ABSTRACT
Lipid metabolism, lipid peroxidation and hemocoagulation were studied in 276 patients with ischemic brain disease which developed due to atherosclerotic stenoses of the extracranial cerebral arteries (ECA). The main biochemical parameters were evaluated bearing in mind to the severity of vascular and ischemic lesion of the brain. It has been revealed as s result that the rise of the degree of arterial stenosis correlates well with the growth of the content of atherogenic lipoproteins and of the atherogenicity index. Total cholesterol (Chs) and low density lipoproteins (LDL) have a greater effect in the early disease stages whereas the high triglyceride content combined with LDL plays a relatively more important part in the late stages of vascular lesion. Both medium and high degree stenoses of the ECA are associated with a significant increase in the activity of lipid peroxidation and the build up of the number of primary products of free radical oxidation in the overwhelming majority of patients. Changes in the hemostatic system toward hyper-coagulation are associated with the high thrombotic preparedness of blood. The treatment of patients suffering from cerebral ischemia and atherosclerotic stenosfia of the EGA requires correction of the disorders in lipid metabolism, hemocoagulation and hyperreactivity of the vessel wall in different stages of disease.
Subject(s)
Blood Coagulation Disorders/metabolism , Carotid Artery Diseases/metabolism , Carotid Stenosis/metabolism , Cholesterol, HDL/metabolism , Cholesterol, LDL/metabolism , Triglycerides/metabolism , Adult , Aged , Blood Coagulation Disorders/complications , Blood Coagulation Disorders/diagnosis , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Female , Humans , Male , Middle Aged , Severity of Illness IndexABSTRACT
Based on clinical and neurophysiological investigations, triplex scanning of the carotid arteries the authors make a conclusion that early clinical forms of the ischemic diseases of the brain (IDB) in hemodynamically significant atherostenosis of the carotid arteries are characterized by certain neuropsychological and neurological complexes of symptoms dependent on the impairments of blood flow at the main and regional levels. The leading role of hypoperfusion was shown in the development of early forms of the cerebral blood flow impairments in patients with IDB. A significantly increased number of atherosclerotic plaques was shown with the increasing degree of carotid artery stenosis. Specific alterations of the central hemodynamics were determined in early impairments of the cerebral circulation against the background of atherosclerotic stenosing lesion of BCA. A complex comparative investigation of these parameters at the pre- and postoperative stages (after carotid endarterectomy) has shown a practically complete regress of hemodynamic impairments and clinical manifestations of ischemia of brain structures. According to the investigations performed, the timely correction of hemodynamically significant atherostenoses of carotid arteries during revascularization of the brain in such patients allows to carry out primary prophylactics of acute impairments of cerebral blood flow and to increase effectiveness of the treatment.
Subject(s)
Carotid Stenosis/physiopathology , Carotid Stenosis/surgery , Cerebrovascular Circulation , Endarterectomy, Carotid , Adult , Aged , Carotid Stenosis/pathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
To reveal typical changes of higher mental functions in patients with atherosclerotic lesion of internal carotid artery and to estimate influence of operative and non-operative treatment of carotid stenosis upon cognitive function. 42 patients who had undergone carotid endarterectomy (CEA) due to high grade carotid stenosis, and 31 patients treated conservatively were examined. A battery of neuropsychological tests was used to evaluate a state of higher mental functions. The neuropsychological syndrome in patients with carotid stenosis manifests with impairment of verbal and visuospatial memory, attention, disorders of impressive speech and constructive praxis. The degree of cognitive impairment was most severe in patients with bilateral stenosis. CEA performed at early stages of cerebral ischaemia has beneficial effect on cognitive functions. Non-operative treatment and late CEA do not prevent further cognitive decline in patients with carotid stenosis.
Subject(s)
Carotid Artery, Internal/surgery , Carotid Stenosis/surgery , Cognition Disorders/diagnosis , Carotid Stenosis/diagnosis , Carotid Stenosis/epidemiology , Cognition Disorders/epidemiology , Depressive Disorder/epidemiology , Endarterectomy, Carotid , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Postoperative Period , Preoperative Care , Severity of Illness IndexABSTRACT
The clinical picture and functional indices were investigated in 22 patients with hemodynamically significant stenosis of the major arteries of the carotid basin before and after carotid endarterectomy at the period up to 3 years. It was shown that medical efficiency of the carotid endarterectomy was more pronounced in patients with the intact compensatory blood flow.
