[Comparison of morphological features of carotid arteries atherosclerotic plaques with clinical-instrumental data in symptomatic and asymptomatic patients with severe carotid atherosclerosis].

A complex histomorphometric and clinical-instrumental analysis of atherosclerotic lesions of the carotid arteries obtained during carotid endarterectomies (CEE) of patients with hemodynamically significant stenoses was conducted. Two groups of patients were compared: symptomatic, which earlier underwent cerebral vascular accident (CVA) or transitory ischemic attacks (TIA), and asymptomatic ones with no complications of the disease. Statistical analysis of clinical and laboratory data showed no significant differences between two groups except for the level of lipoprotein(a) [Lp(a)] in the blood plasma, which was higher (p<0.05) in asymptomatic patients compared with symptomatic ones. Statistical analysis of carotid arteries ultrasound duplex scanning (USDS) in the preoperative period did not reveal significant differences in the degree of maximum vessels stenosis between the compared groups of patients. Surface defects of atherosclerotic plaques (ASP) were shown to be significantly more common (p<0.05) in the group of symptomatic patients compared with asymptomatic ones. According to histological analysis 88% of extracted ASP was unstable in symptomatic patients and 77% of ASP - in asymptomatic patients. This may indicate high risk of CVA/TIA in both groups of patients. Statistical evaluation of magnetic resonance tomography (MRT) and USDS techniques in comparison with abilities of the most reliable histological analysis showed that both non-invasive diagnostic methods are highly sensitive in detecting unstable ASP, though MRT showed higher level of specificity compared with USDS.

[The oxidation stress, lipid metabolism and their relationship in patients with severe course of hypertension disease in aggregate with carotid stenosis].

The experimental samplings consisted of 25 patients with severe course of hypertension disease in aggregate with atherogenic carotid stenosis before and after carotid endarterectomy and 21 donors. The study was organized to analyze in lipid profile blood serum the content of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The study established that in patients took place a reliably increased level of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The patients with this pathology have a reliable positive correlation between the concentration of malonic dialdehydeand lipoproteids of very low density (r = 0.51), malonic dialdehyde and triglycerides (r = 0.36), malonic dialdehyde and cholesterol (r = 0.3). This data confirms the important role of peroxidation of lipids in the development of atherosclerosis. Therefore, the enhancement of oxidation stress and expressed dislipoproteidemia are established in patients with hypertension disease with carotids atherosclerosis as a background. This result testifies the pathogenic significance of these phenomena in the mechanisms of homeostasis disorders.

[Cognitive functions in patients with stenosing lesion of brachio-cephalic arteries].

Authors studied cognitive functions in 97 patients with different clinical presentations, lateralization and number of stenotic brachio-cephalic vessels. The Luria's syndrome neuropsychological analysis distinctly revealed the topics of cognitive deficits. Wechsler verbal memory tests, the Stroop test (words-figures), the Schulte test were administered as well. Disturbances of high psychic functions were found in 97.9% of patients. The bilateral pathology of lobe regions was noted most often. The dysfunction of parietal and temporal lobes was mainly unilateral and was linked with the side of stenosing process. Disturbances of neurodynamic parameters of mental activity were correlated with the age (higher frequency in patients older than 50 years), a side of stenosis and/or lesion of stroke, bilateral lesions of carotid arteries. The results allow a more precise assessment of clinical significance of carotid stenosis in the development of cognitive dysfunction that may assist in recommendation of surgical treatment.

[Dynamics of higher mental functions and complications in the early post-operative phase of carotid endarterectomy].

Authors conducted a clinical-instrumental examination of 97 patients in the post-operative phase of reconstructive surgery of carotid arteries. Evaluation of neurological status, Luria's syndrome neuropsychological analysis for assessment of higher mental functions dynamics (HMF) were carried out. Pre-operative ultrasound duplex scanning of brachio-cephalic arteries and investigation of cerebral perfusion using spiral computed tomography (SCT-perfusion) were done before and 1 day after the surgery. The frequency of intrasurgery stroke in the area of the operated carotid artery was 2.1%. Pre-operative SCT-perfusion revealed the syndrome of cerebral hyperperfusion in 3.1% of patients with higher (>1 s) difference between the average time of blood transition in temporal areas. Dynamics of HMF was the key clinical indicator that allowed to evaluate the course of nearest post-operative phase and to compare it with an area of operated vessel. Changes of HMF were characterized by the decrease in dysfunction of the hemisphere ipsilateral to the side of operation or had differently directed character. The aggravation of HMF disturbances was found in 40% of patients and was represented by syndromes with different topical location. Causes and mechanisms of the development of these changes are discussed.

