Lesions Of Brachiocephalic Arteries Research Articles

IL-1β Inhibition Partially Negates the Beneficial Effects of Diet-Induced Atherosclerosis Regression in Mice.

Thromboembolic events secondary to rupture or erosion of advanced atherosclerotic lesions is the global leading cause of death. The most common and effective means to reduce these major adverse cardiovascular events, including myocardial infarction and stroke, is aggressive lipid lowering via a combination of drugs and dietary modifications. However, we know little regarding the effects of reducing dietary lipids on the composition and stability of advanced atherosclerotic lesions, the mechanisms that regulate these processes, and what therapeutic approaches might augment the benefits of lipid lowering. Smooth muscle cell lineage-tracing Apoe-/- mice were fed a high-cholesterol Western diet for 18 weeks and then a zero-cholesterol standard laboratory diet for 12 weeks before treating them with an IL (interleukin)-1β or control antibody for 8 weeks. We assessed lesion size and remodeling indices, as well as the cellular composition of aortic and brachiocephalic artery lesions, indices of plaque stability, overall plaque burden, and phenotypic transitions of smooth muscle cell and other lesion cells by smooth muscle cell lineage tracing combined with single-cell RNA sequencing, cytometry by time-of-flight, and immunostaining plus high-resolution confocal microscopic z-stack analysis. Lipid lowering by switching Apoe-/- mice from a Western diet to a standard laboratory diet reduced LDL cholesterol levels by 70% and resulted in multiple beneficial effects including reduced overall aortic plaque burden, as well as reduced intraplaque hemorrhage and necrotic core area. However, contrary to expectations, IL-1β antibody treatment after diet-induced reductions in lipids resulted in multiple detrimental changes including increased plaque burden and brachiocephalic artery lesion size, as well as increasedintraplaque hemorrhage, necrotic core area, and senescence as compared with IgG control antibody-treated mice. Furthermore, IL-1β antibody treatment upregulated neutrophil degranulation pathways but downregulated smooth muscle cell extracellular matrix pathways likely important for the protective fibrous cap. Taken together, IL-1β appears to be required for the maintenance of standard laboratory diet-induced reductions in plaque burden and increases in multiple indices of plaque stability.

Technical aspects of hybrid interventions for multilevel lesion of brachiocephal arteries. Literature review

Carotid artery stenosis is one of the leading causes of ischemic strokes and accounts for about 20 % of all strokes. The widespread use of radiological diagnostic methods and recommendations for the carotid artery stenosis patients management led to the identification of atypical forms of damage to the brachiocephalic arteries — a combination of multi-level stenoses of extra and intracranial localization. Multilevel lesion of brachiocephalic arteries is characterized by a combination of hemodynamically significant stenosis of the internal carotid artery in combination with stenosis of the common carotid artery or brachiocephalic trunk. The prevalence of tandem lesions varies from 0.5 to 6.4 %. Despite the rarity of this pathology, the risk of ischemic complications against the background of tandem stenosis of the brachiocephalic arteries is higher than with a single-level lesion. The surgical intervention strategy should provide for the correction of both stenosis, which can be achieved in three ways: endovascular method, open prosthetics and hybrid method. The essence of the hybrid technique is the simultaneous correction of the distal and proximal zones of stenosis by one surgical team in a hybrid operating room. The aim of the study is to review the available literature data and to demonstrate the developed hybrid intervention technique with a detailed description of the technical aspects of all stages of the surgery.

Endovascular treatment of multilevel brachiocephalic artery lesions in asymptomatic patients: a case series

