The Laboratory of X-Ray Endovascular Methods Of Diagnostics And Treatment In Outpatient Settings, 2nd Department of X-Ray Surgical Methods of Diagnostics And Treartment

Units were established in setting of the Scientific dispensary Department of the A.L. Myasnikov Research Institute of Cardiology in March 2009 on the initiative of Academician E.I. Chazov.

The work is carried out on the basis of the 6-beds cardiology day hospital, as well as in close cooperation with the clinical departments and diagnostic laboratories of the of Cardiology Research Center.

Main directions of scientific research:

• Development of the new technologies of X-ray endovascular diagnostics of cardiovascular diseases on outpatient basis.
• Development of new technologies for carrying out X-ray endovascular treatment of patients with coronary heart disease in over-night setting.
• Evaluating the effectiveness of different types of arterial and venous accesses for endovascular diagnosis and treatment in outpatient and short-term hospitalization settings.
• Development of indications and contraindications for invasive diagnostic and treatment in outpatient and short-term hospitalization settings.
• Establishing the cost-effectiveness of the clinical use of endovascular diagnostic and treatment in outpatient and short-term hospitalization settings.
• Evaluation of new methods for estimating resting physiological indices (including iFR co-registration) in patients with complex lesions (diffuse, tandem, ostial, left main lesions), as well as for assessment of percutaneous coronary interventions (PCI) results.
• Evaluation of the new approaches of planning and optimizing PCI results using IVUS co-registration technology.
• Development of methods of endovascular diagnostics (catheterization of the right heart, angiopulmonography, intravascular ultrasound (IVUS)) in patients with various forms of pulmonary hypertension
• Development of methods of endovascular treatment of patients with inoperable forms of thromboembolic pulmonary hypertension.

Major achievements:

• For the first time in Russia, was developed and put into practice a method of performing diagnostic coronary angiography (CAG) on an outpatient basis with discharge on the day of the procedure. During the work of the laboratory, more than 2000 coronary angiographies were performed on an outpatient basis. It was shown that outpatient CAG (without hospitalization) in selected patients with stable coronary artery disease (CAD) is a safe and effective method that significantly reduces the bed-day of the institution and is economically justified. Performing a diagnostical CAG on an outpatient basis reduced the cost of the procedure by 19% compared with standard 3-day hospitalization.
• A clinical approach was developed in which patients, undergoing inpatient treatment in city cardiology hospitals that do not have an angiography laboratory, were admitted and underwent transluminal balloon angioplasty with coronary artery stenting, few hours after the procedure they were discharged and returned to the referring hospital. According to this method, more than 800 patients were treated, the success rate was 98%, and no major cardiovascular complications (death, emergency CABG, local-focal MI, acute cerebrovascular accident) were observed.
• Positive experience of balloon angioplasty and stenting with an over-night hospitalization has been accumulated. It was shown that 70-80% of patients with stable CAD who require endovascular treatment can be discharged within 24 hours after hospitalization without increasing the risk of complications associated with early discharge.
• The laboratory has developed and introduced into clinical practice a new vascular access - through the ulnar artery – for endovascular diagnostics and treatment of CHD. More than 1000 endovascular interventions were performed through the ulnar arterial access, with a high success rate (more than 96%) and a low complications rate (comparable to radial access). An algorithm for selecting the optimal arterial access was developed, based on the assessment of the diameter of the forearm arteries and their anatomical features according to the data of ultrasound duplex scanning.
• Developed and introduced into clinical practice detailed protocols for determining iFR, including hybrid protocol, as well as using the cut-off index ≤0.89, proved the same effectiveness in comparison with traditional FFR with papaverine.
• New venous accesses were developed and put into practice: through the cubital vein and through the superficial lateral and medial veins of the arm (cephalic and basilic veins) – for the right heart catheterization and pulmonary arteries balloon angioplasty in patients with pulmonary hypertension. An original technique of puncture and catheterization of these veins under the control of fluoroscopy has been developed.
• For the first time developed a technique of performing balloon angioplasty of the pulmonary artery in patients with various forms and severity of chronic thromboembolic pulmonary hypertension, as well as an algorithm of preparing and managing patients after the procedure.

On the basis of the laboratory were defended 8 PhD thesis, 1 doctoral dissertation, were published 2 methodological recommendations, were obtained 5 patents of the Russian Federation for the invention.

The laboratory annually conducts a number of courses for doctors, including “Surgical access through the forearm arteries for carrying out endovascular interventions on the coronary arteries”, “Fundamentals of IVUS and coronary physiology”. As a part of the training, in addition to the lecture material, demonstration operations are performed using IVUS and iFR in patients with complex lesions of the coronary arteries. The courses also include mastering practical skills of performing these techniques with modern equipment.

The laboratory regularly carries out a webinar “Endovascular treatment of complex chronic total occlusions of coronary arteries” in cooperation with Professor Sunao Nakamura (Japan), including live-streaming operations.