Small Vessel Lesions Research Articles

Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke

Introduction and GoalLacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. Material and MethodsWe prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. ResultsThe study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). ConclusionsDoppler ultrasound is a useful technique for determining the LO of acute stroke.

Percutaneous coronary intervention for treating de-novo lesions in small coronary vessels: initial experience with the Essential paclitaxel-coated balloon.

Paclitaxel-coated balloon (PCB) coronary angioplasty is an alternative treatment for de-novo coronary lesions in small vessels. This study with the new Essential PCB aimed to evaluate early and mid-term clinical outcomes following angioplasty with the Essential PCB in the treatment of de-novo lesions in small vessels. We included all patients who underwent PCB angioplasty for treating de-novo coronary lesions in small vessels (reference diameter <2.5 mm) between October 2015 and June 2016 in 2 centres. The primary endpoint was the 12-month target lesion failure (TLF) rate: a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization. The secondary endpoints were rates of target vessel failure and global major adverse cardiac events (MACE). A total of 71 patients (comprising 71 lesions) were included, with a mean age of 66±11 years. A 56% were diabetic and 70% had an acute coronary syndrome as an indication for coronary revascularization. The mean vessel diameter and lesion length were 2.21±0.41 and 20.7±9.2 mm, respectively. Predilatation was performed in 85.9% of patients. The median diameter, length, and inflation pressure of the Essential balloon were 2.0 [interquartile range (IQR): 2.0-2.5] mm, 20 (IQR: 15-30) mm, and 12±2 atmospheres, respectively. Angiographic success was achieved in 97.2% of cases, and bail-out stenting was required in nine (12.7%) cases. The incidence of TLF at the 12-month follow-up was 4.2%, with a target lesion revascularization rate of 4.2%. Target vessel failure and global MACE rates were 4.2 and 9.9%, respectively. Use of the Essential PCB for treating de-novo coronary lesions in small vessels was safe, with low TLF and MACE rates at the 12-month follow-up.

Treatment of large de novo coronary lesions with paclitaxel-coated balloon only: results from a Chinese institute.

To evaluate the efficacy of paclitaxel-coated balloons (SeQuent Please®) for large de novo coronary lesions with diameters greater than 2.8mm. We performed a retrospective study of 527 consecutive patients with 595 de novo lesions (222 lesions) that comprised the large vessel disease (LVD) group, with a reference diameter (RD) ≥ 2.8mm; the other 373 lesions comprised the small vessel disease (SVD) group, with a RD < 2.8mm who received drug-coated balloon (DCB) angioplasty at the Beijing Hospital, Beijing, China. Sixty-eight patients with 91 lesions, including 45 LVD lesions, underwent coronary angiography atan average 10.7 months after DCB intervention. Clinical characteristics were recorded, and coronary angiograms were analysed with Quantitative Coronary Angiography (QCA) software. The patients in the LVD group were much younger than those in the small vessel group (61.7 ± 11.3 vs. 63.8 ± 11.7, P = 0.003), and fewer LVD patients had diabetes (27.0 vs. 57.8%, P = 0.001), three-vessel disease (37.5 vs. 52.6%, P = 0.003) and complex lesions (37.8 vs. 48.8%, P = 0.009) than those in the SVD group. Lesion preparations for LVD were more complicated than for SVD, such as 40.1% of lesions required the additional use of a cutting or scoring balloon (P = 0.004), and 21.2% lesions required non-compliant (NC) balloons (P < 0.001). Coronary dissections occurred in 63(28.3%) lesions in the LVD group but bail-out drug-eluting stent (DES) implantation was required only in one lesion (0.5%), which were both comparable with those in the SVD group. The success rate of DCB intervention was quite high and also similar in the LVD group and SVD group (99.5 vs. 99.7%, P > 0.05). QCA analysis showed that the follow-up minimal lumen diameter (MLD) was significantly increased compared with the MLD immediately post angioplasty both in the SVD group (1.75 ± 0.48 vs. 1.58 ± 0.31mm, P = 0.008) and the LVD group (2.26 ± 0.66 vs. 2.09 ± 0.40mm, P = 0.067). At an average of 10.1 months of clinical follow-up, the major adverse cardiovascular event (MACE) rate was 0% in the LVD group and 1.4% in the SVD group, with target lesion revascularization (TLR) rates of 0% and 1.1%, respectively. No death was observed in either group. DCB for de novo coronary lesions with diameters greater than 2.8mm was as safe and effective as for small vessel lesions, suggesting that the DCB-only strategy is also feasible in large de novo lesions intervention.

