Abstract:

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.

References

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].

https://doi.org/10.17116/jnevro20181187112

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].

https://doi.org/10.20969/VSKM.2018.11(5).16-22

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].

https://doi.org/10.18821/0023-2149-2018-96-7-641-647

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].

https://doi.org/10.18821/0023-2149-2017-95-563-570

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.

https://doi.org/10.1016/j.jvs.2015.04.438

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].

https://doi.org/10.15829/1560-4071-2019-12-62-69

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.

URL: https://www.radiantviewer.com

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.

https://doi.org/10.3348/kjr.2014.15.1.161

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.

https://doi.org/10.3174/ajnr.A4715

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.

https://doi.org/10.3174/ajnr.A5113

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].

https://doi.org/10.24411/1609-2163-2018-15973

32.   Khazanov VA. Pharmacological regulation of energy metabolism. Experimental and clinical pharmacology. 2009; 72(4): 61-64 [In Russ].

Abstract:

In recent years, with the growth of number of patients with multifocal atherosclerosis, revascularization of the brain and myocardium through hybrid intervention is gaining popularity. Although, in the world literature there are practically no results of significant randomized researches concerning percutaneous coronary intervention and carotid endarterectomy in hybrid mode, this technique is becoming more and more preferable and promising in comparison with other methods of treatment.

Aim: was to demonstrate results of revascularization of the brain and myocardium with staged and hybrid strategies, on the base of evaluation of advantages and disadvantages of these strategies on the example of case reports.

Materialsand methods: article presents two case reports, demonstrating different approaches to surgical treatment in patients with combined lesions of arteries of the brain and myocardium. Both patients were over 65 years age, at the time of treatment, had a history of acute cerebral circulation disorders, coronary heart disease and arterial hypertension. At the outpatient stage, they received antiplatelet, hypotensive, and hypolipidemic therapy. During further examination, both patients were found to have unilateral hemodynamically significant stenoses of internal carotid arteries and isolated stenoses of coronary arteries. In first case, patient was selected for hybrid surgical tactics in the volume of carotid endarterectomy and stenting of coronary artery, which was performed with a further favorable prognosis. In the second case, tactics was determined in favor of a staged procedure: first performing carotid endarterectomy, then stenting the affected coronary artery. However, taking into account subjective and objective factors, none of planned interventions were performed.

Results: hybrid revascularization allows to perform correction in two arterial of different regions in a short period of time using surgical and endovascular techniques. An important advantage of this method is the one-time performance, that means correction of MFA manifestations for one hospitalization, or even one anesthesia, with increasing in the availability of revascularization. In the first case report, the successful implementation of a hybrid approach in the treatment of combined vascular pathology in an elderly patient with a burdened anamnesis and significant comorbidities was demonstrated. Within one day, we managed to complete the planned volume of myocardial and brain revascularization and avoid the development of adverse events both in the early postoperative and long-term follow-up periods. The second clinical example clearly shows disadvantages of staged strategy, when the patient is at risk of developing adverse cardiovascular events while waiting for staged interventions, or for subjective reasons may refuse to be hospitalized in a clinic for performimg a particular operation, that as a result, led to negative dynamics and fatal outcome due to acute stroke.

Conclusions: thus, demonstrated case reports show significant potential and effectiveness of hybrid myocardial and brain revascularization using percutaneous coronary intervention and carotid endarteectomy in treatment of patients with combined lesions of two vascular regions. This method of treatment is especially promising in patients with burdened anamnesis and additional risk factors. It not only prevents adverse cardiovascular events in brain and myocardium, but also has greatest availability and implementation of the planned volume of treatment, completely excluding the influence of subjective factors (change of tactics, failure of patient to attend the next stage of treatment, etc.).

References

1.     Bajkov VYu. Combined atherosclerotic lesion of coronary and brachiocephalic arteries - choice of surgical tactics. Bulletin o f Pirogov National Medical & Surgical Center. 2013; 8 (4): 108-111 [In Russ].

2.     Shevchenko YuL, Popov LV, Batrashev VA, Bajkov VYu. Results of surgical treatment of patients with combined atherosclerotic lesions of coronary and brachiocephalic arteries. Bulletin o f Pirogov National Medical & Surgical Center. 2014; 9 (1): 14-17 [In Russ].

3.     Tarasov RS, Kazantsev AN, Ivanov SV et al. Personalized choice of the optimal revascularization strategy in patients with combined lesions of coronary and brachiocephalic arteries: results of testing an automated decision support system in clinical practice. Russian Cardiology Bulletin. 2018; 13 (1): 30-39 [In Russ].

4.     Kazanchyan PO, Sotnikov PG, Kozorin MG, Lar'kov RN. Surgical treatment of multifocal lesions in impaired blood circulation of several arterial territories. Russian Journal of Thoracic and Cardiovascular Surgery. 2013; (4): 31-38 [In Russ].

5.     Zaharov PI, Tobohov AV. Tactics of surgical treatment of generalized atherosclerosis with combined hemodynamically significant defeat of coronary and carotid arteries. Yakut medical journal. 2013; 2 (42): 52-55 [In Russ].

