Duplex Scanning Of Carotid Arteries Research Articles

Effect of FEMOKLIM on the state of blood vessels in hypoestrogenemia and arterial hypertension

The article presents the results of duplex scanning of the common carotid arteries (CCA) and assessment of the structural and functional state of the vascular bed of 57 women with arterial hypertension (AH) with hypoestrogenemia. It was found that with hypertension with a reduced level of estradiol, the lumen of the OCA increases, the speed of blood flow in the carotid arteries decreases, which indicates vascular remodeling. In the studied patients, in every third case, an inertial type of vasomotor reaction is detected before treatment, which indicates the contribution of dishormonosis to the progression of hypertension due to the development of endothelial dysfunction. Combined therapy with phytoestrogens and ACE inhibitors improves the structural and functional characteristics of the vascular wall, reduces arterial stiffness. The drug Femoklim is a source of phytohormones, hormones of entomological origin and natural antioxidants, has a positive effect on the state of the vascular system, improves blood microcirculation, is a capillary protector, has a complex harmonizing effect on the body.

Lipid-lowering therapy in patients with arterial hypertension with concomitant chronic obstructive pulmonary disease

Оbjective: in order to evaluate the effects (lipid-lowering, the effect on the endothelial function and oxidative stress) of pitavastatin at a dose of 4 mg in patients with dyslipidemia, arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) at baseline, after 4 weeks and 12 months of treatment. Material and methods: the prospective study included 33 patients (mean age 60 [54;61] years) with AH, COPD and dyslipidemia. Laboratory examination consisted in determining the lipid spectrum, the level of lipid peroxidation products, creatinine, bilirubin, alanine aminotransferase, aspartate aminotransferase. The endothelium’s function was performed by the test with the endothelium-dependent vasodilation. We prescribed Pitavastatin (4 mg, Livazo, Recordati, Ireland) as a lipid-lowering therapy. After 12 months, the atherosclerotic plaques (AP) in the vessel was seen by the ultrasound duplex scanning of carotid arteries. Results: after 4 weeks of treatment with pitavastatin (4 mg), there was a decrease in total cholesterol — 26%, low-density lipoprotein (LDL) — 33%, triglycerides (TG) — 19%, high-density lipoprotein was increased by 18%. There was an improvement in endothelial dysfunction and oxidative stress. There were no side effects in patients. Conclusion: correction of lipid metabolism disorders in AH patients with COPD by prescribing pitavastatin (4 mg) can reduce total cholesterol, LDL and TG, can positively affect endothelial function and lipid peroxidation processes. Therapy with pitavastatin (4 mg) in patients with dyslipidemia, AH and COPD is safe. It is noted the regression of AP after 12 months of regular intake of pitavastatin at a dose of 4 mg.

Evaluation of the effect of metabolic therapy on the state of blood vessels in estrogen deficiency and hypertension

The article presents the results of duplex scanning of the common carotid arteries (CCA) and assessment of the structural and functional state of the vascular bed women with arterial hypertension (AH) with hypoestrogenemia. It was found that in patients with hypertension with a reduced level of estradiol, there is an expansion of the lumen of the CCA, a decrease in the speed of blood flow in the carotid arteries of a rectilinear course, without hemodynamically significant stenoses, which indicates structural and functional changes in the vascular wall. In the studied patients, in almost every third case, an inertial type of vasomotor reaction is detected before treatment, which indicates the contribution of dishormonosis to the progression of hypertension due to an increase in the stiffness of the vascular wall and the development of endothelial dysfunction. Combination therapy with BioDihydroquercetin and ACE inhibitor improves the structural and functional characteristics of the vascular wall of the CCA, has a positive effect on endothelial dysfunction, reduces the stiffness of the vascular wall of the arteries compared with patients taking ACE inhibitor monotherapy. The drug BioDihydroquercetin, produced with trade mark “Baikal Legend”, is a natural antioxidant, capillaroprotector, strengthens blood vessels, improves blood microcirculation, and is recommended to slow down the aging process of the body.

