bireysel olarak değerlendirilmelidir.

Catheter-directed intra-arterial thrombolysis (CDT) is a rational treatment method in patients with acute/subacute and even some chronic occlusions of lower extremity arteries and bypass grafts having salvageable limb ischemia. Immediate vessel patency can be achieved with an acceptable complication rate in many patients, especially those with fresh thrombus or emboli. It can be also an adjuvant treatment modality for endovascular interventions for chronic occlusions. There is no standard method of CDT including thrombolytic agent dose and technique. Selection of treatment strategy should be based on individual judgment based on viability of limb, lesion characteristics, and risks of hemorrhage.

Objective: Arrhythmogenic right ventricular dysplasia (ARVD) is a myocardial genetic disease that occurs primarily in the right ventricle. Patients with ARVD may present with severe ventricular arrhythmias, syncope, and cardiac arrest. The purpose of this study is to evaluate the clinical features and arrhythmic complications of patients with pediatric-onset ARVD.
Methods: Patients diagnosed with ARVD between January 2010 and January 2019 were included in this study.
Results: A total of 19 patients with ARVD were evaluated. Of them, 15 patients were male, and their mean age was 12±4 years. The most common symptoms were palpitations (n=6), syncope (n=4), and heart failure symptoms (n=2). Five patients were asymptomatic. Thirteen patients had an epsilon wave; all patients ≥14 years had a T wave inversion in V1–3. Premature ventricular contractions (PVCs) were observed in 15 patients, and ventricular tachycardia (VT) was observed in 9 patients. All patients underwent cardiac magnetic resonance imaging (MRI). Echocardiography and cardiac MRI of two patients were normal at the time of admission; patients were in the concealed phase, and the diagnosis was made by ECG, Holter monitoring, and genetic findings. We administered a beta-blocker in all patients. Two patients underwent an electrophysiological study and ablation because of PVC/VT. An implantable cardiac defibrillator was implanted in 8 patients. The mean follow-up period was 21.5±11 months. Two patients were deceased with incessant VT and heart failure, and one patient was deceased with multiorgan dysfunction after biventricular assist device implantation (n=3).
Conclusion: Diagnosis of pediatric-onset ARVD might be much more difficult in children. Sudden cardiac death might be prevented in the early period by raising the awareness of physicians about the disorder. Prevention of sudden death with implantable cardiac defibrillators is crucial in the management of these patients. It should be kept in mind that children with structurally normal hearts may present with an earlier concealed phase and can be diagnosed with ARVD.

Objective: It is unknown whether the intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI) should be routinely used in small-vessel coronary lesions in patients affected by Type 2 diabetes mellitus (T2DM). This study aimed to assess the clinical significance of the IVUS-guided PCI treatment for small-vessel coronary lesions in T2DM.
Methods: This was a prospective interventional trial. A total of 228 patients affected by T2DM with stable angina and a positive stress test in the presence of coronary arteriography (CAG) involving small vessels [online measurement reference vessel diameter ≤3.0 mm by means of quantitative coronary angiography (QCA)] were recruited and divided into two groups: an IVUS-guided group (n=120) and a CAG-guided group (n=108). Follow-up PCIs were performed via CAG or IVUS criteria, respectively. Between-group comparisons were made for the number of stents implanted, length, diameter, and high-pressure balloons used post-dilatation. Major adverse cardiac events (MACEs) defined as cardiac death, nonfatal myocardial infarction, and target lesion revascularization (TLR) were the primary endpoint. The value of late lumen loss and proportion of in-stent restenosis (ISR) were the secondary endpoint, all of which were also evaluated during the follow-up period.
Results: There was an increased lesion length observed using the IVUS measurement when compared with QCA measurements in the IVUS-guided group (p≤0.001). The number of implanted stents, diameter, length, percentage of high-pressure balloons used during post-dilatation, value of late lumen loss, and proportion of ISR decreased in the IVUS-guided group when compared with the CAG-guided group (p=0.002, p=0.001, p=0.003, p=0.004, p=0.007, p=0.001, respectively). After a 2-year follow-up, the Kaplan–Meier curves indicated that the incidence of MACEs was significantly lower in the IVUS-guided group (log-rank p=0.029), mainly because of the TLR reduction (log-rank p=0.037).
Conclusion: The IVUS-guided PCI treatment improved the event-free survival in small-vessel coronary lesions in patients affected by T2DM.

