Cihan Yücel, Mete Gürsoy, Serkan Ketenciler, Aslıhan Tenekeciğil, Feryaz Kızıltan, and Nihan Kayalar. Vasc Specialist Int 2021;37:. https://doi.org/10.5758/vsi.210011

Introduction: Worldwide, >200 million patients are affected by peripheral arterial disease (PAD) and endovascular interventional treatments are increasingly being applied. Contrast-induced nephropathy (CIN) is the third most common cause of renal failure in hospitals. However, factors such as renal vasoconstriction, decrease in renal blood flow, endothelial dysfunction, and oxidative stress have been suggested in the etiology of CIN. Studies are showing that inflammatory markers increase in CIN. Systemic immune inflammation index (SII), a newly defined parameter, is calculated by multiplying the platelet and lymphocyte counts and dividing by the neutrophil count. Studies are showing that this parameter influences prognosis in various cancer types. Considering that inflammation may play a role in CIN, we planned this study to investigate the role of SII in patients undergoing percutaneous peripheral vascular interventions. Material and Method: 300 patients who underwent percutaneous peripheral vascular interventions between August 2018-December 2021 due to peripheral arterial disease were included in the study. The data of the patients were scanned retrospectively from the patient files. The neutrophil-lymphocyte ratio (NLR) was calculated by dividing the neutrophil count by the lymphocyte count. SII was found by multiplying NLR with platelet count Results: Contrast-induced nephropathy developed in 41 (12.3%) patients. CIN(+) patients also, had higher CRP levels (5.1±0.7vs 2.4±0.4,P<0.05), NLR (4.07±1.07vs 2.65±0.84, P<.005), SII score (1778±627.57vs 867.14±491.88, P<.005.) the contrast media used was also higher in CIN(+) patients (176.19±48.44 vs 128.72±48.44;P<0.05) Multivariate logistic regression analysis demonstrated that a high SII score was an independent predictor of development of CIN (odds ratio [OR]: 1.002, 95% confidence interval [CI]: 1.001-1.002, P<.0005) together with high NLR (OR: 3.56, 95% CI: 1.905-6.675, P<.005) and CRP (OR: 1.002, 95% CI: 1.001-1.002, P<.005 Receiver operating characteristic curve analysis demonstrated that the best cutoff value of 1224 for SII to predict the development of CIN with 85% sensitivity and 72% specificity (area under ROC curve 0.904 [95% CI: 0.866-0.942], P<.005). Conclusion: Imbalance in inflammatory cells, the increase in neutrophils, and the decrease in lymphocytes play a role in developing kidney damage. Impaired immune functions due to lymphocytopenia contribute to the development of acute kidney injury. Oxidative stress exacerbates the inflammatory state by increasing inflammatory cell infiltration. AS a result, SII may be a powerful predictor of inflammation and can be used to determine the risk before interventional procedures.

Objective: This study aimed to compare the effects of empagliflozin and dapagliflozin on classical lipid parameters—including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)—as well as on atherogenic risk indices, including the atherogenic index of plasma (AIP), Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II), atherogenic coefficient (AC), and triglyceride-glucose index (TyG), in patients with heart failure and a history of coronary artery bypass grafting (CABG). To our knowledge, this is the first study to comprehensively evaluate these parameters in this high-risk population. Methods: This single-center, retrospective study included 484 patients with preserved ejection fraction heart failure and prior CABG who were treated with sodium–glucose cotransporter-2 (SGLT2) inhibitors. Patients were allocated to empagliflozin (n = 201) or dapagliflozin (n = 283) groups. All patients were receiving statin therapy. Lipid parameters and atherogenic indices were evaluated at baseline and after 12 weeks of treatment. Results: Both empagliflozin and dapagliflozin significantly reduced TC and LDL-C at 12 weeks (p < 0.001). No significant changes were observed in HDL-C or TG. Both agents produced significant improvements in CRI-I, CRI-II, AC, and TyG index (all p < 0.001), while AIP remained unchanged. Dapagliflozin achieved a greater reduction in TC (p = 0.044). Conclusions: This study represents the first direct comparison of empagliflozin and dapagliflozin on lipid profiles and atherogenic indices in patients with heart failure and prior CABG. Both agents significantly improved TC, LDL-C, and atherogenic indices. Dapagliflozin achieved a greater reduction in TC compared with empagliflozin, but overall both drugs demonstrated favorable and largely comparable effects. Beyond improvements in absolute values, both agents also contributed to favorable shifts in risk categories of lipid-derived indices. These findings suggest that clinical decision-making between empagliflozin and dapagliflozin may rely on factors other than lipid modulation. Larger multicenter prospective trials are warranted to confirm these results and clarify their long-term cardiovascular implications.

