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    Hematological predictors of silent new cerebral ischemic lesions in carotid artery stenting: A retrospective study
    (Elsevier Sci Ltd, 2024) Altunova, Mehmet; Demir, Yusuf; Gulmez, Recep; Evsen, Ali; Aktemur, Tugba; Sahin, Ahmet Anil; Arslan, Enes
    Background: Silent new cerebral ischemic lesions (sNCIL) are a common complication of carotid artery stenting (CAS) that can lead to an increase in morbidity and mortality. We aimed to evaluate the impact of hematological parameters on sNCIL in patients undergoing CAS. Methods: We retrospectively evaluated 103 patients who underwent CAS, with a mean age of 70.5 +/- 6.7 years, and 31 (20.1 %) of whom were female. Stents were placed for internal carotid artery revascularization. The presence of new hyperintense lesions on diffusion-weighted imaging (DWI) without neurological symptoms was considered as sNCIL in cases without apparent neurological findings. Patients were categorized into two groups based on DWI results: positive (29) and negative (74). Results: In the study population, sNCIL was observed in 29 patients (28.2 %). The DWI-positive group exhibited significantly higher Plateletcrit (PCT) levels, advanced age, and a lack of embolic protection device usage compared to the DWI-negative group. The Receiver Operating Characteristic (ROC) analysis identified a PCT value of 0.26 as the optimal threshold, detecting the development of sNCIL with a sensitivity of 75.9 % and specificity of 59.1 % (AUC: 0.700; 95 % CI: 0.594 -0.806, p = 0.002). Conclusion: To be determined by a simple blood parameter, PCT can predict the risk of sNCIL before CAS and holds clinical value in the treatment of patients with carotid artery stenosis.
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    Impact of the HALP Score on Long-Term Mortality among Patients Undergoing EVAR
    (Galenos Publ House, 2024) Altunova, Mehmet; Evsen, Ali; Demir, Yusuf; Aktemur, Tugba; Erdogan, Onur; Atmaca, Sezgin; Koseoglu, Mehmet
    Introduction: Endovascular aortic repair (EVAR) is commonly used for abdominal aortic aneurysms, but its mortality rate remains high. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which measures hemoglobin, albumin, lymphocyte, and platelet levels, provides prognostic value by reflecting the nutritional status and systemic inflammation. This study aimed to explore the relationship between the HALP score upon admission and long-term mortality in patients with EVAR. Methods: Consecutive patients with EVAR at our tertiary center from October 2010 to August 2021 were retrospectively analyzed. HALP scores were calculated using the following formula: hemoglobin (g/L) x albumin (g/L) x lymphocyte count (/L)/platelet count (/L). In-hospital and long-term mortality data were extracted. Receiver operating characteristic curve analysis identified predictors of in-hospital mortality. Multivariate Cox regression analysis was performed to examine determinants of long-term mortality. Results: Among the 162 participants (mean age: 69.4 +/- 8.2 years, 90.1% male), the HALP score was the most significant predictor of inhospital mortality (area under the curve: 0.752, 95% confidence interval: 0.674-0.830; p<0.001). Multivariate Cox regression analysis revealed HALP (p=0.001) and C-reactive protein (p=0.004) as independent determinants of long-term mortality. Conclusion: This study is the first to investigate the association between the HALP score and in-hospital and long-term mortality in EVAR patients. The HALP score is a robust prognostic tool compared with its components and other parameters in this patient population.
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    Is plasma atherogenic index or LDL/HDL ratio more predictive of peripheral arterial disease complexity?
    (Sage Publications Ltd, 2024) Evsen, Ali; Aktan, Adem; Altunova, Mehmet; Ozbek, Mehmet
    Introduction: The most basic and well-known cause of peripheral arterial disease (PAD) is atherosclerosis. One of the main factors causing atherosclerosis is dyslipidemia. We will evaluate whether specific ratios of dyslipidemia, such as the atherogenic plasma index (AIP) and LDL/HDL ratio, which have recently been used in practice, can help us to predict the complexity of PAD in the clinic. Methods: A total of 305 patients with PAD admitted to our clinic were retrospectively included in this study. After evaluation according to angiography images using TASC-II classification, patients were divided into TASC A-B and TASC C-D. AIP was evaluated with the following formula: Log (TG/HDL). Cut-off values for AIP and LDL/HDL were determined on the ROC (receiver operating characteristic) curve. Logistic regression analysis were conducted to predict peripheral arterial disease complexity. Results: The mean ages of Group 1 (n:180, 68.3% male) and Group 2 (n:125, 77.6% male) patients were 64.10 +/- 12.39 and 64.94 +/- 11.12 years, respectively. The prevalence of diabetes mellitus (DM, p < 0.016) and coronary artery disease (CAD, p < 0.001) was higher in group 2. Group 2 had higher TG (p = 0.045), LDL-C (p = 0.004), AIP (p = 0.010), LDL/HDL (p < 0.001), and lower HDL-C (p = 0.015). In multivariate logistic regression analysis evaluating parameters in predicting PAD complexity, DM (OR: 1.66 Cl 95%: 1.01-2.73 p = 0.045), CAD (OR: 2.86 Cl 95%: 1.75-4.69 p < 0.001) and LDL/HDL (OR: 1.47 Cl 95%: 1.10-1.96 p = 0.008) were independent variables. Conclusion: In our study, we compared LDL/HDL ratio and AIP in PAD for the first time in the literature and showed that LDL/HDL ratio is a more valuable ratio and an independent predictor of PAD complexity.
