[Dynamic of cerebrovascular disorders in patients with carotid stenosis]
L I Pyshkina1, A R Abieva1, A N Yasamanova1
1Pirogov Russian National Research Medical University, Moscow, Russia.
Insights
Carotid stenosis (CS) worsens cognitive function and cerebral blood flow. Carotid endarterectomy (CEA) improves these, and combined antiplatelet therapy can further reduce cardiovascular events.
Area of Science:
- Neurology
- Vascular Surgery
- Hematology
Background:
- Carotid stenosis (CS) significantly impacts cerebral hemodynamics and cognitive function.
- Platelet hemostasis plays a crucial role in the pathophysiology of CS and its complications.
Purpose of the Study:
- To investigate cerebral hemodynamics and platelet hemostasis in patients with atherosclerotic carotid stenosis (CS).
- To evaluate the impact of carotid endarterectomy (CEA) versus conservative treatment on these parameters.
- To assess the frequency of adverse cardiovascular events and the role of antiplatelet therapy.
Main Methods:
- Prospective study of 123 patients with atherosclerotic CS, divided into CEA (n=53) and conservative treatment (n=70) groups.
- Cerebral blood flow assessed via Doppler flowmetry.
- Platelet aggregation studied using ADP, epinephrine, and collagen.
- 12-month follow-up for acute cardiovascular events.
Main Results:
- Neurological deficits and cognitive impairment correlated with CS severity.
- CEA improved cerebral hemodynamics and cognitive function.
- Adverse events occurred in 23.6% of patients; restenosis observed in 15% post-CEA.
- Abnormal platelet aggregation noted in both groups, particularly in those on aspirin (ASA).
Conclusions:
- CEA offers benefits for cerebral hemodynamics and cognitive function in CS patients.
- Combined antiplatelet therapy can normalize platelet hemostasis and decrease cardiovascular event rates.
- Management of platelet function is critical in preventing adverse outcomes in CS.
Aim:
To study the state of cerebral hemodynamics and platelet hemostasis in patients with carotid stenosis (CS).
Material And Methods:
The prospective study included 123 patients with atherosclerotic CS. The 1st group included 53 patients (mean age 52±12.5 yrs) who underwent carotid endarterectomy (CEA); the 2nd group - 70 patients who were treated conservatively (mean age 58.5±15.9 yrs). The state of blood flow through the main arteries of the head (Doppler flowmetry), platelet aggregation induced by adrenaline, the frequency of acute cardiovascular events that occurred during 12 months were evaluated.
Results And Conclusion:
The severity of neurological deficits and cognitive impairment increased with increasing of the degree of CS. CEA leads to an improvement of cerebral hemodynamics and stabilization of cognitive functions. The adverse course of the disease occurred in 23.6% of patients (stroke/heart attack during the year in 5.7%, progression of cerebral ischemia in 20%, restenosis within 5 years after CEA in 15%). Hyperaggregation of platelets induced by ADP and epinephrine and decreased aggregation of platelets induced by collagen in patients receiving ASA were identified in 53% of the operated and in 60% of non-operated patients. The use of combined antiplatelet therapy normalize the platelet hemostasis and reduce the frequency of acute cardiovascular events.
Related Concept Videos
01:22Mitral Stenosis I: Introduction
02:18Intrinsically Disordered Proteins
01:26Mitral Stenosis III: Medical Management
02:20Dynamic Equilibrium
01:27Mitral Stenosis IV: Nursing Management
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...