Objective: The objectives of this study were to characterise induction-phase regional cerebral oxygen saturation (rSO₂)–mean arterial pressure (MAP) dynamics during near-infrared spectroscopy (NIRS)-guided selective carotid endarterectomy (CEA) and to examine whether the Awake→Intubated pressure–oxygenation pattern may represent an early adjunctive physiological signal of subsequent cross-clamp-related ipsilateral cerebral desaturation. Methods: In this retrospective observational cohort study, 322 consecutive elective CEAs managed with an NIRS-guided selective shunting protocol between October 2019 and February 2025 were analysed, after excluding patients considered for routine pre-emptive shunting because of contralateral internal carotid artery occlusion or ≥70% stenosis. Standardised MAP and bilateral rSO₂ values were extracted at the Awake, Intubated, and Clamp stages, defined as 3 min after carotid cross-clamping. Awake→Intubated ipsilateral ΔrSO₂/ΔMAP was evaluated as a continuous, exploratory pressure–oxygenation index, with MAP–rSO₂ directional change classified as concordant or discordant. Clamp-related desaturation was defined as a ≥20% ipsilateral rSO₂ decrease from Awake to Clamp. Discrimination and adjusted associations were evaluated using receiver operating characteristic analysis and multivariable logistic regression, respectively. Results: Clamp-related ≥20% ipsilateral rSO₂ desaturation occurred in 43 patients (13.4%). The Awake→Intubated ipsilateral ΔrSO₂/ΔMAP ratio differed significantly between patients with and without ≥20% desaturation and showed significant discrimination on receiver operating characteristic analysis, with an area under the curve (AUC) of 0.799 (95% confidence interval [CI] 0.723–0.876; p < 0.001). Concordant pressure–oxygenation change was more frequent among patients with ≥20% desaturation (31/43, 72.1%), whereas discordant change predominated among those without desaturation (228/279, 81.7%; p < 0.001). In multivariable analysis, Awake→Intubated ipsilateral ΔrSO₂/ΔMAP remained associated with clamp-related ≥20% desaturation after adjustment (adjusted odds ratio [OR] 1.63, 95% CI 1.15–2.33; p = 0.006), along with symptomatic presentation and 50–69% contralateral stenosis. Postoperative stroke occurred in 4/322 patients (1.2%), and no 30-day mortality occurred. Conclusions: During NIRS-guided selective CEA, induction-phase rSO₂–MAP dynamics were associated with subsequent cross-clamp-related ipsilateral cerebral desaturation. As the outcome was a NIRS-defined desaturation rather than an independent clinical, neurological, or imaging endpoint, these findings indicate association with a surrogate marker rather than prediction of clinically relevant cerebral ischaemia. The Awake→Intubated ΔrSO₂/ΔMAP ratio and directional pressure–oxygenation pattern may represent early adjunctive physiological signals associated with clamp-related desaturation. These findings are hypothesis-generating and require prospective validation with systematic multimodal monitoring.

Objectives: This study aimed to examine the mid-term results of patients who underwent directional atherectomy (DA) for vascular preparation before drug-coated balloon (DCB) angioplasty with superficial femoral artery lesions longer than 150 mm and severe calcification and compare these patients with those treated with DCB angioplasty alone. Patients and methods: This prospective study enrolled 76 patients (66 males, 10 females; mean age: 63.3+9.8 years; range 44 to 105 years) with calcific superficial femoral artery lesions longer than 150 mm treated with DA before DCB angioplasty or DCB angioplasty alone between May 2019 and November 2020. The patients were evaluated in two groups according to DA use: the DA+DCB group with 46 patients and the DCB group consisting of 30 patients. The results of these two methods were compared, and the outcomes were followed up for one year after the treatment. Primary outcomes were patency, freedom from target lesion revascularization, and unplanned amputation. Results: There was no statistically significant difference between the two groups in demographic features, risk factors, comorbidity, and functional capacity assessment tests. At the 12th month, the primary patency of the DCB and DA+DCB group was 66.6% and 82.6%, respectively (p<0.05). Although the bail-out stent requirement rate for the treatment of the flow-limiting dissection (type C-F) was lower in the DA+DCB group (8.6% vs. 10.0%), there was no statistically significant difference (p=0.46). Conclusion: The DA prior to DCB in long segment severe calcific superficial femoral artery lesions may provide better patency and may decrease rate of flow-limiting and non-flow limiting dissections.