The effectiveness and safety of the RESTORE® drug-eluting balloon versus a drug-eluting stent for small coronary vessel disease: study protocol for a multi-center, randomized, controlled trial.

ObjectiveSmall coronary vessel disease (disease affecting coronary vessels with main branch diameters of ≤ 2.75 mm) is a common and intractable problem in percutaneous coronary intervention (PCI). This study was designed to test the theory that the effectiveness and safety of drug-eluting balloons for the treatment of de novo lesions in small coronary vessels are non-inferior to those of drug-eluting stents.MethodsWe designed a prospective, multicenter, randomized, controlled clinical trial aiming to assess the effectiveness and safety of the RESTORE® (Cardionovum, Bonn, Germany) drug-eluting balloon (DEB) versus the RESOLUTE® (Medtronic, USA) drug-eluting stent (DES) in the treatment of small coronary vessel disease. This trial started in August 2016. A total of 230 patients with a reference vessel diameter (RVD) ≥ 2.25 mm and ≤ 2.75 mm were randomly assigned to treatment with a DEB or a DES at a 1:1 ratio. The study was also designed to enroll 30 patients with an RVD ≥ 2.00 mm and ≤ 2.25 mm in the tiny vessel cohort.ResultsThe key baseline data include demographic characteristics, relative medical history, baseline angiographic values and baseline procedural characteristics. The primary endpoint is in-segment diameter stenosis at nine months after the index procedure. Secondary endpoints include acute success, all-cause death, myocardial infarction, target vessel revascularization, target lesion revascularization and stent thrombosis.ConclusionsThe study will evaluate the clinical efficacy, angiographic outcomes, and safety of DEBs compared to DESs in the treatment of de novo coronary artery lesions in small vessels.

Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry

BackgroundDrug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. MethodsFrom June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis > 30% or type C–F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). ResultsA total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467–1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. ConclusionsBailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.

Bioresorbable Scaffold for Treatment of Coronary Artery Lesions: Intravascular Ultrasound Results From the ABSORB Japan Trial

ObjectivesThe aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries. BackgroundDespite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries. MethodsIn the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter <2.75 mm. Tapered-vessel lesions were defined as tapering index (proximal/distal reference lumen diameter) ≥1.2. ResultsOverall, IVUS revealed that the Absorb BVS arm had smaller device expansion than the CoCr-EES arm did, which was particularly prominent in small- and tapered-vessel lesions. Higher tapering index was also associated with higher rates of incomplete strut apposition in Absorb BVS, but not in CoCr-EES. With respect to procedural techniques, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm. In contrast, tapered-vessel lesions were post-dilated at equivalent pressure but with significantly smaller balloon catheters in the Absorb BVS arm, compared with the CoCr-EES arm. ConclusionsThe significantly smaller device expansion especially in small vessels may account for the poorer outcomes of Absorb BVS in this lesion type. Appropriate optimization strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284)

OUTCOMES OF PATIENTS WITH SMALL VESSELS UNDERGOING PCI WITH CONTEMPORARY DRUG-ELUTING STENTS: A SUB-ANALYSIS FROM THE BIONICS STUDY

Treatment of lesions in small coronary vessels is associated with an increased risk of adverse cardiovascular events after PCI. We sought to compare the clinical and angiographic outcomes of patients with vs. without small-vessel PCI with contemporary DES in the BioNIR Ridaforolimus-eluting coronary

Neuropsychological Outcome One Year after Carotid Revascularization: A before-and-after Study.

