Cerebral Disorders Research Articles

The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series.

Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success. A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures. From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years). Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.

Indicators of cerebral venous drainage with non-thrombotic disorders in extracranial veins

The growing number of studies on cerebral venous circulation disorders associated with extrinsic stenosis of the internal jugular veins, as well as attempts to surgically influence the restoration of blood flow, are an indicator of the importance of this problem. Studies show that extracranial outflow disorders are associated with a wide range of neurological clinical manifestations and may contribute to the development of congestive intracranial hypertension. Anatomical variants of the development of the extracranial venous system, constitutional insufficiency and stenosis often play similar roles in the development of disorders of the cerebral venous outflow, but differ parametrically. There are no standard diagnostic criteria for differential diagnosis, normal and pathological parameters are contradictory, and the diagnosis largely depends on the combined use of imaging techniques. The history of attempts to study disorders of the cerebral venous circulation is quite long, associated with the technical innovations in every period of time. The most non-invasive, accessible and safe tools for diagnosing non-thrombotic lesions and anomalies of the internal jugular veins are currently recognized as ultrasound scanning and MR venography in tandem. Researchers note both local hemodynamic disturbances at the level of stenosis and changes in the overall picture of the venous vascular network of the neck with certain patterns of its remodeling. The pathological significance of the compensatory expansion of nonjugular outflow tracts (vertebral, paraspinal collateral, spinal epidural veins, etc.) is still a controversial issue. MRI and ultrasound combined show a high degree of agreement between the results, which should stimulate further research into the pathophysiology and differentiation of various causes and severity of non-thrombotic lesions of the jugular veins.

ВТОРИЧНЫЕ ГНОЙНЫЕ ОТОГЕННЫЕ МЕНИНГИТЫ У ВЗРОСЛЫХ: ОСОБЕННОСТИ ПРОТИВОМИКРОБНОЙ ТЕРАПИИ

Secondary purulent otogenic meningitis (SPOM) in adult patients is less common than in children, but among all intracranial complications of middle ear pathology it occupies the leading position. In the absolute majority of cases, a patient with SPOM on admission to the emergency room is supervised by a neurologist with a suspicion of acute cerebral circulation disorder, and an otorhinolaryngologist, along with other subspecialists, is initially an invited consultant. All this is associated with the risks of untimely diagnosis of SPOM and inadequate tactics of medical care, including the rationality of prescribing the choice of systemic antimicrobial therapy (SPMT), which increases the likelihood of unfavorable outcomes. As a result of retrospective analysis of medical records of 33 completed cases of SPOM for the period from 2017 to October 2023, the features of the course of SPOM microbial landscape in this pathology and the nature of SPMT were studied. It was revealed that in the structure of secondary meningitis of otogenic and rhinosinusogenic etiology VHOM took the leading positions (81.1%). In 62.5% of cases, patients had comorbid pathology, which negatively affected the course of the underlying disease and worsened the prognosis of the disease. Such manifestations as headache, vomiting, disorders of consciousness were observed in 62.5%, 57.6%, 62.1% of cases, respectively. Clearly expressed signs of inflammatory process on the part of general blood analysis and cerebrospinal fluid were revealed. The structure of etiologic factors in adult SPOM was dominated by coccal microflora (S.pneumoniae, Streptococcus spp., Staphylococcus spp.). In 81.8% of cases of SPOM we started with recommended ceftriaxone, but absence of positive dynamics, severity of the course of the inflammatory process required correction of SPMT and transition to meropenem. Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT using, including de-escalation schemes, led to favorable outcomes in 87.9% of patients.

Effectiveness of slow deep breathing therapy on lowering blood pressure in hypertensive patients: A case study

Introduction: Hypertension is a cerebral vascular disorder in the form of narrowing of cerebral blood vessels, resulting in reduced oxygen and nutrient supply to the brain. It is characterized by an increase in systolic blood pressure >140 mmHg and diastolic pressure >90 mmHg. Non-pharmacological management is needed to be applied in lowering blood pressure. Slow deep breathing therapy exercises are done by breathing long and deep breaths slowly can stimulate the secretion of endorphins neurotransmitters in the autonomic nervous system which has an effect on decreasing the work of sympathetic nerves, increasing the work of parasympathetic nerves whose effects can affect heart rate to be slow and also vasodilation occurs in blood vessels. Objective: To lower blood pressure in hypertensive patients by using slow deep breathing exercises. Methods: The method used in this study used a case study with pre and post intervention, patients were given slow deep breathing exercises by breathing in through the nose for 3 seconds until they felt that the stomach expanded then held their breath for 3 seconds, then exhaled slowly through the mouth for 6 seconds, and repeated all steps for 15 minutes. Results: Obtained results of a decrease in blood pressure in patients after being given slow deep breathing exercises. Conclusion: Slow deep breathing therapy exercises with appropriate methods and procedures can be an alternative to lower blood pressure in hypertensive patients

