What is atherosclerosis of the main arteries of the brain. Stenosing atherosclerosis mag. Manifestations of stenosis of the arteries of the lower extremities

For modern diagnostics various diseases or pathological conditions, many techniques have been developed using discoveries in science and technology. For example, some people are prescribed a procedure with the abbreviation USDG MAG. What kind of examination this is, why and how it is carried out will be described below.

Ultrasound and diagnostics

Sounds surround a person constantly. Moreover, this is not only the range that is perceived by ear, but also those sounds that the human ear cannot hear. For example, ultrasound - its wave frequency is more than 2000 hertz. It is precisely this sound, inaudible by humans, that is used in medicine, because it penetrates well soft fabrics of the human body, encountering obstacles in the form of bones, neoplasms, and tissues of a different density. For diagnostic procedures With the help of ultrashort sound waves, such a physical phenomenon as the piezoelectric effect is used, in which one element acts in a dual role - as a supplyer and as a receiver of sound waves. It is on this physical phenomenon that the operation of ultrasound devices is based, allowing the specialist to see what is happening inside the body. One of the examination methods using ultrasound is MAG ultrasound. What is this? This is the question patients ask their doctor when prescribing this study.

What can vascular examination using ultrasound do?

Compared to other methods of examining the body, which allow examining without surgical intervention internal organs, for example, radiography, ultrasound is the most gentle and safe. It is not without reason that it is used during pregnancy to examine the fetus. To make a diagnosis, when it is necessary to find out the state of the blood flow of the head and neck, ultrasound Dopplerography is used. main arteries heads. This method uses two physical phenomena: ultrashort frequency sound waves produced in an ultrasound machine, and the so-called Doppler effect (the ability of the receiver to perceive changes in wavelength and frequency when the source or receiver moves). This diagnostic method provides a sufficiently comprehensive picture of the condition of the vessels of the head, brain and neck to make a diagnosis.

When to get tested

One of the safest, most popular examinations that allows us to identify disturbances in the blood flow of the brain is MAG ultrasound. Indications for use this method quite extensive:

• neck pain;
• congenital anomalies in the cervical spine;
• hypertonic disease;
• headaches of unknown etiology;
• dizziness;
• dystonia;
• migraine;
• visual impairment (blackouts, spots);
• hearing impairment (tinnitus);
• neurological reversible deficit;
• obesity;
• oncological diseases in the neck and head;
• feelings of nausea;
• diabetes;
• stroke symptoms;
• vascular malformations;
• concussions;
• transient ischemic attacks;
• surgical intervention in the myocardium;
• surgical interventions in the neck area;
• traumatic brain injuries;
• cervical osteochondrosis;
• encephalopathy.

What will USG MAG show?

Ultrasound scanning of the vessels of the head is performed to detect certain problems in the body that can become the source of many diseases and pathological conditions. This technique allows you to identify:

• congenital anomalies in the circle of arteries responsible for supplying blood to the brain;
• foci of stenosis;
• angiospastic problems;
• vascular occlusion;
• pathologies of the circle of Willis vessels;
• tone and reactivity of cerebral vessels;
• chronic vascular diseases of the head and neck;
• aneurysms.

This examination method also helps to visualize the results of treatment for certain health problems.

When the procedure cannot be performed

Perhaps any medical intervention may potentially have contraindications. Ultrasound Doppler MAG is no exception. “What is this, what kind of procedure is it and what are the contraindications to its implementation?” - patients ask when scheduling such an examination. Ultrasound waves penetrate through soft tissues using a special device that directs and receives them, transforming them into an image on the monitor screen, which is assessed by a specialist. This intervention is absolutely safe and there are no contraindications to its implementation, because it is even used to diagnose the condition of the fetus during pregnancy. So there is no need to be afraid of ultrasound scanning.

Special training

Doppler ultrasound - modern method diagnosing diseases vascular system, allowing to identify the source of the disease for its precise elimination and prescribing high-quality treatment. No special preparation is required to examine the vessels of the head and neck. The only recommendation that doctors give when prescribing this examination is to give up smoking and coffee on the day of the examination. About admission medical supplies The physician should also be notified to consider the possible influence of certain medications on the examination results. In this case, it will be necessary either to temporarily discontinue treatment, or to take into account the effect of the drugs when summarizing the results.