The Occurrence of Thrombotic Complications Due to Combat Trauma Against the Background of the COVID-19 Pandemic

An important point in the provision of highly specialized cardiac surgical care for combat trauma is determination of the optimal time, method and volume of surgical intervention, taking into account the persisting threat of infection with the SARS-COV-2 virus and associated thrombotic complications.
 The aim. To investigate the mechanism of development and methods of prevention of thrombotic complications resulting from combat trauma against the background of the COVID-19 pandemic.
 Materials and methods. We analyzed clinical case of patient R., a 37-year-old soldier with a postinfarction thrombosed aneurysm of the left ventricle. The patient underwent standard clinical and laboratory tests, electrocardiography, echocardiography, coronary angiography, computed tomography of the chest, duplex scanning of carotid arteries, arteries and veins of the upper and lower extremities. It was established that 4 months ago, during a combat mission, the service-man received a mine-explosive injury, shrapnel wounds of lower extremities, multifragmentary fracture of the right ϐibula and a gunshot wound to the right chest. The causes of post-traumatic myocardial infarction are mine-explosive injury, intramural course of the left anterior descending artery, youngage, poorly developed collaterals of coronary arteries, long-term transportation during the stages of medical evacuation and post-traumatic stress disorder. A month ago, the patient was diagnosed with COVID-19, thromboembolism of the right main branch of the pulmonary artery, for which thrombolytic therapy was performed. Follow-up computed tomography showed the signs of thromboembolism of the pulmonary arteries. Ultrasound examination revealed thromboses of upper and lower limbs. Thrombotic complications against the background of combat polytrauma are the result of hypercoagulation, acute inϐlammation with the release of proinϐlammatory cytokines and damage of the endothelium. SARS-COV-2 infection triggers a state of hypercoagulation and creates additional conditions for the occurrence of arterial and venous thrombosis. Considering the nature of the thrombotic lesions, was made a decision to postpone the cardiosurgical intervention for 3 months.
 Conclusions. Thrombotic complications are an urgent problem after combat trauma. COVID-19 is an additional risk factor for hypercoagulation and a reason for delaying elective cardiac surgery. Conducting an electrocardiography to the wounded, regardless of age, is crucial for timely diagnosis andtreatment of acute coronary events. It is important to initiate anticoagulant therapy after eliminating all possible sources of bleeding due to the high risk of thrombotic complications against the background of chest trauma and limb fractures.

Features of Atherosclerosis of the Carotid Arteries in Elderly patients with Acute Coronary Syndrome

Aim. To study features of atherosclerosis and signs of instability of atherosclerotic plaque in the carotid arteries by ultrasound duplex scanning of elderly patients with myocardial infarction or unstable angina.Material and methods. The study included 87 patients with ACS and 78 patients without ACS aged 75 and over. Ultrasound duplex scanning of carotid arteries was carried out with Philips EPIQ5 ultrasound system and L12–3 linear array transducer on the 2–5 day from the moment of hospitalization. Quantitative and structural indicators of atherosclerosis of the carotid arteries were assessed .Results. The frequency of detection of atherosclerotic plaques in carotid arteries in elderly patients with ACS was signifi cantly higher than in patients without ACS – 78 and 67 % (p=0,179). Patients with ACS compared with the group without ACS more often had signs of instability of atherosclerotic plaque: heterogenous structure – 28,8 and 19,3 % (p=0,017), hypoechogenic component – 39,2 and 9,9 % (p<0,001), irregular surface – 46,3 and 8,2 % (р<0,001), local calcifi cation –14,2 and 7 % (р=0,001). At the same time, ulcerated atherosclerotic plaques were found only in the group of patients with ACS – 1,9 % (р=0,412). The incidence of atherosclerotic plaques in carotid arteries among men was higher in the group with ACS compared to patients without ACS – 36,2 and 23,4 % (р=0,003); among women the data are higher in the group without ACS compared with the group of patients with ACS – 76,6 and 63,8 % (р=0,003).Conclusion. Atherosclerotic plaques in carotid arteries among elderly patients are more common in the group of patients with ACS. As the same time, among this group atherosclerotic plaques with signs of instability were significantly more common found.

Atherosclerosis of the carotid and coronary arteries in elderly patients with acute coronary syndrome.

