Multifocal Atherosclerosis Research Articles

Substantiation of the stages of interventions in patients with multifocal atherosclerosis with combined lesions of coronary arteries and lower extremity arteries

Objective. To study the features of staged interventions in patients with combined lesions of coronary arteries and arteries of the lower extremities. Materials and Methods. The results of surgical treatment of 26 patients with combined lesions of coronary arteries and lower extremity arteries for the period from 2016 to 2023, the first stage of which was myocardial revascularization, were analyzed, and the data of 22 patients who underwent revascularization of the lower extremity arteries before 2016 were retrospectively analyzed. The operations were performed without cardiopulmonary bypass. Venous and arterial graphs were used. Results. The postoperative period was uneventful in 35 (73%) patients. Perioperative complications were assessed according to the presence of major adverse cardiovascular events. Among the complications in the intra­ and postoperative period, myocardial infarction was observed in 5 (23%) patients who underwent revascularization of the lower extremity arteries (p < 0.001), which was accompanied by longer mechanical ventilation and higher doses of vasopressor and inotropic support in the intensive care unit. Problems associated with increased lower extremity ischemia were noted in 5 (19%) patients who underwent myocardial revascularization as the first step (p < 0.005). Conclusions. In the case of combined lesions of the coronary arteries and arteries of the lower extremities, coronary artery bypass grafting should always be performed first. If coronary pathology is not corrected, the risk of perioperative myocardial infarction, fatal arrhythmia, and death increases.

Coagulation hemostasis disorders and elevated lipoprotein (a) levels in patients with arterial hypertension and multifocal atherosclerosis

Introduction. Hemostatic disorders may act as additional risk factors in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL). Elevated lipoprotein (a) (Lp(a)) levels may exacerbate procoagulant shifts.Aim. To identify disorders in the coagulation link of hemostasis in patients with AH and MFAL, depending on the level of Lp(a).Materials and methods. The study included 219 patients with hypertension and MFAL, median age 59 (53; 66) years, of which 110 patients with stage I–II controlled hypertension (group 1) and 109 patients with stage III controlled hypertension with a history of ischemic stroke. Depending on the level of Lp(a), patients in each group were divided into 2 subgroups with Lp(a) levels < 50 mg/dl and with Lp(a) levels above 50 mg/dl. Patients of both groups received antihypertensive, lipid-lowering, antiplatelet therapy and had comparable values of blood pressure and lipid spectrum.Results. In group 2 patients, procoagulant shifts were significantly more often recorded, despite the constant use of antiplatelet therapy. Violations of hemostasis parameters depending on the level of Lp(a) were observed in subgroups 1b and 2b. According to the results of multiple a posteriori comparisons, the most significant hypercoagulation changes were observed in patients with stroke, as well as with Lp(a) levels > 50 mg/dl.Conclusions. Thus, in some patients with hypertension and MFAL, despite taking antihypertensive, lipid-lowering and antiplatelet therapy, coagulation hemostasis disorders may occur. Elevated Lp(a) levels are combined with more pronounced hemostatic disorders, especially in the presence of a previous stroke. Intensification of antithrombotic therapy may be considered in such patients to prevent cardiovascular complications.

X-RAY-GUIDED ENDOVASCULAR SURGERY FOR SUBCLAVIAN STEAL SYNDROME (CLINICAL CASE)

Defining the sequence and methods of revascularization in patients with multifocal atherosclerosis should be associated with a minimal risk of adverse events and identification of predictors of adverse outcomes of operations, which is of great importance for improving the results of surgical treatment. We present a clinical case of successful treatment of a patient with multifocal atherosclerosis. The case included atherosclerotic disease of the left subclavian artery with complete steal syndrome of the brachiocephalic arteries, arteries of the lower limbs and arteries of the heart. It is shown that, when choosing a method for treating multifocal atherosclerosis, treatment should begin with preserving and restoring blood supply to the brain, and followed by restoring blood supply to other body parts.

