[Treatment of acute tandem occlusion of arteries of anterior cerebral circulation without emergency stenting]. / Lechenie ostroi tandemnoi okkliuzii arterii perednei tsirkuliatsii golovnogo mozga bez ékstrennogo stentirovaniia.

The article deals with problems of endovascular treatment of acute tandem and isolated occlusions of arteries of the anterior cerebral circulation, as well as the problem of reocclusions and new occlusions of these target arteries in the early postoperative period after thrombectomy. PURPOSE: To determine the effect of reocclusions and new, previously not identified occlusions of the carotid artery and middle cerebral artery after cerebral thrombectomy on the outcomes of ischaemic stroke, as well as to substantiate feasibility of endovascular policy without simultaneous carotid stenting in thrombectomy in case of tandem occlusions of arteries of the anterior cerebral circulation. PATIENTS AND METHODS: We studied the results of endovascular treatment of 52 patients with acute ischaemic stroke, including 26 patients with combined occlusions of the internal carotid and middle cerebral arteries (group 1) and 26 patients with isolated occlusion of the M1 segment of the middle cerebral artery or its equivalent (group 2). The groups were compared using the Chi-squared and Mann-Whitney test, and the effect of the factors was assessed by calculating the relative risk. RESULTS: Disability of patients in group 1 was significantly two-fold higher as compared with group 2. Differences in mortality and frequency of a good functional outcome (0-2 points on the Rankin scale) were, on the contrary, insignificant. Reocclusion of the internal carotid artery demonstrated no significant influence on outcomes of the disease in combined type of the lesion. Reocclusion of the target vessel after thrombectomy significantly decreased the probability of a good functional outcome in patients 1.7-fold (p<0.05), as well as increased the relative risk of disability 4-fold in initially isolated occlusion of the middle cerebral artery (p<0.05). CONCLUSION: Surgical policy aimed at thrombectomy from the middle cerebral artery in the presence of tandem occlusions of the internal carotid artery and middle cerebral artery without emergency carotid stenting is safe and efficient in acute period of ischaemic stroke. Reocclusion of the middle cerebral artery after performed thrombectomy related to its isolated occlusion increased the probability of patients' disability. Newly identified in the postoperative period occlusion of the internal carotid artery in thrombectomy from the middle cerebral artery also increased the risk of disability.

[Clinical and neuroimaging heterogeneity of dementia with Lewy bodies]. / Kliniko-vizualizatsionnaia geterogennost' dementsii s tel'tsami Levi.

AIM: To study clinical characteristics of dementia with Lewy bodies (DLB) depending on neuropsychological, neuroimaging and concomitant cerebrovascular changes as well as on the character of disease onset. MATERIAL AND METHODS: Forty-five patients with DLB (25 men and 20 women, men age 72.9±7.2 years, illness duration 2.9±2.2) were studied. The diagnosis was made according to international criteria (McKeith, et al, 2017). MRI, clinical/neurological examination and psychometric scales were used. RESULTS AND CONCLUSION: Clinical, neuropsychological and neuroimaging results reveal the heterogeneity of DLB, which remains poorly investigated. An analysis of the clinical picture, cognitive profile, neuropsychiatric changes and MRI results identified three subtypes of DLB course: 1) typical; 2) with early psychotic manifestation; 3) atypical (mixed). This approach may improve the diagnosis of DLB, prognosis of disease course and treatment effectiveness.

[Clinical, neuropsychological and neuroimaging features of patients with mixed dementia]. / Neiropsikhologicheskaia i neirovizualizatsionnaia kharakteristika smeshannoi dementsii.

Objective. Mixed dementia (MD), characterized by a combination of Alzheimer's disease (AD) and cerebrovascular disease, is one of the most common and, at the same time, poorly diagnosed forms of dementia in the elderly. The aim of our study was to investigate features of AD with its combination with cerebrovascular disease on the basis of clinical, neuropsychological and neuroimaging data. Material and methods. Authors examined 79 patients with dementia: 30 patients with AD, 33 patients with MD and 16 patients with vascular dementia. Patients with MD were older, had more often frontal gait disorders (48.5%), postural instability (45%), pseudobulbar syndrome (60%). Results and conclusion. The neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, in some cases was closer to AD and in others to vascular dementia. A negative effect of vascular risk factors on medial temporal atrophy was found. Neuroimaging changes in MD were correlated with clinical manifestations. Proposed approaches to the diagnosis of MD help to determine more precisely the main directions of the treatment of patients and predict the course of the disease.

