[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.

[Treatment tactics for patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries].

OBJECTIVE: To evaluate the tactics of surgical treatment of patients with coronary heart disease and atherosclerotic lesions of cerebral vessels in dependence of risk stratification of heart and brain complications. MATERIAL AND METHODS: One hundred and fifty-six patients were examined. Cerebral and coronary blood flow and functional state of the brain and heart were studied. According to treatment characteristics, 3 groups were singled out: patients of the 1(st) group underwent simultaneous surgery of coronary and brachiocephalic arteries, patients of the 2(nd) group were first operated for brachiocephalic arteries, in the 3(rd) group, bypass graft was performed in the first stage. RESULTS AND CONCLUSION: A role of coronary and brachiocephalic arteries, functional state of the myocardium and brain in the postoperative risk was established. The authors suggest the algorithm for choosing the order of priority of surgical interventions on coronary and brachiocephalic arteries.

[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.

[Modern approaches to diagnostics and surgical correction of brachiocephalic arteries disorders in patients with ischemic heart disease].

The main causes of morbidity in Russia are ischemic heart and cerebrovascular disease. The mortality rate of these conditions accounts for almost 50% of all the lethality causes of the Russian population. The frequency of associated coronary and brachiocephalic arteries disorders varies from 18 to 54%. The complex evaluation of the anatomical and functional features of the disorder, as well as of the perfusion and functional heart and brain reserves allows to choose the appropriate methods of surgical treatment of patients with associated coronary and carotid disorders and to decrease the risk of intra- and postoperative cerebral and cardiac complications. The modern approaches of myocardium and cerebral revascularization enable to safely and effectively eliminate the myocardial and cerebral ischemia, to significantly decrease the risk of myocardial infarction and stroke development and to ensure the long ability to work among this group of patients. Over 500 patients with ischemic heart disease and associated brachiocephalic arteries disorders have been operated at the A.N. Bakoulev Scientific Centre for Cardiovascular Surgery for the last 5 years. The results of these operations are comparable to the ones of the leading European clinics.

[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.