Objective: A well-developed coronary collateral circulation lowers both in-hospital and long-term morbidity and mortality limiting the infarct. Angiogenin (AGN) and osteopontin (OPN) are known to be potent inducers of angiogenesis. The aim of the present study was to investigate the relationship between serum ANG and OPN levels and collateral filling grade in subjects with stable coronary artery disease (SCAD).
Methods: A total of 122 age- and gender-matched consecutive patients who were found to have total occlusion (n=70) and no significant stenosis in epicardial coronary arteries (n=52) who underwent coronary angiography due to SCAD between January 2015 and July 2017 were included in the study. AGN and OPN levels were measured using enzyme linked immunosorbent assay. Coronary collateral circulation was graded using Rentrop’s classification of collateral filling.
Results: A total of 52 patients (61.60±11.78 years, 61.5% male) without significant epicardial coronary artery stenosis and 70 patients (62.87±8.24 years, 65.7% male) with totally occluded coronary arteries were included in the study. Subjects with total occlusion had significantly higher levels of AGN [122.00 (79.00–623.00) pg/mL vs. 98.00 (18.00–160.00) pg/mL, p<0.001] and OPN [1863.50 (125.00–6500.00) pg/mL vs. 451.00 (112.00– 1850.00) pg/mL, p<0.001] than those without significant stenosis. In addition, AGN [127.00 (87.00–623.00) pg/mL vs. 110.00 (79.00–188.00) pg/mL, p=0.011] and OPN [2681.00 (126.00–6500.00) pg/mL vs. 649.00 (125.00–4255.00) pg/mL, p=0.001] levels were significantly higher in patients with better developed collaterals. Serum AGN and OPN levels were found to be significantly associated with coronary collateral development.
Conclusion: AGN and OPN are associated with better developed coronary collateral circulation and may have therapeutic implications for the promotion of coronary collateral development.

Objective: Behçet's disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias and sudden cardiac death. The mechanism of increased ventricular arrhythmias in BD remains uncertain. The aim of the present study was to assess the ventricular repolarization by using the Tp–e interval, Tp–e/QT ratio, and Tp–e/QTc ratio as candidate markers of ventricular arrhythmias in patients with BD.
Methods: A total of 42 patients (mean age: 42.71±10.99 years) with BD and 50 sex- and age-matched healthy volunteers (mean age: 39.24±11.32 years) as the control group were evaluated. The risk of ventricular arrhythmia was evaluated by calculating the electrocardiographic, the Tp–e interval, and the QT, QTc, Tp e/QT, and Tp–e/QTc ratios.
Results: QTmax (p=0.005), QTcmax (p=0.015), QTmin (p=0.011), and QTcmin (p=0.024) were statistically significantly higher in the BD group than in the control group. The Tp–e, cTp–e, Tp–e/QT, and Tp–e/QTc ratios were also significantly higher in patients with BD than in the control group (80.26±4.55 and 74.74±6.47, respectively, p<0.001; 88.23±6.36 and 82.68±7.81, respectively, p<0.001; 0.21±0.01 and 0.20±0.01, respectively, p=0.008; and 0.19±0.01 and 0.18±0.01, respectively, p=0.01). Positive correlations were found between Tp–e/QTc ratio and disease duration (r=0.382, p=0.013).
Conclusion: Our study showed that the Tp–e interval, Tp–e/QT ratio, and Tp–e/QTc ratio, which are evaluated electrocardiographically in patients with BD, have been prolonged compared with normal healthy individuals. A positive correlation was determined between disease duration and Tp–e/QTc ratio. These results may be indicative of an early subclinical cardiac involvement in patients with BD, considering the duration of the disease. Therefore, these patients should be more closely screened for ventricular arrhythmias.