Aim To study the relationship between severities of the carotid artery injury and the atherosclerotic process in coronary arteries of elderly patients with acute coronary syndrome (ACS).Material and methods The study included 110 patients aged >75 years. Based on the degree of maximal carotid stenosis according to data of duplex scanning (DS), all patients were divided into group I, (>50% stenosis) and group II (<50% stenosis).Results According to coronary angiographic data, multivessel disease was observed in 63.6 % of patients. Patients of group I more frequently had three-vessel coronary artery disease than patients of group II (35.8 and 5.3 %, р<0.001). Coronary angiography and DS showed that 82.7 % patients (in group II, not all carotid stenoses were hemodynamically significant) had a combined damage of coronary and carotid arteries; carotid artery stenoses of >50% were associated with three-vessel coronary artery disease. A correlation between atherosclerosis of carotid and coronary arteries was found. Considering this correlation, a scale was introduced that suggested the severity of coronary atherosclerosis based on DS of carotid arteries. The score was assigned by assessing the degree of maximal stenoses in carotid arteries. A ROC analysis has determined a threshold score suggestive of the severity of coronary atherosclerosis: score <6, absence of >70% coronary stenosis; score >6, likely presence of >70% coronary stenosis (sensitivity, 70 %; specificity, 89 %).Conclusion Combined coronary and carotid artery disease was detected in 82.7% of elderly patients with ACS. A correlation between the severity of atherosclerosis in carotid and coronary arteries was found. DS of carotid arteries can be extensively used in evaluation of elderly patients with ACS, which will allow additional stratification of patients at high risk of cerebrovascular and recurrent cardiovascular diseases.

Carotid Restenosis Rate After Stenting for Primary Lesions Versus Restenosis After Endarterectomy With Creation of Risk Index

Purpose: Carotid artery stenting (CAS) is an option for carotid restenosis (CR) treatment with favorable outcomes. However, CAS has also emerged as an alternative to carotid endarterectomy (CEA) for the management of patients with primary carotid stenosis. This study aimed to report CR rates after CAS was performed in patients with primary lesions versus restenosis after CEA, to identify predictors of CR, and to report both neurological and overall outcomes. Materials and methods: From January 2000 to September 2018, a total of 782 patients were divided into 2 groups: The CAS (prim) group consisted of 440 patients in whom CAS was performed for primary lesions, and the CAS (res) group consisted of 342 patients with CAS due to restenosis after CEA. Indications for CAS were symptomatic stenosis/restenosis >70% and asymptomatic stenosis/restenosis >85%. A color duplex scan (CDS) of carotid arteries was performed 6 months after CAS, after 1 year, and annually afterward. Follow-up ranged from 12 to 88 months, with a mean follow-up of 34.6±18.0 months. Results: There were no differences in terms of CR rate between the patients in the CAS (prim) and CAS (res) groups (8.7% vs 7.2%, χ2=0.691, p=0.406). The overall CR rate was 7.9%, whereas significant CR (>70%) rate needing re-intervention was 5.6%, but there was no difference between patients in the CAS (prim) and CAS (res) groups (6.4% vs 4.7%, p=0.351). Six independent predictors for CR were smoking, associated previous myocardial infarction and angina pectoris, plaque morphology, spasm after CAS, the use of FilterWire or Spider Fx cerebral protection devices, and time after stenting. A carotid restenosis risk index (CRRI) was created based on these predictors and ranged from –7 (minimal risk) to +10 (maximum risk); patients with a score >–4 were at increased risk for CR. There were no differences in terms of neurological and overall morbidity and mortality between the 2 groups. Conclusions: There was no difference in CR rate after CAS between the patients with primary stenosis and restenosis after CEA. A CRRI score >–4 is a criterion for identifying high-risk patients for post-CAS CR that should be tested in future randomized trials.

Patterns of the association among ultrasound, hemodynamic and biochemical parameters of atherosclerosis of the carotid and coronary arteries in patients with coronary heart disease

An increase in the proportion of comorbid cardiac patients with primary nosologies such as arterial hypertension and atherosclerosis actualizes the search for optimal approaches to their diagnosis and treatment. The emerging pathogenetic mechanisms of concomitant diseases must be taken into account on an individual basis. Aim of the study was to investigate the patterns of atherosclerotic changes in carotid arteries in patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty and their correlation with biochemical and hemodynamic markers of atherosclerosis. Material and methods. 53 patients with coronary heart disease (CHD) were examined and treated in the clinic of the Federal Research Center of Fundamental and Translational Medicine. The average age of the patients was 64.73 ± 1.66 years. A comprehensive clinical laboratory examination was conducted, including the blood lipids test to measure content of total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, as well as serum markers of systemic inflammation (concentration of C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR)) and carotid artery duplex scan. Results. A direct correlation between the severity of atherosclerotic changes in the carotid arteries and indicators of systemic inflammation, i.e. CRP, ESR and fibrinogen was found. The study also revealed greater severity of atherosclerotic stenosis of the carotid arteries in patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty with coronary artery stenting compared to patients without any intervention. Conclusion. The obtained data indicate the effectiveness of ultrasound scan of the carotid arteries for the early diagnosis of multifocal atherosclerosis for timely treatment and prevention of cardiovascular polymorbidity in patients with a cardiovascular profile.