6.     Charchyan ER, Stepanenko AB, BelovYuV, et al. One-Stage Carotid and Coronary Artery Surgeries in Treatment of Multifocal Atherosclerosis. Cardiology. 2014; 54 (9): 46-51 [In Russ].

7.     2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal o f Cardiology. 2019; 24 (8): 151-226 [In Russ].

8.     ESC/ESVS Recommendations for the diagnosis and treatment of peripheral arterial disease 2017. Rossijskij kardiologicheskij zhurnal 2018; 23 (8), 218-221 [In Russ].

9.     Tarasov RS, Kazantsev AN, Ivanov SV, et al. Surgical treatment of multifocal atherosclerosis: coronary and brachiocephalic pathology and predictors of early adverse events development. Cardiovascular Therapy and Prevention. 2017; 16 (4): 37-44 [In Russ].

10.   Tarasov RS, Ivanov SV, Kazantsev AN etal. Hospital results of different strategies of surgical treatment of patients with concomitant coronary disease and internal carotid arteries stenoses. Complex Issues o f Cardiovascular Diseases. 2016; 5 (4): 15-24 [In Russ].

11.   Shilov AA, Kochergin NA, Ganyukov VI. Hybrid myocardial revascularization in multivessel coronary disease. Current state of the issue. Interventional cardiology. 2015; (41): 22-29 [In Russ].

12.   Alekyan BG, Karapetyan NG. Hybrid surgery in treatment of coronary heart disease. Russian journal of Endovascular surgery. 2017; 4 (1): 5-17 [In Russ].

13. Khubulava GG, Kozlov KL, Sedova EV et al. Importance and role of endovascular techniques in the diagnosis and treatment of generalized atherosclerosis in patients of elderly and senile age. Clinical gerontology. 2014; 20 (5-6): 35-40 [In Russ].

14.   Tarasov RS, Kazantsev AN, Ivanov SV et al. Choosing a strategy for brain and myocardial revascularization in patients with atherosclerosis of internal carotid and coronary arteries: a place for personified medicine. Russian journal of Endovascular surgery. 2018; 5 (2): 241-249 [In Russ].

15.   Frota dos Reis PF, Linhares PV, Pitta FG, Lima EG. Approach to concurrent coronary and carotid artery disease: Epidemiology, screening and treatment. Rev Assoc Med Bras. 2017; 63(11): 1012-1016.

16.   Tomai F, Pesarini G, Castriota F et al. Early and Long-Term Outcomes After Combined Percutaneous Revascularization in Patients With Carotid and Coronary Artery Stenoses. Cardiovascular interventios. 2011: 560-8.

17.   Zhang J, Dong Z, Liu P et al. Different Strategies in Simultaneous Coronary and Carotid Artery Revascularization - A Single Center Experience. Arch Iran Med. 2019; 22 (3): 132-136.

18.   Drakopoulou M, Oikonomou G, Soulaidopoulos S et al. Management of patients with concomitant coronary and carotid artery disease. Expert Review o f Cardiovascular Therapy. 2019: 1-32.

Abstract:

Aim: was to elucidate factors of poor prognosis for chronic brain ischemia in «asymptomatic» patients with atherosclerotic stenosis of vertebral arteries, who regularly take optimal medical therapy.

Methods: in 1st group (n = 44), secondary prevention of cerebrovascular accidents was carried out in a combined strategy - stenting of vertebral arteries in combination with medication therapy, and in 2nd group (n = 56) - only medication therapy. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: «asymptomatic» patients with stenosis of vertebral arteries 50-95%; diameter of vertebral arteries is not less than 3.0 and not more than 5 mm; presence of cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of chronic brain ischemia (according to E.V. Schmidt). Primary endpoint: total frequency of cardiovascular complications (death, transient ischemic attack or stroke, myocardial infarction).

Results: the total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (? ²=15.101; p<0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to 1st and 2nd groups (? ²=14.784; p<0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of stents was observed in general, in 38.67% of patients from group I. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (? ²=0.1643; p=0.735). Most significant poor prognosis factors of chronic brain ischemia in «asymptomatic» patients with vertebral artery stenosis, who regularly take optimal medical therapy are: arrhythmia, total cholesterol more than 6.0 mmol/l, incomplete circle of Willis, arterial hypertension, bilateral defeat of vertebral arteries, (low-density lipoprotein) LDL levels of more than 3.5 mmol/I, combined lesion of vertebral and carotid arteries, calcification of vertebral arteries, coronary heart disease in anamnesis.

Conclusion: endovascular intervention in combination with medical therapy could help to avoid the development of major brain complications arising from the instability of atherosclerotic plaque in «asymptomatic» patients with vertebral artery stenosis, and in the presence of poor prognosis factors identified can be regarded as a method of secondary prevention of cerebral circulatory disorders.

References 

1.     Britov AN, Pozdnyakov YuM, Volkova EG, et al. National guidelines on cardiovascular prevention. Kardio-vaskulyarnaya terapiya i profilaktika. 2011;10(6)2: 1-64 [In Russ].

2.     Suslina ZA, Guglevskaja TS, Maksimova MJu, Morgunov VA. Cerebrovascular accidents: diagnosis, treatment, prevention. Moscow: MEDpress-inform, 2016, 440 [In Russ].