PurposeThe aim of our study was to determine the clinical profile of patients considered cognitive ‘responders’ to surgery in order to establish clinical variables associated with a favorable cognitive performance.Materials and MethodsA total of 70 patients were included in the study. A well-validated, comprehensive standardized neurocognitive battery of tests of about 2 hours was administered. Patients were examined twice, 1-week before surgery and 1-year postoperatively. The criterion to be included in the ‘responder’ group was the following: to obtain a positive difference between post-revascularization and pre-revascularization neuropsychological assessment ≥1 standard deviation in ≥2 tests.ResultsTwenty-seven patients (38.6%) were cognitive responders to treatment. In bivariate analysis between responders and non-responders, presence of atrophy (P=0.003), small vessels (P=0.577), symptoms (P=0.046), and age (P=0.030) were the factors statistically significant. When comparing cognitive performance before and after carotid revascularization, significant differences were observed in semantic fluency with a lower performance after 12 months (P=0.004, d=0.29), and in the Language index (Repeatable Battery for the Assessment of Neuropsychological Status) (P=0.005, d=0.34).ConclusionPatients without neurological symptoms, of a younger age and without atrophy and white matter small vessel lesions are better cognitive responders 1-year after carotid revascularization.

Long-Term Safety and Efficacy of Platinum Chromium Everolimus-Eluting Stents in Coronary Artery Disease: 5-Year Results From the PLATINUM Trial

ObjectivesThe authors sought to evaluate the final 5-year safety and effectiveness of the platinum-chromium everolimus-eluting stent (PtCr-EES) in the randomized trial, as well as in 2 single-arm substudies that evaluated PtCr-EES in small vessels (diameter <2.5 mm; n = 94) and long lesions (24 to 34 mm; n = 102). BackgroundIn the multicenter, randomized PLATINUM (PLATINUM Clinical Trial to Assess the PROMUS Element Stent System for Treatment of De Novo Coronary Artery Lesions), the PtCr-EES was noninferior to the cobalt-chromium everolimus-eluting stent (CoCr-EES) at 1 year in 1,530 patients undergoing percutaneous coronary intervention. MethodsPatients with 1 or 2 de novo coronary artery lesions (reference vessel diameter 2.50 to 4.25 mm, length ≤24 mm) were randomized 1:1 to PtCr-EES versus CoCr-EES. All patients in the substudies received PtCr-EES. The primary endpoint was target lesion failure (TLF), a composite of target vessel-related cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization. ResultsIn the randomized trial, the 5-year TLF rate was 9.1% for PtCr-EES and 9.3% for CoCr-EES (hazard ratio [HR]: 0.97; p = 0.87). Landmark analysis demonstrated similar TLF rates from discharge to 1 year (HR: 1.12; p = 0.70) and from 1 to 5 years (HR: 0.90; p = 0.63). There were no significant differences in the rates of cardiac death, myocardial infarction, target lesion or vessel revascularization, or stent thrombosis. PtCr-EES had 5-year TLF rates of 7.0% in small vessels and 13.6% in long lesions. ConclusionsPtCr-EES demonstrated comparable safety and effectiveness to CoCr-EES through 5 years of follow-up, with low rates of stent thrombosis and other adverse events. The 5-year event rates were also acceptable in patients with small vessels and long lesions treated with PtCr-EES. (The PLATINUM Clinical Trial to Assess the PROMUS Element Stent System for Treatment of De Novo Coronary Artery Lesions [PLATINUM]; NCT00823212; The PLATINUM Clinical Trial to Assess the PROMUS Element Stent System for Treatment of De Novo Coronary Artery Lesions in Small Vessels [PLATINUM SV]; NCT01498692; The PLATINUM Clinical Trial to Assess the PROMUS Element Stent System for Treatment of Long De Novo Coronary Artery Lesions [PLATINUM LL]; NCT01500434)

TCT-643 Safety and efficacy of Sirolimus coated balloon for the treatment of coronary lesions in small vessels: a subgroup analysis from the Nanolute registry

We sought to investigate the clinical outcomes after the treatment of Magic Touch Sirolimus Coated Balloon (SCB, Concept Medical Research Pvt Ltd, Surat, India) in patients with lesions located in small coronary arteries. The all comers, multicentre Nanolute registry enrolled patients with lesions

Angina in granulomatosis with polyangiitis: A case report.

