Treatment Of Chronic Cerebral Ischemia Research Articles

Resolution of the Council of Experts on the topic “New treatment options for patients with chronic cerebral ischemia”, March 31, 2023

On March 31, 2023, the first meeting of the Council of Experts was held in Moscow to discuss new options for the treatment of chronic cerebral ischemia (CCI), one of the most common causes of vascular cognitive impairment in middle-aged and elderly patients. The issues of screening, diagnosis and treatment of patients with CCI, including through the interaction of neurologists with related specialists, are discussed.

Optimal extra-anatomical reconstructions of the carotid and vertebrobasilar basins (case reports)

The paper considers a case of surgical treatment of a patient with a completed stroke in the brain stem in anamnesis and with a clinical picture of chronic vertebrobasilar insufficiency caused by combined occlusion of the right vertebral artery (VA), hypoplasia of the left VA, and pathological tortuosity of the right internal carotid artery (ICA). The patient underwent extra-anatomical reconstructive surgery: simultaneous lowering of the loop of the right ICA and its resection in the middle third with redressement and reimplantation in the proximal third of the ICA with the formation of the ICA-ICA end-to-side anastomosis and the subsequent creation of an end-to-side anastomosis between the free end of the resected ICA and the V3 segment of the right VA. In addition, a case of surgical treatment of isolated bifurcation of the common carotid artery (CCA) that occurs when the proximal CCA is occluded and the blood flow is maintained in the external carotid artery (ECA) and ICA is considered. These reconstructive surgical interventions for combined lesions of the main arteries of the head are safe and reliable methods for the treatment of chronic cerebral ischemia and effective prevention of recurrent ischemic strokes.

Combination of indirect revascularization and endothelial progenitor cell transplantation improved cerebral perfusion and ameliorated tauopathy in a rat model of bilateral ICA ligation

ObjectiveEndothelial progenitor cells (EPCs) contribute to the recovery of neurological function after ischemic stroke. Indirect revascularization has exhibited promising effects in the treatment of cerebral ischemia related to moyamoya disease and intracranial atherosclerotic disease. The role of EPCs in augmenting the revascularization effect is not clear. In this study, we investigated the therapeutic effects of indirect revascularization combined with EPC transplantation in rats with chronic cerebral ischemia.MethodsChronic cerebral ischemia was induced by bilateral internal carotid artery ligation (BICAL) in rats, and indirect revascularization by encephalo-myo-synangiosis (EMS) was performed 1 week later. During the EMS procedure, intramuscular injection of EPCs and the addition of stromal cell-derived factor 1 (SDF-1), and AMD3100, an SDF-1 inhibitor, were undertaken, respectively, to investigate their effects on indirect revascularization. Two weeks later, the cortical microcirculation, neuronal damage, and functional outcome were evaluated according to the microvasculature density and partial pressure of brain tissue oxygen (PbtO2), regional blood flow, expression of phosphorylated Tau (pTau), TUNEL staining and the rotarod performance test, respectively.ResultsThe cortical microcirculation, according to PbtO2 and regional blood flow, was impaired 3 weeks after BICAL. These impairments were improved by the EMS procedure. The regional blood flow was further increased by the addition of SDF-1 and decreased by the addition of AMD3100. Intramuscular injection of EPCs further increased the regional blood flow as compared with the EMS group. The rotarod test results showed that the functional outcome was best in the EMS combined with EPC injection group. Western blot analysis showed that the EMS combined with EPC treatment group had significantly decreased expressions of phosphorylated Tau and phosphorylated glycogen synthase kinase 3 beta (Y216 of GSK-3β). pTau and TUNEL-positive cells were markedly increased at 3 weeks after BICAL induction. Furthermore, the groups treated with EMS combined with SDF-1 or EPCs exhibited marked decreases in the pTau expression and TUNEL-positive cells, whereas AMD3100 treatment increased TUNEL-positive cells.ConclusionThe results of this study suggested that indirect revascularization ameliorated the cerebral ischemic changes. EPCs played a key role in augmenting the effect of indirect revascularization in the treatment of chronic cerebral ischemia.

Potential Protective Effect of Dl-3-n-butylphthalide on Chronic Cerebral Ischemia Brain Injury.