Methods for studying cerebral vessels using ultrasound

One of the high-quality, effective and safe methods for examining the blood flow system in the neck, head and brain is MAG ultrasound. The description of the procedure can be summarized in a simple algorithm:

• the patient should be in clothing that allows access to the neck and head, as well as the collarbone area;
• You need to lie down on your back, following the instructions of the diagnostician to turn your head in the right direction;
• a special gel is applied to the area of ​​contact with the linear sensor, which improves the glide and sound conductivity of ultrashort waves in tissues;
• During the examination, there may be a need for functional tests; for this patient, the doctor may ask to do deep breath or hold the vessel with your finger and then remove your hand, or hold your breath.

Moving the sensor around the patient’s body, the doctor examines the vessels of the neck and head in different planes, which allows him to fully assess the condition of the main vessels: common carotid arteries (external and internal), vertebral arteries, jugular and vertebral veins.

Two research modes

Scanning of the main arteries of the head - quality way adequate assessment of the state of cerebral vessels and potential risks and threats to human health. This method can be used if necessary in several modes:

• two-dimensional mode;
• duplex scanning.

Two-dimensional scanning is also called B-mode. It allows you to determine the location of blood vessels, deformations of the blood flow that are significant for hemodynamics, the structure of the walls of the vascular system, and the presence of atherosclerotic plaques or blood clots. Also, at the first stage of the examination, the doctor determines the thickness of the inner and middle linings of the arteries, this is the so-called intima-media complex (IMC). The specialist observes and describes the degree of differentiation of the CMM into layers or its absence. When plaques are detected, the doctor uses ultrasound to determine their structure, surface contour, height and extent, as well as the degree of narrowing of the lumen of the vessel. At the same stage, it is possible to describe the place of attachment of the base of the thrombus, its structure and size, and signs of flotation (mobility). This allows us to draw conclusions about the potential threat of fragmentation (separation) of a blood clot, blockage of the distal branches of blood vessels with subsequent ischemia of the organs supplied by these vessels.

If necessary, three-dimensional duplex light scanning is then used to examine the direction and nature of blood flow in the veins and arteries, determine the speed, peripheral resistance index, pressure gradient and other indicators.

Doppler ultrasound - modern, affordable informative method examination of the vascular system of the brain.

Children and ultrasound

Ultrasound scanning of the vessels of the head is an absolutely safe procedure with no contraindications for use. That is why it is used to study the health status of children of all ages, starting from the period of intrauterine development. No preparation is required specifically for small patients before the procedure, nor is the use special drugs and funds.

What will the ultrasound results tell you?

One of the safe, but informative and advanced methods for studying cerebral vessels is MAG ultrasound. Decoding the received data allows us to potentially establish dangerous conditions, identify precursors of severe brain damage. The information content of this method lies in its ability to visualize the objects under study, despite their closeness in the human body. This includes:

• condition of the main blood arteries of the brain;
• compliance of the main flow with age standards;
• flows characteristic of vasospasm;
• shunt flow;
• flow stenosis;
• residual flow (occlusion);
• difficult perfusion.

Patients should remember that any ultrasound examination requires the work of a specialist who can correctly see the examination results. The doctor takes into account not only age indicators, compliance with standards, but also individual characteristics human body. And only a specialist will be able to make a diagnosis and prescribe adequate treatment based on the examination results. You should not listen to those who have already undergone such an examination and have a diagnosis. After all, adequately identifying the cause of poor health is a set of measures and procedures, the data of which only a competent specialist can reduce to a single denominator.

Where is the research conducted and how much does it cost?

For many patients who come with certain health complaints, an examination such as MAG ultrasound is prescribed. Its price varies medical institutions varies, and the range is quite wide - from 1,500 to 9,500 rubles, depending on the region, equipment, and status of the clinic. If directed by a specialist - a neurologist, a cardiologist - such an examination can be completed free of charge at compulsory medical insurance policy by signing up for the queue.

Ultrasound of the main blood arteries of the brain can be done in specialized rooms of city clinics, as well as in specialized medical institutions - diagnostic centers, sanatorium and resort institutions.