Emergency neurosurgical care for patients with acute cerebral circulation disorders

Aim. To improve the results of neurosurgical treatment of patients with acute cerebrovascular disorders.Material and Methods. An analysis of the results of neurosurgical treatment of 48 patients admitted to the Department of Neurosurgery of the State Institution National Medical Center - “Shifobakhsh” was carried out. The age of patients ranged from 30 to 75 years. In each case, patients underwent clinical and laboratory studies, including using CT and MRI, as well as using three-dimensional (3D) and four-dimensional (4D) reconstruction methods of cerebral vessels.Result and Discussion. The most common cause leading to the formation of intracranial hematomas was hypertension, found in 32 (66.6%) patients, while other causes were identified in 12 (25%) patients (including angiopathy, cerebral vascular pathologies, amyloidosis, and the use of certain medications, among others). All patients underwent neurosurgical operations. The highest frequency of recurrences (4.1%) was observed after surgical interventions performed within the first 24 hours following the hemorrhagic event.Conclusion. With early detection of intracranial hematomas and with the optimal choice of method for their treatment, good functional results are observed with a low incidence of deaths.

BOTULINUM TOXIN A FOR BLEPHAROSPASM WITH DRY EYE: A SYSTEMATIC REVIEW

Introduction & Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms.
 Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI).
 Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p<0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies.
 Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.

Epileptic Seizures in People with HIV- Related Toxoplasmosis and Other Cerebral Disorders

Epileptic Seizures in People with HIV- Related Toxoplasmosis and Other Cerebral Disorders

Considerations Over Cerebral Toxoplasmosis and Other Cerebral Disorders in HIV-Infected Patients

Considerations Over Cerebral Toxoplasmosis and Other Cerebral Disorders in HIV-Infected Patients

Hematological indicators as predictors of atrial fibrillation after cardiac surgery

Newly diagnosed postoperative atrial fibrillation (NDPAF) is one of the most common complications after cardiovascular surgery, provoking early and late complications, such as cardiovascular, thromboembolic complications, cerebral circulation disorders, prolonged hospital stay and repeated hospitalizations to the intensive care unit and hospital. Objective. To identify biochemical and clinical predictors of NDPAF in patients who underwent open-heart surgery for any indication. Materials and methods. The study included patients operated in the cardiac surgery department No.2 of the Research Institute – Prof. S.V. Ochapovsky Territorial Clinical Hospital One (Krasnodar) in the period from January 1, 2020 to January 1, 2021. During the analyzed period of time, open heart surgery was performed in 1503 patients, of whom 158 (10.5%) had NDPAF. Results. Hematological/biochemical parameters include low levels of hemoglobin (<12.5 g/dl), hematocrit (<35%), erythrocytes (<4,2•1012/L), and high levels of lymphocytes (>3,0•109/L), bilirubin (20.5 mmol/L), creatinine (115 mmol/L), urea (8.3 mmol/L), aspartate aminotransferase (>35 U/L), alanine aminotransferase (>55 U/L), C-reactive protein (>5 mg/L) were associated with an increased frequency of NDPAF in single-factor analysis (p<0.05 for all comparisons). Conclusion. Hematological indicators can predict the risk of atrial fibrillation before surgery. The study of risk factors for NDPAF will allow to effectively influence them, thereby preventing the possibility of arrhythmia and improving the prognosis for postoperative complications and survival.

Correlation analysis of clinical and laboratory markers in COVID-19 and acute cerebrovascular accident

Coagulopathies developing with COVID-19 are a serious problem. Increased fibrinogen levels, activation of coagulation, a direct damaging effect of the virus on the endothelium, and increased interaction of the platelet with the vascular endothelium play an important role in the development of thrombotic complications and the occurrence of acute cerebral circulatory disorders. Case histories of COVID-19 patients and those with secondary CHF were analysed. Among the biochemical blood parameters in COVID-19, an increased level of D-dimer, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin were revealed more frequently.
 Results: Among biochemical blood parameters in COVID-19, an increase in D-dimer level, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin, is more frequently detected. In correlation analysis, a positive correlation was observed between the level of ferritin, CRP and stage of CT as well as between the level of D-dimer and the number of platelets

Microvascular Dysfunction and Whole-Brain White Matter Connectivity: The Maastricht Study.

Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole-brain white matter connectivity. Cross-sectional data from The Maastricht Study, a Dutch population-based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light-induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017-0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures. These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole-brain white matter connectivity.

Biomarkers of Brain Ischemia (Review)

Introduction. Strokes remain the second leading cause of death and the third leading cause of disability. Additional serum biomarker testing should be used to better diagnose transient ischemic attack (TIA), but most neurospecific biomarkers have low prognostic specificity and sensitivity. Timely identification of TIA and differential diagnosis of stroke in the first hour will ensure a shorter period of patient recovery and reduce the risk of mortality and disability. Serum biomarker studies should be included to overcome the difficulty of diagnosing TIA.Text. Neurospecific biomarkers such as S100B, GFAP, and NSE are used to diagnose acute ischemic damage to glial cells and neurons. S100B and GFAP are detected in astrocytes and NSE in neurons and cells of the neuroendocrine system. Elevated serum concentrations of these biomarkers are associated with various pathological conditions such as strokes and brain injuries and other central nervous system (CNS) lesions. Dynamic monitoring of biomarker concentrations makes it possible to evaluate the efficacy of the ongoing therapy and to identify predictors of patient deterioration for prompt correction of therapeutic procedures. To create a diagnostic panel it is necessary to study metabolic processes in ischemic tissue, taking into account concomitant diagnoses and results of neuroimaging, and to use breakthrough advances in machine learning and big data.Conclusion. The review showed that none of the assessed biomarkers can be recommended for the diagnosis of cerebral circulation disorders, but the combination of several neurospecific biomarkers can significantly improve diagnostic efficiency and find application in the differential diagnosis of stroke, intracranial hematoma, and other brain lesions for the purpose of early pharmacotherapy of CNS lesions and as surrogate endpoints during clinical trials.

SOSIALISASI DAN PEMBERIAN MINUMAN HERBAL JAHE SEBAGAI PENURUNAN TEKANAN DARAH DI POSYANDU LANSIA DESA ARA CONDONG DUSUN 7 WONOGIRI KABUPATEN LANGKAT

Hypertension is one of the most common cardiovascular diseases suffered by the community. Hypertension is now a major problem for all of us, not only in Indonesia but in the world, because if it is not controlled properly it can be a risk factor for the emergence of complications such as heart, kidney failure, diabetes, stroke, retinopathy, nervous disorders and cerebral disorders. The increase in cases of hypertension can be caused by many factors, one of which is public knowledge that is not limited to hypertension, but what efforts can be made by the community to prevent and lower blood pressure. One of the efforts to increase people's knowledge is through counseling methods so that they are able to adopt a healthy lifestyle to improve their health. The purpose of this article is to obtain an overview of public knowledge about hypertension and to introduce herbal drinks from ginger that can lower blood pressure. The method was carried out with interactive counseling which was carried out at the Children's Poling Village Hall, Ara Condong village Langkat district, Dairi Regency using leaflet media, , and giving ginger drinks. The counseling was carried out smoothly and gave good results, where many people asked questions about their hypertension, how to avoid increasing blood pressure and trying to understand how to make the given ginger drink.

Characterizing a new clinical phenotype: the co-existence of cerebral venous outflow and connective tissue disorders.

There is increasing recognition of connective tissue disorders and their influence on disease in the general population. A conserved clinical phenotype involving connective tissue disorders and idiopathic intracranial hypertension (IIH) and associated cerebral venous outflow disorders (CVD) has not been previously described. A single-institution retrospective review of a prospectively maintained database of patients with connective tissue disorders and CVD was performed. A total of 86 patients were identified. The majority of these patients carried a diagnosis of Ehlers-Danlos syndrome (55%) and most were non-obese (mean body mass index 29.7 kg/m2), Caucasian (90%) females (87%). Most prevalent presenting symptoms included pressure headache (98%), dizziness (90%), tinnitus (92%), and cognitive dysfunction (69%). Aside from CVD and IIH, the most common associated conditions were postural orthostatic tachycardia syndrome (POTS; 55.8%), cerebrospinal fluid (CSF) leaks (51.2%), dysautonomia (45.3%), cranio-cervical instability (37.2%), mast cell activation syndrome (25.6%), and tethered cord syndrome (23.3%). Allergies to medications (87.2%) and surgical tape (19.8%) were also frequent. Despite significantly lower opening pressures on lumbar puncture, headache severity and quality of life scores were reported with the same severity of classic IIH patients, suggesting an underlying hypersensitivity to intracranial pressures and cerebral venous congestion. There is a rare but conserved clinical phenotype that has not been described previously that presents with severe IIH symptoms in predominantly young, non-obese Caucasian women with a high associated incidence of dysautonomia, POTS, craniocervical instability, and CSF leaks, among others.

