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    Comparison of short-term outcomes of patients with embolism-protected and unprotected carotid artery stenting
    (2024) Demir, Yusuf; Senoz, Oktay; Eren, Abdurrahman; Demir, Ali Rıza
    Objectives: This study aimed to evaluate the effect of using or not using a protective device on clinical outcomes in patients undergoing carotid artery stenting. Patients and methods: A total of 80 patients (53 males, 27 females; mean age: 68.1±9.1 years; range, 47 to 93 years) with symptomatic severe carotid artery stenosis or asymptomatic severe carotid artery stenosis were included in the prospective study between March 2016 and August 2018. The patients were divided into two groups: those who used an embolism protection device (n=60) and those who did not (n=20). Results: In terms of primary endpoints, rates of ischemic stroke (5% vs. 5%, p=1.00) and transient ischemic attack (5% vs. 0%, p=0.56) were found to be similar between the protected and unprotected groups after carotid artery stenting. While total embolism numbers (2.11±2.62 vs. 1.26±2.19, p=0.072) and infarct sizes (8.80±4.5 mm vs. 9.00±5.05 mm, p=0.97) were similar between the protected and unprotected groups, the presence of silent microemboli was higher in the unprotected group (40% vs. 15%, p=0.02). Conclusion: Although embolism protection devices do not reduce the risk of clinically significant embolism, they significantly reduce the risk of silent microemboli.
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    Effect of COVİD-19 pandemic and coronavac vaccine on blood pressure regulation in chronic hypertensive patients
    (2021) Şenöz, Oktay; Erseçgin, Ahmet; Demir, Yusuf; Yurdam, Ferhat Siyamend; Yapan Emren, Zeynep; Gürses, Ecem
    Objective: The most common comorbidity in patients with Covid-19 infection is hypertension. Apart from the direct effects of the virus on hypertensive patients, the pandemic period also negatively affected these patients. In addition, the effect of the newly discovered CoronaVac vaccine, which has been widely used in our country in recent months for the prevention of covid-19 infection, on blood pressure regulation is unknown. In this study, we aimed to investigate the effects of the pandemic period and the CoronaVac vaccine in patients receiving treatment for essential hypertension.Method: One hundred ninety-six patients who applied to the cardiology outpatient clinic between 4 June - 9 July 2021, were treated for essential hypertension and had at least 1 dose of CoronaVac vaccine were included in the study. In the pre-pandemic, pre-vaccine and post-vaccine period, mean home and office blood pressures of the patients were examined separately. Results: While the mean home blood pressures of the patients differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 125.1±12.6 vs 129.1±14.1 mmhg, p<0.001, diastolic: 75.3±9.7 vs 77.1±9.8 mmhg, p=0.004), there was no significant difference between the pre- and post-vaccination period (systolic: 129.1±14.1 vs 129.7±13.7 mmhg, p=0.229, diastolic: 77.1±9.8 vs 77.9±9.9 mmhg, p=0.091). Similarly, while office blood pressures differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 133.5±16.5 vs 136.1±16.4 mmhg, p=0.015, diastolic: 79.4±10.9 vs 81.2±12.1 mmhg, p=0.036), there was no significant difference between the pre- and post-vaccination period (systolic: 136.1±16.4 vs 135.6±16.9 mmhg, p=0.651, diastolic: 81.2±12.1 vs 81.1±11.2mmhg, p=0.914). Conclusion: While the Covid-19 pandemic increased the blood pressure of chronic hypertensive patients, the CoronaVac vaccine did not affect the blood pressure regulation of these patients.
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    Impact of the HALP Score on Long-Term Mortality among Patients Undergoing EVAR
    (Galenos Publ House, 2024) Altunova, Mehmet; Evsen, Ali; Demir, Yusuf; Aktemur, Tugba; Erdogan, Onur; Atmaca, Sezgin; Koseoglu, Mehmet
    Introduction: Endovascular aortic repair (EVAR) is commonly used for abdominal aortic aneurysms, but its mortality rate remains high. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which measures hemoglobin, albumin, lymphocyte, and platelet levels, provides prognostic value by reflecting the nutritional status and systemic inflammation. This study aimed to explore the relationship between the HALP score upon admission and long-term mortality in patients with EVAR. Methods: Consecutive patients with EVAR at our tertiary center from October 2010 to August 2021 were retrospectively analyzed. HALP scores were calculated using the following formula: hemoglobin (g/L) x albumin (g/L) x lymphocyte count (/L)/platelet count (/L). In-hospital and long-term mortality data were extracted. Receiver operating characteristic curve analysis identified predictors of in-hospital mortality. Multivariate Cox regression analysis was performed to examine determinants of long-term mortality. Results: Among the 162 participants (mean age: 69.4 +/- 8.2 years, 90.1% male), the HALP score was the most significant predictor of inhospital mortality (area under the curve: 0.752, 95% confidence interval: 0.674-0.830; p<0.001). Multivariate Cox regression analysis revealed HALP (p=0.001) and C-reactive protein (p=0.004) as independent determinants of long-term mortality. Conclusion: This study is the first to investigate the association between the HALP score and in-hospital and long-term mortality in EVAR patients. The HALP score is a robust prognostic tool compared with its components and other parameters in this patient population.