Granulomatosis with polyangiitis (GPA) often causes small blood vessel lesions in multiple organs, with less impact on large vessels. We report a case involving not only large blood vessels, but also angina. The computed tomographic angiography of large vessels and vascular ultrasonography of the extremity also suggested great arteries of the body were involved. Further cytoplasmic antineutrophil cytoplasmic antibody tests, pathological examination and dynamic chest computed tomography scan confirmed the diagnosis of GPA. Anti-inflammatory therapy and coronary secondary prevention were given after diagnosis by pathological examination and laboratory evaluation. The symptoms of angina pectoris were relieved. This rare case report reminds us that among the well-known risk factors of atherosclerotic diseases, GPA is also an important risk factor for acute coronary syndrome. Early foresight for this rare risk factor can improve the early diagnosis and treatment of the disease, which will improve the prognosis of the patients.

COGNITIVE CORRELATES OF BLOOD PRESSURE VARIABILITY IN ALZHEIMER’S DISEASE

Vascular abnormality, especially small vessel disease, has been frequently reported in Alzheimer's disease (AD). Some studies suggest that small vessel lesions and cognitive performance are affected by the loss of a nocturnal BP dip or SBP variability. In this study, we compared and analyzed 24-hour BP values between patients with amnestic mild cognitive impairment (aMCI) and dementia of the Alzheimer type (AD). Case-control comparisons were made among outpatients that visited the Department of Neurology, The Catholic University of Korea, Bucheon St. Mary's Hospital for the evaluation of cognitive impairment between January 2015 and November 2016. Twenty-eight patients with MCI and 46 patients with Alzheimer's disease were selected according to inclusion criteria. All of the subjects received brain MRI and MR angiography, detailed neuropsychological testing, and 24-hour ambulatory BP monitoring. Frequency of non-dippers and reverse dippers were higher in patients with AD (84.4%; 7 dippers, 17 non-dippers, and 21 reverse dippers), compared to patients with MCI (71.4%; 8, 14, and 6). Demographic data including age and education, and MRI parameters such as WMHs and medial temporal atrophy were not different between non-dippers and dippers. Just 2 variables of MMSE score and BMI value were different. MMSE score of the non-dippers was lower (19.18±6.36) than that of dippers (22.43±5.03). BMI was lower in non-dippers (22.90±3.21) than dippers (24.76±2.97). We have found that AD is associated with loss of nocturnal BP dipping and SBP. variability. Loss of nocturnal dipping was significantly associated with cognitive impairment. Accordingly, the correction of these factors could be important for prevention of AD, independent of the reduction in BP.

A multicenter randomized comparison of paclitaxel-coated balloon with plain balloon angioplasty in patients with small vessel disease.

We investigated the efficacy and safety of using paclitaxel-coated balloon (PCB) to treat small vessel disease. In this multicenter, prospective, randomized controlled trial, one-hundred and thirty-five patients with native coronary lesions in small vessels were randomized into a PCB group and plain balloon angioplasty (POBA) group at a ratio of 2:1. There were no differences in target vessel failure (TVF) that was defined as cardiac death or target vessel-related myocardial infarction or target lesion revascularization (TLR), between the two groups (3.4 vs. 10.3%; P=0.20), and TLR was slightly lower in the PCB group (2.3%) than that in the POBA group (10.3%) during 24weeks follow-up. The late lumen loss (LLL) was significantly lower in the PCB group (0.01±0.31 vs. 0.32±0.34mm; P<0.01) and late lumen enlargement (LLE) was more frequently observed in the PCB group (48 vs. 15%; P<0.01) by angiographic follow-up after 24weeks. There were no cases of death, myocardial infarction, thrombosis and reocclusion in either group. This study was not able to demonstrate superiority of PCB compared with POBA.

Drug-coated balloon: Long-term outcome from a real world three-center experience.