[Cerebral amyloid angiopathy]. / Tserebral'naia amiloidnaia angiopatiia.

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of Β-amyloid protein in the media and adventitia of small arteries and capillaries. It may be an independent disease, but is often combined with Alzheimer's disease (AD). This review will discuss up-to-date understanding of the pathophysiology, clinical manifestations of CAA, its diagnosis with neuroimaging and biomarkers. Cerebral microbleeds (CMBs) may be considered as neuroimaging markers of AD and CAA. The clinical significance of CAA is defined by the risk of intracerebral hemorrhages during thrombolytic therapy and warfarin therapy in patients with acute myocardial infarction, pulmonary embolism, ischemic stroke.

[Cerebral microbleeds in cerebrovascular and neurodegenerative diseases].

Cerebral microbleeds (CMBs) are a kind of the morphological changes of the brain associated with damage to small cerebral arteries detected on GRE MRI as small, round, well-defined, hypointense lesions, sized 3-10 mm, which indicate the deposition of hemosiderin. CMBs can be detected in cerebral microangiopathy of different origins (cerebral amyloid angiopathy, hypertensive arteriopathy, vasculitis, hereditary angiopathy) and may be a predictor of macrobleeds. This article discusses the clinical significance of CMBs in cerebrovascular, neurodegenerative diseases, cognitive disorders as well as the possibility of using antiplatelet agents and anticoagulants in patients with CMBs.

[Diagnostics of cavitary processes in the lungs].

The paper concerns CT-semiotics of cavitary processes in the lungs. Their major forms are discussed with reference to underlying pathological changes. The most common manifestations of the diseases associated with the cavitary processes are described. CT is a highly informative method for the visualization of pulmonary cavitation and the surrounding chest structures; this method improves diagnostics of pulmonary pathology.

[Endovascular treatment of ischemic heart disease in patients with multivessel coronary artery disease: immediate and long-term results].

Immediate and long-term results of endovascular treatment of multivessel coronary artery disease by using different revascularization strategies were analyzed in 171 patients. Duration of follow up ranged from 12 to 18 months. Complete myocardium revascularization was performed in 63 patients, culprit vessel revascularization--in 86 pts and incomplete revascularization--in 22 pts. Results of this study showed that strategy of complete and culprit vessel revascularization in patients with multivessel coronary artery disease has comparable immediate and long-term results. Strategy of incomplete revascularization reduce immediate clinical success and lead to increased number of myocardial infarctions and needs of coronary artery bypass surgery in long-term follow-up period.

[Diagnosis, follow-up, and treatment policy making in patients with acute pancreatitis (CT and MRI evidence)].

The paper deals with the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis, followup, and treatment policy making in patients with severe acute severe pancreatitis with manifestations as pancreatic necrosis, fluid collections (exudate accumulations in peripancreatic and retroperitoneal spaces), as well as that complicated by infection, abscess, and pseudocysts. The results of examining 502 patients with acute pancreatitis (AP) with different complications, who had been treated at the S.P. Botkin City Clinical Hospital in 2007 to 2010, were used to analyze the data of the study, to detail tactics in the diagnosis and follow-up of patients with AP, by using bolus contrast-enhanced CT in combination with MRI, which allows one to reveal the nature and severity of the disease with a high accuracy, to make its prognosis, and to determine the effective procedure of treatment. Substantiation of the imperfection of the 1992 Atlanta classification and its specifying Balthazar classification figures high in the paper.

[Potential of endovascular embolization, chemoembolization and chemoimmunoembolization based at a multidisciplinary hospital].

The paper is devoted to a topical problem of modern roentgenovascular surgery, i.e. endovascular embolization. The results of its application in S.P. Botkin City Clinical Hospital demonstrate high efficacy of this method for the arrest of hemorrhage and treatment of various diseases.

[Analysis of immediate and mid-term outcomes of surgical and endoscopic treatment of patients with coronary heart disease and multiple lesions of coronary arteries].

The study included retrospective analysis of the results of treatment in 529 patients with CHD and multiple coronary lesions divided into 2 groups. Group 1 included 280 patients who underwent surgical myocardial revascularization, group 2 comprised 249 patients after coronary stenting. The groups did not significantly differ in the occurrence of serious clinical complications (death, acute myocardial infarction) in both early and mid-late postoperative periods. Patients in group 2 more frequently suffered anginal attacks and required repeat myocardial revascularization. The main factor limiting clinical efficiency of endovascular procedures was coronary restenosis in roughly 34% of the patients.

[The results of endovascular myocardial revascularization and pharmacotherapy in patients with chronic forms of coronary heart disease].

