[Risk factors and adherence to treatment of patients with cerebrovascular diseases]. / Faktory riska i priverzhennost' lecheniyu patsientov s tserebrovaskulyarnymi zabolevaniyami.

OBJECTIVE: To assess the representation of risk factors and treatment adherence in patients with cerebrovascular diseases. MATERIAL AND METHODS: A single-stage cross-sectional non-comparable study was conducted, which included 492 patients, of whom 133 had an ischemic stroke/transient ischemic attack (main group, MG), 344 had chronic cerebrovascular pathology (comparison group, CG). The representation of risk factors, the state of cognitive functions, the severity of anxiety and depression were evaluated. RESULTS: MG respondents visit specialized specialists more often than CG (p<0.001), are more committed to taking antiplatelet agents (p<0.003), statins (p<0.005), antihypertensive drugs (p<0.005). Regular intake of antithrombotic drugs was associated with the history of ischemic stroke (r=0.483; p<0.01), type 2 diabetes (r=0.637; p<0.011), atrial fibrillation (r=0.481; p<0.001), living in a family (r=0.493; p<0.03). An inverse correlation was established between the systematic intake of antiplatelet drugs and the age of the respondents (r=-0.637; p<0.002), cognitive impairment (r=-0.433; p<0.05), the history of the gastrointestinal tract diseases (gastric ulcer and duodenal ulcer) (r=-0.563; p<0.001). Irregular medication intake was observed in patients aged over 60 years compared with younger (17.3% and 6.4%, respectively, p=0.001), patients living in a family compared with single (85.6% and 65.1%, p=0.032). The history of ischemic stroke or myocardial infarction is associated with increased adherence to regular medication. CONCLUSION: The study of risk factors and the assessment of treatment adherence can ensure the formation of an effective strategy for primary and secondary prevention of cerebrovascular diseases.

[Dynamic of cerebrovascular disorders in patients with carotid stenosis]. / Techenie tserebrovaskuliarnoi patologii u bol'nykh so stenoziruiushchim porazheniem sonnykh arterii.

AIM: To study the state of cerebral hemodynamics and platelet hemostasis in patients with carotid stenosis (CS). MATERIAL AND METHODS: The prospective study included 123 patients with atherosclerotic CS. The 1st group included 53 patients (mean age 52±12.5 yrs) who underwent carotid endarterectomy (CEA); the 2nd group - 70 patients who were treated conservatively (mean age 58.5±15.9 yrs). The state of blood flow through the main arteries of the head (Doppler flowmetry), platelet aggregation induced by adrenaline, the frequency of acute cardiovascular events that occurred during 12 months were evaluated. RESULTS AND CONCLUSION: The severity of neurological deficits and cognitive impairment increased with increasing of the degree of CS. CEA leads to an improvement of cerebral hemodynamics and stabilization of cognitive functions. The adverse course of the disease occurred in 23.6% of patients (stroke/heart attack during the year in 5.7%, progression of cerebral ischemia in 20%, restenosis within 5 years after CEA in 15%). Hyperaggregation of platelets induced by ADP and epinephrine and decreased aggregation of platelets induced by collagen in patients receiving ASA were identified in 53% of the operated and in 60% of non-operated patients. The use of combined antiplatelet therapy normalize the platelet hemostasis and reduce the frequency of acute cardiovascular events.

[Pathogenesis of chronic disorders of cerebral circulation]. / Patogenez khronicheskikh rasstroistv mozgovogo krovoobrashcheniia.

Chronic disorders of cerebral circulation are a common syndrome, in the pathogenesis of which the important role play structural and functional alterations in large and small arteries, autoregulation of cerebral circulation and the level of systemic arterial pressure. Drugs that increase cerebral blood flow and restore the ability to its autoregulation are used, among others, in treatment of patients with CRMC. The possibility of using nicergoline (sermion) for the treatment of patients with CRMK is considered.

[Demographic characteristics of risk factors of ischemic stroke in the Dagestan Republic]. / Demograficheskie osobennosti struktury faktorov riska razvitiia ishemicheskogo insul'ta v Respublike Dagestan.

Objective. To study risk factors for ischemic stroke (II) in patients from the Dagestan Republic. Material and methods. We studied 135 patients (57 women and 78 men) with II, aged from 52-82 years (mean age 68.22±8.25 years). Results and conclusion. The main risk factors for II were: arterial hypertension and cerebral atherosclerosis; 58.5% patients had stenocardia, 34.1% fibrillary oscillation, 17.8% diabetes mellitus, 67.4% excessive body mass, 19.3 survived myocardial infarction and 10.4 - II, 35.6% patients smoked. Hemodynamia, dyslipidemia, distress, diabetes mellitus, myocardial infarction were more often noted in patients from flat regions, excessive body mass and smoking were risk factors for patients from sub-mountain areas and arterial hypertension, cerebral atherosclerosis, fibrillary oscillation for patients from mountain regions.