Modern medicine, interacting with science and technology, tries to help people stay healthy. Methods are constantly being improved, making it possible to examine all systems of the human body as accurately and painlessly as possible, including the blood supply to the brain, for example, using MAG ultrasound. What it is? This is a study of the main arteries of the brain using ultrasound based on the Doppler effect. This is the most gentle, information-rich method to determine the condition of the arteries and veins supplying blood to the brain. It is used in the diagnosis of many diseases in patients of any age, from the first days of life to old age.

What is cerebral atherosclerosis

On initial stage narrowing, non-stenotic atherosclerosis of the main arteries of the head is diagnosed. At this point, the disease is practically asymptomatic. The disease is usually discovered accidentally during one of your regular aptitude tests or when visiting a doctor.

Once the cholesterol plaque covers more than 50% of the internal lumen, stenosing atherosclerosis of the main arteries of the head is diagnosed. This pathology more dangerous and threatens serious complications. Atherosclerotic changes in blood vessels become chronic. The pathology acquires a clear clinical picture. The cardiologist is required to determine what type of disease the patient has.

Due to the fact that pathologies of cerebral vessels threaten human life, in order to defeat atherosclerosis, it is necessary to carefully follow the doctor’s recommendations. Self-medication is unacceptable!

Signs of the disease

• Ultrasonography.
• MRI (magnetic resonance imaging).
• CT (computed tomography).
• Angiography - the study is carried out with the introduction of contrast. Angiography helps to see the location, extent of damage and the consequences of atherosclerosis.

According to international classification diseases, atherosclerosis is considered to be a separate pathology. To coordinate the efforts of doctors, the disease is assigned its own ICD 10 code.

Why is atherosclerosis dangerous?

Diffuse atherosclerosis in this regard poses the greatest danger, since it does not have strict localization and spreads through adjacent vessels and arteries.

Another serious complication is the risk of loss of integrity and rupture of vascular tissue. As a result of narrowing of the arteries, blood pressure increases. Over time, the walls of blood vessels become thinner and lose their elasticity as a result of constant stress. Atherosclerotic plaques are constantly growing. Any hypertensive crisis can lead to a stroke - rupture of blood vessels and internal hemorrhage of the brain.

The first sign of a developing stroke is partial or total loss vision for a short period of time. If the necessary drug treatment for cerebral atherosclerosis is not prescribed, the changes can be fatal.

How and with what to treat the disease

Modern treatment methods are aimed at eliminating the consequences of the disease and restoring the normal functionality of blood vessels and arteries. For this purpose the following are assigned:

Disability is assigned to the patient when vascular stenosis is diagnosed. In this case, any overexertion can cause a stroke or lead to other complications.

How to cleanse brain vessels

To clean the vessels, the following is prescribed:

• Treatment with leeches. The saliva that enters the patient's bloodstream when bitten by a leech contains an enzyme that thins the blood and loosens existing cholesterol plaques. Through several hirudotherapy procedures, congestion is eliminated and the metabolic process is activated.
• Homeopathy - the essence of the method comes down to the correct dosage selection of the drug aimed at the causes of atherosclerosis.
• Therapeutic gymnastics - normalizes arterial pressure, promotes metabolic processes, ensures blood flow and flushes out deposits from the body. Physical exercise increases the tone of blood vessels, with a gradual restoration of their elasticity.

Folk remedies for atherosclerosis

Traditional methods of treatment make it possible to normalize blood pressure and provide the body with all essential vitamins to normalize metabolic processes. The following recipes are popular:

• Every day you need to eat half a glass of chokeberry. The product normalizes blood pressure well and gives the body the necessary amount of vitamin C.
• 1 tbsp. A spoonful of dill is poured into half a liter of boiling water. After infusing for an hour, take 100 ml of the decoction before meals.
• Raw potato juice is taken three times every day. To do this, peel a medium-sized potato, grate it, and then squeeze the juice through cheesecloth. This recipe can help even with cerebral type atherosclerosis, but requires long-term use.

Diet and nutrition rules

Healthy foods include fruits and vegetables, fish, lean meat, cereals and boiled potatoes. You can season salads and food in any way. vegetable oil, better olive or sunflower.