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    Predictors of contrast nephropathy after percutaneous intervention of chronic total occlusion in patients with chronic coronary syndrome: A single-center study
    (2023) Yurdam, Ferhat Siyamend; Demir, Yusuf; Bakır, Eren Ozan; Başkurt, Ahmet Anıl
    Objectives: This study was planned to determine the predictors of contrast nephropathy developing after percutaneous coronary intervention (PCI) in patients who underwent coronary angiography due to chronic coronary syndrome and were found to have chronic total occlusion (CTO). Patients and methods: The retrospective observational study included 110 patients with chronic coronary syndrome who were diagnosed with CTO between March 2017 and February 2023. All patients were divided into two groups: 53 patients (29 males, 14 females; mean age: 62.8±10.2 years; range, 42 to 84 years) who developed contrast-induced nephropathy (Group 1) and 57 patients (38 males, 19 females; mean age: 58.8±11.2 years; range, 37 to 79 years) who did not (Group 2). Results: The mean age of the patients in Group 1 was statistically greater than in Group 2 (p=0.04). In the multivariate regression analysis we performed for the prediction of contrast nephropathy in patients with CTO, chronic renal failure (OR: 0.025; 95% CI: 0.001-0.430, p=0.01), amount of opaque substance (OR: 1.115; 95% CI: 1.031-1.206, p=0.006), left ventricular ejection fraction (OR: 0.683; 95% CI: 0.551-0.847, p=0.001), and glucose (OR: 1.046; 95% CI: 1.014-1.078, p=0.004) were found to be independent predictors of contrast nephropathy. Conclusion: Our study revealed that baseline high creatinine (underlying chronic renal failure), high blood sugar that increases plasma osmolarity (uncontrolled diabetes mellitus), high amount of opaque material used, and low left ventricular ejection fraction are predictors of post-PCI contrast nephropathy. Paying attention to correctable risk factors before giving opaque material to patients for whom PCI is planned is valuable in terms of reducing kidney damage.
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    Predictors of coronary tortuosity in patients with chronic coronary syndrome
    (Russian Heart Failure Soc, 2023) Yurdam, Ferhat Siyamend; Kis, Mehmet; Demir, Yusuf; Bakir, Eren Ozan; Akhan, Onur; Guzel, Tuncay
    Aim Coronary artery tortuosity is a common coronary angiographic finding. This tortuosity can cause myocardial ischemia even in the absence of significant coronary artery stenosis. Our aim was to compare the demographic, clinical and echocardiographic features of patients with chronic coronary syndrome (CCS) and with and without coronary artery tortuosity. Material and methods 361 patients who underwent elective coronary angiography (CAG) due to CCS were included in the study. These patients divided into two groups, those with coronary tortuosity (Group 1) and those without (Group 2). Univariable and multivariable logistic regression analysis was performed to identify predictors associated with coronary artery tortuosity. Results The mean age of the 361 CCS patients (44 % female; 56 % male) was 56.7 +/- 11.5 years. In the univariable regression analysis, age, female sex, hypertension (HT), PR interval, QTc interval, ST /T segment changes, left ventricle diastolic dysfunction (LVDD), left ventricle hypertrophia (LVH) were identified as predictors of coronary tortuosity. In the multivariable regression analysis, age (OR: 1.059; 95 %CI: 1.032-1.087, p<0.001) and hypertension (OR: 0.484; 95%CI: 0.278-0.843, p=0.01) were identified as independent predictors of coronary tortuosity. Conclusion Coronary artery tortuosity is an angiographic finding that develops as a result of adaptive mechanisms in the heart and can cause myocardial ischemia. Predictors of coronary artery tortuosity in patients with CCS were long PR and QTc intervals, ST/T segment changes, LVH, LVDD, advanced age, and female gender. Evaluation of these demographic, electrocardiographic, and echocardiographic data may help clinicans to anticipate coronary artery tortuosity in patients with CCS and to be precautious for PCI.