Association of the increased circulating CD62LloCXCR4hi neutrophil count with carotid atherosclerosis

Introduction. The role of neutrophils in the initiation and progression of atherosclerosis as well as in the development of its complications has received scientific attention only in the recent years. Today, there is growing evidence to support a role of the CXCL12/CXCR4 axis in sustained inflammation during different chronic inflammatory diseases by retaining neutrophils at inflammatory sites.The aim of the study is to assess the diagnostic and prognostic significance of circulating CD62LloCXCR4 hi neutrophils in patients with carotid atherosclerosis.Materials and methods. A total of 75 patients (52% of men and 48% of women) aged 40 to 64 years were examined. None of them were diagnosed with atherosclerotic cardiovascular diseases. All the patients underwent carotid artery duplex scanning. The flow cytometry and CD16, CD11b, CD62L, CD182 (CXCR2) and CD184 (CXCR4) conjugated monoclonal antibodies were used for phenotyping and differentiation of neutrophil subpopulations.Results. Atherosclerotic plaques in carotid arteries were detected in 72% of the patients; most of the patients were diagnosed with stenosis development in more than one of the carotid arteries (CA). The elevated levels of circulating CXCR4h neutrophils were associated with the levels of total cholesterol (r = 0.377; p = 0.001), low-density lipoprotein (LDL) cholesterol (r = 0.293; p = 0.014) and triglycerides (r = 0.388; p = 0.003). The study revealed direct correlation between the circulating CXCR4 hi neutrophil count and the cumulative percentage of CA stenosis (r = 0.300; p = 0.011), including the number of stenosed CA (r = 0.291; p = 0.034). It was also found that CXCR4 hi neutrophil counts demonstrated a statistically significant increase along with the increased number of stenosed CA (p = 0.025). The ROC analysis findings show that the elevated CXCR4 hi neutrophil counts ≥260 cells/μL made it possible to diagnose stenotic lesion of 4 CAs with a sensitivity of 71.4% and specificity reaching 76.6%.Conclusion. In patients with carotid atherosclerosis, the increased count of circulating CD62LloCXCR4 hi neutrophils was associated with the increased number of stenosed CAs, while no significant changes were observed in the other examined subpopulations of neutrophil granulocytes. The increased CD62LloCXCR4 hi neutrophil count made it possible to diagnose stenotic lesion of 4 CAs with a sufficient sensitivity and specificity.

Neutrophil extracellular traps and echogenicity of carotid atherosclerotic plaques

Aim.To study the association between the number of neutrophil extracellular traps (NETs) formed by circulating neutrophils and echogenicity of carotid atherosclerotic plaques.Materials and Methods.We enrolled 72 patients (40-64 years of age) without the clinical signs of atherosclerotic vascular disease, who then underwent ultrasound duplex scanning of carotid arteries. Grayscale median analysis of the images was performed using Adobe Photoshop CS6 software. Neutrophils were stained and examined by means of light microscopy to count NETs.Results.Carotid atherosclerotic plaques were found in 69.4% of asymptomatic patients. Echogenicity of atherosclerotic plaques inversely correlated with the number of NETs (r = - 0.310; p = 0.029). The number of NETs in patients with echolucent plaques (GSM < 60) was significantly higher in comparison with echogenic plaques (GSM ≥ 60, p = 0.042).

PHARMACEUTICAL PROVISION AND PHYSICAL ACTIVITY FOR SUPPORTING WORKING CAPACITY OF MILITARY AND SECURITY SERVICES

Aim. The paper aims to explore the effect of Trekrezan on working capacity, psychosomatic status, and hemodynamic parameters of military and security personnel, as well as the possibility to increase its psychological tolerance to stress. Materials and methods. 52 men participated in the study with the average age of 35.4 ± 6.6 years. The participants had been taking Trekrezan in tablets at a dose of 600 mg/day for 3 months. Duplex scanning of carotid and vertebral arteries was carried out according to the method of R. Barnes. Assessment of psychological and somatic status was carried out by the Hamilton test. Physical activity was tested by standard exercises (volunteer military service). Results. Trekrezan intake demonstrated a positive effect on anxiety and emotional stability and provided a significant increase in the maximum and average blood flow rates into common and internal carotid arteries. In 37.5% of 94.7% of men with thickening of the intima/media complex (IMT), IMT values demonstrated normalization after 3 months of taking the pills. Conclusion. Trekrezan significantly improves regional blood flow in the carotid artery system, has a positive effect on the psychosomatic status and improves life quality. Trekresan intake (600 mg / day per 3 months) increases working capacity of military and security personnel and can be recommended as a supplement that improves tolerance to physical activity.