In-stent restenosis (ISR) and diffuse small vessel disease still represent challenging subsets for percutaneous coronary interventions, also in the new-generation DES era. We aim at reporting on the long-term clinical outcome of drug-coated balloons (DCB) in all-comers population. Consecutive patients treated with DCB between January 2011 and December 2014 were retrospectively studied in three centers of northern Italy. The measured end-points were cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and major adverse cardiac events (MACE) defined as combination of cardiac death, MI, and TLR. We included 143 patients. Of the 167 lesions treated, 41 (24.5%) were de novo lesions in small coronary vessels (<2.5 mm) and 126 (75.4%) were ISR. Among ISR lesions, 78.5% were DES-ISR, 32.5% were focal, 15.8% multifocal, 30.1% diffuse, 18.2% proliferative, and 3.1% were total occlusions. Procedural success was achieved in 94.6% of cases. Overall survival free from MACEs was 91.6% at 12 months, and 75.3% at 48 months, with a total of 3 cardiac deaths, 8 MI, and 27 TLR. No thrombotic event occurred in the treated segments. There were no differences in MACESs between the ISR and de novo lesions groups. At multivariate analysis, acute coronary syndromes, previous MI, previous surgical revascularization, peripheral arterial disease and diabetes were independent predictors of MACEs at long-term follow-up. DCB proved a valid revascularization strategy in an all-comers population of patients with ISR and de novo lesions in small vessels, with an acceptable rate of cardiac events up to 48 months follow-up.

HISTORY OF THE STUDY OF HEMORRHAGIC FEVER ETIOLOGY WITH RENAL SYNDROME

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease of zoonotic nature, characterized by systemic lesions of small vessels, hemorrhagic diathesis, hemodynamic disorders and a peculiar renal disease (interstitial nephritis with acute renal failure).

Immediate and short-term performance of a novel sirolimus-coated balloon during complex percutaneous coronary interventions. The FAtebenefratelli SIrolimus COated-balloon (FASICO) registry.

Drug-coated balloons (DCB) currently represent an alternative to drug-eluting stents (DES) for the treatment of in-stent restenosis and they are also variably used for small coronary vessel and bifurcation lesion management. All DCB variably elute paclitaxel as an anti-proliferative drug. The first sirolimus coated balloon (SCB) received the CE mark in 2016, but its clinical performance has not been shown yet. FASICO in an all-comer registry of the first consecutive patients with at least one lesion treated with SCB between March and July 2016 at the first European centre that used this device. All patients were prospectively enrolled in a dedicated database. Primary endpoint was procedural success; co-primary endpoint was the rate of major adverse cardiac events at short-term follow-up. The 32 patients (34 lesions) enrolled had at least 6-month clinical follow up available. Forty-five percent had diabetes and indication to PCI was ISR in 47% of the cases. Lesions were always pre-dilated and device deployment was successful in all the cases. Procedural success was achieved in 100% of patients. We observed 3 cases of TLR at follow-up. SCB shows high immediate technical performance and adequate short-term efficacy and safety. The ongoing EASTBOURNE registry will shed light on mid-and long-term performance of this device in an adequately powered population.

Visceral-to-subcutaneous fat ratio is independently related to small and large cerebrovascular lesions even in healthy subjects

Background and aimsThe severity of obesity is evaluated by visceral-to-subcutaneous fat ratio (VS ratio), which may be useful for predicting atherosclerosis. However, it is unclear how VS ratio affects different types of cerebrovascular lesions. This study was conducted to evaluate the clinical impact of visceral fat accumulation on the cerebrovascular lesions. MethodsThis cross-sectional study included 980 apparently healthy Japanese adults who underwent a health check-up program focused toward atherosclerosis, between 2011 and 2014. Visceral and subcutaneous fat accumulation was measured using abdominal computed tomography, and its relation to cerebrovascular disease was surveyed. ResultsVisceral and subcutaneous fat accumulation was 88 ± 50 cm2 and 141 ± 77 cm2, respectively. VS ratio was 0.69 ± 0.38. Intimal thickening in the carotid arteries was detected in 849 cases (86.6%) and stenosis was observed in seven (0.7%). Brain magnetic resonance imaging showed white matter hyperintensities regarded as ischemic changes in 196 subjects (20.0%). Multiple logistic regression analysis adjusted for age, gender, diabetes mellitus, dyslipidemia, hypertension, and hyperuricemia showed that a 0.1 increase in VS ratio was related to the presence of ischemic changes [odds ratio (OR): 1.05, 95% CI: 1.01–1.10, p = 0.009], cerebral artery stenosis or occlusion (OR: 1.14, 95% CI: 1.03–1.25, p = 0.007), and cervical plaque (OR: 1.09, 95% CI: 1.05–1.13, p < 0.001). ConclusionsVS ratio was independently associated with both large and small vessel lesions in apparently healthy subjects.