3.     Shchukin IA, Lebedeva AV, Burd GS, et al. Chronic cerebral ischemia: syndromological approaches to thera­py. Nevrologiya irevmatologiya. 2015;1:17-24 [In Russ].

4.     Zakharov W, Voznesenskaya TG. Neuropsychiatric Disorders: Diagnostic Tests; podobshch. red. N.N.Yakhno. M.: MEDpress-inform, 2015: 320 [In Russ].

5.     Chechetkin AO, Skrylev SI, Koshheev AJu, et al. Clinical and instrumental assessment of the effectiveness of stenting of the vertebral arteries in the near and remote postoperative periods. Annaly klinicheskoj i jeksperimental'noj nevrologii. 2018;12(3): 13-22 [In Russ].

http://doi.org/10.25692/ACEN.2018.3.2

6.     Sermagambetova ZhN, Maksimova MJu, Skrylev SI, et al. Interventional technologies for the prevention of stroke in the vertebral-basilar system. Consilium Medicum. 2017;19(2): 96-103 [In Russ].

7.     Migunova SG. Clinical and epidemiological study of cerebrovascular diseases and a comparative analysis of the effectiveness of treatment of patients with cerebral atherosclerosis: Diss. kand. med. Ekaterinburg, 2018: 145 [In Russ].

8.     Aboyans V, Ricco JB, Bartelink MEL et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Soci­ety for Vascular Surgery (ESVS). Eur J Vase Endovasc Surg. 2017 Aug 26.

http://doi.org/10.1093/eurhearti/ehx095

9.     Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardio­vascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal. 2020;41:255-323.

http://doi.org/10.1093/eurhearti/ehz486

10.   Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2020;41: 111-188.

http://doi.org/10.1093/eurhearti/ehz455

11.   Kamchatnov PR, Umarova HJa, Kabanov AA, Abieva NA. The problem of diagnosis and treatment of patients with vertebrobasilar insufficiency. Lechebnoedelo. 2017;3: 68-75 [In Russ].

12.   Kocak B, Korkmazer B, Islak C, et al. Endovascular treatment of extracranial vertebral artery stenosis. World J. 2012;4:391-400.

http://doi.org/10.4329/wir.v4.i9.391

13.   Markus HS, Larsson SC, Kuker W, et al. VIST Investigators. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischemia Stenting Trial. Neurology. 2017;89(12):1229-1236.

http://doi.org/10.1212/WNL.00000000000Q4385

14.   Babayan GB, Zorin RA, Pshennikov AS, et al. Predictors of neurological deficiency in hemodynamically significant stenoses of the carotid and vertebral arteries. Nauka molodykh (Eruditio Juvenium). 2019;7(4): 533-540 [In Russ].

http://doi.org/10.23888/HMJ201974533-540

15.   Rakhmonov RA, Todzhiddinov ТВ, Isoeva MB, Zuurbekova DP. Total Cardiovascular Risk - A New Approach to Stroke Prediction. Vestnik Avitsenny. 2017;19(4): 471-475. [In Russ].

http://doi.org/10.25005/2074-0581-2017-19-4-471-475

16.   Shao JX, Ling YA, Du HP, et al. Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis. M edicine(Baltimore). 2019;98( 13): e14899.

http://doi.org/10.1097/md.0000000000014899

Abstract:

Aim. For determination of Alzheimer's disease (AD) stages, we offer a morphologically determined scale - The Tomography Dementia Rating scale (TDR) based on the severity of atrophic changes in the temporal lobes of the brain revealed during CT and MRI. Materials and methods. The research involved 140 patients aged 28-79. The Test Group included 81 patients aged 34-79 with AD various stages. The Control Group included 59 patients aged 28-78 with various types of brain lesions accompanied by manifestations of dementia and cognitive impairment, but not suffering from AD.

Results. CT and MRI data allowed to compose the TDR scale determining the severity of atrophic changes in the temporal lobes at each AD stage:

•          Pre-clinical AD stage TDR-0: temporal lobes atrophy with 4-8% tissue mass decrease (26-28 MMSE points).

•          Early AD stage - mild dementia TDR-1: temporal lobes atrophy with 9-18% tissue mass decrease (corresponds to CDR-1; 20-25 MMSE points).

•          Middle AD stage - mild dementia TDR-2: temporal lobes atrophy with 19-32% tissue mass decrease (corresponds to CDR-2; 12-19 MMSE points). 

References

1.     Alzheimer’s Disease Facts and Figures, 2007. A Statistical Abstract of US Data on Alzheimer’s Disease published by the Alzheimer’s Association http://www.alz.org/national/documents/Report_2007FactsAndFigures.pdf.

2.     Alzheimer’s Disease Facts and Figures 2009 Alzheimer’s Association. http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf.

3.     Alzheimer's Disease Facts and Figures

3.     2010 Alzheimer’s Association. http://www.alz.org/ documents_custom/report_alzfactsfigures2010.pdf.

4.     2011 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2011.pdf.