[Determining surgical policy in combined atherosclerotic lesion of carotid arteries in patients with uncomplicated aortic aneurysm].

Presented herein are the outcomes of managing a total of twenty-six patients suffering from an uncomplicated abdominal aorta aneurysm with a concomitant atherosclerotic lesion of the coronary arteries, referred to our Clinic over the period form 2003 to 2006. Of these, nineteen (70%) patients were diagnosed with the first (symptom-free) stage of cerebral ischaemic disease, and six presented with the second stage [to have endured a transient ischaemic attack (TIA) within the terms from 16 to 3 months prior to admission]. Two patients had residual events of the previously sustained acute cerebral ischaemia (ACI) (stage 4). The current stage ofischaemic cerebral disease was determined according to the classification of A. V. Pokrovskii (1979). The haemodynamically significant stenoses of carotid arteries (over 70%) were revealed in five patients, an aneurysm of the internal carotid artery - in one patient, and eighteen patients were presenting with the degree of carotid arteries stenosis varying from 30 to 60% (of these, in two subjects after previously endured TIA, the plaque was heterogeneous and defined as embolism-threatening). No atherosclerotic lesions of the carotid artery were revealed in two patients, though these patients had previously sustained an AIA with the preserved neurological deficit by the moment of examination. Eight patients underwent reconstruction of the internal carotid arteries. The average age amounted to 64.5 years. Al of the eight operated on patients with a combination of ischaemic cerebral disease and an aneurysm of the abdominal aorta were found to have had no neurological complications either after the first, or after the second operations. The devised algorithm of examination and surgical management for patients presenting with an abdominal aorta aneurysm and a combined lesion of the brachiocephalic arteries made it possible to reduce the rate of neurological complication from 4.3% to 1.3%.

[Efficacy of surgical and therapeutic methods of repeated carotid ischemic stroke prophylaxis].

Comparative efficacy of surgical and therapeutic methods of repeated ischemic stroke prophylaxis at the patients with clinical symptoms of acute brain ischemia and carotid stenosis less 70% was analyzed. Three-year period of follow-up demonstrated that at the patients who have undergone carotid endarterectomy the repeated ischemic events were seen only at 4 (3.9%), and in the group of therapeutic prophylaxis--at 57 (52.7%). Carotid endarterectomy permits to reduce relative risk of repeated ischemic stroke from 0.77 in therapeutic prophylaxis to 0.07 in surgical treatment. Antiaggregant therapy after surgery is mandatory. Prolonged administration of Clopidogrel permits to reduce restenosis and thrombotic complication rate.

[The efficacy of surgical and conservative methods in secondary prevention of carotid ischemic stroke].

A comparative analysis of the efficacy of surgical and conservative methods in secondary prevention of carotid ischemic stroke has been conducted in patients with clinical symptoms of acute ischemic brain lesions (carotid artery stenosis less than 70%). The results of the 3-year follow-up study revealed that carotid endarterectomua is a method of choice. Comparing to conservative therapy, it allows a reduction of the absolute risk of secondary ischemic episode development to 4% (57% for conservative therapy) and of the relative risk--to 0.07 (0.77 for conservative therapy). The necessity of antiaggregate therapy that enables increased percentage of strokes prevented is proved. Comparing to aspirin, clopidogrel is a drug of choice contributing to the regress of thrombotic layers in the cases of restenosis development in the area of sutures after the interventions using special patches.

[The nature of a relationship of nitric oxide with angiotensin-converting enzyme and malonic dialdehyde in patients with atherogenic stenosis of the internal carotid artery]. / Kharakter vzaimosviazi oksida azota s antiotenzinprevrashchaiushchim fermentom i malonovym dial'degidom u bol'nykh s aterogennym stenozom vnutrennei sonnoi arterii.

In patients with stenosis of the internal carotid artery (ICA), a relationship was studied between the level of nitric oxide (NO) and the activity of angiotensin-conversing enzyme (ACE) and malonic dialdehyde (MDA) in the blood serum taken from: 1) the cubital vein an hour before carotid endarterectomy; 2) ICA before surgery; 3) the internal jugular vein before surgery; 4) ICA 5 min after surgery; 5) the internal jugular vein 5 min after surgery; 6) the cubital vein an hour following surgery. There was a direct correlation between the level of NO and the activity of ACE and an inverse correlation between the content of NO and MDA in the sera taken from the cubital, internal jugular vein, and ICA before and after endarterectomy. There were significant increases in the level of NO, in the activity of ACE, and in the content of MDA and total cholesterol in the serum taken from the cubital vein before carotid endarterectomy, which is indicative of significant oxidative stress and the necessity of its pathogenetic correction.