Increased lipoprotein (a) as an additional factor in the failure to achieve target blood pressure levels and lipid spectrum optimal parameters in patients with arterial hypertension and multifocal atherosclerosis

Aim. To establish the frequency of achieving target of blood pressure (BP) levels and lipid spectrum parameters (LS) in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL) with normal and elevated levels of lipoprotein (a) (Lp(a)) in real clinical practice.Material and methods. The study included 110 patients with AH and MFAL, median age was 59.0 (51.0; 64.3) years. Depending on the level of Lp(a), all patients were divided into 2 groups: group 1 — 72 patients (65.5%), Lp(a) level was ≤50 mg/dl (13.2 (3.7; 21.1)), group 2 — 38 patients (34.5%) Lp(a) level was >50 mg/dl (89.5 (62.5; 110.0)). The diagnosis of MFAL included damage to two or more arterial basins according to carotid artery, abdominal aorta and lower extremities arteries duplex scan. Patients of both groups received antihypertensive, lipid-lowering, and antiplatelet therapy.Results. Patients in groups 1 and 2 showed similar blood pressure levels and frequency of antihypertensive therapy use. In both groups, the majority of patients were on a free combination of antihypertensive drugs, only a third of patients used a fixed combination. In most cases, patients of both groups did not reach the target blood pressure levels (63.9% — group 1, 55.3% — group 2), despite the fact that the average blood pressure figures were relatively low (132;83 mmHg in each group). Drug control was also unsatisfactory in both groups, regardless of the level of Lp(a). However, all drug indicators were significantly worse in group 2, despite comparable lipid-lowering therapy, which more often included statin monotherapy. Combination therapy with lipid-lowering drugs was used in patients of groups 1 and 2 only in 20.8% and 10.5%, respectively. Parameters of low-grade inflammation high-sensitivity C-reactive protein and interleukin-6 did not differ between the groups and did not exceed the reference values.Conclusion. An increased level of Lp(a) may be accompanied by drug disorders and increased BP in patients with MFAL. Due to the lack of effective Lp(a) reducing therapy, the prevention of cardiovascular events in such patients should focus on BP and lipid spectrum correction. The use of fixed combinations, including antihypertensive and lipid-lowering drugs, can lead to improved adherence to therapy, increased BP and LS control.

Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).

To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%). A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

Lung Lesions in Exposure to Pesticides and Herbicides (Literature Review and Case Report)

Pesticides (herbicides, insecticides, fungicides, zoocides) are mixtures of substances of chemical or biological origin used to destroy or inhibit the growth of microorganisms, fungi, harmful vegetation, and other living organisms. These organisms damage crop and livestock production, degrade the quality of agricultural products, materials, and goods. Pesticides are classified into organic, and inorganic based on their chemical composition. About 1,000 active ingredients are used in pesticides, of which 310 are considered particularly hazardous. Extensive use of pesticides leads to the destruction of biocenoses and the emergence of various pathological changes in the human body. Among the pesticide ingredients with acute and chronic toxicity, abamectin, aluminum phosphide, beta-cyfluthrin, bifenthrin, chlorpyrifos, deltamethrin, diazinon, fenamiphos, malathion, methomyl, oxamyl, primicarb, propargite, tebuconazole, chlorothalonil, bromoxynil, bromoxynil octanoate, brodifacoum, and others stand out. In conditions of pesticide load on soils, the frequency of allergic and respiratory diseases is steadily increasing. Chronic obstructive pulmonary disease (COPD), caused by smoking and pesticides, leads to loss of working capacity and social activity, as well as significant costs for treatment and rehabilitation. The article discusses the pathogenetic and clinical aspects of the formation of COPD under conditions of synergy (smoking + pesticides). Various clinical phenotypes of COPD are also considered. A clinical case of a patient with COPD caused by smoking and prolonged contact with pesticides (mosplan, zellek-super, goal 2E), which manifested with chronic respiratory failure, multifocal atherosclerosis, and heart failure, is described.