5.     Generation Alzheimer’s: The Defining Disease of the Baby Boomers http://act.alz.org/site/Doc-Server/ALZ_BoomersReport.pdf/docID=521.

6.     Jun G., Naj F.C., Beecham G.W., et al. Meta-analysis confirms CR1, CLU, and PICALM as Alzheimer disease risk loci and reveals interactions with APOE genotypes. Arch. Neurol. 2010; 67 (12):1473-1484.

7.     Saykin A.J, Wishart H.A. Mild cognitive impairment: conceptual issues and structural and functional brain correlates. Seminars in Clinical. Neuropsychiatry. 2003; 8 (1): 12-30.

8.     Saykin A.J., Wishart H.A., Rabin L.A., et all. Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology. 2006; 12 No. 67 (2): 834-842.

9.     Shen L., Fipri H.A., Saykin AJ.,West J.D. Parametric surface modeling and registration for comparison of manual and automated segmentation of the hippocampus. Hippocampus. 2009; 19 (6): 588-595.

10.   Maksimovich I.V. Vozmoznosti covremennoy kompiuternoy tomografii v diagnostike bolezni Alzheimra.[Possibilities of computed tomography in diagnostics of Alzheimer’s diseases.] Nevrologicheskiy vestnik .2009; 1: 5-10 [In Russ].

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81.

11.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., Manly J.J. et. all. “Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

12.   Seashadri S., Beaser A., Au R., Volf P.A., Evans D.A. et.al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 2. Alzheimers & Dementia. 2011; 7 (I): 35-52.

13.   2012 Alzheimer’s Disease Facts and Figures. http://www.alz.org/downloads/facts_figures_2012.pd.

14.   National Plan to Address Alzheimer's Disease http: / /www.whitehouse.gov/ blog/2012/05/17/national-plan-address- alzheimers-disease.

15.   Morris J.C. The clinical dementia rating (CDR): current version and scoring rule. Neurology. 1993; 43 (II):2412-2414.

16.   Maksimovich I.V. Gotman L.N. Sposob kompleksnoy luchevoy diagnostiki doklinicheskih I klinicheskih stadiy bolezni Alzheimera. [Method of complex beam-diagnostics of subclinical and clinicas stages of Alzheimer’s disease.] Russian patent, №. 2315559 [In Russ].

17.   Maksimovich I.V., Gotman L.N., Masiuk S.M. Sposob opredelenia razmera visochnich doley golovnogo mozga pri bolezni Alzheimera [Measuring the size of the temporal lobes in patients with Alzheimer's disease] Russian patent № 2306102 [In Russ].

18.   Maksimovich I.V. Luchevaia diagnostika bolezni Alzheimera. [Beam-diagnostics of Alzheimer’s disease.] Diagnosticheskaia i intervencionnaia radiologia [Diagnostic and interventional radiology. ]. 2008; 2 (4): 27-38 [In Russ].

19.   Maksimovich I.V. Dyscirculatory Angiopathy of Alzheimer's Type. Journal of Behavioral and Brain Science. 2011; 1 (2): 57-68.

20.   Dickerson B.C. Functional magnetic resonance imaging of cholinergic modulation in mild cognitive impairment. Current Opinion in Psychiatry. 2006; 19: 299-306.

21.   Chiang G.C., Insel Ph.S, Tosun D., Schuff N., Truran-Sacrey D., Raptentsetsang S., Jack C.R., Weiner M.W. Identifying cognitively healthy elderly individuals with subsequent memory decline by using automated MR temporoparietal volumes. Radiolog. 2011; 259 (3): 844-51.

22.   Schuff N., Insel Ph., Chiang G., Truran D, Gamst A., Jack C., Aisen P., Petersen R., Shaw L., Trojanowski J., Weiner M. Acceleration of brain atrophy rates with advancing cognitive deterioration from normal aging to MCI to Alzheimer's disease. J. Alzheimer's &Dementia. 2011; 7 (4): S223.

23.   Trojanowski J.Q., Vandeerstichele H., KoreckaM., et all. Update on the biomarker core of the Alzheimer's Disease Neuroimaging Initiative subjects. Alzheimer's & Dementi. 2010; 6 (3): 230-238.

24.   Meyer P.T., Hellwig S., Amtage F., et al. Dual-biomarker imaging of regional cerebral amyloid load and neuronal activity in dementia with PET and 11C-labeled Pittsburgh compound B. J. Nucl. Med. 2011; 52 (3): 393-400.

25.   Perrin R.J., Craig-Schapiro R., Morris J.C., et al. Identification and validation of novelcerebrospinal fluid biomarkers for staging early Alzheimer's disease. Public Library of Science On. 2011; 12 (6): e16032.

26.   Jack C., Vemuri P., Viste H., et al. Ordering of Alzheimer's disease biomarkers. Alzheimer's & Dementia. 2011; 7 (4): S4-S5.

27.   Mayeux R., Reitz C., Brickman A.M., Haan M.N., ManlyJ.J. et. al. Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment. Part 1. Alzheimers & Dementia. 2011; 7 (1): 15-34.

28.   Folstein M.F., Folstein S.E., McHugh P.R. Minimental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975; 12 (3): 189-98.