The cardiologist will definitely plan the diet of a patient suffering from atherosclerosis and help find best option food for a week.

Prevention and prevention of disease

Atherosclerotic lesion of the aorta and main arteries of the head, upper and lower extremities is manifested by hemodynamic disturbances in these anatomical areas, due to a decrease in distensibility and narrowing of the lumen of large and medium-sized arteries due to lipid infiltration of their inner membrane and proliferation of connective tissue in their walls.

In some cases (usually with atherosclerosis of the aorta), the elastic structures of the wall of the affected artery are destroyed, and its aneurysmal expansion is observed. Clinical manifestations of atherosclerosis are determined by the location and degree of arterial stenosis, their blockage with thrombotic masses, and the presence of complications such as thromboembolism, dissection or rupture of an aneurysm.

Currently, more than 200 factors have been described that contribute to the occurrence of atherosclerosis or adversely affect its course (including the presence of diseases such as diabetes, gout, psoriasis, etc.), however highest value, in addition to hyper- and dyslipoproteinemia, have arterial hypertension, obesity, insufficient physical activity and smoking - they are considered to be the so-called major risk factors for the development of atherosclerosis (it is considered especially high when two or more of these factors are combined).

Atherosclerotic lesion of the aorta with significant The compaction of its walls limits the role of their systolic stretching by blood, as a result of which diastolic blood pressure decreases and systolic blood pressure increases. Most dangerous complications occur during the development of an aortic aneurysm - dissection and rupture.

Atherosclerotic lesion of arteries brain and extracranial arteries supplying the brain (carotid, vertebral), manifested by decreased memory, especially for recent events, dizziness, and periods of confusion are possible. Personality changes are observed: premorbid character traits become sharper: sensitive person becomes tearful, faint-hearted; irritable – aggressive, etc. Severe atherosclerosis of the cerebral arteries predisposes to the development of stroke, especially when combined with arterial hypertension.

Atherosclerotic lesion of the arteries of the extremities more often observed in the vessels of the legs. Most often, obliteration or occlusion develops at the site of separation abdominal aorta on iliac arteries, the femoral arteries and arteries of smaller caliber are less often affected. Acute occlusion is manifested by severe pain in one or both legs, paleness and coldness, as well as marbling of the skin.

With slowly increasing obliteration, when collaterals develop bypassing the affected arteries, the so-called intermittent claudication is observed when walking and stops almost immediately after stopping. In the early stages of atherosclerotic lesions of the aorta and main arteries of the head, upper and lower extremities possible reverse development cholesterol plaques when following a diet, taking statins, hemosorption.

For significant stenoses, blockages, or aneurysms of large arteries, surgical treatment is indicated.

Ultrasound of neck vessels (duplex angioscanning of the main arteries of the head)

The cost of duplex scanning of the great vessels of the neck is 200 hryvnia. The price includes examination of the vessels of the carotid and vertebral arteries, venous outflow tracts and functional tests. Detailed report on the study, printing of images and recording on electronic media.

Promotion: when examining the vessels of the head and neck (duplex scanning) - echocardiography (ultrasound of the heart) - free! Saving 250 hryvnia!

Purposes of performing ultrasound of neck vessels

Ultrasound of neck vessels is used to diagnose vascular changes. which arise from the aortic arch and carry blood to the brain, muscles of the neck and head, and to the thyroid gland. Ultrasound of the vessels of the neck allows you to diagnose changes in such arteries as the brachiocephalic trunk on the right, common carotid arteries on both sides, vertebral arteries on both sides, external and internal carotid arteries on both sides. During ultrasound of the neck vessels, the diameter of the arteries, the condition of the vessel walls, changes in the lumen due to the presence of blood clots, diseases of the vessel wall, atherosclerotic plaques or external compression of the vessels are assessed. It is possible to diagnose abnormalities in the structure of blood vessels - for example pathological tortuosity, absence of a vessel, its narrowing or expansion. Main question, which is performed when prescribing an ultrasound of the vessels of the neck to assess the ability of the vessels to provide nutrition to the brain. Any process that occurs both inside the vessel and outside can lead to a narrowing of the lumen of the artery - stenosis or to complete closure of the lumen of the vessel - occlusion. The purpose of vessel ultrasound is to assess the degree of stenosis, and in case of occlusion, to assess the development of the collateral circulatory system. The collateral circulatory system develops by creating bypass routes for delivering blood to those areas that were supplied by the blocked artery. The most striking example is atherosclerosis. subclavian artery, when the blood supply to the arm is carried out through the vertebral artery and movements of the arm can cause a deterioration in the blood supply to the brain. To diagnose this condition, it is necessary to know not only the diameter of the neck vessels, but also the direction of blood movement in them. During ultrasound of the vessels of the neck, the characteristics of blood flow are assessed - the speed of blood movement through the vessels, the nature of the blood flow (laminar or turbulent), changes in speed various areas vessel, elasticity of the vessel wall, symmetry of all the listed characteristics on both sides.