Efficacy and safety of different regimens prolonged antithrombotic therapy in revascularized patients with stable cad and multifocal atherosclerosis

Efficacy and safety of different regimens prolonged antithrombotic therapy in revascularized patients with stable cad and multifocal atherosclerosis

Outpatient regenerative therapy of a chronic diabetic foot ulcer with exposed bone surface

BACKGROUND: Treatment of deep chronic wounds with the bone tissue involvement against the background of lower limb atherosclerosis and diabetic foot syndrome does not fit any reasonable hospital stay duration and at the same time has no effective outpatient methods. Therapy with conditioned medium derived from human mesenchymal stem cells (CM-MSC) may be a solution for this problem. CLINICAL CASE DESCRIPTION: Patient F., 77-year-old, arrived for an outpatient treatment of local necrosis in the area of the 1st toe of the left foot in April, 2022. The main diagnosis: Peripheral arterial disease of the lower extremities. Multifocal atherosclerosis. Occlusion of the superficial femoral and popliteal arteries, diffuse lesions of the lower leg arteries on the left. Chronic arterial insufficiency of the 4th degree. Attempts of revascularisation of the left lower limb. Limited gangrene (Wagner IV) of the 1st toe of the left foot. Associated diseases: insulin-dependent type 2 diabetes mellitus (for more than 30 years). Diabetic polyneuropathy. Diabetic foot syndrome, neurotrophic form. Local treatment was performed by the microsurgical debridement of the affected surface in combination with the method of multilayered dressings, according to the previously patented technology. The microsurgical treatment of the bone surface in the wound area was carried out with the use of CM-MSC. Positive dynamics in the form of a partial closure of the bone fragment with soft tissue was observed on the sixth month of therapy. The complete closure of the open bone fragment was observed in 12 months from the beginning of the outpatient treatment. CONCLUSION: The developed method of treatment using CM-MSC can be effective for chronic wounds with open bone surfaces.

Pro‑coagulant Considerations in Patients with Arterial Hypertension and Multifocal Atherosclerosis

The aim of the work to determine the features of hemostasis and blood rheology in patients with arterial hypertension (HTN) and multifocal atherosclerosis (MFA).Materials and methods. The study enrolled male and female patients aged from 40 to 70 years, including 59 patients with controlled stage I–II hypertension and multifocal vascular lesions (Group 1) and 42 patients with controlled stage III hypertension, who have suffered an ischemic stroke and have multifocal vascular lesions (Group 2). A test using the Thrombodynamics analyser system T-2 (GemaKor, LLC, Moscow, Russia) was performed to detect the impairment of hemostasis.Results. Patients with HTN and MFA have an impaired coagulation hemostasis system (an increase in the initial and stationary clot growth rate and the size of the clot, as well as the presence of spontaneous clots), which leads to a high residual risk of cerebral complications, despite BP lowering to target figures and control of lipid profile.Discussion. Elevated blood pressure in patients with MFA leads to endothelial dysfunction, which is accompanied by activation of coagulation and fibrinolysis pathways. These changes lead to a violation of microcirculatory hemostasis in the brain, the development and progression of cerebral ischemia, and subsequently the occurrence of stroke, both the first and repeated.Conclusion. An important result of this study is the first registered change in the coagulation link of hemostasis in patients with HTN and MFA aged from 40 to 70 years, which can be considered an additional criterion for stroke prediction.

Assessment of the severity of associated ischemia in conditions of atherosclerosis of the carotid arteries and arteries of the lower extremities