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Objective Asymptomatic carotid stenosis (ACS) is closely associated to the incidence of severe cerebrovascular diseases. Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke. This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors. The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data. All of the original data were retrieved from the China National Stroke Screening and Prevention Project (CNSSPP), including demographic, clinical and laboratory characteristics. The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1. The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled, 326 (11.6%) were diagnosed as ACS by ultrasonography. The top five risk factors contributing to ACS in this model were identified as family history of dyslipidemia, high level of low-density lipoprotein cholesterol (LDL-c), low level of high-density lipoprotein cholesterol (HDL-c), aging, and low body mass index (BMI). Their weights were 11.8%, 7.6%, 7.1%, 6.1%, and 6.1%, respectively. The total weight of the top 15 risk factors was 85.5%. The AUC values of the model for detecting ACS with training dataset and testing dataset were 0.927 and 0.888, respectively.Conclusions This study demonstrated that the machine-learning algorithm could be used to identify the risk factors for ACS among high risk population of stroke. Family history of dyslipidemia may be the most important risk factor for ACS. This model could be a suitable tool to optimize the clinical approach for the primary prevention of stroke.

ASSOTIATION OF THE GENETIC POLYMORPHISM E670G OF THE PCSK-9 AND THE SEVERITY OF THE CAROTID ATHEROSCLEROSIS IN PATIENTS WITH HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA IN UZBEK POPULATION

Objective: to study the severity of carotid artery atherosclerosis in patients with heterozygous familial hypercholesterolemia in the Uzbek population, depending on the level of PCSK-9 and the genetic polymorphism E670G of the PCSK-9 gene.Material and methods. The study included 57 patients with chronic stable coronary artery disease (SCAD) and familial heterozygous hypercholesterolemia (HeFH, group I). The comparison group consisted of 144 patients with SCAD without HeFH divided into two subgroups: A - statin free before the research (n=63) and B (n=81) who took it as outpatients; control group consisted of 17 healthy people. The level of proprotein convertase subtilisin-kexin type 9 (PCSK-9) was measured with Human Proprotein Convertase 9/PCSK9 ELISA Kit (MULTI SCIENCE, China). The genetic typing of PCSK9 E670G (rs505151) polymorphism was performed by means of the PCR-RFLP method.Results. A comparison of the results of duplex scanning of carotid arteries in patients with HeFH showed that the carotid intima-media thickness (CIMT) on the left (1.14±0.18 mm, P<0.01) and on the right (1.15±0.16 mm, P<0.01) was higher, than in the comparison group: 1.05±0.17 mm and 1.04±0.18 mm, respectively. The studies revealed a positive correlation between the incidence of Myocardial infarction (MI) in the history in patients with HeFH and the (r=0.38, P<0.05). The CIMT also correlated with an increase in the concentration of PCSK9 (r = 0.31, P <0.05) in the blood and the carriage of the G allele of polymorphism E670G (r = 0.39, P <0.05) of the PCSK9 gene.Conclusion. Inpatientswithheterozygousfamilialhypercholesterolemia in the Uzbek population a direct correlation was established between Myocardial infarction in the history, the carotid intima-media thickness, an increase in the concentration of PCSK-9 in the blood and the carriage of the G allele of E670G polymorphism of the PCSK9 gene, that allows them to be used as prognostic markers for the risk of development of cardiovascular complications.