Chronic cerebral ischemia is one of the common ischemic cerebrovascular diseases. Chronic cerebral ischemia can lead to brain dysfunction, and its pathophysiological mechanism involves inflammation, blood-brain barrier destruction, oxidative stress, and other factors. As it is difficult to detect, it is easily overlooked, and it is often only observed following the onset of cognitive dysfunction. At present, there are only a few drugs for its treatment. Dl-3-n-butylphthalide (NBP), a compound extracted from celery seed, may play an important role in protecting against brain damage caused by chronic cerebral ischemia. Therefore, here, we have paid attention to the prevention and treatment of chronic cerebral ischemia with NBP.

Xi-Xian-Tong-Shuan capsule alleviates vascular cognitive impairment in chronic cerebral hypoperfusion rats by promoting white matter repair, reducing neuronal loss, and inhibiting the expression of pro-inflammatory factors.

While the number of cases of vascular cognitive impairment caused by chronic cerebral hypoperfusion (CCH) has been increasing every year, there are currently no clinically effective treatment methods. At present, Xi-Xian-Tong-Shuan capsule is predominantly used in patients with acute cerebral ischemia; however, its protective effect on CCH has rarely been reported. To explore the underlying mechanisms by which Xi-Xian-Tong-Shuan capsule alleviates cognitive impairment caused by CCH. A model of CCH was established in specific-pathogen-free (SPF)-grade male Sprague-Dawley (SD) rats using bilateral common carotid artery occlusion (BCCAO). Xi-Xian-Tong-Shuan capsules were intragastrically administered for 42 days after the BCCAO surgery. We then assessed for changes in cognitive function, expression levels of pro-inflammatory factors, and coagulation function as well as for the presence of white matter lesions and neuronal loss. One-way ANOVA and Tukey's test were used to analyze the experimental data. The rats showed significant cognitive dysfunction after the BCCAO surgery along with white matter lesions, a loss of neurons, and elevated levels of inflammatory factors, all of which were significantly reversed after intervention with Xi-Xian-Tong-Shuan capsules. Xi-Xian-Tong-Shuan capsules can ameliorate vascular cognitive impairment in CCH rats by preventing damage of white matter, reducing neuronal loss, and inhibiting the expression of pro-inflammatory factors. Our study provides a new reference for the clinical treatment of chronic cerebral ischemia with Xi-Xian-Tong-Shuan capsules.

IMPLEMENTATION OF QUANTITATIVE ELECTROENCEPHALOGRAPHY TO IMPROVE EFFICACY OF DIAGNOSIS AND TREATMENT MANAGEMENT OF CHRONIC CEREBRAL ISCHEMIA.

The aim: To improve the effectiveness of diagnosis and treatment of chronic cerebral ischemia through the use of quantitative electroencephalography in civil servants on the outpatient and hospital stage. Materials and methods: A total of 150 patients (59 males and 91 females) aged from 40 to 69 years were examined. The patients were divided into three groups statistically correlated with the main disease - chronic cerebral ischemia (CCI), degree of severity - CCI level 2, age and statistical status. Registration of brain biopotentials was performed using a computerized electroencephalograph of «TredexExpert» series. The total spectral power capacity - ASP (μV/√Hz), relative power capacity - RSP (%) were studied in the investigated frequency ranges. Results: The study of three groups of patients with CCI of different genesis, an increase in ASP of all studied ranges, but of varying degrees of severity, was found: first, delta and theta ranges, then beta ranges, and finally, to a lesser extent, ASP of the alpha1 range and alphaS range. Therefore, the RSP of alpha1- and alphaS-bands significantly decreased in all studied groups. Conclusions: 1. In all studied groups, the relative spectral power of the alpha 1 and alphaS bands decreased significantly. An increase in the relative spectral power of the beta-frequency rhythm in all leads was established. 2. The identified neurophysiological differences in the formation and course of dyscirculatory encephalopathy of various genesis are used to monitor the effectiveness of treatment of chronic brain ischemia.

The experience of using iodine-bromine baths and ozone therapy at the stage of health resort treatment of patients with chronic cerebral ischemia