[Surgical prevention of stroke in patients with carotid stenosis]. / Khirurgicheskaia profilaktika ishemicheskogo insul'ta u bol'nykh so stenoziruiushchim porazheniem vnutrennikh sonnykh arterii

Objectives. To study the cerebral and central hemodynamics in patients with stenotic lesions of inner carotid arteries (ICA) before and after reconstructive surgery. Material and methods. Fifty-nine patients, aged from 46 to 78 years, with >50% atherosclerotic stenosis of ICA who underwent preventive carotid endarterectomy (CEAE) were examined. The isolate stenosis of ICA was identified in 13.6% of patients, concomitant lesions of brachiocephalic arteries in 86.4%. Atherosclerotic lesions of coronary arteries were found in 91.1% of patients and those of arteries of lower extremities in 45.8%. In 25.5% of patients, the heart surgery was performed before the current hospitalization. Heterogeneous atherosclerotic plaques with dense or hyperdense components were more frequents in symptomatic stenosis (63.3%). The maximal stenosis was identified in heterogeneous hyperechogenic plaques, the minimal ones in homogenous hypoechogenic plaques. Parameters of central hemodynamics were better in patients with 2nd stage of reconstructive surgeries. The emission fraction decreased proportionally to the degree of stenosis. The parameters of cerebral hemodynamics were significantly decreased in ICA stenosis and improved in the early post-surgery period. Results. CEAE promoted the improvement of cognitive functions and the recovery of motor functions. The best positive dynamics was recorded in asymptomatic ICA stenosis. Poor outcome (transitory ischemic attacks, urgent surgery, restenosis) was found in patients with low levels of central and cerebral hemodynamics 12-24 months after the discharge. Moreover, smoking and the degree of stenosis predicted poor outcome. Conclusions. Surgical treatment in combination with the complex pharmacotherapy (hypotensive drugs, antiaggregants and statins) had the maximal effect, including the remote period.

[Cerebral venous disorders in young patients with neurotic depression].

Authors examined 143 patients with neurotic depression using ultrasonic Doppler method. Disorders of the cerebral venous hemodynamics associated with clinical symptoms of the disease were found. It is recommended to use ultrasonic Doppler method for the diagnosis and objectification of functional changes in the cerebral blood circulation and for increasing treatment efficacy.

[Changes in cognitive functions in patients with occlusive lesions of brachiocephalic arteries after reconstructive surgery on carotid arteries].

Seventy-six patients after the reconstructive surgery on carotid arteries underwent neuropsychological testing with the MMSE, the FAB, the Clock Drawing Test at baseline and 8-10 days and 3 months after the surgery. Patients were stratified into 3 groups: 20 patients with predominant lesions of one internal carotid artery (group 1), 22 patients with bilateral carotid stenosis (group 2) and 34 patients with the combination of lesions of carotid and vertebrobasilar system (group 3). The association between the rate of spreading of atherosclerotic processes in cerebral vessels and cognitive disorders was shown. The positive effect of reconstructive surgery on cognitive functions of patients was confirmed.

[Cerebral blood flow in neurotic depression: results of ultrasonic dopplerography].

Using the method of ultrasonic dopplerography, authors have investigated the cerebral blood flow in main arteries of the head on extra- and intracranial levels in 83 patients, aged from 20 to 50 years, with depression (ICD-10 codes F32-F33). Different clinical presentations, duration and severity of depression were described. Correlations between these characteristics and the state of cerebral blood flow and changes of sympathoadrenal system were found.

[Cerebral blood flow in syndrome of vertebral artery]. / Tserebral'nyi krovotok pri sindrome pozvonochnoi arterii.

The paper presents the results of clinical-neurologic study of the indices of cerebral hemodynamics (ultrasonic dopplerography of major arteries of the head, transcranial dopplerography) in 114 patients aged 15-36 years with vertebral artery (VA) syndrome. In the clinical status both subjective manifestations and typical vertebral symptomatology prevailed. There were tendencies to changes of blood flow in extracranial arteries of the carotid system that differed in compression-irritative and reflex-angiospastic forms of VA syndrome. The most significant changes (decrease of blood flow velocity, increase of the indices of the kinematics of blood flow) were observed in vertebral and posterior cerebral arteries (PCA), especially in compression-irritative form of VA syndrome. Homolateral decrease of blood flow in PCA was characteristic for unilateral decrease of blood flow in VA. The results show an important role of the changes of cerebral hemodynamics in pathogenesis of the syndrome of VA.

[The cerebral and central hemodynamics of patients with vertebrobasilar stroke]. / Tserebral'naia i tsentral'naia hemodinamika u bol'nykh vertebral'no-baziliarnym insul'tom.

Cerebral and central hemodynamics were studied in 45 patients acutely affected with vertebrobasilar apoplexy. Noninvasive methods-ultrasonic dopplerography of the extracranial carotid and vertebral arteries, unidirectional echocardiography were employed on post-apoplectic days 1, 7 and 21. The same examinations were performed in two groups of control subjects: healthy persons and patients with dyscirculatory encephalopathy degree I and II. The comparison of relevant data elucidated regularities of interaction existing in the changes of cerebral and central hemodynamics in patients with vertebrobasilar apoplexy of moderate severity. Prognostic significance of the findings is characterized.

