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In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the fifth communication we consider data of two randomized studies in which efficacy and safety of clopidogrel in combination with acetylsalicylic acid (ASA) has been assessed in comparison with ASA in stable patients with atherothrombotic cardiovascular disease. It has been shown in both studies that in stable patients with atherothrombotic cardiovascular disease long-term therapy with combination of clopidogrel and ASA was no more effective than monotherapy with ASA or clopidogrel but was associated with high risk of hemorrhagic complications. Thus contrary to acute coronary syndromes and percutaneous interventions with stenting combinations of clopidogrel and ASA is not indicated to patients with stable course cardiovascular diseases.

Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.

In Turkey as well as in the whole world, cardiac catheterization is an invasive intervention that is being increasingly used both for diagnosis and treatment. With technological and pharmacologic development and experience, the indications for this intervention are ever increasing. This invasive intervention brings, of course, some complications with it. These may range from local ones to death. In this study the authors analyzed the local cardiac complications and those related to other systems that they encountered in 10,445 catheterizations conducted for diagnosis and treatment in their clinic over a 26-month period. They found the rate of all complications to be 3.54% (2.05% diagnostic, 9.1% therapeutic). Of these complications, 1.89% (0.80% diagnostic, 6.02% therapeutic) were cardiac, 1.27% (0.97% diagnostic, 2.4% therapeutic) local. They found that the ratios of death were 0.09% for diagnostic interventions, 1.13% for therapeutic interventions, and 0.31% altogether. In the diagnostic group 0.02% required urgent coronary bypass surgery, and 0.41% needed urgent coronary bypass surgery in the therapeutic group. In conclusion, despite the noticeable changes in patient profile and application, the ratios for cardiac catheterization have changed little over the years.

The stent was placed in 528 coronary artery segments (39% complicated lesions) in 448 patients with coronary artery disease and no previous invasive interventions. Immediate angiographic success was 99.8% with no case of acute thrombosis. Six months survival without restenosis, angina, and reintervention was 83%. Repeat angiography was carried out in 432 patients with 502 stented stenoses. Index of vessel diameter loss and level of restenosis were 0.32+/-0.26, and 15,6%, respectively. Fifty four patients with in-stent restenosis were subjected to successful repeat revascularization. Eighteen months survival without myocardial infarction and reintervention was 70%. The study demonstrated favorable effect of TAIS on 18 month rate of thrombosis and restenosis in patients with native atherosclerotic lesions.

Aim: To evaluate two-year results of using a metallic stent EPHESOS in patients with native atherosclerotic lesion of coronary arteries (without prior interventions)., Material and Methods: The stent was implanted to 731 patients. 53% had manifestations of unstable angina. 42% of the lesions were complicated. The length of the stenosis was 15.5 +/- 6.8 mm, 44% stenoses were long., Results: The success of stenting was 99.6%. Cases of acute and subacute thrombosis were absent. Non-Q wave myocardial infarction in primary hospitalization developed in 4 patients. For 6 months, cardiovascular complications (death, angina, restenosis, repeated revascularization) occurred in 21%. Angiographic control follow-up of 6 months maximum covered 329 (45%) patients. Hemodynamically significant restenosis was detected in 18% patients. Cardiovascular complications for 24 months occurred in 39%., Conclusion: The EPHESOS stent has demonstrated a stable long-term effect on prevention of thrombosis and restenosis in the majority of patients with a relatively high risk of intervention.