Objective: To evaluate the outcomes of complete endovascular carotid revascularization in asymptomatic patients with tandem lesions of common carotid arteries (CCA) and internal carotid arteries (ICA) and to demonstrate the endovascular technique.Methods: Endovascular treatment of two-level brachiocephalic artery lesions was performed in 23 patients at the Almazov National Medical Research Centre from 2017 to 2022. The mean age of the patients was 71.3 years. The lesions were localized in the left CCA and ICA in 11 patients, in the right CCA and ICA in 7 patients, and in the brachiocephalic trunk and right ICA in 5 patients. All patients were asymptomatic on the affected side. Results: Completed with successful stent implantation, all the procedures were effective, with no complications at the access site (hematoma, dissection, bleeding) and no perioperative mortality or residual stenoses. Postoperative neurological disorders developed in two patients including ipsilateral neurological symptoms (NIHSS score 4, Rankin score 1) in one of them and moderate aphasia and dysarthria NIHSS score 2, Rankin score 1) in the other. Brain MSCT showed signs of ischemic stroke that did not require any additional surgical treatment in the second patient. Following the rehabilitation, the neurological symptoms regressed. The mean hospital stay was 4 days. Two years after the intervention two patients required reintervention, i.e. repeat angioplasty of the ICA stent, due to in-stent restenosis.Conclusion: The outcomes in a series of patients with tandem brachiocephalic artery lesions indicate the efficacy of complete endovascular intervention with good short-term results. Received 23 June 2022. Revised 31 July 2022. Accepted 23 August 2022 Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interests: Authors declare no conflict of interest. Contribution of the authorsLiterature review: A.V. Soboleva, V.A. SolovievDrafting the article: A.G. Vanyurkin, Yu.K. BelovaCritical revision of the article: M.A. ChernyavskiySurgical treatment: M.A. Chernyavskiy, A.G. Vanyurkin, N.V. SusaninFinal approval of the version to be published: A.G. Vanyurkin, A.V. Soboleva, N.V. Susanin, Yu.K. Belova, V.A. Soloviev, M.A. Chernyavskiy

Immediate and long-term results of two methods of eversion carotid endarterectomy

Cerebrovascular disease ranks third after coronary artery disease and cancer among the causes of death in the Russian Federation. Currently, carotid endarterectomy is used for primary and secondary stroke prevention, and in brachiocephalic artery lesions. The authors of the article developed a new method of eversion carotid endarterectomy. Its immediate and long-term results are studied. The new method was compared with R. Kieny eversion carotid endarterectomy. The clinical safety and efficacy of the new method were demonstrated.

Smooth Muscle Cell Notch2 Is Not Required for Atherosclerotic Plaque Formation in ApoE Null Mice.

We previously identified Notch2 in smooth muscle cells (SMC) in human atherosclerosis and found that signaling via Notch2 suppressed human SMC proliferation. Thus, we tested whether loss of Notch2 in SMC would alter atherosclerotic plaque progression using a mouse model. Atherogenesis was examined at the brachiocephalic artery and aortic root in a vascular SMC null (inducible smooth muscle myosin heavy chain Cre) Notch2 strain on the ApoE-/- background. We measured plaque morphology and size, as well as lipid, inflammation, and smooth muscle actin content after Western diet. We generated an inducible SMC Notch2 null on the ApoE-/- background. We observed ∼90% recombination efficiency with no detectable Notch2 in the SMC. Loss of SMC Notch2 did not significantly change plaque size, lipid content, necrotic core, or medial area. However, loss of SMC Notch2 reduced the contractile SMC in brachiocephalic artery lesions and increased inflammatory content in aortic root lesions after 6 weeks of Western diet. These changes were not present with loss of SMC Notch2 after 14 weeks of Western diet. Our data show that loss of SMC Notch2 does not significantly reduce atherosclerotic lesion formation, although in early stages of plaque formation there are changes in SMC and inflammation.

Abstract 13168: Total Lipoprotein Lipase Deficiency Does Not Impact Atherosclerosis Development in Low Density Lipoprotein Receptor Deficient Mice