The purpose of the research is to develop a method for assessing the severity of ischemic processes in multifocal atherosclerosis against the background of chronic cerebrovascular insufficiency and chronic ischemia of the lower extremities.Methods. The main methods used in this study are the methodology for the synthesis of hybrid fuzzy decision rules, exploratory analysis, and the Delphi expert assessment method; calculations were based on the G. Rush model and the E. Shortliff iterative model.Results. In the course of the research, particular decisive rules were synthesized to assess violations of the regulatory functions of the brain, ischemic disorders of the brain and lower extremities, disorders of the motor functions of the lower extremities, on the basis of which, using the iterative model of E. Shortliff and aggregating decisive rules, intermediate decisive rules were formed, which, in turn, entered the final decisive the rule "severity of ischemic interaction". Further, based on the final decisive rule, an algorithm was developed to assess the severity of ischemic interactions for comorbid patients with disintegration of affective-effector mechanisms of interaction between peripheral organs and regulatory functions of the central nervous system, allowing to assess the severity of the ischemic process and the risk of fatal complications in patients with the pathology in question.Conclusion. In the course of the conducted research, high results were demonstrated in the application of synthesized partial decision rules within the framework of the task set in this study, and the expediency of using the obtained models and methods in the practice of a neurologist, vascular surgeon, angioedrologist, neurosurgeon was also shown.

Secondary Prevention of Multifocal Atherosclerosis Combined with Chronic Obstructive Pulmonary Disease

The problem of secondary prevention of multifocal atherosclerosis (MAS) combined with chronic obstructive pulmonary disease (COPD), is a leading cause of death in the world. Therefore, the search for drugs capable of affecting the destructive mechanisms underlying both MAS and COPD is an extremely urgent problem today. Objective — to reduce the risks of destabilization of atherosclerotic plaques by reducing the levels of metallomatrix metalloproteases (MMP)-2 and MMP-9 in patients on MAS combined with COPD. Materials and methods. The study included 62 men (68.1 ± 4.2) years old with MAS. All patients with MAS had clinical and functional signs of injury in coronary, cerebral and femoral vascular territories, 30 of these patients (group MAS-2) additionally had clinical and functional signs of COPD (GOLD-2). The control group (CG) consisted of 18 practically healthy men, aged (65.4 ± 3.7) years. Examination of the patients included echocardiography, dopplerography of the vessels of the neck and arteries of the lower extremities, determination of walking distance and ankle-brachial index, Holter ECG monitoring, spirography and determination of MMP-2 and MMP-9 levels in blood. Patients of both groups were prescribed cilostazol (50 mg twice a day) and GABA aminalon (250 mg twice a day) on the background of basic treatment. The course of treatment lasted 16 weeks. Results and discussion. During the initial examination of patients, MAS-2 group showed significantly (p < 0.001) lower volumetric blood flow in the studied arteries, and significantly (p < 0.01) higher levels of MMP-2 and MMP-9, as compared to CG, as well as with patients of the MAS-1 group. After 16 weeks of treatment, with the addition of cilostazol and aminalon, the level of MMP in the blood significantly (p < 0.05) decreased in both groups, in particular, in the MAS-2 group, in patients with the combined pathology of MAS and COPD, a significant decrease was found MMP-2 by 23.6 % (p < 0.01), and MMP-9 by 12.1 % (p < 0.05). Volumetric blood flow indicators increased significantly (p < 0.05) in all studied vascular territories, which led to improvement in clinical manifestations of the disease — a decrease in the number of painful and painless episodes of myocardial ischemia, and an increase in walking distance. Conclusions. The use of a complex therapy of statins, cilostazol and GABA in patients with MAS combined with COPD allows to reduce significantly the levels of MMP-2 and MMP-9, which ensures the stability of atheromatous plaques and significantly improves blood supply in vascular territories with atherosclerotic lesions.

Mature neutrophils as a marker of hypoechoic carotid plaques and a predictor of polyvascular disease progression

