Prospective multicenter online testing of the carotid endarterectomy risk stratification calculator carotidscore.ru.

Aim: To evaluate the incidence of complications, including fatal outcomes, ischemic strokes, and transient ischemic attacks, associated with carotid endarterectomy (CEA) in patients categorized as low-, medium-, and high-risk based on their CarotidSCORE (carotidscore.ru). Material and Methods: This prospective, multicenter study was conducted from January 1, 2022, to December 20, 2022, and enrolled 5,496 patients with stenosis of the internal carotid artery (ICA), who were categorized into four groups according to their risk level. Group 1 (n=1,759) included patients at low risk; Group 2 (n=2,483) included those at medium risk; Group 3 (n=429) included those at high risk, who underwent carotid angioplasty with stenting (CAS) due to the high risk of complications associated with carotid endarterectomy (CEA); and Group 4 (n=825) did not use CarotidSCORE (carotidscore.ru). Patients in Groups 1, 2, and 4 underwent CEA. Results: During the postoperative hospital stay, the highest number of complications, including fatal outcomes (p=0.0007), ischemic strokes (p<0.0001), and the combined endpoints (p<0.0001) were observed in Group 4. No complications were reported in Group 1. Conclusion: The use of CarotidSCORE (carotidscore.ru) allows for the identification of high-risk patients, enabling clinicians to opt for CAS instead of CEA and reduce the incidence of complications.

Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery - analysis of the multicenter Russian register.

Aim: The aim of the study was to assess the role of a temporary carotid shunt in patients undergoing carotid endarterectomy. Materials and methods: This was a retrospective, multicentric (n = 159) study carried out between January 2005 and October 2020. The study included 3114 patients undergoing carotid endarterectomy who had a reduced retrograde internal carotid artery pressure (<60% of systolic blood pressure). A temporary carotid shunt was used in 1328 patients and 1786 patients underwent carotid endarterectomy without a shunt. Results: The in-hospital outcomes were comparable in terms of the incidence of deaths, myocardial infarctions, and stroke between the two groups. However, asymptomatic strokes (confirmed on computed tomography) occurred more frequently in the group where the temporary shunt was used (34 (2.5%) vs. 10 (0.55%), p < 0.0001). The composite endpoints of adverse events were also higher in the group where a temporary shunt was used (44 (3.3%) vs. 28 (1.5%), p = 0.002). The risk of symptomatic stroke (both fatal and non-fatal) was higher in the group where a temporary shunt was not used, though this was statistically not significant. Logistic regression analysis identified diabetes mellitus and stenosis (81-90%) of the contralateral internal carotid artery to be important predictors for stroke. Conclusion: Temporary carotid shunts during carotid endarterectomy were associated with increased rates of asymptomatic stroke. There were no statistically significant differences in the incidence of non-fatal or fatal stroke, myocardial infarction, and mortality.

Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment.

We have described a variant of the structure of the vertebral artery. In the V3 segment, the vertebral artery bifurcated and then joined again. This building looks like a triangle. Such anatomy has not been previously described in the world literature. By the right of the first description, this anatomical formation was called the «vertebral triangle of Dr A.N. Kazantsev¼. This discovery was made during stenting of the V4 segment of the left vertebral artery in the most acute period of stroke.

The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure.

GOAL: Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure. MATERIALS AND METHODS: This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation. RESULTS: Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5.3%, n = 9; group 2: 72.8%, n = 67; group 3: 100%, n = 45; p < 0.0001), rethrombosis (group 1 : 18.4%, n = 31; group 2: 69.5%, n = 64; group 3: 91.1%, n = 41; p < 0.0001), and limb amputations (group 1: 9.5%, n = 16; group 2: 56.5%, n = 52; group 3: 91.1%, n = 41; p < 0.0001) was recorded in group 3 (ventilated) patients. CONCLUSION: In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.

Computer Modeling of Carotid Endarterectomy With the Different Shape Patches and Prediction of the Atherosclerotic Plaque Formation Zones.