This study of the vessels of the neck is called duplex angioscanning, since a study in two-dimensional mode and in Doppler mode (color and/or spectral) is used simultaneously.

Assessment of narrowing of arteries with ultrasound of neck vessels

To assess the degree of carotid artery stenosis, the American Society of Radiology in 2003 recommended using the following criteria:

• Normal - peak systolic velocity in the internal carotid artery does not exceed 125 cm/s, and plaques or thickening of the inner layer of the vessel are not visualized
• Stenosis from 50-69% - peak systolic velocity is 125-230 cm/s
• Stenosis greater than 70%—peak systolic velocity greater than 230 cm/s
• Stenosis more than 90% - duplex scanning reveals a significant narrowing of the lumen of the vessel and a drop in blood flow velocity
• With complete occlusion (blockage) of the vessel, blood flow is not recorded.
• Of auxiliary importance is the determination of the ratio of peak systolic velocity in the internal and common carotid arteries. With stenosis of the internal carotid artery, the ratio increases by more than 3 times. It is especially useful to calculate this ratio in patients with heart failure and a decrease in the ejection fraction of the heart muscle (left ventricle of the heart). For the same reasons, it is necessary to measure blood pressure in both arms of the patient before starting the examination.

Prognostic criteria for ultrasound of neck vessels

On modern devices Using high-resolution ultrasound of neck vessels, the state of the intima-media complex is assessed. This is the innermost layer of arterial vessels, which is the first to begin to change during atherosclerosis. Changes in the thickness and structure of the intima-media complex are a very important prognostic sign during ultrasound of neck vessels. It is believed that exceeding the thickness of the intima-media complex in the common carotid artery by more than 0.87 mm, and in the internal carotid artery by more than 0.9 mm is a factor that is associated with high risk cardiovascular diseases (myocardial infarction and stroke). Figuratively speaking, assessing the thickness of the intimate media complex in the carotid arteries is a window into which one can look to diagnose atherosclerotic lesions of all vessels. The maximum thickness of this complex varies depending on gender, age and race.

What can be revealed by ultrasound of the vessels of the neck

The most common pathology detected by ultrasound of neck vessels– the presence of atherosclerotic plaques in the lumen of blood vessels. Since symptoms of circulatory disorders, noticeable to the patient, develop only after blocking the lumen of the vessel by more than 60%, the process of formation of plaques and blood clots can occur long time asymptomatic. Plaques during ultrasound of neck vessels can be of various shapes and compositions. The researcher’s task is to describe in detail the composition of the plaque and its location.

Often atherosclerotic plaques disintegrate, blood clots form on them, which can completely block the lumen of the artery or break off, causing blockage of other, more small vessels. These conditions often result in the development of a stroke (death of a section of brain tissue) due to acute disorder cerebral circulation. Stroke is a disease accompanied by high mortality (about 40%), and more than half of people who have had a stroke become disabled. IN Lately Strokes are developing in people at increasingly younger ages (up to 60 years).

Factors contributing to the development of cerebral stroke: smoking, diabetes, high blood pressure, overweight bodies, female gender, the presence of a similar disease in blood relatives.

If such factors are present in a person, he needs to undergo a study of the vessels of the neck as early as possible. It is also necessary to undergo a study of the vessels of the neck if you are worried about dizziness, chronic headaches, problems with coordination, memory and speech.