The article covers the results of medicamentous and endovascular methods of treatment of chronic coronary artery disease forms. The results demonstrate improvement in the clinical state, a decrease in drug requirements, an increase in physical tolerance and absence of myocardial ischemia signs during physical load testing in patients after endovascular or surgical myocardial revascularization. At the same time, the frequency of cardial complications and the need for repeated interventions increases. Administration of hypolipidemic therapy allows improvement of prognosis in patients after transluminal balloon coronary angioplasty and stenting.

[The effects of cholesterol-lowering therapy on the results of coronary arterial stenting in patients with chronic forms of coronary heart disease].

The paper presents an analysis of correlations between long-term results of coronary arterial stenting and anticholesterol therapy with statins in 131 patients with chronic forms of coronary heart disease. The study revealed that anticholesterol therapy, when administered regardless the initial cholesterol level, improved the clinical condition of patients with initial hypercholesterolemia, and lowered the necessity of repeated endovascular procedures for restenosis and the progression of atherosclerotic changes. The necessity of repeated interventions is lowered by statin application rather than by normal levels of total cholesterol and low-density lipoproteins.

[The results of direct myocardial revascularization in patients with various forms of coronary heart disease].

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.

[The modern view on the use of aspirin for the primary prophylaxis of cardiovascular diseases in women].

Cardiovascular diseases (CVD) occupy the first place in the world among all causes of disability and death. Aspirin is an effective antithrombocyte agent, the efficiency and safety of which has been demonstrated by numerous studies. Despite its high effectiveness in treatment of acute myocardial infarction and secondary prophylaxis of CVD both in men and women, the use of aspirin for primary prophylaxis is still questionable. Presently, the appropriateness of aspirin application as a means of primary prevention of CVD in women older than 45 has not been clarified yet. The present article discusses this question.

[Multispiral computed tomography in diagnosis of tumors of the mammary gland].

For the first time, results of multispiral computed tomography (MSCT) with intravenous contrast enhancement in diagnosis of difficult case of breast tumors are presented. This method permits localization and staging of tumor. Contrast enhancement aids to reveal small tumors (less 1 cm). Thin sections and algorithm of high image resolution permit to diagnose microcalcinates which are early and important symptoms of malignant tumor. Evaluation of state of regional lymph nodes, analysis of bones permits to evaluate generalization of the process. MSCT-mammography may be used as amplifying method in diagnosis of breast diseases. This method is also indicated in atypical location of cancer. Further studies of MSCT-mammography permit to increase diagnostic value of this method.

[Endovascular treatments in coronary heart disease patients with restenosis after primary ballon angioplasty]. / Endovaskuliarnye metody lecheniia bol'nykh IBS s restenozom posle pervichnoi ballonnoi angioplastiki.

The study was undertaken to comparatively assess the results of stenting and transluminal balloon angioplasty (TBAP) of coronary arteries in patients with chronic forms of coronary heart disease concurrent with restenosis of primary TBAP. The data on 77 patients undergone endovascular procedures for restenosis of prior primary TBAP of coronary arteries at the Moscow Research and Practical Center of Interventional Cardioangiology in March 1997 to May 2003 were analyzed. Group 1 comprised 35 patients with a stent implanted at the site of coronary restenosis; Group 2 included 42 patients undergone repeated TBAP. These groups did not significantly differ in main clinical and functional characteristics, the extent coronary bed lesion, the number of diseased arteries and the morphological type of a coronary lesion (p < 0.05). The angiographic success of secondary TBAP, as well as coronary stenting was 100%. Survival was 100% in the late period. A control examination revealed the clinical picture of angina on exertion in 57.1% and 76.2% of the patients in Groups 1 and 2, respectively (p = 0.039). In the late period, a satisfactory angiographic result of coronary stenting was revealed in most cases (74.3 and 35.7% in Groups 1 and 2, respectively); restenosis was detected in 20 and 59.5% of cases, respectively (p < 0.01); occlusion in 5.7 and 4.8% (p > 0.05). Need for repeated interventional and surgical (aortocoronary bypass surgery) procedures was significantly less after coronary stenting than that after repeated TBAP (20 and 40.5%, respectively). In the late period, the factors significantly increasing a risk for in-stent restenosis were hypercholesterolemia (cholesterol > or = 5.5 mmol/l); the length of restenosis of an operated segment was > or = 18 mm and that of a stent > or = 20 mm. It is expedient to use coronary endroprosthesis to reduce the incidence of repeated restenosis and needs for repeated procedures for myocardial revascularization in the late period.