Zimbakov, ZHan

Preferred name

Zimbakov, ZHan

Official Name

Zimbakov, ZHan

Translated Name

Zimbakov, Zh, Zimbakov Z, Zan Zimbakov, Zhan Zimbakov, Зимбаков Ж

Main Affiliation

Now showing 1 - 10 of 13

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Safety and Feasibility of Retrograde Recanalization of Radial Artery Occlusion in Patients with Need for Repeated Wrist Procedures
(Scientific Foundation SPIROSKI, 2022-11-25)
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AIM: The purpose of the study was to present a new technique of retrograde recanalization of radial artery (RA) occlusion (RAO) in patients with need for repeated wrist access percutaneous angiographic procedures. MATERIALS AND METHODS: During a 10-year period from March 2011–May 2021, 53 000 patients were referred for percutaneous coronary intervention (PCI) in a high-volume transradial center. RAO on angiography was documented in 1165 patients. Retrograde recanalization of RAO was attempted in 70 patients. The selected patients were with multiple previous bilateral wrist interventions (n = 3–9). Ipsilateral ulnar artery was usually rudimented or occluded and contralateral wrist approach could not be used. We examined clinical and procedure characteristics, access site bleeding and ischemic complications and procedural success of retrograde recanalization of RAO. Visual analog scale (VAS) score forearm pain assessment was performed after procedure. Technique: All patients had palpable pulse distal of previous puncture site due to collaterals from ipsilateral ulnar and interosseous artery. The RA was punctured with an inner metallic needle with a plastic cannula. Using retrograde radial angiography performed by injecting contrast through the plastic cannula, the occluded segment was visualized and crossed with different types of hydrophilic chronic total occlusion guide wires. After sheath insertion, balloon dilatation of the occluded RA segment, successful catheterization, and/or percutaneous coronary intervention was performed. Final RA angiography was performed on all patients. RESULTS: Successful retrograde opening of RAO was achieved in 65 out of 70 patients (92%). PCI was performed in 56% of patients through the opened RAO and 5 patients underwent CAS. Procedural success through opened RA was achieved in all 65 patients. Forearm pain during procedure was present in all cases (VAS score 3 ± 2.1). Access site bleeding EASY score 3 and 4 occurred in 6 patients (8.5%). One patient had discharge of embolic material up the arm without clinical consequences. In one patient, we observed dissection of the interosseous artery. Clinical and duplex long-term follow-up with a median of 4.1 years showed patent RA in only 20 patients. There were no registered cases of hand ischemia. About 61% of patients underwent subsequent PCIs, through other alternative access sites. CONCLUSION: Retrograde recanalization of RAO is successful and safe in patients with need of repeated coronary angiography procedures and inability to use other wrist access sites. Puncturing the collateral and performing retrograde radial angiography through the cannula is a key factor in successful opening of the RAO.
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High Risk Percutaneous Coronary Intervention of Left Main Bifurcation Stenosis in a Peritoneal Dialysis Patient
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2021-10-26)
Bushljetikj, Oliver
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Dezulovic, Frosina Arnaudova
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Complex coronary artery disease is the leading cause of death in patients with end-stage renal disease. We report a case of a patient on peritoneal dialysis, preloaded with Prasugrel and acetylsalicylic acid as а potent dual antiplatelet therapy (DAPT). The patient underwent a high-risk percutaneous coronary intervention (PCI) due to bifurcation stenosis of the left main stem branch. A "double kiss crush" bifurcation stenting technique was performed. This case provides additional data about the treatment of this group of patients, a group that is often excluded from randomized control trials, but is frequently encountered in cardiovascular practice. Furthermore, it helps to advance PCI treatment along with exploring the safety of potent DAPT in a group that is susceptible to both ischemia and bleeding, thus presenting a great challenge in the decision for treatment.
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Sex-related differences regarding cephalic vein lead access for CIEDs implantation
(Springer Science and Business Media LLC, 2021-11-17)
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Risteski, Dejan
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Janusevski, Filip
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Pocesta, Bekim
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Minimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes.</jats:p> </jats:sec><jats:sec> <jats:title>Methods and results</jats:title> <jats:p>This single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (<jats:italic>p</jats:italic>-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Female patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.</jats:p> </jats:sec>
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Acute Arterial Thrombosis in Anticoagulated Patient for Acute Pulmonary Thromboembolism
(Nizameddin KOCA, 2023-04-29)
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Elena Grueva
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Elma Kandic
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Oliver Bushljetikj
Acute limb ischemia is a rare condition in patients with venous thromboembolism (VTE), who already receive anticoagulation treatment. Inflammation is a risk factor for thrombus formation. Patients with active ulcerative colitis, especially at time of exacerbation, are more prone to thromboembolism, both venous and arterial. Risk for thrombosis is 18% higher risk, with also higher risk of bleeding. Up to date, there is no contraindication to any anticoagulant drug in patients with ulcerative colitis. We represent a case of a 73 year - old woman with ulcerative colitis (UC) exacerbation, hospitalized initially for pulmonary thromboembolism, that developed acute arterial thrombosis when switched on novel oral anticoagulant (NOAC).
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SERUM ANTI-OXLDL ANTIBODIES IN PATIENTS WITH ANGRIOGRAPHICALLY CONFIRMED CORONARY ARTERY DISEASE
(Macedonian Association of Anatomists and Morphologists, 2023-12)