The article describes a method for constructing geometric models of the carotid bifurcation and computer simulation of endarterectomy surgery with the patches of various configurations. The purpose of this work is to identify the areas of the greatest risk of restenosis in the constructed models and to conduct a comparative analysis of risk factors when using the patches of different widths and shapes. The method is demonstrated on a reconstructed model of a healthy vessel. Its building is based on a preoperative computed tomography study of a particular patient's affected vessel. The flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasound Doppler velocimetry. Risk factors are assessed through the hemodynamic indices on the vessel wall associated with Wall Shear Stress. The distribution of risk zones in the healthy vessel, presumably leading to its observed lesion (plaque), is analyzed. Comparative evaluation of 10 various patches implantation results is carried out and the optimal variant is determined. The proposed method can be used to predict the hemodynamic results of surgery using patches of various sizes and shapes.

Mathematical Model for the Choice of Tactics of Revascularization in Case of Combined Lesions of the Carotid and Coronary Arteries.

Based on the assessment of the long-term results of various surgical treatment strategies for patients with combined hemodynamically significant lesions of the coronary basin and internal carotid arteries, to develop a model for choosing the optimal revascularization strategy for patients with multifocal atherosclerosis. In 391 patients with combined hemodynamically significant atherosclerotic lesions of the coronary bed and internal carotid arteries, various options for reconstructive operations were performed. 1 - Staged surgery in the volume of coronary artery bypass grafting followed by carotid endarterectomy (n = 151, 38.6%); 2 - Combined coronary bypass surgery and carotid endarterectomy (n=141, 36%); 3 - Hybrid revascularization in the volume of percutaneous coronary intervention and carotidal endarterectomy (n = 28, 7.2%); 4 - Phased surgery in the volume of carotidal endarterectomyand subsequent coronary bypass surgery (n = 71, 18.2%). The study analyzed the frequency and structure of complications in the remote postoperative period (33.95±12.05 months - for of the total sample of patients). To select the optimal tactics of revascularization, the prognostic coefficients of all levels of risk factors for each tactic were evaluated and, on their basis, integral indicators characterizing a comprehensive assessment of risk factors for the corresponding surgical tactics were calculated. The developed model of personalized choice of the optimal surgical strategy, based on a comprehensive assessment of risk factors for an unfavorable outcome (clinical-demographic, coronary and cerebrovascular), makes it possible to predict the likelihood of developing unfavorable cardiovascular ones.

Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension.

OBJECTIVE: Analysis of the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (СЕЕ) (classical with plasty of the reconstruction zone with a patch, eversion, formation of a new bifurcation, autoarterial reconstruction, glomus-saving techniques) in patients with resistant arterial hypertension (RAH). MATERIALS AND METHODS: The actual cohort, comparative, retrospective, open research for the period from January 2013 to December 2021 includes 1577 patients with significant hemodynamic stenosis of the internal carotid artery Depending on revascularization strategy five groups were formed: Group 1: 18.3% (n = 289) - classical Carotid endarterectomy with plasty of the reconstruction zone with a patch (from diepoxy-treated xenopericardium or synthetic); Group 2: 29.9% (n = 472) - eversional CEE with cut-off of carotid gloomus (CG); Group 3: 6.9% (n = 109) - the formation of a new bifurcation; Group 4: 7.4% (n = 117) - autoarterial reconstruction; Group 5: 37.4% (n = 590) - glomus-saving CEE (1 technique - according to A.N. Kazantsev; two technicians - according to R.A. Vinogradov; three technicians - according to K.A.Antsupov). According to the 24-h blood pressure monitor in the preoperative period, the following degrees of AH were identified: 1° - 5.7% (n = 89); 2° - 64.2% (n = 1013); and 3° - 30.1% (n = 475). RESULTS: In the postoperative period, no significant differences were obtained in the frequency of deaths, myocardial infarction, stroke, hemorrhagic transformation. However, according to the frequency of the combined endpoint (death + myocardial infarction + ischemic stroke + hemorrhagic transformation), the lowest rates were observed in the group of classical carotid endarterectomy with plasty of the reconstruction zone with a patch and glomus-sparing CEE (group 1: 1.03% (n = 3); group 2: 3.6% (n = 17); group 3: 3.67% (n = 4); group 4: 2.56% (n = 3); group 5: 0.5% (n = 3); p = 0.10). This is due to the absence of cases of labile AH and hypertensive crises among patients of groups 1 and 5, which was ensured by the preservation of carotid glomus (CG). As a result, the number of patients with 2 and 3 degrees of hypertension in these groups decreased statistically significantly. The vast majority of patients after these operations achieved a stable target SBP. In groups 2, 3, and 4, there was a statistically significant increase in the number of patients with 2 and 3 degrees of AH, which is associated with excision of the CG. CONCLUSION: Classical CEE and glomus-sparing CEE techniques make it possible to achieve a stable target SBP level in patients with RAH as a result of CG preservation. Removal or traumatization of the latter during eversional CEE, the formation of a new bifurcation, autoarterial reconstruction is accompanied by the development of labile hypertension, an increase in the degree of hypertension and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE, accompanied by the lowest incidence of adverse cardiovascular events caused by postoperative hypertensive crisis and hyperperfusion syndrome.