TO rare cases, which are diagnosed by ultrasound of the vessels of the neck, is dissection of the wall of the carotid artery - detachment of its section followed by thrombosis.

Mandatory information obtained from ultrasound of neck vessels is a study of the volume of blood that flows through all neck vessels to the brain per unit time. Adequate blood supply to the brain is the main factor that is taken into account when assessing the pathology of cerebral circulation. Normally healthy person about 15% of the blood that the heart pumps per minute enters the vessels of the brain. Using ultrasound of the neck vessels, you can very accurately calculate exactly how much blood enters the brain. To do this, add up the volumetric blood flow velocity in all four vessels supplying the brain, namely in the internal carotid arteries and in the vertebral arteries on both sides. A correctly conducted study approaches the accuracy of the results obtained from positron emission tomography.

Preparation and conduct of the study

No preparation is required when performing an ultrasound of the neck vessels. It is only necessary, if possible, to stop taking medications that affect blood pressure.

During the examination the patient does not experience any discomfort or pain. The examination of the vessels of the neck is carried out in several planes, first in black and white mode, then proceed to duplex scanning and pulse Doppler. In this case, the shape of the vessel and its geometry are first assessed, linear dimensions and areas are measured in the presence of stenoses. Color Doppler is used primarily to diagnose plaques that are invisible in black and white. At low blood flow rates, for example, with almost complete occlusion of a vessel, power Doppler is used. Using pulsed Doppler, linear and volumetric blood flow velocity is measured.

Very often, ultrasound of the neck vessels is performed as a study preceding ultrasound of the brain vessels. This is due to the fact that when searching for the causes of cerebrovascular accidents, it is first more logical to make sure that a sufficient amount of blood flows through the main vessels.

antenatal clinic Natalia Petrik 2©08-2015

ATHEROSCLEROTIC LESION OF THE MAIN ARTERIES OF THE HEAD

INDICATIONS FOR SURGICAL TREATMENT

Among vascular diseases cerebral stroke occupies one of the leading places both in terms of incidence and severity, as well as in disability and mortality.

In Russia, 35 people per 10 thousand population suffer cerebrovascular accidents annually, i.e. up to 700 thousand per year, with ischemic stroke taking the leading place among them. Currently, more than 1 million people in the country are profoundly disabled due to a stroke. Only in Moscow over the last five years ischemic disorders cerebral blood flow increased by 40 percent. Mortality after a cerebral stroke remains high and amounts to 30-35 percent. Only 10-20 percent. patients who have survived acute stage diseases, restore their ability to work, the rest become disabled with persistent neurological deficits. Now, in terms of the severity of economic losses, cerebral stroke has firmly taken first place, surpassing even myocardial infarction. Treatment costs and social Security patients who have suffered a cerebral stroke are enormous; in the USA, for example, they amount to $7.5 billion per year.

The very fact of the development of cerebral ischemic stroke cannot be considered as an indication for surgery. In particular, a stroke that developed as a result of material embolism against the background of endocarditis or diffuse atherosclerosis currently has no real prospects surgical treatment. Methods of revascularization at the pial-capillary level of the arterial bed have not yet gone beyond experimental laboratories, and the main burden of treating this category of patients falls on the neurological hospital.

Surgical treatment of stroke resulting from damage to the intracranial great vessels is often possible by creating bypass shunts - applying extra-intracranial anastomoses in neurosurgical and vascular hospitals.

Treatment of cerebral stroke due to pathology of extracranial great vessels is one of the most important tasks of vascular surgery and neurosurgery.

The problem of surgical treatment deserves special attention atherosclerotic lesions main arteries at the “pre-stroke” stage, when patients suffer only transient ischemic attacks or have a deficiency of blood supply to the brain.

The current stage of solving the problems of diagnosing and treating cerebral stroke is characterized by a fairly high resolution of the diagnostic complex and operating equipment. At the same time, the arsenal of medications to influence the pathogenetic components of stroke has not undergone significant changes. This circumstance has led to a significant increase in the role of surgical methods for treating diseases of the cerebral vessels and main arteries of the head, the consequence or complication of which is cerebral stroke. Surgical interventions of a revascularizing nature occupy a significant, and in some cases, a leading place in the complex treatment of cerebral circulatory disorders and their residual effects, successfully fulfilling the task of restoring impaired cerebral function and optimizing cerebral blood flow parameters.