Aim: An open non-randomized trial was initiated to assess clinical and angiographic results of using the coronary stent "Ephesos" in 457 patients with stable or unstable angina pectoris and native coronary affections., Material and Methods: 268 stents have been implanted in 231 patients with stable angina (SA) and 271 stents--in 226 patients with unstable angina (UA). 46% lesions were complicated. The length of stenosis was 12.9 +/- 6.7 mm in the group SA and 14.1 +/- 7.4 mm in the group UA, 30% stenoses were long., Results: Successful stenting was stated in 99% without cases of acute thrombosis. Non-fatal myocardial infarction took place in hospital in 1.3% of SA patients and in 2.6% of UA patients. Incidence of cardiac complications (death, recurrent angina pectoris, myocardial infarction, restenosis, repeated revascularization) for 6-month follow-up was 15.6% in SA group and 18.1% in UA group. At angiographic control, the index of vascular diameter loss made up 0.22 +/- 0.2 in SA group and 0.3 +/- 0.27 in UA group. Incidence of restenosis was 12 and 14%, respectively. 18-month follow-up found no differences in frequency of complications: 21.6 and 22.6% in groups SA and UA, respectively., Conclusion: Implantation of the stent "Ephesos" is effective in prevention of thrombosis and restenosis in patients with stable or unstable angina pectoris at high risk of intervention.

The Ephesos is a new balloon-expandable, stainless steel, tubular stent with multicellular design. This open nonrandomized study assesses the immediate and long-term clinical and angiographic outcomes after Ephesos implantation in patients with native coronary artery disease. The Ephesos was implanted in 168 patients with 198 de novo lesions. Most patients (56%) had unstable angina, and 38% of lesions were type B2-C. The mean lesion length was 12.5-/+7.2 mm, and 29% of lesions were >15 mm in length. No stent deployment failure occurred, as well as acute or subacute stent thrombosis. In-hospital non-Q-wave myocardial infarction occurred in 2 patients. The 6-month event-free survival was 83.9%. Two patients with no restenosis in the target vessel died of fatal infarction due to abrupt closure of a nontarget vessel. The 6-month angiographic follow-up was obtained in 164 patients (98%) (192 lesions). The loss index was 0.27-/+0.25. Angiographic restenosis rate was 12%. Twenty patients with restenosis had repeat target lesion revascularization. The results of this study indicate a potential benefit of EPHESOS for the prevention of stent thrombosis and restenosis in these relatively high-risk patients.

Aim: To assess immediate and long-term outcomes after BioDiamond-stent implantation in patients with native coronary artery disease., Materials and Methods: The BioDiamond stent was implanted in 112 patients with 132 de novo lesions. Most patients (54%) had unstable angina, 33% of the lesions were of type B2-C., Results: No stent deployment failure occurred as well as acute or subacute stent thrombosis. The 6-month angiographic follow-up was obtained in 108 patients (98%) (125 lesions). The loss index was 0.40 +/- 0.27. Angiographic restenosis rate occurred in 14%. Repeat target lesion revascularization was successful in 16 patients with restenosis., Conclusion: The results of this study indicate a potential benefit of BioDiamond for prevention of stent thrombosis and restenosis in these relatively high-risk patients.

Aim: To assess immediate and long-term results of urgent coronary stenting in patients with cardiogenic shock., Material and Methods: Twenty three patients (15 men, 8 women mean age 58-/+12 years) with myocardial infarction and cardiogenic shock treated with vasopressors and intraaortic balloon pumping (IABP). Culprit lesions were localized in left anterior descending and right coronary arteries in 16 and 7 cases, respectively. Prior to stenting 18 and 5 patients had TIMI grade 0 and 1 flow, respectively., Results: Stents (n=26, Seaquence and Ephesos, length 12-28 mm, diameter 2-3.5 mm) were successfully implanted in all patients after balloon predilation. After stenting TIMI grade 3 flow was achieved in 15 patients, 8 patients had TIMI-2 flow without angiographic signs of dissection or residual stenosis. There were 4 inhospital deaths and 19 patients (83%) were discharged. One angioplasty and 2 coronary artery bypass grafting procedures because of restenosis and reocclusion were successfully performed during first 4 months of follow-up., Conclusion: Urgent stenting combined with IABP was effective method of treatment of cardiogenic shock with 83% inhospital survival and 61% freedom from repeat revascularization.