Faculty of Medicine

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Comparison of distal radial with conventional radial access in patients with ST-segment elevation myocardial infarction, undergoing primary percutaneous coronary intervention.
(MDPI (Multidisciplinary Digital Publishing Institute), 2021-12)
Kitanoski, Darko
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Postadzhiyan, Arman
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Velchev, Vasil
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Stoyanov, Nikolay
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Background: There is limited data available regarding the technique of dTRA, and its potential benefit in patients with STEMI. This study investigated the feasibility, safety, and potential benefit of dTRA in patients with STEMI, compared to conventional TR approach. Methods: This was a prospective single center study that included 292 patients referred for STEMI. 152 (52%) patients had primary PCI through distal transradial access, and 140 (48%) had PPCI through conventional radial access. Exclusion criteria was absence of radial artery pulse and previous RAO. We compared clinical and procedure characteristics, access site bleeding complications, rate of Radial Artery Occlusion (RAO) and failure of primary chosen access site between two groups of STEMI patients. Results: The success rate of the puncture for dTRA was 98.7% (150/152), and for conventional TRA 99.3% (139/140). Successful primary PCI via dTRA and conventional TRA was performed in all patients in both groups. dTRA was associated with lower rate of study clinical outcomes as rate of radial artery occlusion (dTRA: 0%, TRA 5.7%, p=0.0028) and local hematoma according to EASY score (dTRA Grade I: 15.13%, Grade II: 0%, Grade III: 0%, Grade IV: 0%, TRA: Grade I 22.9%, Grade II: 7.1%; Grade III: 0.7%, Grade IV: 0%, p=0.0009). There was no difference recorded in radial artery spasm between two access sites (dTRA: Grade I: 7.2%, Grade II: 2.7%, Grade III: 1.3%, Grade IV: 0%, TRA: Grade I 7.1%, Grade II: 2.1%, Grade III: 0.7%, Grade IV: 0%) and there was no statistically significant difference in access site crossover (dTRA: 2 patients, TRA: 1 patient). dTRA was associated with a longer access time (dTRA 38.6 sec, TRA: 36.3 sec, p=0.0077). Time of hemostasis was significantly shorter with dTRA (dTRA 30-60 min, TRA 120-150 min, p<0.0001). Conclusion: dTRA is safe and successful in STEMI patients, when performed by experienced radial operators, with previous experience with dTRA. It is associated with lower rate of access site complications and early haemostasis in comparison with TRA.
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One-year post-Covid-19 follow up
(Macedonian Association of Internal Medicine, 2022-05)
Vraynko, Elif
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Eftimova, Aleksandra
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Trajkova, Marija
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Bushljetikj, Oliver
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DISTAL TRANSRADIAL APPROACH IN HIGH-RISK PATIENT WITH STEMI AND CARDIOGENIC SHOCK – A CASE REPORT
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022)
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Kitanoski, Darko
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Bushljetikj, Oliver
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Conventional transradial access has been considered as a recommended choice in PCI and myocardial revascularization.The vascular complications such as radial artery occlusion, perforation and spasm have led to the development of a new approach, which was proposed to overcome these limitations. This was a distal transradial approach (snuffbox approach). A 74-year-old woman presented to the emergency department with oppressive chest pain and dyspnea formore than 3 hours.On clinical examination, the patient appeared pale and diaphoretic, with weak and rapidpulsation and systolic blood pressure below 70mmHg. A 12 lead ECG lead was performed, whichshowed ST segment elevation of 4 mm in inferior lead.She was admitted to the catheterization laboratory with blood pressure 70/40mmhg andnorepinephrine vasopressor support. A 6Fr introducer sheath was placed in distal radial (anatomical snuffbox). The coronary angiography revealed RCA with acute total occlusion and high thrombotic burden TIMI 5 in proximal segment,normal LMCA, LAD and Circumflex. RCA was engaged with a guide catheter and advanced distally a floppy guidewire, then the occlusion site was predilated with a balloon and advanced stent from proximal segment with TIMI3 final flow. 2D transthoracic echocardiography was performed, and it showed heart failure with mildly reduced ejection fraction and hypokinesia of the inferior wall. Distal transradial access is a new approach which might offer several advantages over conventional radial access such as reduction of the risk of radial artery occlusion, short hemostasis andsaving the radial artery for possible future coronary artery graft.
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Covid infection as devastating post-transplant complication
(Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020)
Dohchev, Sasho
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Trifunovski, Aleksandar
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Trajkovski, Dimitar
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Janchulev, Josif
In march 2020 Covid 19 was declared as a pandemic by World Health Organisation. The marked risk group were older patients and patients with comorbidity such as hypertension, DM, obstructive pulmonary disease and chronic kidney disease. Patients on dialysis and kidney transplant recipients are among highest risk groups to be infected with Corona virus. Since the very beginning, Corona virus pandemic have great impact on the transplant program worldwide. There are recommendations for kidney transplant profe- ssionals that suggest the prioritization of patients for kidney transplantation. We present an expanded criteria donor, and recipient with multiple vascular access problems as an indication for kidney transplantation. In the early posttransplant period vascular problems with implication on the graft function were diagnosed and surgically treated, and cholecystecto- my was performed due to an uncalculous cholecystitis. Unexpected Corona virus infection early post transplan- tation occurred as a devastating complication for our kidney transplant recipient.
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Carotid artery stenting of internal carotid artery "Near occlusion stenosis"- case report
(Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2021-03-31)
Bushljetikj, Oliver
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Zdravkovski, I
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Carotid near-occlusion stenosis is distal luminal collapse of the internal carotid artery beyond a tight stenosis. In everyday practice, it is easily misdiagnosed as a conventional high degree stenosis. Because of the different stroke risk, proper differentiation of these two types of lesions is important for the correct treatment decision. Recent data showed no advantage of best medical therapy versus surgical endarterectomy or carotid artery stenting.We report a case of carotid artery stenting of symptomatic ICANOstenosis without full collapse, via transradial approach, in the presence of contralateral ICA (Internal Carotid Artery) “critical” stenosis. This case provides additional data about optimal treatment of these patients,who are often excluded from randomized control trials (RCT’s), but frequently encountered in the cardiovascular practice.

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