Aim. To evaluate the diagnostic and prognostic value of circulating mature and aging neutrophils in relation to hypoechoic carotid plaques and short-term progression of carotid and multifocal atherosclerosis.Material and methods. The study included 200 patients (89 males and 111 fe­males), aged 40-64 years. All patients underwent duplex ultrasound of the carotid and lower extremity arteries at the first visit and at a repeat visit after 12-24 months. Ultrasound morphology of carotid plaques was assessed using greyscale median analysis. Phenotyping and differentiation of neutrophil subpopulations was carried out using flow cytometry.Results. The absolute and relative number of mature neutrophils directly correlated with ultrasound indicators of carotid atherosclerosis, while the number of aging neutrophils — with the degree of lower extremity artery stenosis. Patients with hypoechoic carotid plaques were characterized by a significantly higher absolute number of mature neutrophils (p=0,0340). An increase in the number of mature neutrophils over 3023,0 cells/μL made it possible to predict the hypoechoic carotid plaques with a sensitivity of 75,0% and a specificity of 69,5%. Patients with carotid atherosclerosis progression had a higher absolute number of mature neutrophils (p=0,0140), as did patients with progression of multifocal atherosclerosis (p=0,0162). An increase in the number of mature neutrophils more than 3223,0 cells/μL was associated with an increase in the relative risk of polyvascular disease progression by 3,09 times (95% confidence interval, 1,34-7,17; p=0,0082) after adjustment for baseline cardiovascular disease risk.Conclusion. Among patients aged 40-64 years, increased numbers of circulating mature neutrophils are associated with an increased carotid plaque burden and hypoechoic carotid plaques. An increase in the number of mature neutrophils over 3223,0 cells/μL was associated with a 3,09-fold increase in the relative risk of polyvascular disease after adjustment for baseline cardiovascular risk.

Associations of the variable site rs2010963 of the VEGF-A gene with multifocal atherosclerosis in aluminum industry workers with chronic occupational intoxication with fluoride compounds

Introduction. The aluminum industry occupies a leading position among non-ferrous metallurgy industries in revealing somatic pathologies in workers that occur against the background of chronic fluoride intoxication. Long-term exposure to fluorides on the body has a cardiovasotoxic effect, leads to structural and functional disorders of the myocardium and the development of comorbid cardiovascular pathology. This dictates the need for a risk-oriented approach to its diagnosis, including one based on molecular genetic analysis, for the timely identification of risk groups for the development of atherosclerosis and the elaboration of preventive measures aimed at preserving the health and maintaining working longevity of the studied occupational cohort. Materials and methods. There were examined ninety seven metallurgists with a previously proven diagnosis of chronic occupational intoxication with fluoride compounds, engaged in aluminum production. The comparison group consisted of 33 workers of this enterprise without a proven occupational disease. All respondents underwent ultrasound investigation of the main arteries. Genotyping of the rs2010963 polymorphic locus of the VEGF-A gene was carried out in a 96-well format using TaqMan technology (allele-specific real-time PCR). Results. The associative connection of the G/G VEGF-A genotype is determined in metallurgists with the risk of developing chronic occupational intoxication with fluoride compounds and heterozygous G/C genotype in subjects with multifocal atherosclerosis. The high level of predictive value of the polymorphism -634 G/C (rs2010963) of the VEGF-A gene allows considering it a marker of the risk for the developing atherosclerosis in workers exposed to long-term impact to fluoride compounds on the body. Limitations. The study was limited to the number of long-term work experienced subjects undergoing periodic medical examinations and undergoing inpatient treatment at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. It is recommended to conduct a screening molecular and genetic analysis in a clinical hospital setting for timely assessment of the prognostic significance of risk markers for the development of atherosclerosis and its complications in workers of basic occupations engaged in aluminum production.

Equivalent density of calcium deposits – a new diagnostic pattern for atherocalcinosis