29.   Maksimovich I.V. Dyscirculatory Angiopathy of the Brain of Alzheimer's Type. Eurointerventional. 2011; 7: M 253.

30.   Maksimovich I.V. Endovascular Application of Low-Energy Laser in the Treatment of Dyscirculatory Angiopathy of Alzheimer’s Type. Journal of Behavioral and Brain Science. 2012; 2 (1): 67-81. 

Abstract:

The author presents the endovascular technique for treatment of the Alzheimer disease. 40 patients aged 34–78 years were included into the study 4 of them were at risk, 13 had early and moderate stage, 16 – full-scaled stage, and 7 had preterminal stage of the disease.

The survey design included computed tomography with temporal lobes volume calculation, brain scintigraphy, rheoencephalography, and digital cerebral angiography.

Temporal lobes atrophy and capillary flow reduction in fronto-parietal and temporal regions are shown to be the characteristic radiomorphological features of the Alzheimer disease. Indications and contrindications for the treatment are presented.

Interventions were pefformed in terms of 1 to 12 years after the disease manifestation. The aim of treatment was percutaneous revascularization and capillary bed restoration by means of transluminal low-energy laser.

Clinical improvement was seen in all the cases; however, it differed in each group of patients. Thus, it is possible not only suspend the advancement of the Alzheimer disease, but to achieve its regression, with regeneration of the brain tissues and to return the people into the active life.  

References 

1.        Винблад Б. Болезнь Альцгеймера: эпидемиология, экономические затраты и терапевтические стратегии. Материалы 2-й российской конференции «Болезнь Альцгеймера и старение: от нейробиологии к терапии» 18–20 октября 1999 г. М.: Пульс. 1999; 24.  

2.        Alzheimer’s Disease Facts and Figures 2007. A Statistical Abstract of US Data on Alzheimer’s Disease published by the Alzheimer’s Association. Washington. 2008; 1–30.

3.        Гаврилова С.И., Калын Я.Б., Брацун А.Л. Эпидемиологические аспекты болезни Альцгеймера и других деменций позднего возраста. XII съезд психиатров России. М. 1995; 424–425.

4.        Гаврилова С.И. Практическое руководство по диагностике и лечению болезни Альцгеймера. М.: Медицина. 2002; 43.  

5.        Galasko D. New approaches to diagnose and treat Alzheimer’s disease: a glimpse of the future. Clin. Geriatr. Med. 2001; 17 (2): 393–410.  

6.        Tsuchiya K., Makita K., Furui S., Nitta K. MRI appearances of calcified lesions within intracranial tumors. Neuroradiology. 1993; 35: 341–344.  

7.        Tzika A.A., Robertson R.L., Barnes P.D. et al. Childhood moyamoya disease: hemodynamic MRI. Pediatr. Radiology. 1997; 27: 727–735.  

8.        Rusinek H., de Leon M.J., George A.E. et al. Alzheimer disease: measuring loss of cerebral gray matter with MR imaging. Radiology. 1991; 178: 109–114.  

9.        Kesslak J.P., Nalcioglu O., Cotman C.W. Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer’s disease. Neurology. 1991; 41: 51–54.  

10.      Жариков Г.А., Рощина И.Ф. Диагностика деменции альцгеймеровского типа на ранних этапах ее развития. Психиатрия и психофармакотерапия. 2001; 2 (2): 3–27.

11.      Гаврилова С.И. Фармакотерапия болезни Альцгеймера. М.: Пульс. 2003; 337.  

12.      Grundman M. Current therapeutic advances in Alzheimer’s disease. In: Research and practice in Alzheimer’s disease. Paris. 2001; 5: 172–177.  

13.      Jacobsen J.S., Reinhart P., Pangalos M.N. Current Concepts in Therapeutic Strategies Targeting Cognitive Decline and Disease Modification in Alzheimer’s Disease. Neuro Rx. 2005; 2: 612–626.

14.      Wilkinson D. Drugs for treatment of Alzheimer’s disease. Int. J. Clin. 2001; 55 (2): 129–134.  

15.      Masse I., Bordet R., Deplanque D. et al. Lipid lowering agents are associated with a slower cognitive decline in Alzheimer’s disease. J. of Neurol., Neurosurg. and Psych. 2005; 76: 1624–1629.  

Abstract:

Fetal with fetal growth restriction (FGR) are at increased risk for acidemia, hypoxemia and adverse perinatal outcomes. Placental insufficiency and FGR are the most common and important clinical problems in obstetrics and the leading causes of perinatal morbidity and mortality. Lots of diagnostic procedures are assessed to evaluate FGR, among them ultrasounds are the most relevant ones. Advances in Doppler velocimetry have improved possibility of assessing cerebral blood flow in this pathology This article discusses the clinical case of brain-sparing effect in fetuses with FGR. Assessment of the fetal cerebral circulation provides important information on the hemodynamic changes associated with chronic hypoxia, intrauterine growth restriction and their clinical management. 

References 

1.    Figueroa-Diesel H., Hernandez-Andrade E., Acosta- Rojas R. et al. Doppler changes in the main fetal brain arteries at different stages of hemodynamic adaptation in severe intrauterine growth restriction. Ultrasound Obstet. Gynecol. 2007; 30: 297-302.