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    Long-Term Outcomes of Endovascular Intervention for Iliac Artery Stenosis: A Single-Center Experience
    (2024) Altunova, Mehmet; Tasbulak, Omer; Evsen, Ali; Uzun, Nedim; Demir, Yusuf; Panc, Cafer; Atmaca, Sezgin
    Abstract Objectives: This study aims to evaluate the technical success, safety, and long-term outcomes of iliac artery endovascular procedures performed at our institution between 2017 and 2022 and to investigate potential risk factors associated with in-stent restenosis (ISR). Methods: This single-center, observational, retrospective cohort study included 398 patients who underwent endovascular intervention for symptomatic iliac artery stenosis. Data were obtained from electronic records, and patients were followed up clinically and radiologically. Multivariate Cox regression analysis was used to identify independent predictors of ISR. Results: ISR was observed in 11.3% of patients during a mean follow-up of 34.7 months. Atrial fibrillation (AF) (p=0.019) and stent diameter (p=0.006) emerged as independent determinants of ISR development. Kaplan-Meier analysis showed a significant difference in ISR between patients with and without AF (log-rank p = 0.022). Conclusion: This study highlights AF and stent diameter as independent predictors of ISR in long-term follow-ups after iliac artery stenting. Patients with AF may require closer monitoring, while appropriate stent selection is crucial in minimizing ISR risk. These findings contribute to optimizing patient management strategies in peripheral artery disease.  
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    The relationship between hyperpolypharmacy and one-year outcomes in patients with critical limb ischemia undergoing below-knee endovascular therapy
    (Sage Publications Ltd, 2023) Altunova, Mehmet; Gulmez, Recep; Karakayali, Muammer; Gurbak, Ismail; Tasbulak, Omer; Demirci, Gokhan; Guler, Arda
    Background Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality.Methods A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using >= 10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacyResults We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p<.001] and mortality [28 (42.4) versus 12 (9), p<.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality.Conclusion Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI.
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    The relationship between plasma atherogenic index and long-term outcomes after endovascular intervention in superficial femoral artery lesions
    (Sage Publications Ltd, 2023) Altunova, Mehmet; Karakayali, Muammer; Karakan, Ceren Yildirim; Karakurt, Seda Tukenmez; Demirci, Gokhan; Aslan, Serkan; Guler, Arda
    Objectives Peripheral arterial disease (PAD) results from the systemic atherosclerotic process. In this study, we aimed to determine the relationship between plasma atherogenic index (AIP), a ratio of molar concentrations of triglycerides to HDL-cholesterol, and long-term outcomes after endovascular therapy (EVT) in patients with superficial femoral artery (SFA) stenosis. Methods We retrospectively evaluated 673 patients who underwent EVT for PAD in our tertiary center between January 2015 and December 2020. In the receiver operating characteristic (ROC) curve analysis, the AIP value with the optimum cutoff value was determined as 0.576 to detect the presence of major adverse limb events (MALEs). Patients were divided into two groups according to low AIP (<0.576 as group 1) and high AIP (>0.576 as group 2). Results Among the major endpoints, long-term restenosis rates were significantly higher in patients in the high-AIP group than in the low-AIP group (p<.001). The lower extremity amputation rate was not statistically significant between the two groups. All-cause mortality rate (54 (31.6) versus 117 (68.4), p<.001) was significantly higher in patients in the high-AIP group than in the low-AIP group. In addition, the MALE rate (94 (29.2) versus 218 (62.1), p<.001) was significantly higher in patients in the high-AIP group than in those in the low-AIP group. Conclusions In conclusion, we found that AIP is a significant independent predictor of long-term MALE in patients who underwent EVT for SFA.