The dissertation presents a new solution to the actual scientific and practical problem of modern neurology – optimization of prediction of atherothrombotic stroke and therapeutic tactics in patients with extracranial carotid atherosclerosis based on the establishment of the role of vascular pro-inflammatory factors in the activity of the atherosclerotic process.
Ischemic stroke is the second most common cause of death worldwide and the third leading cause of the loss of disability-adjusted life years. Atherosclerotic stenoses are known to cause about 30% of ischemic strokes. Asymptomatic carotid artery stenosis is a factor that significantly increases the risk of ipsilateral ischemic strokes. The degree of carotid stenosis remains the main marker for stratifying the risk of stroke in "carotid disease" and choosing tactics for revascularization interventions. However, the degree of carotid artery stenosis alone does not allow us to accurately predict the risk of stroke in asymptomatic carotid artery atherosclerosis. The inclusion criteria were: the presence of atherosclerotic stenosis of the extracranial carotid artery ≥50%; the absence of atrial fibrillation and other potential sources of cardiogenic embolism (acute myocardial infarction, rheumatic and congenital heart defects, etc.); the absence of severe somatic pathology (diseases of the lungs, kidneys, joints, decompensated diabetes mellitus, cancer and other inflammatory diseases). The examined patients divided on 3 clinical groups: 35 patients with acute atherothrombotic stroke, 41 patients who suffered of ischemic and underwent ipsilateral surgical intervention – carotid endarterectomy (CEAE), and 30 patients with asymptomatic carotid stenosis who had no history acute ischemic even. The average age of patients was (62.60.9) years old. Research methods included: clinical and neurological examination, assessment on the NIHSS, Rankin, MMSE, MOCA scales; study of the risk factors (anamnestic information, blood lipid spectrum, body mass index); neuroimaging examination of the brain; Doppler ultrasound of extracranial arteries of the neck; determination of the levels of lipoprotein-associated phospholipase A2 (LP-PLA2) and E-selectin in
In all the examined patients, there was a statistically significant relationship between the degree of stenosis and the patient's gender. Severe atherosclerotic stenosis (70-99%) was more common in men than in women (P=0,00492), as well as in the group of patients with CEAE, which was dominated by younger men. The proportion of women with stenosis from 50% to 69% significantly exceeds the proportion of men with a similar degree of stenosis (p=0,00300). Evaluation of ultrasound characteristics showed that before surgical treatment, the degree of ipsilateral stenosis of 50-69% was determined in 7 (17.1%), critical stenosis of 70-99% - in (58.5, occlusion - in 10 (24.3%) patients, and therefore 31 patients underwent CEAE, 13-extra-intracranial micro-anastomosis, 3 patients were subjected to subluxation intervention. Atherosclerotic plaque before surgery on the contrlateral side with a certain degree of stenosis was observed in 29 (70.7%) of the examined patients, while stenosis ≥50% or occlusion was detected in 16 (39.0%), but in most cases they remained clinically silent. Stroke and a transient ischemic attack on the contralateral side developed in 3 patients who then underwent CEAE. Upon repeated examination of USDG, progression of atherosclerotic carotid stenosis was observed in 29 (70.7%) patients. The absence of progression, which was considered as the absence of atherosclerotic stenosis ≥50% on both the ipsilateral and contralateral sides, was observed in 12 (29.3%) patients. Acute cerebrovascular accident was not observed in the group of re-examined patients after surgical treatment on the CEAE side. In patients with atherosclerotic stenosis ICA plasma levels of LP-PLA2 were statistically significantly higher than 55.664±3.537 ng/ml, comparable to the control group of 9.296±0.935 ng/ml (p<0,05). This confirms the importance of LP-PLA2 as a marker of atherogenesis in carotid artery atherosclerosis. When comparing different clinical groups, the level of LP-PLA2 was significantly higher in the group of symptomatic patients who underwent CEAE (p<0,05), which indicates a more aggressive course of the atherosclerotic process in this category of patients. This is also confirmed by the results of ultrasound examination of blood vessels in dynamics, which revealed the progression of atherosclerotic stenosis with the development of restenosis after CEAE on the ipsilateral side in 52.4%, and on the contralateral side in 39.5% of patients.