Chapter 17 - Familial cerebral amyloid disorders with prominent white matter involvement

Familial cerebral amyloid disorders are characterized by the accumulation of fibrillar protein aggregates, which deposit in the parenchyma as plaques and in the vasculature as cerebral amyloid angiopathy (CAA). Amyloid β (Aβ) is the most common of these amyloid proteins, accumulating in familial and sporadic forms of Alzheimer's disease and CAA. However, there are also a number of rare, hereditary, non-Aβ cerebral amyloidosis. The clinical manifestations of these familial cerebral amyloid disorders are diverse, including cognitive or neuropsychiatric presentations, intracerebral hemorrhage, seizures, myoclonus, headache, ataxia, and spasticity. Some mutations are associated with extensive white matter hyperintensities on imaging, which may or may not be accompanied by hemorrhagic imaging markers of CAA; others are associated with occipital calcification. We describe the clinical, imaging, and pathologic features of these disorders and discuss putative disease mechanisms. Familial disorders of cerebral amyloid accumulation offer unique insights into the contributions of vascular and parenchymal amyloid to pathogenesis and the pathways underlying white matter involvement in neurodegeneration. With Aβ immunotherapies now entering the clinical realm, gaining a deeper understanding of these processes and the relationships between genotype and phenotype has never been more relevant.

Neuroradiological and pathohistological markers of the main epileptogenic substrates in children. Other cerebral disorders

High-resolution MRI is an important tool in the diagnosis of structural epilepsy |in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we have tried to demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The second part of the article is devoted to the spectrum of epileptogenic cerebral disorders, in addition to cortical malformations.

Cerebral hemodynamic disorders in patients with schizophrenia with concomitant metabolic syndrome

To identify the differences or comparability of parameters of cerebral hemodynamics between patients with schizophrenia with or without concomitant metabolic syndrome (MS). The study included 94 patients with schizophrenia (48 men and 46 women). A control group consisted of 40 mentally and somatically healthy individuals (17 men and 23 women) comparable in sex and age to the main group of patients. The diagnosis of metabolic syndrome was carried out according to the criteria of the International Diabetes Federation (IDF). Assessment of cerebral hemodynamics was carried out by 4 - channel rheoencephalography (REG) at rest with closed eyes. Data analysis was carried out using the Kraskel-Wallis ANOVA criterion with the procedure of automatic a posteriori pairwise comparison, the χ2 criterion and Spearman correlation analysis. According to the IDF criteria, 37 (39.4%) patients were diagnosed with MS. REG results revealed significantly (p<0.05) lower indicators of blood filling in the carotid basin, elasticity of the wall of the main arteries, the tone of small-caliber arteries and arterioles, as well as higher values of the tone of medium-caliber arteries in the carotid and vertebrobasilar basins, in both groups of patients with schizophrenia compared with the control group. In patients with schizophrenia with MS, compared with patients without MS, there were lower indicators of blood filling (p=0.044 and p=0.016) and elasticity of the wall of the main arteries (p=0.044 and p=0.028) in the carotid basin on the left and right sides. The presence of MS in patients with schizophrenia was accompanied by more pronounced disorders of cerebral blood flow in the form of a decrease in blood filling and elasticity of the wall of the main arteries in the carotid basin. The results indicate that patients with schizophrenia with MS should be considered as a group at increased risk of cerebrovascular diseases.

THE INFLUENCE OF MESENCHYMAL STROMAL CELLS OF DIFFERENT GENESIS ON ENERGY METABOLISM IN THE RAT SOMATOSENSORY CORTEX DURING ISCHEMIA-REPERFUSION