Background. Treatment of chronic cerebral ischemia should be aimed both to the main etiological factor and to the pathogenetic mechanisms of cerebral ischemia and hypoxia. The action of ozone therapy is characterized with a multilateral positive effect on the main aspects of chronic cerebral ischemia pathogenesis, such as chronic cerebral hypoxia, impaired microcirculation, rheological disorders, and activation of lipid peroxidation. The use of iodine-bromine baths in chronic cerebral ischemia has been proved to be accompanied by an improvement in cerebral circulation, normalization of the brain bioelectric processes, an initially impaired condition of the autonomic nervous system, and an increase in the level of adaptive capabilities of the body.
 Aim: to develop effective pathogenetically substantiated methods for the combined use of iodine-bromine baths and ozone therapy in patients with chronic cerebral ischemia to increase the effectiveness of health resort treatment.
 Methods. In accordance with the tasks set in the work, 90 patients with chronic cerebral ischemia of the degree 1, who were randomized into three treatment groups, were examined and treated. Patients of the control group (n = 30) received iodine-bromine baths, patients of the comparison group (n = 30) received ozone therapy, patients of the main group (n = 30) received iodine-bromine baths and ozone therapy. Examination of patients included Doppler ultrasound, electroencephalography, rheoencephalography, сardiointervalography, lipid metabolism studies, fibrinogen content studies.
 Results. As a result of treatment, the improvement of clinical symptoms and the normalization of biochemical and neurophysiological parameters were noted in patients of all treatment groups. Overall efficiency (improvement and significant improvement) was 53.3% in the control group, in the comparison group it was 63.3%, and 73.3% in the main group.
 Conclusion. The authors proved the practicability of rehabilitative treatment of early forms of vascular diseases of the brain at the stage of sanatorium and resort rehabilitation, which is due to significant compensatory reserves and high plasticity of the structural and functional formations of the brain with preserved ability to develop nonspecific elements of the nervous tissue and restore reversibly damaged structures.

A multimodal approach in the treatment of chronic cerebral ischemia: what should a doctor know?

The article discusses one of the leading problems of modern angioneurology - chronic cerebral ischemia. The main etiological factors playing a significant role in the development of chronic cerebral ischemia, among which atherosclerosis, hypertension, myocardial diseases, diabetes mellitus, etc. play a major role. The main clinical manifestations of this disease are described. The emphasis is on the fact that the main nucleus of the clinical picture of chronic cerebral ischemia is cognitive impairment, which in most cases determines the severity of patients. The development of cognitive impairment is associated with focal or diffuse brain lesions, resulting in the impairment of one or more cognitive functions. Vascular cognitive deficits are the result of acute or chronic cerebrovascular processes. The main causes and mechanisms of vascular cognitive impairment development are presented. It is shown that depending on the mechanism and the cause, the rate of cognitive impairment development may vary. The clinical picture of cognitive impairments developing as a result of the lesion of small brain vessels is described. The peculiarities of vascular cognitive disorders occurring against the background of cerebral hypoperfusion are described. The modern criteria of diagnosis are given. The main diagnostic methods are listed. The main approaches in treatment of patients with chronic cerebral ischemia depending on the disease stage are described. In-depth attention is given to neuroprotection with a more detailed description of the mechanisms of action and clinical efficacy of drugs with active substances - citicoline and ethylmethylhydroxypyridine succinate.

Effectiveness of acupuncture and farmacopuncture in the complex treatment of chronic cerebral ischemia (CCI) in elderly patients

Effectiveness of acupuncture and farmacopuncture in the complex treatment of chronic cerebral ischemia (CCI) in elderly patients

Results of the sequential use of Mexidol and Mexidol Forte 250 in patients with chronic cerebral ischemia

To study the efficacy and safety of mexidol's intravenous injections (500 mg once a day) for 14 days, followed by oral administration of mexidol FORTE 250 at a dose of 250 mg (1 tablet) 3 times a day for 60 days, in treatment of chronic cerebral ischemia (CCI) in patients with hypertension and atherosclerosis of the brachiocephalic arteries. The observation program included 60 patients with an established diagnosis of CCI confirmed by neuroimaging methods. Patients of the main group (n=26) received mexidol along with basic therapy, patients of the comparison group (n=26) received only basic therapy. The results of the experience show the high efficacy and safety of sequential therapy (parenteral therapy followed by tablets of mexidol FORTE 250). The treatment improves emotional and cognitive status, decreases static-motor disorders and severity of subjective neurological symptoms. High adherence of patients to the therapy is shown.

A randomized, double-blind, placebo-controlled study of the efficacy and safety of ampasse in the treatment of chronic cerebral ischemia

To study the efficacy and safety of ampasse in the treatment of chronic cerebral ischemia. A randomized, double-blind, placebo-controlled study of the efficacy and safety of the 5-hydroxy-3-carboxypyridine-L-glutamine acid monocalcium salt (ampasse) was performed in 80 patients, aged from 50 to 75 years, with chronic cerebrovascular accident due to arterial hypertension and/or atherosclerosis of the main arteries of the head. The drug was used in daily doses of 5, 10, or 25 mg intravenously once a day for 15 days. Sodium chloride 0.9% was used as a placebo. It has been established that ampasse improves the state of patients with chronic cerebral ischemia in relation to depression, sleep quality and cognitive functions.

