Website is intended for physicians



Introduction: the role of intracerebral stenosis of brain arteries in the development of postoperative strokes in patients with extensive atherosclerosis remains unresolved, and in clinical practice, magnetic resonance angiography (MRA) of cerebral arteries is not carried out routinely to predict the risk of postoperative cerebrovascular disorders.

Aim: was to identify factors of MRA of intracerebral arteries essential for prognosis of ischemic strokes in postoperative period of angiosurgical interventions and in acute period of myocardial infarction (AMI), from the quantitative processing of brain MRA recruited from the MRI — MRA register.

Materials and methods: results of brain MRA of 195 patients with extensive atherosclerosis carried out before cardio- or angiosurgical interventions were analyzed. Of these, three had an ischemic stroke after carotid endarterectomy, three — after CABG operations, and five — after surgical treatment of thoracic aortic aneurysms, on 2-5 day after surgery. We also studied results of brain MRA in five patients who developed an episode of ischemic brain stroke in the acute period of acute myocardial infarction. In all cases of circulatory disorders were localized in the region of middle cerebral artery (MCA). Everyone was given a time-of-flight MRA with reconstruction of three-dimensional anatomical picture of cerebral arteries. The index of gradient of narrowing of arterial lumen (GNL) of artery was calculated as the ratio of the difference in the area of artery at stenosis and at nearest proximal non-stenosed level, to the distance between them, along the course of the vessel: GNL={(Snorm–Sstenosis)/Dnorm–stenosis}, mm2/mm.

Results: analyzing the visual picture of brain MRA in patients, the sign of critical narrowing of MCA for >50% was observed in all five patients with acute ischemic stroke concomitant with acute myocardial infarction. In all 11 patients who developed postoperative stroke, the visual picture of MCA stenosis was bilateral, more pronounced on the side of the ischemic disorder after the operation. When using the GNL index, it was obvious that ischemic stroke developed only when the stenosis was more sharp than GSP >1,05 mm2/mm. Of five patients who showed signs of MCA stenosis but did not have postoperative stroke, four took doses of 250 mg/day or more of ethylmethylhydroxypyridine succinate (mexidol) for more than a month at the outpatient stage. The sensitivity of MRA preoperative sign of MCA stenosis in relation to postoperative ischemic stroke was 100% in all groups, the specificity and diagnostic accuracy was 97,5%, the predictability of a positive conclusion was 62,5-75%, and the predictability of a negative conclusion was 97-99%.

Conclusion: technology for evaluating the gradient of narrowing of arterial lumen in the area of atherosclerotic stenosis of intracerebral arteries in patients with extensive atherosclerosis allows predicting the risk of postoperative stroke. Gradient of narrowing of arterial lumen index for atherosclerotic middle cerebral artery over 1,05 mm2/mm in patients with extensive atherosclerosis predicts increased risk of strokes in postoperative period, or as a complication of acute myocardial infarction. Long-term preoperative injection of mexidol probably reduces the risk of postoperative stroke in extensive atherosclerosis.




1.     Louyenko VB, Doudarev VYe, Sorokina YeA. Diagnosis of ishemic stroke reasons early after the surgery in patients with occlusive atherosclerosis of brachiocephalic arteries. Siberian medical journal (Tomsk). 2009; 24(4-2): 62-64 [In Russ].

2.     Filimonova PA, Volkova LI, Alasheev AM, Grichuk EA. In hospital stroke in patients after cardiovascular surgery. Annals of clinical and experimental neurology. 2017; 11(1): 28-33 [In Russ].

3.     Kamenskaya OV, Loginova IYu, Klinkova AS, et al. Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection. S.S.Korsakov Journal of neurology and psychiatry. 2018. 118(7): 12-17 [In Russ].

4.     Bilalova RR, Ibragimova GZ, Zaytseva AR, et al. Combined acute cerebrovascular disease and myocardial infarction treatment experience. Bulletin of Current Clinical Medicine. 2018; 11(5): 16-22 [In Russ].

5.     Berns SA, Zykova DS, Zykov MV, et al. The Role of Multifocal Atherosclerosis in Realization of New Cardiovascular Complications During One Year After Non ST-Elevation Acute Coronary Syndrome. Cardiologia. 2013; 53(8): 15-23 [In Russ].

6.     Garganeeva AA, Tukish OV, Kuzheleva EA, et al. Portrait of the patient with myocardial infarction over a 30-year period. Clinical medicine. 2018; 96(7): 641-647 [In Russ].

7.     Echahidi N, Pibarot P, O'hara G, Mathieu P. Pathogenesis, Prophylaxis and treatment of atrial fibrillation after cardiac surgery interventions. Pathology of circulation and cardiac surgery. 2014; 18(3): 87-96 [In Russ].

8.     Karetnikova VN, Kalaeva VV, Evseeva MV, et al. Chronic renal disease in evaluation of course of postinfarction period. Clinical medicine. 2017; 95(6): 563-570 [In Russ].

9.     Arous EJ, Simons JP, Flahive JM, et al. National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis. J.Vasc.Surg. 2015; 62(4): 937-944.

