Abstract

Aim. To study the clinical significance of the gradient of narrowing of arterial lumen (GNL) for atherosclerotic stenosis of the internal carotid artery (ICA) as a risk factor for ischemic brain damage.Material and methods. We proposed a new parameter of hemodynamic severity of ICA atherosclerotic stenosis — GNL. It calculated as ratio of the difference in the ICA cross section areas on the stenotic lesion and the near non-stenotic region to the distance between them: Snorm — Sstenosis)/Dnorm — stenosis, mm2 /mm. We examined 25 patients with advanced atherosclerosis and with uni(n=22) or bilateral (n=3) ICA stenosis >50% according to European Carotid Surgery Trial, and 11 individuals without ICA stenosis. Each participant underwent magnetic resonance angiography (MRA) of the carotid arteries with reconstruction of the arteries from C6-C7 level to the parietal bones, and the GNL was calculated. The thickness of the baseline slice was 0,8-1 mm. Each subject also underwent cerebral magnetic resonance imaging (MRI) in T1-, T2-, PD-, flair-weighted protocols. Results. Patients were divided into groups: group 1 (n=12) — without ischemic injury in the ICA system, and group 2 (n=13) — with MRI signs ischemic injury history. The groups did not differ in proportion of stenosis (74,9±4,25% and 77,8±3,8%, p<0,05), ICA lumen area on the stenotic lesion (1,05±0,18 mm2 and 1,14±0,17 mm2 , p<0,05) and the ICA diameter at the non-stenotic region (4,30±0,32 mm and 4,9±0,29 mm, p<0,05). In control group, GNL was <0,75 mm2 /mm. Groups 1 and 2 significantly differed (2,47±0,41 mm2 /mm and 4,60±0,51 mm2 /mm, p<0,02). In group 2, 12 out of 13 patients had GNL >3,35 mm2 /mm, and, in group 1, 9 out of 12 — less than 3,35 mm2 /mm. GNL did not correlate significantly with other parameters of ICA stenosis. Two patients with the highest GNL in each group (5,5 and 8,6 mm2 /mm) had a fatal ischemic stroke within six monthsConclusion. Firstly, proposed parameter of stenosis hemodynamic severity GNL is independent, informative and prognostically important indicator for carotid artery atherosclerotic lesion.

Highlights

  • внутренней сонной артерии (ВСА) — внутренняя сонная артерия, градиента сужения просвета (ГСП) — градиент сужения просвета, МРА — магнитно-резонансная ангиография, МРТ — магнитно-резонансная томография, НСА — наружная сонная артерия, острых нарушений мозгового кровообращения (ОНМК) — острое нарушение, ПМА — передняя мозговая артерия, парамагнитного контрастного средства (ПМКС) — парамагнитное контрастное средство, ПМКУ — парамагнитное контрастное усиление, European carotid surgery trial (ECST) — European Carotid Surgery Trial

  • We proposed a new parameter of hemodynamic severity of ICA atherosclerotic stenosis — GNL

  • We examined 25 patients with advanced atherosclerosis and with uni- (n=22) or bilateral (n=3) ICA stenosis >50% according to European Carotid Surgery Trial, and 11 individuals without ICA stenosis

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Summary

Introduction

ВСА — внутренняя сонная артерия, ГСП — градиент сужения просвета, МРА — магнитно-резонансная ангиография, МРТ — магнитно-резонансная томография, НСА — наружная сонная артерия, ОНМК — острое нарушение, ПМА — передняя мозговая артерия, ПМКС — парамагнитное контрастное средство, ПМКУ — парамагнитное контрастное усиление, ECST — European Carotid Surgery Trial. Порядок расчета показателя градиента сужения просвета (ГСП) артерии на уровне атеросклеротического стеноза, по данным

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