Publications by authors named "Iwan Dakota"

Background: Endovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia.

Methods: We review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024.

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Article Synopsis
  • Endovascular repair for abdominal aortic aneurysms (AAA) has been the preferred method since 1991, with new techniques like contralateral gate cannulation being developed to enhance the process.
  • A new device called the Taofan and Kang (T&K) bidirectional endovascular aortic repair (B-EVAR) was introduced, utilizing a unique approach to deploy stent grafts through both femoral arteries while ensuring safety and effectiveness.
  • In a pilot study involving six patients, the T&K B-EVAR showed promising results with no complications or prolonged hospital stays, indicating it simplifies the AAA repair process and could be beneficial for a wider range of patients.
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  • Active venous leg ulcers (VLU) are a serious form of chronic venous disease that drastically impact patients' health and quality of life, prompting economic concerns due to the need for treatment.* ! -
  • The study describes three patients with active VLUs treated through endovenous laser ablation (EVLA), which involved using specific laser energy protocols to target severe great saphenous vein reflux.
  • Follow-up results showed significant healing of the ulcers and reduced venous clinical severity scores, indicating that EVLA is a safe and effective treatment for patients with VLUs.
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  • - Varicose veins are a chronic venous disease that can lead to significant healthcare complications if treatment is delayed; common treatments include endovenous laser ablation (EVLA) and stab avulsion.
  • - A 71-year-old woman received innovative treatment for chronic venous insufficiency using direct varicose ablation, which was performed for the first time at the National Cardiovascular Center - Harapan Kita in Indonesia.
  • - The procedure resulted in complete obliteration of the incompetent great saphenous vein without any incisions or complications, and the patient was discharged with no significant issues two days later, highlighting the effectiveness of the Utoh's technique.
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Background: Geographical terrains of Indonesia pose a major hindrance to transportation. The difficulty of transportation affects the provision of acute time-dependent therapy such as percutaneous coronary intervention (PCI). Also, Indonesia's aging population would have a significant impact on the prevalence of acute coronary syndrome in the next decade.

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Background: Suitable aortic neck is one of the essential components for thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR). Advanced techniques were developed to adjust and compromise the aneurysm neck angulation but with adding additional devices and complexity to the procedure. We proposed a simple technique to modify severe neck angulation and/or iliac artery tortuosity by using the multiple stiff wire (MSW) technique.

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  • Acute limb ischemia (ALI) is linked to high morbidity and mortality, particularly after cardiovascular surgeries, raising concerns about patient outcomes.
  • This study analyzed data from 52 patients who developed ALI post-surgery between 2016 and 2020 to identify risk factors affecting mortality rates.
  • The findings showed a 1-year mortality rate of 55.8%, with prolonged cardiopulmonary bypass time and postoperative acute kidney injury identified as significant risk factors for increased mortality.
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Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries. Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies. Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment.

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The incidence of chronic concomitant DeBakey Type II and IIIa aortic dissection is uncommon and complex. Since the mortality rate is very high, it requires a precise and holistic treatment plan. In some cases, when the patients refuse to undergo open surgery or the patients' condition is not suitable for open surgery, thoracic endovascular aortic repair (TEVAR) is the recommended therapeutic approach.

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Middle aortic syndrome presents with segment narrowing of the descending thoracic and abdominal aorta. A common manifestation is uncontrolled hypertension, which can lead to severe aortic regurgitation in the long term. We have presented the case of a 31-year-old woman with worsening heart failure symptoms and longstanding uncontrolled hypertension.

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Introduction And Importance: Wiring true lumen during Thoracic Endovascular Aortic Repair (TEVAR) is sometimes difficult in complicated Type B Aortic Dissection (TBAD).

Case Presentation: We treated a TBAD patient with large false lumen, compressed true lumen and multiple entries. After repeated wire misdirection to false lumen, we tried a new technique in which the wire in the false lumen was looped after entrance to true lumen and pushed distally.

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Background And Aim: The coronavirus disease 2019 pandemic has brought deteriorating physical and mental burdens to health care workers (HCWs) in Indonesia, mainly attributed to the lack of protection and screening among HCWs, patients' concealment of their travel and medical history, and perceived social stigma and discrimination. Hence, we deliver our perspectives and recommendations based on the current situation in Indonesia to enforce their safeties. We encourage stakeholders to implement a systematic approach by employing stringent prevention strategies, ensuring adequate personal protective equipment (PPE) provision and equitable PPE distribution, and routine HCWs screening to prevent nosocomial clusters, in addition to the provision of psychosocial support to HCWs by offering social aids and psychological sessions.