Can We Improve the Outcomes of Multivessel Disease Using Modified SYNTAX and Residual SYNTAX Scores?

In spite of the benefits of drug eluting (DES), these advantages were not translated to better outcome when percutaneous coronary interventions (PCI) were compared with coronary artery bypass surgery. PCI strategy allowing stent deployment in all intermediate lesions including small vessels together with DES design may be the reasons of these findings. Recently randomized and observational studies demonstrated using functional flow reserve analysis, residual Syntax score risk, or residual ERACI score after PCI that a reasonably incomplete revascularization was associated with good long-term outcome and low events rate at follow-up. In the ERACI IV study, which included patients with multiple vessel disease and left main, all intermediate lesions and severe lesions in small vessels were excluded from the revascularization strategy, and the 3-year follow-up results showed a remarkable low incidence of death/MI and stroke. Intermediate stenosis or severe lesions in small vessels should not be incorporated in the PCI strategy in order to define patient clinical cardiac prognosis or completeness of revascularization.

Optimal blood pressure target in stroke prevention.

A generalized single blood pressure (BP) goal may appear not suitable to achieve an optimal stroke prevention at the individual level. The aim of the present review is to consider the clinical relevance of individualized BP goal according to patient's age, comorbidities and established cerebrovascular disease. Observational and interventional data support heterogeneity in target organ prevention in that lower BP values than recommended by hypertension guidelines are associated with further stroke risk reduction. However, more ambitious BP treatment targets appear not broadly applicable to ageing hypertensive individuals or patients with established cerebrovascular disease. Strict BP control in early diagnosed hypertensive individuals, without established arterial disease, should be a priority in primary stroke prevention. In ageing hypertensive individuals, difficult to control SBP can be considered as a marker of increased systemic arterial disease in the brain, the heart and the kidneys. A delayed aggressive intervention to reduce BP in these high-risk patients may be associated with a J-shaped relationship between BP level and adverse events. Moreover, patients suffering from stroke frequently presented with a high burden of small cerebral vessel lesions that are associated with an increased risk of cognitive decline progression, particularly with stringent BP levels.

The Degree of Cognitive Impairment in Patients with Lacunar Stroke Depending on the Hemispheric Lateralization of the Lesion

The most susceptible to vascular dementia persons with lesions of small cerebral vessels. This variant of the pathology is characterized by subacute course and pathologic basis is diffuse changes in the white matter of the cerebral hemispheres and lacunar infarctions, in most cases - multiple. That is why the appearance of lacunar infarcts associated with step-progression of the disease. However, not in all cases, there is a significant cognitive defect even in a lacunary condition. The aim of the study was to identify cognitive impairment in patients with lacunar stroke, depending on hemispheric lateralization of the lesion. We observed and surveyed 70 patients (mean age 60.2 + 6.3) suffered the lacunar stroke with hemispheric lateralization of the lesion. In this work, we used the Mini-Mental State Examination (MMSE) and Montreal scale assessment of cognitive functions (MoCA), the Saint Louis University Mental Status Examination (SLUMS), which have been developed as a tool to identify and assess the severity of cognitive functions in general practice. Comparative analysis of cognitive impairment on the stage of the disease in the control group showed that in general, patients suffered lacunar stroke level of violations was significantly higher than the control group (p≤0.01). Cognitive function in right lacunar stroke corresponded moderate cognitive impairment and the restoration of the neurological defect in the dynamics were less expressed and are not complete. Cognitive impairment in the left hemisphere lacunar stroke had a mild degree of cognitive impairment and restoration of disturbed functions is progressing at a faster pace, about what speak reliable indicators of the late recovery period (p≤0.05). The differences in cognitive disorders at different focus lateralization underlie the clinical features and determine the nature and pace of the recovery of lost functions. Mild cognitive impairment in the left-hand lacunar stroke is a favorable prognostic factor in terms of the recovery of lost functions.