[Status of central and cerebral hemodynamics in patients with occlusive lesions of major arteries of the head in the acute period of ischemic stroke]. / Sostoianie tsentral'noi i tserebral'noi gemodinamiki u bol'nykh s okkliuziruiushchimi porazheniiami magistral'nykh arterii golovy v ostrom periode ishemicheskogo insul'ta.

A study was made of the central and cerebral hemodynamics in 65 patients with occlusive lesions of the main arteries of the head in the acute period of ischemic brain stroke (on days 1, 7 and 21). Ultrasound dopplerography of the extracranial part of the main arteries of the head and unidimensional echocardiography were employed. Analysis of the linear velocity of the blood flow in the internal carotid and vertebral arteries, of their diameter and volumetric blood flow, and of the central hemodynamics allowed a conclusion that the presence of cardial pathology in ischemic brain stroke promotes a progressive decrease of contractile and pump function of the left ventricular myocardium toward the end of the acute period of ischemic brain stroke.

[Computer-assisted spectrum analysis of Doppler ultrasonograms in occlusive lesions of the carotid arteries]. / Spektral'nyi komp'iuternyi analiz ul'trasonogramm po Dopleru pri okkliuziruiushchikh porazheniiakh sonnykh arterii.

Efficacy of surgical treatment is related to the early diagnosis of extracranial injuries to the carotid arteries. Thirty-five patients with initial manifestations of brain circulatory failure were examined with the aid of spectral computer analysis of ultrasonograms (SCA USG). According to SCA and radiocontrast angiography, 3 grades of stenosis were distinguished: grade I--unevenness of contours, grade II--stenosis exceeding 50%, and grade III--occlusion. Based on the grades of stenosis, 7 quantitative parameters of SCA USG and significance of each parameter were analyzed with the aid of dispersion analysis. The postoperative period was characterized by positive dynamics of the quantitative parameters of SCA USG: spectral enlargement, systolic acceleration; the time of the systolic peak rise.

[Cerebral hemodynamics in occlusive diseases of major extracranial arteries]. / Tserebra'lnaia gemodinamika pri okkliuziruiushchikh porazheniiakh ékstrakrania'lnykh magistra'lnykh arterii.

The blood flow was studied in occlusive disorders of major extracranial blood arteries. Doppler ultrasound was used to quantify the blood flow and velocity in 120 patients. Four stenosis degrees were singled out. In the 1st one, internal carotid artery (ICA) was narrowed by 50%, and blood flow and velocity were reduced by more than 35% as related to normal levels. In 2nd degree stenosis. ICA blood flow decreased below the 65% level and ante- and retrograde blood flow was detected in orbital artery. In 3rd grade stenosis (over 75% ICA occlusion) the retrograde flow in the orbital arteries was recorded and ICA blood flow was considerably reduced. ICA occlusion featured no blood flow in ICA and orbitals, or high retrograde orbital blood flow (p less than 0.001). Reliable criteria were developed for detection of vertebral and ICA stenosis.

[Compression spectral analysis of the EEG of patients with occlusive diseases of the main vessels of the head]. / Kompressionnyi spektral'nyi analiz EEG y bol'nykh s okkliuziruiushchimi porazheniiami magistral'nykh sosudov golovy.

The authors have examined 37 patients with occlusive lesions of the main vessels of the head using electroencephalogram and compression spectral analysis of the EEG findings. A group of patients with the predominant damage to the carotid and vertebral arteries has been identified on the basis of angiographic data. It has been shown that alterations in the bioelectrical activity of the brain are determined by hemodynamic disturbances in patients with transient disorders of the cerebral circulation and circulatory encephalopathy. In patients with acute impairments of the cerebral circulation, the nature of the EEG and spectrogram depends primarily on localization of the ischemic focus. The quantitative parameters of changes in the bioelectrical activity of the brain in different groups of patients are outlined.

[Features of the hemodynamics of major extracranial arteries in patients with occlusive lesions of the brachiocephalic vessels]. / Osobennosti gemodinamiki ékstrakranial'nykh magistral'nykh arterii u bol'nykh s okkliuziruiushchimi porazheniiami brakhiotsefal'nykh sosudov.

The article deals with characteristics of the hemodynamics of the extracranial major arteries in patients with different forms of cerebrovascular insufficiency due to occlusive lesions of the brachiocephalic arteries. Clinicoangiographic characteristics of patients with this pathology associated with atherosclerosis and nonspecific aortoarteritis are presented. Angiography showed two variants of occlusive damage to the brachiocephalic arteries: bicarotid and multiple. The authors were the first to use comprehensive examination of patients with the employment of the spectral computerized analysis (SCA) of ultrasonograms (USG) of the common carotid and suprapubic arteries and ultrasonic angiography with the calculation of the circulation rate in the common carotid arteries. Using SCA of USGs criteria of different degrees of stenosis of the common and internal carotid arteries were developed. A correlation analysis of the data obtained by SCA of USGs and of the values of the circulation rate in the common carotid arteries was made. The highest correlation of these parameters was observed in patients with stenosis of 60-90% and occlusion of the internal carotid and common carotid arteries.