Introduction: Elevated LDL cholesterol (LDL-C) is a major causal factor for CVD. However, the importance of elevated triglyceride rich lipoproteins (TRLs) on CVD is still being investigated. Lipoprotein lipase (LpL) is the rate limiting enzyme hydrolyzing circulating very low density lipoprotein (VLDL) and chylomicrons. The effect of increased TRLs as an independent factor on atherosclerosis is not known, in part, because hypertriglyceridemia associates with low levels of LDL-C. Objective: We tested whether whole body LpL deficiency in mice combined with LDL receptor (LDLR) deficiency and an atherogenic diet affects lesion formation. Hypothesis: LpL deficient mice will not show increased atherosclerosis progression as compared to control mice, despite severe dyslipidemia, due to reduced infiltration of atherogenic lipids into the aortic endothelium. Methods: Induced global LpL deficiency (i Lpl -/- ) was created by tamoxifen injection to activate beta actin-driven cre. To knock down hepatic LDLR we utilized anti sense oligonucleotides (ASOs) as well as a PCSK9 expressing AAV. Results: i Lpl -/- mice on chow diet have elevated plasma triglycerides, increased VLDL cholesterol, lower LDL-C and lower high density lipoprotein cholesterol (HDL-C) compared to control Lpl fl/fl mice. However, when hepatic LDLR was knocked down with using LDLR ASO or AAV PCSK9, iLpl -/- mice displayed elevated LDL-C of about 150 mg/dl, similar to the levels seen in control mice with LDLR knockdown. When i Lpl -/- mice were fed an atherogenic Western diet for 16 weeks, i Lpl -/- mice developed severe hypertriglyceridemia (1500-8000 mg/dl) and increased total cholesterol to ~1500 mg/dl. LDL-C levels were similar to those of control mice with LDLR knockdown; ~200 mg/dl. HDL-C was lower in i Lpl -/- mice compared to the controls (~10 mg/dl vs ~30 mg/dl). i Lpl -/- mice had slightly smaller lesions in brachiocephalic arteries but macrophage content was similar to the controls. Aortic root lesion size was similar in both groups of mice. Conclusion: Despite severe hypertriglyceridemia, hypercholesterolemia and low HDL-C, iLpL -/- mice did not exhibit altered atherosclerosis progression, likely because of the absence of LpL-derived atherogenic lipids or remnant lipoproteins.

The detection rate of non-invasive markers of subclinical atherosclerosis of brachyocephalic and coronary arteries with an assessment of their relationship in patients with arterial hypertension

Abstract Introduction Atherosclerosis is a chronic, progressive, inflammatory disease, which is characterized by an undulating course and multifocal nature of the lesion. Arterial hypertension (AH) is widespread in the population, and also contributes to the development and progression of atherosclerosis. Non-invasive imaging techniques make it possible to diagnose atherosclerosis, also at its subclinical stage. The detection of coronary calcification, atheromatous plaques in the brachiocephalic arteries (BCA), and the detection of the ankle-brachial index (ABI) are referred to as non-invasive markers of atherosclerosis. Estimation of the strength of the relationship between the detection rate of non-invasive markers of atherosclerosis in AH is on the front burner. Purpose To estimate the presence and degree of relationship between non-invasive markers of subclinical atherosclerosis in patients with AH. Methods 99 patients were studied with an proven diagnosis of AH, without anamnesis of symptomatic diseases of atherosclerotic genesis. Median age is 58 years, of them 37 are men. To detect subclinical atherosclerotic lesions of the coronary arteries (CA), all persons included in the study, after obtaining informed consent, were performed the multispiral computed tomography of CA on a 64-slice computed tomography Optima CT 660 (General Electric Co, USA) with the calculation of the cardiac calcium score (CCS) according to the Agatston score. Duplex ultrasound of BCA and determination of ABI value was performed using a supersonic diagnostic apparatus Vivid E9 (General Electric Co, USA) according to the standard procedure. Statistical data processing was performed using the Statistica for Windows ver 10.0 software (StatSoft, Inc., USA). To describe the relationship between the parameters under study, the Kendall's rank correlation coefficient was used (at a statistical significance p<0.05). Results Subclinical atherosclerotic lesions of CA (CCS >0) was detected in 53 persons (53.5%), and BCA (presence of atheromatous plaque) – in 52 persons (52.5%). In 13 patients (13.1%), a decrease in ABI <0.9 was recorded. Correlation analysis revealed the presence of a direct correlation of average strength between subclinical lesions of the BCA (presence of atheromatous plaque) and CA (CCS >0), τb=0.33 (95% CI: 0.14; 0.49), p<0.001). Besides, atherosclerotic lesions of BCA had a negative correlation weak strength with subclinical peripheral arterial lesion (ABI <0.9) τb=−0.19 (95% CI: −0.37; 0.01), p=0.005. We have not detected a correlation between the ABI decrease and the presence of coronary calcification. Conclusion Subclinical lesions of CA and BCA were more often detected in persons with AH (in 53.5% and 52.5%, respectively). Correlation analysis showed that in persons with AH, subclinical BCA lesion is positively associated with the presence of coronary calcification and has a weak negative relationship with a decrease value of ABI. Funding Acknowledgement Type of funding sources: None.