MODELING OF PROBABILITY OF OSTEOPENIC SYNDROME IN PATIENTS WITH MULTIFOCAL ATHEROSCLEROSIS

Aim.To evaluate the effectiveness of the mathematical model for determining the probability of osteopenic syndrome in patients with multifocal atherosclerosis.Materials and methods. The study included 251 male patients with verified atherosclerosis of the coronary and carotid arteries. The average age of the patients was 60,56±8,7 years. All patients included in the study performed multispiral computed tomography of coronary and carotid arteries with a quantitative evaluation of calcification by the method of Agatston (calcium index and equivalent weight of calcium deposits), color duplex scanning of carotid arteries, densitometry. The obtained data were used to calculate the probability of having an osteopenic syndrome (р) using a mathematical model. Criterion for the risk of osteopenic syndrome in the patient is the value р>0,688. The results of the analysis were compared with the densitometry data chosen as the reference method.Results. According to the quantitative assessment of coronary artery calcification in patients with osteopenia and osteoporosis, significantly higher values of the calcium index and equivalent weight of calcium deposits were observed than in patients with normal bone mineral density. Regardless of the presence of bone mineralization, more than half of the respondents (66,7% of patients with normal bone mineral density and 59,6% of patients with osteopenic syndrome) had coronary artery stenoses up to 50%. Calcification and presence of stenosis more than 30% of carotid arteries prevailed in the group of patients with osteopenic syndrome. The results of calculating the probability of having an osteopenic syndrome using a mathematical model indicate that it is highly prevalent in the sample (69,3%) and does not differ significantly from the densitometry data (70,1%). The sensitivity of the mathematical model was 89,8%, the specificity was 78,7%, the prognostic value of the positive result was 90,8%, the prognostic value of the negative result was 76,6%.Conclusion. The mathematical model for assessing the probability of osteopenic syndrome is highly diagnostic in men with multifocal atherosclerosis.

DIAGNOSTIC VALUE OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE CAROTID AND VERTEBRAL ARTERIES IN ARTERIAL HYPERTENSION, ASSOCIATED WITH BENIGN PAROXYSMAL POSITIONAL VERTIGO

Objective of the study was to assess the diagnostic significance of hemodynamic disorders in the area of carotid and vertebral arteries in patients with hypertension combined with benign paroxysmal positional vertigo (DPPG) using ultrasound duplex scanning of neck vessels. Material and methods . Thirty eight patients of the clinic of Federal Research Center for Fundamental and Translational Medicine with hypertension and concomitant dizziness were examined. The state of carotid and vertebral arteries, blood flow in the arteries were assessed by duplex ultrasound scanning using the Vivid E9 apparatus. Results and discussion. The influence of the blood flow at the level of carotid and vertebral arteries on the severity of clinical symptoms of dizziness in patients with hypertension with concomitant DPPG was shown. The clinical significance of atherosclerotic changes in carotid arteries, tortuosity of carotid and vertebral arteries of the effectiveness of treatment and prevention of dizziness in patients with hypertension and DPPG was revealed. It is shown that in patients with hypertension and comorbid DPP, the severity of the relationship of hemodynamically significant changes in the carotid and vertebral arteries with clinical manifestations of dizziness is greater than in patients with hypertension without DPP. The use of ultrasound duplex scanning of brachiocephalic arteries in hypertension with comorbid vertigo allows for differential diagnosis of benign paroxysmal positional vertigo and cerebrovascular dyscirculatory disorders, the degree of their participation in clinical manifestations of dizziness. A new medical technology for the diagnosis of pathogenic mechanisms of dizziness in patients with hypertension, using ultrasound duplex scanning of carotid and vertebral arteries, allows to personalize treatment and prevention in such patients.

The surgical treatment of patients with abdominal aorta aneurysm combined with carotid artery stenosis

The aim — to improve the treatment results of patients with a bdominal aorta aneurysm (AAA) by reducing their neurological complications risk.Materials and methods. During 2001 — 2018 an ultrasound duplex scan of carotid arteries was performed for 847 patients with AAA. In 84 (9.9 %) patients, concomitant stenosis of the internal carotid artery > 75 % was found. The average age of the patients was 61.3 ± 2.7 years. Men prevailed among the patients (78 (92.9 %)). All patients underwent a comprehensive examination. One‑stage carotid endarterectomy and open resection of AAA were performed in 25 (29.8 %) patients, staged carotid endarterectomy with the second stage of AAA repair — in 24 (28.6 %), staged AAA resection with the second stage of carotid arteries revascularization — in 16 (19.1 %) patients. Two‑stages intervention was performed in 7 (8.3 %) patients with a combination of an internal carotid artery stenosis, AAA and peripheral artery disease , the first stage was intervention on the carotid arteries, on the second stage (from 3 to 7 days) the reconstruction of the abdominal aorta and arteries of the lower extremities were done. In 7 (8.3 %) patients with concomitant coronary artery disease the two‑stages intervention was performed, with the primary one‑stage revascularization of the carotid and coronary arteries, and in 5 (6.0 %) — three‑staged reconstruction in the following sequence: carotid endarterectomy, coronary artery bypass grafting, reconstruction of the abdominal aorta.Results and discussion. No case of cerebrovascular accident in patients undergoing primary revascularization of the carotid arteries, either simultaneous, or staged was noted. In a group of patients who underwent an intervention on the abdominal aorta without carotid and coronary pathology correction, 1 patient developed ischemic stroke with a fatal outcome. Another 1 patient had myocardial infarction in the first postoperative day. The overall level of neurological complications was 1.2 %. The duration of hospitalization was 11.7 ± 0.7 days for patients with simultaneous interventions and 19.5 ± 0.6 days for staged treatment, stay duration in the intensive care unit were 2.1 ± 0.3 and 4.3 ± 0.5 days respectively.Conclusions. During planning of interventions on AAA the screening test of even clinically non‑manifested arterial segments (carotid and coronary arteries, arteries of the lower extremities) is necessary according to multi‑vascular nature of atherosclerotic lesions. The primary revascularization of the carotid arteries (symptomatic stenoses over 75 %, asymptomatic stenoses with high embolic risk) has to be done prior to the reconstruction of the AAA. The method of one‑stage operation on carotid arteries and abdominal aorta with a weighted risk assessment and plan of aortic intervention is more appropriate.