Objective. To assess the density of the calcified substrate of atherosclerotic plaques of the carotid arteries using data from the computed tomography of patients with multifocal atherosclerosis. Material and methods. In 251 patients with verified atherosclerosis of the coronary and carotid arteries, with a high prevalence of angina pectoris, a history of myocardial infarction and modifiable cardiovascular risk factors, multislice computed tomography (MSCT) of the carotid arteries was performed to assess the calcium index and determine the equivalent density of calcium deposits (EDCD). A morphological sub-study of the material from the removed atherosclerotic plaques was carried out using scanning electron microscopy (SEM) in 12 patients. Results. According to the MSCT data, we identified 5 main types of calcium deposit location in the thickness of the atherosclerotic plaque. We noted that totally calcified plaques were associated with carotid artery stenosis by more than 30 %. According to the SEM data, we identified 2 leading patterns: diffuse and compact types of microcalcification. There was a statistically significant association of a low level of EDCD with a diffuse type of calcification both in vivo (p=0.010) and ex vivo (p=0.008). Patients, having carotid artery EDCD less than 0.21 mg/mm3, reported a significantly higher incidence of type 2 diabetes mellitus (p=0.0001) and a history of stroke (p=0.021). When comparing the MSCT data on the calcium deposit density and their localization in the atherosclerotic plaque, we noted a statistically significant predominance of low EDCD with superficial calcification of the plaque (p=0.002). Conclusion. The use of a calculated indicator of the equivalent density of calcium deposits of the atherosclerotic substrate allows us to non-invasively obtain new data on the structure of plaques. The observed association of the superficial distribution of calcification with low calcification density according to the MSCT data may indicate potential plaque instability.

Prediction of Cardiovascular Diseases in Women With Rheumatoid Arthritis.

To develop prognostic models for arterial hypertension (AH) and atherosclerosis based on studying the totality and significance of traditional and disease-mediated risk factors (RFs) in women with rheumatoid arthritis (RA). 223 female patients with RA aged 54.9±2.1 years were evaluated at the premises of the polyclinic of the Gulla Municipal Hospital #4 (Barnaul), the "Health Center", the City Rheumatology Department of the polyclinic, and the Hospital Department in 2016-2019. Statistical analysis was performed using Excel Microsoft Office 2007, Statistica 6.0 and 10.0, and SigmaPlot 12.5 software packages. Multivariate regression analysis was used for studying the attributes influencing the development of AH and atherosclerosis in RA and for constructing predictive models. ROC analysis was used to determine the quality of the developed models. Differences were considered statistically significant at p<0.05. The following RFs predominating in the onset of disease were identified: traditional (hyperglycemia, obesity, increased diastolic BP (DBP), tachycardia, dyslipidemia); disease-mediated (ESR, fibrinogen, C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies, moderate and high DAS-28 activity), and psychosocial (stress, anxiety, depression, sleep disorders). The highest RF incidence and their combinations were determined with a RA duration of more than a year: traditional (obesity, hyperglycemia, increased systolic BP (SBP)), and decreased glomerular filtration rate; and disease-mediated (prednisolone treatment). A highly sensitive model for AH screening was developed that included a combination of RFs: disease-mediated (RA duration, CRP); traditional (improper diet, low physical activity, history of early cardiovascular diseases, increased SBP and DBP, preeclampsia and/or eclampsia, early menopause, older age, dyslipidemia); psychosocial (anxiety, depression), and a high salt-taste threshold. A highly sensitive model was developed for probable prediction of multifocal atherosclerosis in RA in women. The model includes a complex of risk factors: disease-mediated (RA activity by DAS-28, CRP, fibrinogen, ESR, dose-dependent prednisolone treatment); traditional (AH, SBP, waist circumference, heart rate, early menopause, preeclampsia and/or eclampsia, age 55 years and older, dyslipidemia); and psychosocial (sleep disorders, depression). Algorithms for early prevention of AH and atherosclerosis were developed with consideration of identified predictors and proposed prediction models for women with RA.

Single-Photon Emission Computed Tomography in the Diagnosis of Early Postoperative Cognitive Dysfunction After Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting

Objective: to study the contribution of regional cerebral blood flow (rCBF) indicators to the diagnosis of early postoperative cognitive dysfunction (POCD) in patients with multifocal atherosclerosis (MFA) with heart and brain revascularization.Material and methods. The study involved 45 patients with MFA of coronary and precerebral arteries. We analyzed patients’ cognitive indicators and conducted brain scintigraphy before and after revascularization. The criteria for inclusion in the study were: scheduled combined revascularization of coronary and precerebral arteries; signed informed consent to participate in the study. Criteria for exclusion were: refusal to participate in the study, diseases that would prevent examination. The study of cognitive functions was performed using flow was assessed by single-photon emission computed tomography using lipophilic radiopharmaceutical 99mTc-HMPAO “Ceretec”.Results. The frequency of early POCD in the isolated coronary artery bypass grafting (CABG) group was 73.3%, in the combined carotid endarterectomy (СEA) and CABG group it was 72.5% (p ˃ 0.05). The rCBF index in the isolated CABG group compared with the combined СEA and CABG group was higher in the right and left temporal lobes (p = 0.01 and p = 0.04), in the right frontal lobe (p = 0.03), right parietal lobe (p = 0.005), and in the right and left occipital lobes (p = 0.03 and p = 0.03). In the postoperative period, in the isolated CABG group, right parietal lobe perfusion (p = 0.01), and right and left occipital lobe perfusion (p = 0.01 and p = 0.01) decreased compared to the baseline values. In the combined СEA and CABG group, in the early postoperative period, cerebral perfusion did not change significantly. Right parietal lobe perfusion was higher in the isolated CABG group compared with the combined CABG and СEA group (p = 0.04). The greatest contribution to the development of early POCD in patients after isolated CABG was made by the left temporal lobe perfusion (p = 0.025), in patients after combined CABG and СEA – by the right parietal lobe perfusion (p = 0.04) in the early postoperative period.Conclusion. Assessment of cerebral perfusion in patients before and after surgery can be used to identify areas affected during surgery, as a method for monitoring the safety of procedure, and as an assessment of the preventive methods against POCD.

A case of multifocal atherosclerosis complicated by acute myocardial infarction in a young woman with ulcerative colitis

Coronary artery thrombosis in ulcerative colitis is a serious condition and can occur in the young population. The authors report a case of multifocal atherosclerosis complicated by acute myocardial infarction due to atherosclerotic coronary thrombosis in a young woman with ulcerative colitis.

Эффективная антитромботическая терапия при мультифокальном атеросклерозе

Optimizing the management of ischemic cardiovascular risks through timely and comprehensive surgical interventions, as well as effective drug therapy, is crucial for patients with multifocal atherosclerosis This article summarizes the experience of using low-dose buffered acetylsalicylic acid (ASA) in a 62-year-old man with a family history of cardiovascular disease, dyslipidemia, and hypertension The drug was added to the antithrombotic therapy for multifocal atherosclerosis (coronary and lower limb arteries), ischemic heart disease (stable angina pectoris), myocardial infarction, and coronary artery endovascular revascularization, along with a concomitant duodenal ulcer Despite the high risk of ischemia, there were no reported signs of peripheral atherosclerosis progression or new thrombotic cardiovascular or hemorrhagic events during a 10-month course of low-dose buffered ASA. This illustrates the efficacy and safety of the treatment KEYWORDS: multifocal atherosclerosis, antithrombotic therapy, acetylsalicylic acid, buffered, adherence to treatment FOR CITATION: Kashtalap V.V., Sedykh D.Yu. Effective antithrombotic therapy in multifocal atherosclerosis. Russian Medical Inquiry. 2024;8(1):42–47 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-7.

Dynamic functional assessment of internal carotid artery tortuosity in patients with multifocal atherosclerosis

A personalized approach with attention to anamnesis and specific symptoms is necessary in patients with internal carotid artery tortuosity. Neuroimaging (especially before elective surgery) or functional stress tests following ultrasound of supra-aortic vessels may be necessary depending on medical history and complaints. In addition to standard Doppler ultrasound, these patients should undergo rotational and orthostatic transformation tests. We analyze changes in shape and hemodynamic parameters within the tortuosity area in various body positions. This is especially valuable for patients with concomitant carotid artery stenosis. The article presents a clinical case illustrating the importance of such approach.

Off-pump coronary artery bypass surgery in patients with multifocal atherosclerosis and inoperable internal carotid artery lesion

Off-pump coronary artery bypass surgery in patients with multifocal atherosclerosis and inoperable internal carotid artery lesion