SMC-Derived Hyaluronan Modulates Vascular SMC Phenotype in Murine Atherosclerosis.

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Features of interleukin-33 production in atherosclerotic lesions of brachiocephalic arteries

Features of interleukin-33 production in atherosclerotic lesions of brachiocephalic arteries

The role of lipopolisaccharide and antibodies to the lipopolysaccharide in the systemic circulation to the cardiovascular risk group determination

Abstract The inflammatory concept of atherogenesis is the leading one. Its finds development in the endotoxin theory of atherosclerosis, confirmed by numerous experimental studies and a several of clinical observations. But the involvement of lipopolysaccharide (LPS) in atherogenesis in humans has been studied without assessing the morphological changes in the structure of the vascular wall and not included an antibodies response. Existing scales for assessing the risk of developing cardiovascular diseases have a maximum error for patients with an average level risk. We examined 113 patients belonging to one group of cardiovascular risk (<5% on the SCORE scale). We evaluated such indicators, which can be attribution to risk factors and can be application in practice, as the level of LPS in blood plasma, the level of antibodies to the LPS Salmonella minnnesota RE 595 (AB-LPS-1) and LPS Escherichia coli O55 (AB-LPS-2) in serum. A duplex scanning of extracranial brachiocephalic arteries (BCA) and a testing for lipid profile were made. It was revealed that the lipid profile do not allow to evaluate the condition of the BCA wall prior duplex scanning. A significant difference was found in the concentration and frequency of occurrence of LPS and AB-LPS indicators among patients with varying degrees of severity of atherosclerotic lesions of BCA (table). Thus, the inclusion of as risk factors the level of LPS, the concentration of AB-LPS can help in predicting the condition of the carotid arteries wall and, accordingly, in changing the degree of risk in patients at the primary diagnosis level without the participation of high-tech expensive imaging techniques. Simple binary models with high specificity and sensitivity were constructed using cluster analysis to predict the severity of BCA atherosclerosis using concentration of LPS and AB-LPS adapted for practical (figure). Comparison risk factors between groups Parameter Group (by arterial wall state) p-value Intact wall Thickening of TIM ASP Cholesterol, mmol/L 6.43 [6.04; 6.82] 5.81 [4.75; 8.28] 6.63 [5.68; 7.51] 0.2750 LDL, mmol/L 4.43 [4.03; 4.78] 3.64 [3.04; 4.98] 4.74 [3.74; 5.28] 0.0558 HDL, mmol/L 1.09 [0.94; 1.29] 1.21 [1.07; 1.51] 1.13 [0.98; 1.35] 0.3198 Triglycerides, mmol/L 1.72 [1.23; 2.54] 1.21 [0.91; 1.92] 1.48 [0.99; 2.07] 0.2752 Atherogenicity index 4.23 [3.45; 6.32] 3.67 [2.91; 4.48] 4.93 [3.92; 5.68] 0.3532 LPS, EU/ml 0.90 [0.60; 1.52] 0.60 [0.41; 0.98]* 1.20 [0.60; 1.8]* 0.0067* AB-LPS-1, c.o.u.d. 216.0 [132.5; 248.5]* 127.5 [105.75; 221.5] 123.0 [91.00; 187.0]* 0.0444* AB-LPS-2, c.o.u.d. 374.0 [199.0; 481.0] 399.5 [195.75; 451.0] 265.0 [200.0; 399.0] 0.1991 *Result was significant at p<0.05 at post-hoc pairwise comparisons. “Decision tree” for a group of patients Funding Acknowledgement Type of funding source: None

Rehabilitation of patients after acute cerebrovascular accident followed by hemodynamically significant stenoses of the brachiocephalic arteries

