[The efficacy of pharmacological preconditioning in carotid endarterectomy].

OBJECTIVE: To assess the efficacy of pharmacological preconditioning with actovegin in carotid endarterectomy. MATERIAL AND METHODS: The study was based on the results of surgical treatment of 80 patients with hemodynamically significant uni- and bilateral lesions of carotid arteries. Half of the patients was operated immediately and others after pharmacological preconditioning with actovegin in dose of 1200 mg/daily during 1,5 months. RESULTS: Pharmacological preconditioning with actovegin increased the cerebral perfusion determined with one-photon emission computed tomography that improved significantly results of the surgery. There were significant changes in patient's state 7 days and 6 months after surgery. The improvement was correlated with the less number of asymptotic post-surgery ischemic strokes in different brain areas. CONCLUSION: A positive role of pharmacological preconditioning with actovegin in surgical treatment of carotid artery stenosis has been demonstrated.

[Pharmacological preconditioning in carotid endarterectomy].

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

[State of the brain blood flow autoregulation].

The brain blood flow autoregulation (BFA) has been studied in normalcy and different variants of atherosclerosis in 97 subjects. Group 1 included 32 patients with obliterating atherosclerosis of the arteries of the low extremities with different stages of chronic artery insufficiency without hemodynamic lesions of brachiocephalic arteries; group 2 consisted of 30 patients wit different forms of chronic brain ischemia with hemodynamically significant unilateral atherosclerotic stenosis of the inner carotid artery (from 70 to 95%). The control group included 35 healthy volunteers aged 20-25 years. BFA parameters were assessed using the original technique worked out by the authors. In the normalcy, the BFA mechanism is able to maintain the constancy of perfusion pressure in the brain due to two major components. In the first stage, it is the aggravation of arterial blood inflow lasting for 1,5 min after the removal of pneumatic cuffs with the following surpassing increase of the venous blood outflow from the scull that decreases the tissue pressure. The most distinct BFA changes were seen in patients with hemodynamically significant stenosis of the inner carotid artery while patients with peripheral atherosclerosis had less marked BFA disturbances.

[Haemorheological problems in lower-limb chronic arterial insufficiency].

Chair of Neurology of the Advanced Medical Training Department of the Federal Educational Facility of the Higher Vocational Education Russian State Medical University under the Russian Public Health Ministry, Moscow, Russia. The article deals with the findings obtained in examining and treating a total of eighty-seven patients suffering from atherosclerosis obliterans of the lower-limb arteries with stage IIB and III chronic arterial insufficiency. Studied were impairments of the theological properties of the blood and plasma, erythrocytic deformability and the concentration of malonic dialdehyde in blood at admission to the hospital, upon completion of the course of conservative treatment, and after the reconstructive vascular intervention performed. It was determined that the leading mechanism disturbing oxygen utilization by tissues is a decrease in erythrocytic deformability, which promotes shunting of the arterial blood flow and persists after the surgical vascular reconstruction preformed.

[Present-day possibilities of correcting impaired autoregulation of the cerebral circulation].

Reviewed herein is the present-day literature data concerning the causes leading to the development of ischemic stroke. Special attention is drawn to the haemodynamic mechanism, of cerebral circulation impairment. Also discussed is the fed of the onset of such disorders in patients suffering from peripheral atherosclerosis during reconstructive surgical vascular interventions, in relation with a multifocal nature of the lesion. Presented are modern findings on diagnostic methods making it possible to assess autoregulatory disorders of cerebral circulation, the main causes of these impairments, as well as potential principles of correction thereof.

[Correction of disordered cerebral blood flow autoregulation in atherosclerosis].

The work deals with studying the parameters of autoregulation of the cerebral blood flow in a total of 127 patients subdivided into four groups. Clinical Group I consisted of thirty 45-to-70-year-old male patients (mean age 55.13 +/- 6.44 years) presenting with no signs of systemic atherosclerosis (CAD, chronic arterial insufficiency of the lower extremities, cerebrovascular insufficiency) or any other chronic diseases (chronic cardiac, pulmonary or renal insufficiency, chronic hepatitis, etc.). Clinical Group II comprised 32 patients diagnosed as having varying-degree chronic arterial insufficiency on the background of atherosclerosis obliterans of the lower-limb arteries (average age 57.46 +/- 5.15 years). Clinical Group III was composed of 30 patients presenting with different degrees of chronic cerebral ischaemia and having haemodynamically significant unilateral atherosclerotic lesions of the internal carotid artery (mean age 55.39 +/- 6.25 years), with the Control Group enrolling thirty-five 20-to-25-year-old volunteers. The findings of the work showed that the patients with atherosclerosis had significant impairments of the cerebral blood flow autoregulation, whose type and degree appeared to depend upon localization of the lesion. In the patients with peripheral atherosclerosis, a 10-day therapeutic course of intravenous administration of alpha-lipoic acid (Berlithion) at a dose of 600 mg daily could be used to correct disordered autoregulation of the cerebral vessels and may be considered from the position of preoperative preparation of such patients for reconstructive vascular interventions on the aorta and lower-limb arteries. Efficacy of alpha-lipoic acid (Berlithion) on the alterations in the cerebral blood flow autoregulation in patients presenting with haemodynamic stenosis of the internal carotid artery is insignificant, in connection with which such patients require surgical restoration of the patency of the major cerebral arteries.