A conservative mutant of a proteolytic fragment produced during fibril formation enhances fibrillogenesis.

The fibrillogenesis of a peptide corresponding to residues 35-51 of human α-lactalbumin (¹GYDTQAIVENNESTEYG¹7) can be dramatically enhanced by the addition of a tetrapeptide TDYG homologous to its C-terminus (TEYG). Generation of spontaneous hydrolytic products similar to this peptide was demonstrated by mass-spectrometry analysis of GYDTQAIVENNESTEYG peptide solution components during fibrillogenesis. Possible mechanisms and roles of short peptides in protein metabolism are discussed.

Amyloidogenic peptide homologous to fragment 129-148 of human myocilin.

Myocilin is a protein with a molecular weight near 50 kDa. It is expressed in almost all organs and tissues. We showed that the peptide DQLETQTRELETAYSNLLRD corresponding to N-terminal Leucine zipper motif (LZM) of the protein is able to form amyloid-like fibrils. The possible role of this motif in myocilin aggregation is discussed.

Structural Features of the Peptide Homologous to 6-25 Fragment of Influenza A PB1 Protein.

A mirror-symmetry motif was discovered in the N-terminus of the influenza virus PB1 protein. Structure of peptide comprised of the corresponding part of PB1 (amino acid residues 6-25) was investigated by circular dichroism and in silico modeling. We found that peptide PB1 (6-25) in solution assumes beta-hairpin conformation. A truncated peptide PB1 (6-13), containing only half of the mirror-symmetry motif, appeared to stabilize the beta-structure of the original peptide and, at high concentrations, was capable of reacting with peptide to form insoluble aggregates in vitro. Ability of PB1 (6-13) peptide to interact with the N-terminal domain of PB1 protein makes it a potential antiviral agent that inhibits PA-PB1 complex formation by affecting PB1 N-terminus structure.

Photodynamic inactivation of influenza virus with fullerene C60 suspension in allantoic fluid.

BACKGROUND: Viruses are the most dangerous infectious contaminants of human donor blood and blood products. The purpose of the study was to investigate the virus-inactivating properties of fullerene suspension regarding influenza virus in allantoic fluid of chicken embryos. METHODS: Influenza virus was propagated in chicken embryos, water suspension of C60 fullerene was added to the allantoic fluid. The fluid was light-irradiated at constant oxygen flow through the specimen, and the dynamics of virus titer was studied by virus titration in MDCK cells. The morphology of virions was studied by electron microscopy (EM). RESULTS: Dramatic drop of infectious titer (8 to 1 log10 EID50) of the virus was observed within 2h after start of irradiation. No change of the titers was observed in control specimens without fullerene, or light, or oxygen. EM study revealed numerous defects of virions' morphology (destruction of outer membrane) leading to the loss of infectious properties of the virus. CONCLUSIONS: Water-insoluble fullerenes may be considered as a prospective way for inactivation of enveloped viruses in biological materials including blood products.