The literature data is presented covering epidemiological significance of acute cerebrovascular accidents (CVA) in‑ cidence in patients with brachiocephalic arteries lesion. The role of atherosclerotic lesion of carotid arteries in the develop‑ ment of ischemic cerebral stroke is shown. The basic methods for diagnosis of carotid arteries lesion has been analyzed as well as their availability and informative value. A comparative analysis of modern methods for surgical treatment of athero‑ sclerotic lesion of carotid arteries such as carotid endarterectomy (classic and eversion), endovascular procedure has been done. The main advantages and disadvantages of these treatment methods, indications and contraindications for their use are described. The timing of cerebral revascularization in the acute and delayed periods of ischemic stroke was estimated. The role of bilateral lesion of the carotid territory is shown as well as approaches to the treatment strategy of such patients.

Cerebral hemodynamics and cognitive function in patients with atherosclerotic lesions of brachiocephalic arteries

Steno-occlusive atherosclerotic lesions of extra- and intracranial cerebral arteries is regarded as the most significant factor for ischemic stroke risk. The greater the percentage of stenosis, the higher the risk of stroke. However it is unclear the impact of macroangiopathy (stenos in the carotid arteries) in the inhibition of cognitive functions. In study were included 2 groups of patients: group 1 - patients with asymptomatic carotid stenosis >50% (30 patients); group 2 - patients with carotid stenosis <50% (30 patients). In the group with asymptomatic carotid stenosis >50% were 22 (73.3%) male and 8 (26.7%) women; mean age of patients was 62.5 ± 1.3 years. In the group with carotid stenosis <50% - 19 (63.3%) male and 11 (36.6%) women; mean age of patients was 64.5±1.4 years. All patients underwent assessment of scale of cognitive impairment (MMSE, МоСа), cognitive evoked potentials (P-300), duplex scanning of brachiocephalic arteries, transcranial duplex scan, brain MRI and Single-photon emission computed tomography (SPECT) with 99mТс-HMPAO. Cerebral perfusion according to SPECT in groups 1 and 2 were 76.2% and 79.2%, respectively; differences were not statistically significant (p > 0.05). MMSE and MoCa in groups 1 and 2 appeared to be 25.7 ± 0.5 and 26.8 ± 0.5 (p > 0.05); 26.5 ± 0.4 and 27.5 ± 0.4 (p > 0.05), respectively. According to cognitive evoked potentials, latencyP-300 in groups were 406 ± 0.6 ms and 371 ± 0.6 ms, respectively (p > 0.05). No correlation between severity of stenosis and cognitive functions in groups 1 and 2 were seen (r < 0.3). Macroangiopathy of cerebral arteries (carotid stenosis) is not associated with cognitive deterioration.

Clinical Features of Comorbid Cluster and Premorbidly Manifestations in Patients with High Vascular Risk in the Middle Age Category with the Presence of Multifocal Atherosclerosis

to study clinical and cluster features of cardiovascular burdening taking into account the comorbid polymorbid background in patients of middle age (45-60 years) with the presence of multifocal atherosclerosis (MFA). Patients were examined in the Regional Vascular Center of Ufa (RVCU). Depending on the predominant localization of lesions in the vascular bed patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppleroscopy of main arteries of the head and lower extremities. Ninety-six patients had predominant lesions in the heart (1st cluster), 96 - in carotid arteries (2nd cluster), and 96 patients had ischemia of lower extremities (3rd cluster). Examination during hospitalization in RVCU included when indicated echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound studies of abdomen, kidney, and pelvis. According to data obtained the following conditions were most often observed in different combinations and with varying degrees of severity of clinical manifestation.Claster 1. Clinical manifestation of atherosclerotic heart disease mainly due to stage III hypertension, history of myocardial infarction were combined with pneumonia, chronic obstructive pulmonary disease with the outcome in pneumosclerosis and emphysema, as well as the presence of cholecysto-cardial syndrome, chronic gastritis, chronic cholecysto-pancreatitis, abdominal ischemic syndrome, rheumatoid arthritis, diabetes mellitus, and chronic pyelonephritis.Claster 2. Hemodynamically significant lesions of brachiocephalic arteries mainly with acute ischemic disturbance of cerebral circulation were combined with bronchial asthma, (the development of which was associated with prolonged persistent eosinophilic inflammation), worsening of chronic kidney disease with urolithiasis, angionephropathy and iron deficiency anemia, as well as the presence of dorsopathy associated with stenotic atherosclerosis of brain vessels.Claster 3.Hemodynamic ischemia with clinical manifestation of vascular lesions of lower extremities was accompanied by type 2 diabetes, chronic cholecysto-pancreatitis, erosive and ulcerative lesions in the stomach and duodenum, polyosteoarthrosis, abdominal-ischemic syndrome. Type 2 diabetes prevailed in patients with occlusion of right posterior tibial artery and trophic ulcer of the right foot. Interdependence of comorbid and polymorbid background and cardiovascular burdening changes their clinical picture and course, increases number of complications and their severity.

Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti - inflammatory treatment

to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p.

Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome

to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical courseof ischemic heart disease (IHD) during 3-5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials andmethods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwentcolor duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT)of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels wasassessed by the Agatston method. After 3-5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followupwas 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcificationscores. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinicaland anamnestic factors only one risk factor - smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval[CI] 1.2-78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenicsyndrome and BCA involvement. In the group of patients with baseline coronary calcification index &gt;400 there were more smokers(р=0.026) and patients with lesions in &gt;3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage werevealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= -0.24, р=0.06),Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3-5 years after CABG a mediumpositive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029).Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoralbone as the only significant predictor of calcium score increase during 3-5 years of follow-up. Dynamics of calcificationof CAs in men with IHD during 3-5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive.There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone priorto CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary calcification wasfound. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral densityof femoral bone.

Quantitative Analysis of Cellular Composition in Advanced Atherosclerotic Lesions of Smooth Muscle Cell Lineage-Tracing Mice.

Atherosclerosis remains the leading cause of death worldwide and, despite countless preclinical studies describing promising therapeutic targets, novel interventions have remained elusive. This is likely due, in part, to a reliance on preclinical prevention models investigating the effects of genetic manipulations or pharmacological treatments on atherosclerosis development rather than the established disease. Also, results of these studies are often confounding because of the use of superficial lesion analyses and a lack of characterization of lesion cell populations. To help overcome these translational hurdles, we propose an increased reliance on intervention models that employ investigation of changes in cellular composition at a single cell level by immunofluorescent staining and confocal microscopy. To this end, we describe a protocol for testing a putative therapeutic agent in a murine intervention model including a systematic approach for animal dissection, embedding, sectioning, staining, and quantification of brachiocephalic artery lesions. In addition, due to the phenotypic diversity of cells within late-stage atherosclerotic lesions, we describe the importance of using cell-specific, inducible lineage tracing mouse systems and how this can be leveraged for unbiased characterization of atherosclerotic lesion cell populations. Together, these strategies may assist vascular biologists to more accurately model therapeutic interventions and analyze atherosclerotic disease and will hopefully translate into a higher rate of success in clinical trials.

Some comments on the 2017 European Guidelines on treatment of atherosclerotic lesions of brachiocephalic arteries

Analysed herein are the indications for primary interventions in patients with atherosclerotic lesions of internal carotid arteries according to the recommendations laid down in the 2017 Guidelines of the European Society for Vascular Surgery.