Ultrasound examination of achilles tendons in patients with familial hypercholesterolemia

Aim. To assess the morphometric characteristics of Achilles tendons in patients with familial hypercholesterolemia (FH) and to identify factors associated with an increase in their size.Материал и методы. Totally, 100 patients included, with severe primary hyperlipidemia, defined as an increase in total cholesterol ≥7,5 mM/L and/or lowdensity lipoprotein cholesterol ≥4,9 mM/L. All patients underwent duplex scanning of carotid arteries. Ultrasound examination of the Achilles tendons was carried out on an expert class ultrasound equipment Samsung Medison EKO 7 (Japan) with a linear sensor, frequency of 7-16 MHz. Thickness of the Achilles tendon (anteriorposterior dimension (APD)) was measured during scanning in the longitudinal section, width (transverse dimension (TD)) — scanning in the cross section. The measurements were made 2 cm proximal to the calcaneus.Results. Among the participants, 32 (32,0%) had definite/probable diagnosis of FH. In patients with definite/probable FH the mean values of APD were significantly higher in comparison with patients scored 5 or less points (DLCN) — 5,50 (4,70-6,10) mm vs. 5,00 (4,50-5,40), respectively (p=0,04). TD of Achilles tendons among this category of patients was also statistically significantly higher in comparison with the rest of patients — 14,0 (12,9-15,4) mm and 13,2 (12,2-14,2) mm, respectively (p=0,04). In correlation analysis, the relationship between the growth of patients and the APD of the Achilles tendons (r=0,34, p=0,001), the TD of the Achilles tendon (r=0,28, p=0,009), CIMT and TD of the Achilles tendons (r=0,21, p=0,05), amount of carotid plaques and TD of the Achilles tendon (r=0,26, p=0,01), total percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,27, p=0,01), maximum percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,28, p=0,007). According to regression analysis, factors associated with an increase in thickness of the Achilles tendons for more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and high-density lipoproteide cholesterol.Conclusion. In patients with definite/probable FH, mean values of width and thickness of the Achilles tendons were significantly higher in comparison with the rest of the patients. According to regression analysis, the factors associated with the increase in thickness of the Achilles tendons fro more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and HDL high-density lipoproteide cholesterol.

Screening of familial hypercholesterolemia among patients in age under 40 years old exposed by duplex scanning of carotid arteries, by the local registry data.

To identify patients with probable FH among Duplex-2013 registry patients under the age of 40 years, to analyze their lipid spectrum and duplex carotid artery data, to evaluate the changes of their lipid spectrum parameters. The Duplex-2013 registry database was used for this study (n=2550). Patients under the age of 40 years were selected for follow-up analysis (n=192). 20 of them were selected on the basis of Simon Broome criteria as patients with possible FH. The FH group (n=20) and the control group (n=172) had significant differences in age (35.1 ± 4.01 vs. 32.62 ± 5.29, p=0.044), male gender (18 of 20 (90%) vs 92 of 172 (53%), p=0.003), TC (7.64 ± 0.63 vs 5.34 ± 0.91, p=0.0001) and LDL-C cholesterol (5.45 ± 0.62 vs 3.28 ± 0.78, p=0.00001). When comparing the groups by the combined criterion of atherosclerosis (IMT > 1.0 mm and / or atherosclerotic plaque in the carotid artery >20%), it was noted that signs of carotid atherosclerosis were more often recorded in the FH group compared with the control group (40% vs 26%). Repeated laboratory studies of TC and LDL-C in the FH group after 2.5 years showed their significant dynamics (7.64 ± 0.63 vs 6.03 ± 1.04, p=0.007, 5.45 ± 0.63 vs 3.84 ± 1.24, p=0.035). The frequency of detection of FH in the cohort study was 1:10 (11% of all patients). Thus, patients referred for duplex scanning of carotid arteries can be a potential target for screening for FH.