10.   Belichenko OI, Dadvani SA, Abramova NN, Ternovoi SK. Magnetic resonance tomography in diagnosis of cerebrovascular diseases. Moscow. Vidar Publ.Co. 1998. 112P [In Russ].

11.   Fox AJ. Carotid endartectomy trials. Neuroimaging Clin N Am. 1996; 6(4): 931-938.

12.   Pokrovsky AV, Beloyartsev DF, Talybly OL. Analysis of remote results of eversion carotid endarterectomy. Angiology and vascular surgery. 2014; 20(4): 100-108 [In Russ].

13.   Bobrikova EE, Maksimova AS, Plotnikov MP, et al. Simultaneous cerebral MRI and MR-angiographic study of carotid arteries as screening technique for high-risk carotid atherosclerosis. Siberian medical journal (Tomsk). 2015; 30(4): 49-56 [In Russ].

14.   Purinya BA, Kasyanov VA. Biomechanics of large blood vessels of man. Riga: Zinatne Publ., 1980. 260P [In Russ].

15.   Pedly T. Haemodynamic of large blood vessels. Moscow. Mir Publ., 1983. 400P. [In Russ].

16.   Ussov WYu, Maksimova AS, Sinitsyn VE, et al. Gradient of luminal narrowing of internal carotid artery on atherosclerotic plaque as risk factor for cerebral ischemic damage. Russian Journal of Cardiology. 2019; 24(12): 62-69 [In Russ].

17.   Ragino YuI, Volkov AM, Chernyavskyi AM. Stages of atherosclerotic plaque development and unstable plaque types: pathophysiologic and histologic characteristics. Russ. J.Cardiol. 2013; 5 (103): 88-95 [In Russ].

18.   Medixant. RadiAnt DICOM Viewer [Software]. Version 2020.1. Mar 9, 2020.


19.   Lomivorotov VV, Efremov SM, Pokushalov EA, Boboshko VA. Atrial fibrillation after cardiac surgery operations: pathiphysiology and methods of prophylaxis. Bulletin of anesthesiology and reanimatology. 2017; 14(1): 58-66 [In Russ].

20.   Chernyavskiy AM, Kalybekova AT. Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease. Annals of arrhythmology. 2019; 16(4): 194-03 [In Russ].

21.   Gorokhov AS, Kozlov BN, Kuznetsov MS, Shipulin VM. Concomitant atherosclerosis of carotid and coronary arteries: choice of surgical tctics based on functional reserves of brain. Complex problems of cardiovascular diseases. 2013; (3): 50-56 [In Russ].

22.   Bukhovets IL, Maksimova AS, Plotnikov MP, et al. Ultrasonographic control of cerebral blood flow in patients with stenosis of brachiocephalic arteries before and after carotid endarterectomy. Angiology and vascular surgery. 2018; 24(1): 66-71 [In Russ].

23.   Kokov LS. Rentgeno-surgical methods of diagnosis and treatment of cardiovascular diseases. Urgent medical service. N.V. Sklifosovsky journal. 2013; (1): 23-27 [In Russ].

24.   Prokhorova ES, Kizimenko NN, Prokhorov SI. Magnetic resonance angiography in diagnosis of intracranial aneuisms. Medical Visualisation. 2005; (5): 105-108 [In Russ].

25.   Cho YD, Kim KM, Lee WJ, et al. Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent for intracranial aneurysm: usefulness of source images. Korean J Radiol. 2014; 15(1): 161-8.

26.   Sato K, Yamada M, Kuroda H, et al. Time-of-Flight MR Angiography for Detection of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Moyamoya Disease. Am J Neuroradiol. 2016; 37(7): 1244-8.

27.   Ballotta E, Angelini A, Mazzalai F, et al. Carotid endarterectomy for symptomatic low-grade carotid stenosis. J Vasc Surg 2014; 59: 25-31.

28.   Maximova AS, Bobrikova EE, Bukhovets IL, et al. The structure of atherosclerotic plaque as a defining factor of cerebrovascular reactivity in patients with carotid atherosclerosis. Siberian medical Journal (Tomsk). 2016; 31(2): 38-43 [In Russ].

29.   Baradaran H, Patel P, Gialdini G, et al Quantifying Intracranial Internal Carotid Artery Stenosis on MR Angiography. Am J Neuroradiol. 2017; 38(5): 986-990.

30.   Lishchuk VA, Gazizova DSh, Frolov SV. Mathematical model of vessel bifurcation addressed to cardiovascular clinic. Problems of current sience and praxis. V.I.Vernadski University. 2009; 12(26): 127-131 [In Russ].

31.   Ussov WYu, Plotnikov MP, Del' OA, et al Contrastenhanced MRI of the aortic wall in the efficiency evaluation of ethyl methylhydroxypiridine succinate (mexidol) longterm use to prevent aorticprohression of aortic atherosclerosis. Bulletin of new medical technologies. 2018; 25(1): 125-132 [In Russ].

32.   Khazanov VA. Pharmacological regulation of energy metabolism. Experimental and clinical pharmacology. 2009; 72(4): 61-64 [In Russ]. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы