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Öğe Carotid artery stenting without embolic protection: A randomized multicenter trial (the CASWEP trial)(SAGE Publications Inc., 2022) Görgülü, Şevket; Şahin, Müslüm; Norgaz, Niyazi Tuğrul; Pala, Selçuk; Yalçın, Ahmet Arif; Sipahi, İlke; Sarı, MünevverBackground: Carotid artery stenting (CAS) with a carotid protection device (CPD) has become the standard practice in patients with severe carotid stenosis and high surgical risk. However, the clinical efficacy and safety of CPDs are still controversial issues. We aimed to compare the clinical outcomes of the CAS without CPD with CAS combined with CPD. Methods: This is a multicenter randomized prospective study registered with http://clinicaltrials.gov (NCT02781181). After the exclusion, 279 patients were enrolled (139 patients in the CAS with CPD group and 140 patients in the CAS without CPD group). The primary outcome was a combination of peri-procedural in-hospital transient ischemic attack (TIA), ipsilateral stroke, or death. The secondary outcome was new ischemic brain lesions on post-procedural diffusion-weighted magnetic resonance imaging (DW-MRI). Results: Two patients died in CAS without CPD group, one patient died in CAS with CPD group. TIA was only seen in patients who underwent CAS under protection (n = 5). The combined primary outcome of TIA, ipsilateral stroke, and death rate was not different between groups (5.7% vs. 2.8%; p = 0.254). New defects were noted on the post-procedural DW-MRI in 28% of patients in the CPD group and 27% of patients in the no CPD group (p = 0.881). Conclusions: This study suggests that CAS without CPD is not associated with higher rates of peri-procedural TIA, stroke, and death or new ischemic brain lesions on post-procedural DW-MRI compared to CAS with CPD in selected symptomatic and asymptomatic patients with significant carotid artery stenosis provided that there is no visible thrombus. © The Author(s) 2022.Öğe Comparison of novel Martin/Hopkins and sampson equations for calculation of low-density lipoprotein cholesterol in diabetic patients(ARQUIVOS BRASILEIROS CARDIOLOGIA, 2022) Naser, Abdulrahman; Isgandarov, Khagani; Güvenç, Tolga Sinan; Güvenç, Rengin Çetin; Şahin, MüslümBackground: The accurate determination of low-density lipoprotein cholesterol (LDL-C) is important to reach guidelinere-commended LDL-C concentrations and to reduce adverse cardiovascular outcomes in diabetic patients. The commonly used Friedewald equation (LDL-Cf), gives inaccurate results in diabetic patients due to accompanying diabetic dyslipidemia. Recently two new equations - Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) - were developed to improve the accuracy of LDL-C estimation, but data are insufficient to suggest the superiority of one equation over the other one. Objective: The present study compared the accuracy and clinical usefulness of novel Martin/Hopkins and Sampson equations in diabetic patients. Methods: This study included 402 patients with diabetes. Patients' cardiovascular risk and LDL-C targets were calculated per European guidelines. Calculated LDL-Cmh, LDL-Cs, and LDL-Cf concentrations were compared with direct LDL-C concentration (LDL-Cd) to test agreement between these equations and LDL-Cd. A p-value <0.05 was accepted as statistically significant. Results: Both LDL-Cmh and LDL-Cs had a better agreement with LDL-Cd as compared to LDL-Cf, but no statistical differences were found among novel equations for agreement with LDL-Cd (Cronbach's alpha 0.955 for both, p=1). Likewise, LDL-Cmh and LDL-Cs showed a similar degree of agreement with LDL-Cd in determining whether a patient was in a guideline-recommended LDL-C target (96.3% for LDL-Cmh and 96.0% for LDL- Cs), which were marginally better than LDL-Cf (94.6%). In patients with a triglyceride concentration >400 mg/dl, agreement with LDL-Cd was poor, regardless of the method used. Conclusion: Martin/Hopkins and Sampson's equations show a similar accuracy for calculating LDL-C concentrations in patients with diabetes, and both equations were marginally better than the Friedewald equation.Öğe Formulating and characterizing an exosome-based dopamine carrier system(Jove, 2022) Naser, Abdulrahman; Isgandarov, Khagani; Güvenç, Tolga Sinan; Ekmekçi, Ahmet; Güvenç, Rengin Çetin; Şahin, Müslüm; Gündüz, Sabahattin; Şahin, MüslümExosomes between 40 and 200 nm in size constitute the smallest subgroup of extracellular vesicles. These bioactive vesicles secreted by cells play an active role in intercellular cargo and communication. Exosomes are mostly found in body fluids such as plasma, cerebrospinal fluid, urine, saliva, amniotic fluid, colostrum, breast milk, joint fluid, semen, and pleural acid. Considering the size of exosomes, it is thought that they may play an important role in central nervous system diseases because they can pass through the blood-brain barrier (BBB). Hence, this study aimed to develop an exosome-based nanocarrier system by encapsulating dopamine into exosomes isolated from Wharton's jelly mesenchymal stem cells (WJ-MSCs). Exosomes that passed the characterization process were incubated with dopamine. The dopamine-loaded exosomes were recharacterized at the end of incubation. Dopamine-loaded exosomes were investigated in drug release and cytotoxicity assays. The results showed that dopamine could be successfully encapsulated within the exosomes and that the dopamine-loaded exosomes did not affect fibroblast viability.Öğe Lack of right ventricular hypertrophy is associated with right heart failure in patients with left ventricular failure(Springer, 2022) Naser, Abdulrahman; Isgandarov, Khagani; Güvenç, Tolga Sinan; Ekmekçi, Ahmet; Gündüz, Sabahattin; Güvenç, Rengin Çetin; Şahin, MüslümPresence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a signifcantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3±1.7 mm vs. 6.6±0.9 mm, p=0.02) and the diference remained statistically signifcant after adjusting for confounders (?x?:1.34 mm, p=0.002). RVFWT had a statistically signifcant correlation with tricuspid annular plane systolic excursion (r=0.479, p<0.001) and tricuspid annular lateral systolic velocity (r=0.360, p=0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p<0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a signifcantly higher incidence of RHFÖğe Transcutaneous puncture and successfully retrieval of undeflated peripheral angioplasty balloon(NLM (Medline), 2022) Isgandarov, Khagani; Naser, Abdulrahman; Şahin, Müslüm; Güvenç, Tolga SinanPercutaneous transluminal angioplasty has gained increasing popularity in the treatment of peripheral artery disease. However, the increase in the frequency of this procedure also increases the risk of complications. Percutaneous transluminal angioplasty has serious and general complications in terms of device and technique at puncture and dilatation sites. In this case, we describe the easy and practical management of deflating an undeflated ballon in the right superficial femoral artery.