2.    Hutter D., Kingdom J., Jaeggi E. Causes and Mechanisms of Intrauterine Hypoxia and Its Impact on the Fetal Cardiovascular System: A Review. J. Pediatr. 2010; 2010: 9 pages.

3.    Zayko N.N., Bytsya Y.V. Pathological physiology. M.: MED-press-inform; 2004; 63 5p [In Russ].

4.    Ageeva M.I. Diagnostic value of Doppler sonography in assessing the functional status of the fetus. Diss. ... dokt. med. nauk. M., 2008; 237 p [In Russ].

5.    Benavides-Serralde A., Hernandez-Andrade E., Fernandez-Delgado J. et al. Three-Dimensional sonographic calculation of the volume of intracranial structures in growth-restricted and appropriate-for-gestational age fetuses. J. Ultras. Obstet Gynecol. 2009; 33(5): 530-537.

6.    Feria L.A., Scheier M., Figueras F. et al. Reference values for Doppler parameters of the fetal anterior cerebral artery throughout gestation. Gynecol Obstet Invest. 2010; 69(1): 33-39.

7.    Lopez D.O. Perinatal and neurodevelopmental out come of late-onset growth restricted fetuses. Programa de Doctorat. Barcelona; 2010; 130 p.

8.    Kurjak A., Pooh R.K., Merce L.T. et al. Brain Vascularity Visualized by Conventional 2D and 3D Power Doppler Technology. J. of Ultrasound in Obstet. and Gynecol. 2010; 4(3): 249-258.

9.    Baschat A.A. Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction. Ultrasound Obstet. Gynecol. 2011; 37: 501-514.

10.  Ageeva M.I. Doppler sonography study fetal hemodynamics: A guide for doctors. M.: RMAPO; 2006; 4-5[In Russ].

11.  Oros D., Figueras F., Cruz-Martinez R. et al. Middle versus anterior cerebral artery Doppler for the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age fetuses with normal umbilical artery Doppler. Ultrasound Obstet. Gynecol. 2010; 35: 456-461.

12.  Gadelha-Costa, Spara-Gadelha P, Mauad-Filho F. The maximum systolic velocity increases in middle cerebral arteryof normal fetus from 22nd to 38th week of gestation. Acta MedPort. 2006; 19(2): 105-108.

13.  Cheema R., Dubiel M., Breborowicz G. et al. cerebral venous Doppler velocimetry in normal and high-risk pregnancy. Ultrasound Obstet Gynecol. 2004; 24: 147-153.

14.  Dubiel M., Gunnarsson G.O., Gudmundsson S. Blood redistribution in the fetal brain during chronic hypoxia. Ultrasound Obstet. Gynecol. 2002; 20(2): 117-121.

15.  Medvedev M.V. Fundamentals of Doppler in obstetrics. M: Real time; 2010; 44 p [In Russ].

16.  Rossi A., Romanello I.F., Fachech G. et al. Evaluation of fetal cerebral blood flow perfusion using power Doppler ultrasound angiography (3D-PDA) in growth-restricted fetuses. J Ultrasound in Ob. Gyn. 2011; 38: 175-180.

17.  Valkovich E.I. General and Medical Embryology. SPb.: Foliant; 2003; 317 p[ In Russ].

18.  Kornev M.A. Anatomy of the human embryology to maturity. SPb.: Foliant; 2003; 229 p [In Russ].

19.  Barashnev Y.I. Perinatal neurology. M.: Triada-X; 2005; 672 p[In Russ].

20.  Kurjak A., Pooh R.K., Merce L.T. Structural and functional early human development assessed by threedimensional and four-dimensional sonography. Fertil. Steril. 2005; 84(5): 1285-1299.

21.  Hernandez-Andrade E., Figueroa-Diesel H., Jansson T. et al. Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth-restricted fetuses. Ultrasound Obstet Gynecol. 2008; 32: 71-76.

Abstract:

Aim. Was to investigate the efficiency of transluminal laser revascularization of brain in treatment of vascular dementia.

Materials and methods. We have examined and treated 665 patients aged 29 to 81 (average age 75) suffering from various kinds of atherosclerotic lesions of cerebral vessels accompanied by developed vascular dementia. The research included: CT, MRI, scintigraphy, rheoencephalography, poliprojectional angiography To perform endovascular treatment we selected 639 patients: Group 1 (CDR-1) - 352, Group 2 (CDR-2) - 184, Group 3 (CDR-3) - 103 patients. To conduct revascularization of main intracranial arteries high-energy laser systems were used; for revascularization of distal intracranial branches low-energy laser systems were used.

Results. The clinical outcome depended on the severity of dementia and timing of the intervention. A good clinical outcome in Group 1 was obtained in 281 (79.82%) cases, in Group 2 in 81 (44.02%) cases, in Group 3 in 9 (8.73%) cases. A satisfactory clinical outcome in Group 1 was obtained in 53 (15.34%) cases, in Group 2 in 62 (33.70%) cases, in Group 3 in 31 (30.09%) cases. A relatively satisfactory clinical outcome in Group 1 was obtained in 17 (4.83%) cases, in Group 2 in 41 (22.28%) cases, in Group 3 in 63 (61.16%) cases. No negative effects were observed after the interventions.

