Atherosclerosis and the Structural and Functional State of the Vessels of the Carotid and Vertebro-basilar Basins

Abstract

In connection with modern pathogenetic ideas about the mechanisms of development of ischemic stroke, the early diagnosis of this disease becomes even more important. A relevant issue at the present stage is the information content of non-invasive ultrasound research methods used to study the state of the cerebral arteries that participate in the blood supply to the brain.The objective: to study the structural and functional state of the vessels of the carotid and vertebro-basilar pools in elderly patients with cerebral atherosclerosis (CA) of stage 1–3, including depending on the hemispheric localization of the ischemic focus.Materials and methods. 229 patients with CA of the 2nd – 3rd degree took part in a comprehensive clinical and instrumental study. Patients were divided into 4 groups: I – the general group of patients who underwent ischemic atherothrombotic stroke in the basin of the middle cerebral artery (IS); II – in the right hemisphere (RH); ІІІ – transferred IS in the left hemisphere (LH); ІV – with CA of 1–2 degree (without IS – comparison group). Subsequently, elderly patients from 55 to 75 years old participated in the comparison of groups.Results. In chronic cerebrovascular diseases, a steadily progressing atherosclerotic process is accompanied by a decrease in blood flow velocity in the main arteries of the head. Moreover, changes in LSBV (Linear systolic blood velocity) are detected by transcranial dopplerography at earlier stages both at the extra– and intracranial level, and blood flow depression initially occurs both in the arteries of the vertebro-basilar basin and in the carotid channel. The identification of changes in a Doppler study, in general, precedes the increase in symptoms of organic damage to the nervous system. Compared to patients with initial manifestations of CA, patients who underwent IS are characterized by a high frequency of hemodynamically significant stenosis, a thickening of complex intima-media, a statistically significant decrease in LSBV and an increase in pulsatory and peripheral resistance index in individual vessels of the carotid and vertebro basilar basins on both sides.Conclusion. Structural and functional features of cerebral vessels in patients after ischemic atherothrombotic stroke in the late recovery period have hemispheric features. Moreover, a statistically significant difference in the rate of cerebral blood flow was observed only in the vessels of the carotid basin on the right, and the indices of peripheral vascular resistance and pulsativity were increased in different vessels of both pools from 2 sides.