The use of embolic protection device in the stenting of brachiocephalic arteries

Objective — to optimize the results of endovascular treatment of stenotic pathology of brachiocephalic arteries.&#x0D; Materials and methods. The results of surgical treatment of 112 patients, among whom there were 79 (70.5 %) men and 33 (29.5 %) women aged from 28 to 86 years with symptomatic stenotic lesions of brachiocephalic arteries treated in the neurosurgical department of the Zaporizhzhia regional hospital in the period from 2010 to 2018 were analyzed. Observations were divided into three groups depending on the localization of the defeat: internal carotid artery — 74 (66 %) cases (predominant stenosis of the mouth of the ICA (n = 71)), vertebral artery — 25 (22.4 %), a portion of the subclavian artery or brachiocephalic trunk — 13 (11.6 %). All patients underwent MRI of the brain in the preoperative period, as well as in 45 (40 %) cases of CTangiography. In all cases prior to surgery invasive angiography was performed with an assessment of the state and anatomy of the brachiocephalic and intracranial arteries, as well as the possibilities of collateral blood flow.&#x0D; Results. In the first group, which was conducted carotid stenting embolic protection device was used in 72 (97.2 %) cases. In the second group, distal protection device were used twice 2 (8 %) in the resolution of extended stenoses of the dominant vertebral artery mouth. In the third group, the distal protection device was used in 1 (7.7 %) case for stenting the critical extended stenosis of the brachiocephalic trunk with the transition to common carotid artery. Complications were noted in 9 observations. In one case there was a development of ischemic stroke, intraoperatively, in a patient with an echeloned lesion of the intracranial basin of a stenting internal carotid artery, probably against a background of hypotension of the stent developed during implantation. In 8 (7.1 %) cases the formation of the hematoma of the puncture site of the femoral artery was noted.&#x0D; Conclusions. The use of embolic protection device is mandatory in standard carotid stenting. The choice of method of protection depends on the severity of stenosis, as well as the individual features of collateral blood flow. When stenting subclavian artery, brachiocephalic trunk and vertebral artery, in some cases it is justified to use distal protection devices, the latter increases the safety of the operation.

Atherosclerotic lesions of brachiocephalic arteries and issues of surgical correction of symptomatic and asymptomatic carotid stenosis

The objective of the study was to evaluate the results of carotid endarterectomy in patients with symptomatic and asymptomatic course of hemodynamically significant stenosis of carotid arteries.Material and methods. The work was based on observations of 88 patients: the main group included 28 patients with asymptomatic lesion, the control group – 60 patients with symptomatic critical carotid stenosis.Results. There was a predominance of contralateral carotid stenosis, changes in vertebral arteries in the control group. Features of atherosclerotic lesion of carotid arteries associated with the severity of metabolic disorders, perioperative fluctuations of hemodynamics, time of clamping of carotid arteries.Conclusion. Aggressive course of symptomatic carotid stenosis requires correction of metabolic disorders in the perioperative and in the distant periods, as well as monitoring of hemodynamic abnormalities.

COMPARATIVE CHARACTERISTIC OF ANESTHESIOLOGICAL SUPPORT AND TYPES OF SURGICAL INTERVENTION IN PATIENTS WITH ATHEROSCLEROTIC LESIONS OF BRAHIOCEPHAL ARTERIES

Introduction. Atherosclerotic lesions of the branches of the aortic arch in 60% of cases is the cause of the development of ischemic stroke. As a radical means of preventing neurological disorders, carotid endarterectomy is used, since there is currently no effective drug treatment.Material and methods. This article presents a comparative characteristic of anesthesiological support and types of surgical intervention in 710 patients with atherosclerotic lesions of brachiocephalic arteries in the period from January 2010 to December 2017 in Department of Vascular Surgery at the Clinic of the Bashkir State Medical University. To perform this comparative characteristic, the patients were divided into 2 groups, depending on the time interval. Group 1 — patients operated from 2010 to 2013 (291 patients). Group 2 — patients operated from 2014 to 2017 (491 patients). In Group 1, operations were predominantly performed under regional anesthesia and classical carotid endarterectomy predominated over an eversion. In Group 2, operations were performed under general anesthesia, and here the overthe-top carotid endarterectomy predominated over the classical one. Patients were comparable in age, sex and risk of anesthesia and surgical intervention according to the ASA classification. The overall incidence of ischemic postoperative complications was 4.22%.Results. According to our data, the application of the eversion method of carotid endarterectomy under general anesthesia reduces the relative risk of neurological complications by 1.648 times (as in the 2nd group the technique of eversion carotid endarterectomy under general anesthesia was used). The use of general anesthesia with carotid endarterectomy allows to provide adequate gas exchange, manageability by hemodynamic parameters, absence of emotional reactions from the patient.Conclusion. Thus, at the present moment, our experience in treating patients with atherosclerotic lesions of the brachiocephalic arteries is approaching the optimal one, allowing us to achieve good results of carotid endarterectomy.