Conclusions. Evaluating the data obtained it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of atherosclerotic lesions of the brain accompanied by dementia.  

Reference 

1.    Gillum R.F, Kwagyan J, Obisesan Th.O. Ethnic and Geographic Variation in Stroke Mortality Trends. Stroke:. 2011; 42:3294-3296.

2.    Frolich A.MJ, Psychogios M.N, Klotz E, Knauth M, Knauth P. Angiographic Reconstructions From Whole-Brain Perfusion CT for the Detection of Large Vessel Occlusion in Acute Stroke. Stroke. 2012; 43:97-102.

3.    Жулев Н.М, Пустозерцев В.Г, Жулев С.Н. Цереброваскулярные заболевания. 2002, М. Москва, BINOM.

Zhulev N.M., Pustozertsev, V.G., Zhulev, S.N..(2002) Cerebrovascular Diseases. BINOM, Moscow [In Russ].

4.    Roman G.C. Facts, myths, and controversies in vascular dementia. J. Neurol. Sci. 2004; 226: 49-52.

5.    Folstein M.F, Folstein S.E, McHugh P.R. «Mini-mental state.» A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975;12(3):189-98.

6.    Skoog I. Psychiatric disorders in the elderly. Can. J. Psychiatry. 2011; 56 (7):387-97.

7.    Maksimovich I.V. Long-term Results of Brain Transluminal Laser Revascularization In The Treatment of Ischemic Stroke. J. Am Coll. Cardiol. 2010; 56; B49-0.

8.    Максимович И.В. Транслюминальная лазерная ангиопластика в лечении ишемических поражений головного мозга. дис. д-ра мед. наук М, 2004. Maksimovich, I.V. Transljuminal laser angioplasty in treatment of ischemic lesions of a brain. M. D. 2004, dissertation, Moscow [In Russ].

9.    Maksimovich I.V. Transluminal Laser Revascularization of Cerebral Blood Vessels in the Treatment of Ischemic Stroke. J. Am. Coll. Cardiol. 2010;56; B48-9.

10.  Mahoney F.I, Barthel D.W. Functional Evaluation: The Barthel Index. Md. State Med. J. 1965; 14: 61-65.

11.  El Ali A, Doeppner T.R, Hermann D.M. Increased Blood-Brain Barrier Permeability and Brain Edema After Focal Cerebral Ischemia Induced by Hyperlipidemia: Role of Lipid Peroxidation and Calpain-1/2, Matrix Metalloproteinase-2/9, and RhoA Overactivation. Stroke. 2011;42:3238-3244.

12.  Roman G.C, Kalaria R.N. Vascular determinants of cholinergic deficits in Alzheimer disease and vascular dementia. Neurobiol Aging. 2006; 27(12): 1769-85.

13.  Roman G.C. Facts, myths, and controversies in vascular dementia. J. Neurol. Sci. 2004; 226: 49-52.

14.  Skoog I. Psychiatric disorders in the elderly. Can. J. Psychiatry. 2011; 56 (7):387-97.

15.  Silver F.L, Mackey A, Clark W.M, Brooks W, Timaran C.H, Chiu D, Goldstein L.B, Meschia J.F, Ferguson R.D, Moore W.S, Howard G, Brott T.G. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011; 42 (3): 675-80.

16.  Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald I.Q, Viera J, Politi M, K^ner H, Kostopoulos P, Haass A, Fassbender K, Reith W. Carotid artery stenting in acute stroke. J. Am. Coll. Cardiol. 2011; 58 (23):2363-9.

17.  Biamino G., The excimer laser: science fiction fantasy or practical tool? J Endovasc Ther. 2004; 11; Suppl. 2 :II207-22.

18.  Benedek I., Hintea T. Current developments in interventional treatment of total terminal aortic occlusions-laser, stenting and balloon angioplasty: experience of cardiology clinic of Targu-Mures. Rom J. Intern. Med. 2005; 43 (3-4): 223-32.

19.  Ecanow J.S., Schwartz B.T., Park R. Tibial recanalization with excimer laser angioplasty. Semin InterventRadiol. 2007; 24(1):58-62.

20.  Amb

Abstract:

Modern radiodiagnostics of carotid arteries (CA) defeat has very important value in such patients' treatment tactics. CA reconstruction operations are based on 3 general factors - clinic and arterial blood flow lack in dynamics, special methods of extra- and intracrania brachial arteries diagnostics, risk of arterial blood flow lack. We have pointed indications for surgical prophylactics and necessary patients diagnostic methods. 

References 

 1.   Alsheikh-Ali A.A.  et al.  The  vulnerable atherosclerotic   plaque.    Scope    of   the literature. Ann. Intern. Med. 2010; 153 (6):       7. 387-395.

2.    Cohen  J.E.,   Itshayek   E.   Asymptomatic carotid  stenosis.   Natural  history  versus therapy. Isr. Med. Assoc. J. 2010;  12 (4): 237-242.

