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Page 4 of 11 Yaroustovsky et al. Vessel Plus 2019;3:9 I http://dx.doi.org/10.20517/2574-1209.2019.02

Table 1. Clinical characteristics of patients before H.E.L.P.-apheresis therapy
The manifestations
The disorders of lipid metabolism Revascularization
Patients of atherosclerosis Drug therapy Comorbidity
(with drug therapy) procedure
(vessels)
No.1 Hypercholesterolemia (LDL > 4 Coronary Coronary artery Statin (atorvastatin 10) Hypertensive
mmol/L, atherogenic index > 4) stenting (n = 2) antiplatelet agents disease
hypertriglyceridemia (> 4 mmol/L), (clopidogrel, acetylsalicylic Type 1 diabetes,
hyperLp(a)emia (> 60 mg/dL) acid), angiotensin receptor angiopathy,
inhibitors, β-blockers, retinopathy,
L-thyroxine nephropathy.
Hypothyroidism
No.2 Hypercholesterolemia (LDL > 4 Coronary Coronary artery Statin (rosuvastatin 10) Iron deficiency
mmol/L, atherogenic index > 5.5) Brachiocephalic stenting (n = 6) antiplatelet agents anemia
hypefibrinogenemia (> 4 g/L), (clopidogrel, acetylsalicylic Vascular
hyperLp(a)emia (> 200 mg/dL) acid) calcification
β-blockers
No.3 Hypercholesterolemia (LDL > 3.5 Coronary 1. Coronary artery Statins (rosuvastatin 10), Chronic kidney
mmol/L, atherogenic index > 5.5), Brachiocephalic stenting (n = 2); antiplatelets (aspirin, disease, after renal
hypefibrinogenemia (> 4.5 g/L), Femoral 2. Femoral-popliteal xarelto, clopidogrel), ACE transplantation
hyperLp(a)emia (> 60 mg/dL) bypass inhibitors, CA antagonists, Hypertensive
cytostatics disease
Iron deficiency
anemia
Vascular
calcification
LDL: low density lipoprotein

ultrafiltration can be applied (up to 600 mL per session). Up to 4000 mL of plasma can be treated during one
session; it corresponds approximately to one plasma volume circulating in an adult. H.E.L.P.-therapy was
performed on Plasmat Futura (B|Braun, Germany), which is easy to use and safe to apply. Circuit preparation
and reinfusion are automated.

Cascade lipid-filtration is based on the separation (by filtration) on membrane plasma filters with different
permeability capacities. It is a consecutive cascade technique affecting specific range of substances with
the principle of double-filtration plasmapheresis. First, blood is separated from red blood cells when
passing through the plasma filter, and then rheofilter is used for targeted specific elimination of substances.
Rheofilters with different permeability are chosen depending on the aim of the treatment. For lipid apheresis
techniques, extracorporeal circuit should contain the rheofilter with permeability for substances, whose
molecular weight is less than the weight of IgG (< 150000D). After passing through the rheofilter, plasma
filtrate containing IgG, HDL and other substations of plasma with lower weight molecules, is returned to
the patient with the red blood cells. High weight molecules (LDL, Lp(a), VLDL, triglycerides, chylomicrons,
fibrinogen) remain in the rheofilter. Treated plasma volume was 3,500-4,500 mL per session. Cascade lipid-
filtration was performed on Plasauto (Asahi, Japan).

In our study we chose cubital veins as vascular access, and no problems with the satisfactory blood flow were
noted. We evaluated the clinical and laboratory indications before and after the session.

Statistical analyses were performed with IBM SPSS statistics for Windows (Mann-Whitney U test, P values
less than 0.05). The data are expressed as the median and 25th-75th percentiles.

RESULTS
We performed 166 sessions of H.E.L.P.-apheresis and cascade lipid-filtration for 6 patients with
cardiovascular diseases. The procedure frequency was once per 3-4 weeks. No side effects were detected in
the patients during the study (allergic reactions, bleeding, etc.). No circuit thrombosis was observed. The
interviewed patients observed significant improvement of the clinical state. New acute cardiovascular events