Vodopianov V. Clinical, metabolic and hemodynamic features in patients with transient ischemic attacks

In the research work 142 people were examined, of which 45 (31.6%) with TIA cardioembolic (CE) - 1 group, 56 (39.2%) with TIA atherotrombotic (AT) – 2 group and 41 (29.2%) people in the control group. Based on a comprehensive clinical, metabolic and hemodynamic examination, the main differential diagnostic criteria for TIA CE and TIA AT were identified. Differences in the clinical picture, localization and duration of TIA of various origins were found. TIA CE corresponds to 2 degrees of severity according to the classification of E.V. Schmidt and G.A. Maksudov and has a favorable forecast of ischemic stroke (IS) development on the ABCD scale. TIA АT to 3 degrees of severity according to the classification of E.V. Schmidt and G.A. Maksudov and has a not favorable forecast of IS development on the ABCD scale. Violations of plasma lipid metabolism in the form of hyperlipidemia were detected. Hemostasis changes of both groups are reversible, but in the TIA AT group there are more significant hemoreology and hemocoagulation changes. During studying of endothelial dysfunction a pathogenetic co-dependent of endothelin-1 and NO correlation was established. The pro-inflammatory cytokine TNF-α has a slight escalation in patients of the TIA CE group compared to TIA AT, which indicates predominantly extravasal pathogenetic occlusion mechanisms in contrast to endovascular occlusion during TIA AT, which correlates with hemostasis indicators, E-1 and NO. The characteristic dopplerographic parameters for the differential diagnosis of TIA CE and TIA AT are determined, which are changed more significantly in patients with TIA AT. The proposed main TIA CE and TIA AT clinical, metabolic and hemodynamic markers are substantiated to improve therapeutic and preventive measures.