Introduction. About 60-80% of cerebral circulation disorders are due to ischemia, that leads to high mortality, disability in working age and economic burden on society in developed countries of the world. Objective: To investigate the effect of ischemia-reperfusion on parameters of carbohydrate and energy exchanges in the rat somatosensory cortex and to determine the cerebroprotective action of mesenchymal stromal cells (MSCs) of various genesis, MSC lysate and the reference drug Citicoline. Methods. The study was performed on 200 male Wistar rats, divided into 9 groups. Group 1 included intact animals; group 2 – sham-operated rats; group 3 – control pathology (rats were subjected to ischemia-reperfusion by occlusion of the internal carotid arteries and injected with a 0.9% saline solution (2 ml/kg) into the femoral vein); group 4 – immediately after ischemia-reperfusion rats were transplanted with 106 MSC cells/animal derived from Wharton’s jelly of the human umbilical cord; group 5 – 106 cells/animal of rat embryonic fibroblasts; group 6 – 106 cells/animal derived from human adipose MSCs; group 7 – 106 cells/animal derived from rat adipose MSCs; group 8 – 0.2 ml/animal of lysate derived from Wharton’s jelly MSCs; group 9 – the reference drug Citicoline (250 mg/kg). Parameters of carbohydrate and energy metabolism in rat somatosensory cortex under the conditions of cerebral IR and on the background of correction studied on the 7th and 14th day. Results. It was found that after cerebral ischemia-reperfusion in the rat somatosensory cortex in research periods an increase in the levels of glucose, lactate, lactate/pyruvate ratio and a decrease in the content of pyruvate and succinate dehydrogenase were revealed. In the groups of experimental animals with intravenous transplantation of MSCs of various origins, MSC lysate and Citicoline, the perturbation in glucose metabolism was reduced, lactate content was decreased and the levels of pyruvate and succinate dehydrogenase were significantly increased (p&lt;0.05), compared to rats with control pathology. A more pronounced positive effect in the recovery of disturbed energy processes and elimination of metabolic acidosis was observed with the use of human Wharton’s jelly-derived MSCs. Conclusions. The study demonstrated that experimental 20-minute model ischemia-reperfusion in rats caused a violation of the carbohydrate and energy balance in the somatosensory cortex. Human umbilical cord blood-derived MSCs contributed to the recovery of disturbed energy processes in the somatosensory cortex and eliminated metabolic acidosis at the level of Citicoline or better than it, which is one of the links of the mechanism of the cerebral protective action of MSCs. Embryonic rat fibroblasts were slightly inferior in efficiency to Citicoline and human umbilical cord Wharton’s jelly MSCs, which indicates a higher cerebroprotective activity of xenotransplantation.

The value of revascularisation of atherosclerotic lesions of the innominate artery at the asymptomatic stage of the disease

To analyze the natural course of asymptomatic atherosclerotic lesions of the innominate artery and to study the long-term results of surgical interventions performed at the asymptomatic stage and to compare them with similar results at the symptomatic stage of the disease. The analysis of the natural course of the disease was performed in 74 asymptomatic patients who were divided into 3 groups depending on the initial degree of severity of the stenosis of the innominate artery: insignificant stenoses (less than 50%), moderate stenoses (50-69%) and haemodynamically significant lesions (70% and more). The analysis of the long-term results of surgical treatment was performed in 62 patients, in 29 of whom intrathoracic reconstructions were performed at the asymptomatic stage of the disease, in 33 - at the symptomatic stage. Cumulative freedom from stroke by the 10th year of follow-up was significantly higher in patients with insignificant stenoses and amounted to 100% in the groups of moderate stenoses and hemodynamically significant lesions - 25% and 0, respectively (log-rank p=0.000). Neurological fatality in patients with hemodynamically significant (initial or developed) lesions was 26.3%, while in patients with hemodynamically insignificant lesions it was 0 (log-rank p=0.004), which is confirmed by cumulative indices (log-rank p=0.008). Asymptomatic innominate artery reconstructions were associated with a lower incidence of stroke: the long-term incidence of stroke in such patients was 3.4%, while in initially symptomatic patients it was 18.2% (p=0.038). Initial degree II or IV cerebrovascular insufficiency was a predictor of stroke in the long-term period (OR=1.71; p=0.000). The cumulative freedom from stroke in asymptomatic patients by the 20th year of follow-up was 95% compared with 74% in symptomatic patients (log-rank p=0.032). Surgical interventions in asymptomatic hemodynamically significant lesions of the innominate artery should be performed to prevent primary cerebral circulatory disorders.

The Role of the Complement System in Synaptic Pruning after Stroke.

Stroke is a serious disease that can lead to local neurological dysfunction and cause great harm to the patient's health due to blood cerebral circulation disorder. Synaptic pruning is critical for the normal development of the human brain, which makes the synaptic circuit completer and more efficient by removing redundant synapses. The complement system is considered a key player in synaptic loss and cognitive impairment in neurodegenerative disease. After stroke, the complement system is over-activated, and complement proteins can be labeled on synapses. Microglia and astrocytes can recognize and engulf synapses through corresponding complement receptors. Complement-mediated excessive synaptic pruning can cause post-stroke cognitive impairment (PSCI) and secondary brain damage. This review summarizes the latest progress of complement-mediated synaptic pruning after stroke and the potential mechanisms. Targeting complement-mediated synaptic pruning may be essential for exploring therapeutic strategies for secondary brain injury (SBI) and neurological dysfunction after stroke.