Peripheral arterial disease and indicators of low-grade inflammation in patients with coronary artery disease and type 2 diabetes mellitus

BACKGROUND: The study of low-grade inflammation in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases is a pressing problem. A deeper understanding of the cascade of inflammatory reactions, possibly mediating the severe atherosclerotic lesions of various vascular pools in patients with diabetes, has the potential to introduce more sophisticated diagnostic and therapeutic approaches into practice.
 AIM: To study the interrelation of low-grade inflammation and atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) and T2DM.
 MATERIALS AND METHODS: The study included 137 patients (77 men and 60 women) with CAD. The average age of patients was 62.0 (57.066.0) years. The first group included 67 patients with CAD and T2DM, and the second group included 70 patients with CAD. Low-grade inflammation was assessed by the levels of high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10 and TNF-. All patients underwent duplex scanning of carotid arteries and lower extremity arteries (LEAs).
 RESULTS: Patients with CAD and T2DM showed significantly greater values of stenosis of carotid arteries and LEAs. Direct correlation was revealed between markers of inflammation and the degree of stenosis of the femoral and tibial arteries, as well as the intima-media thickness of the carotid and femoral arteries. In the group of patients with T2DM, the value of IL-1 was 2.04 (0.982.52) pg/mL, which was significantly less than 2.43 (1.843.19) pg/mL for patients in the second group (p = 0.010). The values of IL-6 were also significantly lower in the first group of patients, at 1.84 (0.734.41) pg/mL vs. 3.73 (2.2710.2) pg/mL in the first and second groups, respectively (p = 0.008). The dose of metformin was inversely correlated with the level of IL-6 (r = 0.314, p = 0.003).
 CONCLUSIONS: Patients with CAD and T2DM compared with patients without diabetes had significantly greater values of stenosis of peripheral arteries. The levels of IL-1 and IL-6 in the group of patients with CAD and T2DM were significantly lower in comparison with patients without diabetes. The dose of metformin was inversely correlated with the level of IL-6.

Atherosclerotic plaque in carotid arteries as a risk marker for cardiovascular events risk in middle aged population

Aim. To reveal the associations of carotid arteries atherosclerosis severity and cardiovascular events in mostly middle aged population. Material and methods . In the study, 1100 persons participated of the ATHEROGEN-Ivanovo trial (substudy of ESSE-RF), age 40-67 y. o. All participants underwent duplex scan of carotid arteries (Samsung Medison MySono U6) with assessment of the number of atherosclerotic plaques (AP), maximum stenosis and total stenosis with calculation of gender-specific quintiles. With the Cox regression model, risk was estimated for combinatory endpoint including all-cause death, myocardial infarction, novel onset of coronary heart disease, stroke, any area revascularization. Median follow-up 3,8 years. Results. The AP were found in 74,5% males and 58,0% females. In males atherosclerosis was more severe: maximum stenosis 27 (0-34)% in males vs 22 (0-58)% in females (р<0,001), total stenosis — 48 (0-90)% vs 22 (0-31)% (р<0,001) and plaques number — 2 (0-3) vs 1 (0-2) (р=0,000). There were 24 endpoints documented. 23 of 24 endpoints occurred in persons with at least any ultrasound marker value within quintile ≥3. Regression showed that if at least one ultrasound marker should have reached the quintile ≥3 (e. g., maximum stenosis ≥25% in men), than the risk of events from combinational endpoint would increase 8,5 times — 95% CI 1,12-64,76 (p=0,039). Also, coronary heart disease increases the risk 4,05 times — 95% CI 1,46-11,21 (p=0,007), acute stroke 3,49 times — 95% CI 1,19-10,23 (p=0,023). The number of males with AP <25% was 15%. Conclusion. The presence of AP in carotid arteries does 8,5 times increase the risk of cardiovascular events, and for 15% of males in population with AP in carotid arteries that narrow the lumen <25%, it is needed to clarify the risk.