Diagnosis and treatment of chronic cerebral ischemia (clinical discussion)

The article presents a clinical case of diagnosis and treatment of the initial presentations of chronic cerebral ischemia (CCI) in the form of cognitive impairments in a middle-aged patient. The authors describe such features of cognitive impairments (CI) as the predominance of «subcortical» symptoms (bradyfrenia, fluctuation), which is typical for CCI. The article presents modern approaches to the diagnosis of CCI, according to which it is necessary to focus on the assessment of higher brain functions, while the significance of «focal microsymptoms» is not large. The article discusses the treatment issues of CCI, which should first include the achievement of the maximum possible control over the underlying vascular disease. It also provides the results of recent studies of the effectiveness of pathogenetic neurometabolic therapy for vascular CIs.

Structural and functional properties of erythrocytes in patients with chronic cerebral ischemia.

Treatment of chronic cerebral ischemia is still an important problem, because in most cases you cannot influence the constantly progressive character of the disease. Particularly relevant is the search for relationships between laboratory parameters and clinical manifestations of chronic cerebral ischemia with a subsequent search of the most informative indicators for timely assessment of disease severity and prediction of outcome. The aim of the study was to determine the relationships between neurological and cognitive disorders with representativeness in the membrane of red blood cells proteins and lipids in patients with chronic cerebral ischemia stage I and II treatment. Under constant observation there were 44 patients with a diagnosis of chronic cerebral ischemia stage I or II on the background of hypertensive disease stage II. Already in the early stages of the development of chronic cerebral ischemia are significant changes in the content of proteins that form the structure of erythrocyte membrane, shape and flexibility of the membrane, provide intracellular metabolism. Revealed violations in the content and ratio of lipids in the membrane. Primarily, this refers to the content of membrane glycerophospholipids and sphingomyelins, which are the basis of the double lipid layer of cell membrane and play a major role in regulating protein macromolecules and to the normal metabolism of erythrocytes. There is a relatively large number of significant relationships between laboratory parameters and parameters of the neuropsychiatric status in patients with chronic cerebral ischemia stage I or II before and after treatment.

Diagnosis and treatment of chronic cerebral ischemia. DIAMANT study results

The diagnosis of chronic cerebral ischemia (CHI) is based on the presence of vascular cognitive disorders (CD). Many patients diagnosed with CHI have other neurological or mental illnesses (primary headaches, vestibulopathies, anxiety and depressive disorders), which, unfortunately, are not diagnosed. Prevention of stroke, which is based on the correction of risk factors (smoking, alcohol abuse, low physical activity, and obesity), the treatment of hypertension, diabetes and other diseases is of major importance in the management of patients with CHI. Inhibitors of central acetyl cholinesterase and akatinol memantine showed efficacy in the management of significant vascular CD. The article discusses the issues of use of Divaza for the management of CHI, provides the results of DIAMANT multicentre observational study.

Divasa in the treatment and prevention of cerebrovascular diseases

Disturbances of hemorheology, hemostasis and fibrinolysis play an important role in the pathogenesis and pathophysiology of chronic cerebral ischemia. Physiological functioning of the endothelium is disturbed under the action of damaging factors. Divaza is created on the basis of release-active antibodies to S100b protein and antibodies to endothelial NO-synthase. The efficacy of divaza in the treatment of chronic cerebral ischemia and related diseases (cognitive impairment, anxiety) was demonstrated. A normalizing effect of divaza in the dose of 2 tablets 3 times daily between meals during 12 weeks on endothelial function is shown.

Chronic cerebrovascular diseases: pathogenetic management

The article considers the key issues of the clinical pattern, diagnosis and treatment of chronic cerebral ischemia. The results of the observation program "Thiocetam for focal neurological, mild cognitive, asthenic and emotional disorders accompanying chronic organic disease of the central nervous system - discirculatory encephalopathy." The article demonstrates that Thiocetam has a beneficial effect against mild cognitive impairment, asthenic disorders, light and moderate emotional disorders in the studied population.

Encephaloarteriosynangiosis in the treatment of chronic cerebral ischemia: preliminary report based on 30 cases

A new surgical technique for the treatment of cerebral ischemia is reported. A scalp artery is freed and placed in contact with the cerebral cortex after craniotomy and opening of the dura mater. Thirty such operations have been performed over a period of 2 years. An analysis of the results, advantages and disadvantages, and indications for this type of surgery is given.