3.    Delgado Almandoz J.E. et al. Computed tomography angiography of the carotid and cerebral circulation. Radiol. Clin. North. Am. 2010; 48 (2): 265-281.

4.    Hebb M.O. et al. Perioperative ischemic complications of the brain after carotid endarterectomy. Neurosurgery. 2010; 67 (2): 286-293.

5.    Kar S. et al. Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis.   Eurolntervention.   2010;   6   (4): 492-497.

 6.   Naylor A.R. Managing patients with symptomatic coronary and carotid artery disease. Perspect.   Vasc.  Surg. Endovasc.Ther.  2010; 22 (2): 70-76.

7.    Pokrovsky  A.V.,   Bogatov  Yu.P.   Vascular surgery in Russia. Pages of history. Eur. J. Vasc. Endovasc. Surg. 1997; 13 (2): 93-95.

8.    Rockman C., Riles T. Carotid artery disease: selecting   the   appropriate   asymptomatic patient for intervention. Perspect. Vasc. Surg. Endovasc. Ther. 2010; 22 (1): 30-37.

9.    Spence J.D. Secondary stroke prevention. Nat. Rev. Neurol. 2010; 6 (9): 477-486.

10.  Tallarita T., Lanzino G., Rabinstein A.A. Carotid   intervention   in   acute   stroke. Perspect.   Vasc.  Surg. Endovasc.   Ther. 2010;22 (1): 49-57.

11.  Tholen A.T. et al. Suspected carotid artery stenosis. Cost-effectiveness of CT angiography in work-up of patients with recent TIA or minor ischemic stroke. Radiology. 2010; 256 (2): 585-597.

12.  Walkup M.H., Faries P.L. Update on surgical management for asymptomatic carotid stenosis. Curr. Cardiol. Rep. 2010; 5.

Abstract:

Aim: was to evaluate efficiency of stents-grafts in treatment of cerebral aneurysms.

Materials and methods: for the period of 2001-2012 implantation of stent-grafts was performedm 10 patients with cerebral aneurysms. Indications for implantation: huge or giant aneurysms; wide«neck» of aneurysm; difficult localization for neurosurgical techniques; absence of significant tortuosity of artery that could interfere successful stent delivery All patients underwent examination:

MSCT-angiography, MRI, cerebral angiography To predict possible stent thrombosis we performed angiographic tests with pinching of pathological artery and contrasting of opposite artery Then we assessed blood-flow of anterior and posterior communicating arteries and also changes in neurological status. Unsatisfactory condition of collateral blood-flow - was not a contraindication for stenting. In 8 patient, aneurysms were localized in internal carotid artery, and in 2 patients in the vertebrobasilar artery In 3 cases implantation of stent-graft was proceeded in acute period of hemorrhage; that caused late disaggregant therapy (immediately after implantation, drugs were injected through nasogastric tube instead of 4-5 days of preoperative treatment).

Results: exclusion of the aneurysm from the blood-flow was reached 100% of cases. In one case, implantation of micro-coils was necessary due to inability to cover the whole neck of the aneurysm because of tortuosity of artery In 1 case we had thrombosis of stent in vertebral artery with spreading of thrombosis on basilar artery with development of ischemic stroke and further death.

Conclusion: use of stent-grafts for exclusion of huge and giant aneurysms from cerebral blood- flow is a highly effective method.

References

1.     Zeb M., McKenzie D.B., Scott P.A., Talwar S. Treatment of coronary aneurysms with covered stents: a review with illustrated case. J. Invasive Cardiol. 2012; 24 (9): 465-469.

2.     Briguori C., Nishida T., Anzuini A. et al. Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures. Circulation. 2000; 102 (25): 30283031.

3.     Saatci I,.Cekirge H.S., Ozturk M.H. et al. Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with midterm follow-up results. AJNR Am. J. Neuroradiol. 2004; 25 (10): 1742-1749.

4.     Hirurgija anevrizm golovnogo mozga. V 3 tomah. T. 1. Pod red. V.V. Krylova [Brain aneurysms surgery. In three volumes. Vol. 1. Edited by V.V. Krylov]. Moscow. 2012; 432S [In Russ].

5.    Tissen T.P., Jakovlev S.B. Bocharov A.V. Buharin E.Ju. Ispol'zovanie stent-grafta v jendovaskuljarnoj nejrohirurgii. Voprosy nejrohirurgii im. N.N. Burdenko [The use of stent-graft in endovascular neurosurgery]. 2006; 2: 53-56. [In Russ].

6.     Vulev I., Klepanec A., Bazik R. et al. Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent. Interv. Neuroradiol. 2012; 18 (2): 164-171.

7.     Greenberg E., Katz J.M., Janardhan V. et al. Treatment of a giant vertebrobasilar artery aneurysm using stent grafts. Case report. J. Neurosurg. 2007; 107 (1): 165-168.

8.     Li M.H., Li YD., Tan H.Q. et al. Treatment of distal internal carotid artery aneurysm with the willis covered stent: a prospective pilot study. Radiology. 2009; 253 (2): 470-477.

9.     Chalouhi N., Tjoumakaris S., Gonzalez L.F. et al. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am. J. Neuroradiol. 2014; 35 (3): 546-452.