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Kostovska, Irena
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Cardiovascular disease (CVD) remains the leading cause of death worldwide. Oxidized low density lipoprotein (oxLDL) is believed to be central to the atherosclerotic cascade. Oxidative modification of LDL induces immunogenic epitopes in the LDL molecule, and the presence of antibodies against oxidized LDL (anti-oxLDL) has been demonstrated in human sera. Anti-oxLDL titer not only can predict a presence of atherosclerotic CAD but may also be a marker of plaque instability. The primary aim of this study was measurement of serum anti ox-LDL concentrations in CAD patients confirmed with coronary angiography. The secondary aim of the study was to evaluate if there is an association between anti-ox-LDL concentration and conventional risk factors for CAD. Ninety patients with coronary artery disease and 90 controls were included in the study. Patients were selected according to the positive result of coronary angiography. Total cholesterol, triglycerides, HDL-c and LDL-c were determined on Roche C311 Cobas Analyzer and OxLDLD and anti-oxLDL were determined with sandwich ELISA technique. We find significant difference between CAD patients and controls regarding OxLDL (p< 0.001). Serum anti OxLDL antibodies were correlated with LDL-c and we found significant correlation (p<0.05) in the CAD group. The regression model showed that the variables Age, BMI, DBP, SBP, Total cholesterol, HDL-c LDL-c and TG explained 30.39% of the variance from the variable anti-ox-LDL. Our results show that serum levels of ox LDL are associated with presence of CAD and with the lipid parameters.
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Persistent foramen ovale as a cause of cerebral strokes in young individuals - case reports
(MIT University Skopje, 2025-03)
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Nikolovski, Robert
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Zhaku, Vegim
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Foramen ovale is a small congenital defect in the level of the interatrial septum of the heart that occurs as a result of the failure of fusion between the septum primum and septum secundum during embryogenesis. It is present in about 25% of the population and is usually clinically insignificant. However, in some cases, it can lead to paradoxical embolism, which may result in an ischemic stroke. Objective: To investigate the association between patients with persistent foramen ovale (PFO) and the occurrence of strokes in young individuals, with a case report. Case Report: A 27-year-old patient presented for a check-up with a history of multiple episodes, especially in the morning, of weakness in the left limbs, particularly the left arm, accompanied by dizziness. These symptoms spontaneously improved, but in the last episode, the symptoms lasted up to 5 hours from the onset. The patient lives in a small area at a higher altitude. The patient was referred for a neurological examination. The neurological examination was unremarkable at the time of the visit, but due to the recurring symptoms, the patient was referred for a magnetic resonance imaging (MRI) scan of the brain, where punctiform hyperintense lesions were detected. The patient was then referred to a cardiologist, where a transthoracic echocardiogram (TTE) revealed a thin septum, leading to a recommendation for transesophageal echocardiography (TEE). TEE showed the presence of a 2mm PFO, after which the decision was made to close it using an Amplatzer PFO Occluder – 25mm in size. Conclusion: Although rare, a transient ischemic attack (TIA) in younger individuals should prompt consideration of the potential existence of PFO. Timely diagnosis and treatment of PFO are crucial for the lives of these patients.
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Left Ventricular Aneurysm with Recurrent Ventricular Tachycardia
(2021-12)
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D. Risteski
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B. Pocesta
BACKGROUND: Ventricular tachyarrhythmias as complication of LV aneurysm are not unusual complication and can lead to sudden cardiac death. The accepted consensus for treatment of LV aneurism is medical therapy unless other indication for surgery exists, or existing treatment cannot control the symptoms. CASE REPORT: A 29-year-old man with no prior cardiac history was admitted to the hospital, after an episode of chest pain accompanied with fatigue and dizziness, for the last 2 h. His electrocardiogram on admission showed ventricular tachycardia with heart rate 260/min. Selective coronarography was performed and no significant stenosis of coronary artery was found. On transthoracic echocardiography, the left ventricle was mildly dilated (ejection fraction 50%), but whole apex was akinetic with giant aneurism. CONCLUSION: Aneurysms of the LV, sometimes associated with malignant ventricular arrhythmias, are very late complication of myocardial infarction. Resection of the aneurysm, although has no high-class recommendation (2), can cure the ventricular arrhythmias, as in presented case.
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Acute Myocarditis after Pfizer-BioNTech COVID-19 m-RNA Vaccination
(Scientific Foundation SPIROSKI, 2022-11-30)
Elena Grueva-Nastevska
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Planinka Zafirovska
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Elma Kandic
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BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. CASE PRESENTATION: We are presenting a patient with heart failure symptoms caused by PVE after Pfizer-BioNTech coronavirus disease-2019 (COVID-19) m-RNA vaccination. CONCLUSION: The exact mechanism of myocarditis in young men who received the second dose of mRNA COVID-19 vaccine is not yet known. However, this is a rare complication and most people generally recover quickly requiring only supportive treatment. In contrast, the risk of developing myocarditis from the viral infection is much higher.
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Role of optical coherence tomography in complex percutaneous coronary interventions(case report)
(Македонско здружение по Кардиологија, 2021-10)
Bushljetikj O
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Zdravkovski I
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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.

Zimbakov, ZHan

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