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Abstract:

Aim: was to study the mutual influence of new coronavirus infection COVID-19 and acute coronary syndrome and to evaluate the effectiveness of percutaneous coronary interventions in these conditions.

Material and methods: for the period from March 21, 2020 to October 31, 2021, 5093 patients were treated for COVID-19. Including 208 patients with acute coronary syndrome with concurrent COVID-19 disease. All patients underwent following diagnostic procedures: computed tomography of the chest, electrocardiography, echocardiography, coronary angiography and, if necessary, percutaneous coronary intervention.

Results: we present data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on the nature of coronary interventions and mortality in these groups. A high frequency of massive thrombosis of infarct-related coronary arteries was demonstrated in the group of patients with STEMI. Possible mechanisms of left ventricular dysfunction that persist after percutaneous coronary intervention are described. A positive effect of endovascular myocardial revascularization on the degree of hypoxia in patients with COVID-19 was shown.

Conclusions: development of acute coronary syndrome with concurrent coronavirus infection significantly worsens the prognosis of the disease. Despite of the success of endovascular treatment, worsening COVID-19 infection can be accompanied by a sharp deterioration in the condition of patients, leading to death.

 

 

Abstract:

Aim: was to develop a compleх ultrasound assessment of atherosclerotic plaque instability in correlation with morphological evaluation.

Material and methods: research included 121 patients with stenosis of left/right internal carotic artery (ICA) of 50% and more (due to NASCET scale): 80 men and 41 women, mean age 56,0 years. All patients underwent standart and contrast-enhanced ultrasonic scanning (CEUS), bilateral duplex monitoring of cerebral blood flow with registration of microembolic signals (MES). All patients in period up to 3 days after hospitalization - underwent carotid endarterectomy with histological examination of atheroscleroitc plaque.

Results: analysis of relationship between ultrasound and histological characteristics showed a moderate association between the intensity of contrast agent accumulation and the degree of plaque vascularization (Cramer's V 0,529; p<<0,000;) number of lipofages (Cramer's V 0,569; p<<0,001). There were no significant differences between the degree of plaque vascularization and the degree of plaque stenosis (p<0,05). We revealed significant differences between the number of MES and the intensity of atherosclerotic plaque blood supply (<<0,001).

Discussions: intensive accumulation of contrast agent in a plaque is associated with the process of angiogenesis and inflammation, and contrast-enhanced ultrasound examination of the plaque is promising for assessing its instability and the possible risk of developing cerebral vascular complications. Neovascularization intensity detected by contrast-enhanced ultrasound is associated with the number of detected microparticles in the cerebral blood flow, and does not depend on the degree of stenosis.

Conclusions: method of comprehensive assessment using CEUS and Doppler detection of microembolic particles can be effective in stratifying the risk of possible ischemic stroke in asymptomatic patients, for optimizing indications for surgical treatment of atherosclerotic plaque, and evaluating the effectiveness of lipid-lowering and statin therapy.

  

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Abstract:

The review is devoted to possibilities of ultrasound and functional diagnostic methods in the diagnosis of ischemic stroke of unknown etiology. Main causes of cryptogenic ischemic stroke are highlighted in the article. Advances in high resolution ultrasound of extracranial and intracranial vessels and of the heart, prolonged heart rhythm monitoring are instrumental techniques to identify arterial and cardiac hidden causes of stroke. We reviewed literature, on the basis of available data, designed a diagnostic algorithm for patients with patent foramen ovale (PFO) and risk of embolism from atherosclerotic plaque. 

 

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