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There has been concern whether the declining cases of ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) outbreak associate with primary angioplasty performance. We assessed the performance of primary angioplasty in a tertiary care hospital in Jakarta, Indonesia, by comparing the door-to-device (DTD) time and thrombolysis in myocardial infarction (TIMI) flow after angioplasty between two periods of admission: during the outbreak of COVID-19 (March 1 to May 31, 2020) and before the outbreak (March 1, to May 31, 2019). Overall, there was a relative reduction of 44% for STEMI admission during the outbreak (  = 116) compared with before the outbreak (  = 208).

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Acute renal occlusion is an uncommon emergency problem in daily practice. The diagnosis is often missed or delayed not only because of its rarity but also nonspecific of clinical presentation. Sudden and complete termination of arterial blood supply to the kidney may lead to renal infarction and a complete loss of renal function.

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Objective: Pro-inflammatory stimuli induce a variety set of microRNAs (miRs) expression that regulate long pentraxin-3 (PTX3) protein, which associates with a procoagulant state in the endothelial cells. We evaluated, for the first time in human, the association of miR-224-3p and miR-155-5p expressions with plasma PTX3 concentration and coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) with symptom onset ≤ 12 h and treated by primary angioplasty. Blood samples for miRs and PTX3 measurement were drawn at emergency department presentation, and were measured by TaqMan real-time PCR and human ELISA kit, respectively.

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There is concern whether patients with ST-segment elevation myocardial infarction (STEMI) who admitted to a percutaneous coronary intervention (PCI) center from interhospital transfer is associated with longer reperfusion time compared with direct admission. We evaluated the reperfusion delays in patients with STEMI who admitted to a primary PCI center through interhospital transfer or direct admission. We retrospectively analyzed 6,494 consecutive STEMI patients admitted between 2011 and 2019.

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Background: There is limited data evaluating the sex differences in outcomes of patients with ST-segment elevation myocardial infarction presenting with acute heart failure. We compared the outcomes between women and men with ST-segment elevation myocardial infarction presenting with acute heart failure (Killip classification ≥II).

Method: All ST-segment elevation myocardial infarction patients presenting to the emergency department of a cardiovascular center in Jakarta, Indonesia, from 1 February 2011 to 30 August 2019 were retrospectively analyzed.

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 Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care.  We evaluated the door-in to door-out (DI-DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network.  We retrospectively analyzed the DI-DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019.

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The association of hyperglycemia at admission and final thrombolysis in myocardial infarction (TIMI) flow with 1-year mortality of patient with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not much been explored. We evaluated the association of hyperglycemia and final TIMI flow with 1-year mortality in patients with acute STEMI who underwent primary PCI. We retrospectively analyzed 856 patients with STEMI who underwent primary PCI in a tertiary care academic center between January 2014 and July 2016.

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Introduction: Although Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection.

Materials And Methods: The design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub.

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Aims: Data on the long-term outcomes of STEMI patients treated via a network in Asian countries are very limited. We aimed to evaluate the characteristics and outcomes of STEMI patients at two different periods, before and five years after the establishment of a regional STEMI network in Jakarta, Indonesia.

Methods And Results: Out of 6,291 patients with STEMI admitted to hospital between January 2008 to January 2016, we compared the characteristics and outcomes of STEMI patients from two different periods, January 2008 to July 2009 (before instalment of the STEMI network, N=624), and from January 2015 to January 2016 (five years after the start of the network, N=1,052).

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Background: Studies with short-term follow-up found higher mortality in patients with STEMI who underwent primary PCI during off-hours as compared to regular working hours. We analyzed the interaction between one and two-year survival of patients with STEMI who underwent primary PCI during regular working hours and off-hours in a tertiary care academic teaching hospital.

Methods: A total of 1126 STEMI patients treated with primary PCI between 2008 and 2013 were analyzed.

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Article Synopsis
  • A study was conducted on 1,024 patients with STEMI, part of a larger cohort of 3,015 patients with acute coronary syndrome, to analyze the characteristics and outcomes of reperfusion therapy in a metropolitan area with a population of about 26 million.* -
  • The results showed that 54% of patients received acute reperfusion therapy, predominantly through primary PCI (86%), with a significant difference in in-hospital mortality rates between non-reperfused patients and those receiving therapy (9.1% vs 3.2% vs 3.8%).* -
  • Additionally, patients at academic PCI centers had better outcomes, including shorter door-to-device times and higher use of advanced procedures, although 46
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Objective: Routine evaluation of performance measures for the system of care for patients with ST-elevation myocardial infarction (STEMI) is needed to improve the STEMI network. We sought to evaluate the current status of reperfusion therapy for STEMI in the capital city of a developing country where a STEMI network was introduced in 2010.

Methods: Data were obtained from a local registry.

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