JofIMAB-2016-vol22-issue3

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REFERENCES: 1. Kiryakova S. [Dietary behavior of students as prevention of chronic non-infectious diseases]. [in Bulgarian] Science dietet. 2011; 3:18-20. 2. American Academy of Pediatric Dentistry. Policy on Oral Health Care Programs for Infants, Children, and Adolescents. Oral Health Policies. revised 2011. [Internet] 3. Neill D. The relationship between masticatory performance and diet. Proc Roy Soc Med. 1973 Jun;66(6):598-599. [PubMed] 4. Holick MF. Vitamin D deficiency. New Engl J Med. 2007 Jul;357(3):266-281. [PubMed] 5. Naydenova D, Porozhanova S, Kavaldzhieva B, Dimitrova E, Gerov T. [Fish products as part of the daily diet of the Black Sea population]. [in Bulgarian] Science dietet. 2011; 3(4):19- 23. 6. Food and Nutrition National Action Plan (2005 - 2010) Republic of Bulgaria, Ministry of Health. [in Bulgarian]. 7. Penchev P. [Rational and preventive professional nutrition]. [in Bulgarian] Sofia: Meditsina I Fizkultura. 1974; 227. 8. Allen LH. Priority areas for research on the intake, composition, and health effects of tree Nuts and peanuts. J Nutr. 2008 Sep;138(9):1763S-1765S. [PubMed] 9. Delikostadinov SG. [Properties of the Bulgarian varieties of peanuts]. [in Bulgarian] Agriculture Magazine. 2009; 3:4. 10. Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007 Jan 16;6:2. [PubMed] [CrossRef]. 11. Fraser G, Sabaté J , Beeson W, Strahan T. A possible protective effect of nut consumption on risk of coronary heart disease. Arch Intern Med. 1992 Jul;152(7):1416-1424. [PubMed] 12. McKiernan F, Mattes RD. Effects of Peanut Processing on Masticatory Performance during Variable Appetitive States. J Nutr Metab. 2010 (2010), 487301, 6. [CrossRef] Please cite this article as: Konstantinova D, Dimova M, Naydenova D. IMPACT OF FOOD PREFERENCES ON THE DEVELOPMENT OF PATHOLOGICAL CHANGES IN THE MASTICATORY APPARATUS IN YOUNG PATIENTS. J of IMAB. 2016 Jul-Sep;22(3):1230-1234. DOI: http://dx.doi.org/10.5272/jimab.2016223.1230 Received: 21/05/2016; Published online: 25/07/2016 Address for correspondence: Desislava Konstantinova, 84, Tzar Osvoboditel bul., 9000 Varna, Bulgaria. E-mail: konstantinovadesi@yahoo.com 1234 http://www.journal-imab-bg.org / J of IMAB. 2016, vol. 22, issue 3/
Journal of IMAB ISSN: 1312-773X http://www.journal-imab-bg.org http://dx.doi.org/10.5272/jimab.2016223.1235 Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3 PERFORMING TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH CAROTID STENOSIS Veselin Valkov 1 , Dobrin Kalchev 1 , Atanas Kostadinov 1 , Branimir Kanazirev 2 1) First Clinic of Cardiology, UMHAT “St. Marina”, Varna, 2) Department of Internal Medicine, UMHAT “St. Marina”, Varna, Medical University, Varna, Bulgaria ABSTRACT: The management of carotid artery disease in patients with severe aortic stenosis referred for transcatheter aortic valve implantation is challenging. By reviewing the very limited amount of literature we will try to answer the question should we perform carotid revascularization before or after the TAVI procedure. Keywords: Transcatheter aortic-valve implantation (TAVI), aortic artery stenosis, carotid stenosis, carotid artery stenting (CAS), carotid endarterectomy (CEA) INTRODUCTION: Combination of aortic stenosis and carotid artery stenosis is not uncommon. Aortic stenosis is a disease with a long latency period, followed by fast progression of the symptoms with a high rate of death. The classic symptoms of aortic stenosis are: angina pectoris – usually during physical effort and relieved by rest; heart failure - typically presents with paroxysmal nocturnal dyspnea, orthopnea, dyspnea during exertion, and shortness of breath; syncope occurs upon physical stress. Syncope is caused by vasodilatation in the presence of a fixed stroke volume and inability of the left ventricle to compensate for a sudden drop of BP when standing up. Less common reason for syncope are AV-blocks and short lasting arrhythmias, due to ischemic arias in hypertrophied myocardium [1, 2, 3]. The atherosclerotic plaques consist of cholesterol crystals, necrotic sells and lipids. When present in carotid arteries they can lead to thrombosis and embolization. Atherosclerotic disease of the carotid artery is usually associated with focal neurological deficit (such as by ipsilateral visual loss, motor skills deficit) caused by transient ischemic attacks (TIAs), strokes and cerebral infarctions [4]. The main indication for carotid revascularization is stroke prevention. It is contraindicated in patients with a severe neurological deficit with cerebral infarction, patients with totally occluded carotid artery and concurrent diseases that reduce the patient’s life expectancy. Patients with severe and symptomatic stenoses have a higher risk of stroke. According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) symptomatic patents with >70% stenoses respond good to the treatment; In symptomatic patients with 50 – 69 % stenoses the profit is negli- gible and appears to be greater for males. Asymptomatic patients with greater than 60% narrowing profit significantly less than first group [5]. Depending on the periprocedural risk carotid endarterectomy (CEA) or carotid artery stenting (CAS) is chosen. Anatomical (bilateral stenosis, postoperative restenosis) and clinical (cardiopulmonary diseases, prior cranial injury) factors can increase the risk during an operation. For stenting they are as follows: anatomical (complex aortic arch and brachiocephalic arterial anatomy, presence of thrombus, and heavy calcification) and clinical (need for heart surgery within 30 days) [6]. “Carotid artery stenosis occurs in 8–13 % of patients with degenerative aortic stenosis. The risk of new postoperative stroke after cardiac surgery is thought to be two- to four-fold higher in patients with concomitant carotid stenosis” [7, 8]. AIM of the study: The aim of this study is to analyze retrospectively additional database containing patients who suffer from aortic and carotid stenosis simultaneously, undergoing TAVI. By reviewing the very limited amount of literature we will try to answer the question should we perform carotid revascularization before or after the TAVI procedure.We try to determine what is the proper way to treat those patient even when they are completely asymptomatic and the carotid stenosis was an accidental finding during the preparational studies for TAVI. Carotid artery stenting is performed in order to reduce the number of ischemic episodes. It has been proven that operative revascularization is highly beneficial for symptomatic patients. Interventional treatment has an advantage over operational when it comes to asymptomatic patients [9]. CAS has evolved rapidly over the last 15 years. Randomized trials comparing stenting with conservative treatment are not available. The role of stenting is not yet clear despite the existence of several studies comparing interventional with operational techniques. CAS should be considered in high surgical risk patients requiring revascularization according to the SAPPHIRE study results [7, 10]. It is recommended by the European Society of Cardiology (ESC) guidelines that symptomatic patients with high surgical risk undergo CAS (Class IIa). It is reasonable to perform CAS on asymptomatic patients with other indications for revascularizaion in high-volume centers with low rates / J of IMAB. 2016, vol. 22, issue 3/ http://www.journal-imab-bg.org 1235
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