Multicenter studies of the results were conducted complex treatment cerebral stroke in Europe (European Trial of Carotid Surgery - ECST), in North America with the participation of several European centers (North American Symptomatic Carotid Endarterectomy Trial -NASCET). In addition, a third study (Asymptomatic Carotid Atherosclerosis Study - ACAS) was performed among individuals with carotid atherosclerosis without concomitant cerebral symptoms in North American centers. These studies, each of which included at least 1.5 thousand cases, made it possible to formulate indications for surgical correction main arteries of the head. Based on randomized trials, two treatment methods were compared: carotid endarterectomy in combination with drug prevention stroke and only drug treatment. The undoubted advantage of carotid endarterectomy has been proven, especially when the degree of stenosis increases in patients with clinical manifestations discirculation in the internal carotid artery basin, all other things being equal. For asymptomatic disease surgical prophylaxis gives a slight but statistically significant reduction in the incidence of stroke in individuals with a narrowing of the diameter of the internal carotid artery by more than 60 percent.

Treatment and clinical observation for patients with cerebrovascular pathology caused by lesions of the main arteries of the head, should be carried out under the supervision of neurologists - neurosurgeons and vascular surgeons.

The diagnostic algorithm includes physical and neurological examination, Doppler ultrasound of the main extra- and intracranial vessels, duplex scanning; computed tomography brain or magnetic resonance imaging of the brain, cerebral selective angiography; study of central hemodynamics, function external respiration, kidney; biochemical and clinical laboratory tests.

Volume diagnostic studies at the outpatient stage can be reduced for patients with repeated transient attacks and acute thrombosis retinal arteries in the presence of Doppler hemodynamically significant stenosis of the great arteries of the head (MAG), supplying this pool, until the cardiologist assesses the tolerability of the operation.

In cases of acute or progressive cerebrovascular pathology, the integrative scheme should be significantly reduced, and such patients are sent from the clinic to specialized department on an emergency basis.

Based on the examination results, patients with clinical manifestations of cerebrovascular insufficiency should be assigned to groups of conservative or surgical treatment.

Patients with various types of lesions of the carotid and vertebrobasilar areas are subject to surgical treatment. Absolute and relative indications and contraindications for surgical treatment methods are determined.

Absolute indications for carotid endarterectomy (CAE):

- carotid stenoses with a clinical picture of transient ischemic attacks or manifestations of decompensation of dyscirculatory encephalopathy (in patients with severe, more than 70 percent ipsilateral stenosis, leading to cerebrovascular accident and cerebral infarction).

— the presence of a heterogeneous plaque at the mouth of the internal carotid artery of the ICA, even with asymptomatic stenosis.

In this group, risk factors for developing cerebral stroke should also be taken into account, such as age, arterial hypertension, elevated blood lipid levels, smoking, and diabetes.

Relative indications for CEA:

— asymptomatic stenoses (up to 70 percent) of the carotid arteries;

- asymptomatic stenosis of the carotid arteries with Doppler signs of stenosis of more than 90 percent;

stenosis of the carotid arteries from 30 to 69 percent. with neurological manifestations;

rapidly progressing carotid stenosis (patients who had asymptomatic stenosis six months ago);

severe carotid stenosis with ipsilateral neurological symptoms and contralateral carotid artery thrombosis;

severe carotid stenosis with the only symptom - ipsilateral amorosis fugax;

severe carotid stenosis complicated by stroke with manifestations of hemiparesis or aphasia (not earlier than a month after the stroke);

severe carotid stenosis with complete stroke in the affected artery;

severe carotid stenosis with ipsilateral symptoms and cardiac embologenic cause of stroke (confirmed by echocardiography or atrial fibrillation);

severe carotid stenosis, asymptomatic before coronary artery bypass surgery.

Contraindications to carotid endarterectomy:

- carotid stenosis less than 30 percent. with ipsilateral neurological deficit;

— thrombosis of the carotid artery with ipsilateral neurological symptoms;

- nonhemispheric symptoms, such as headache, increased fatigue, syncope, etc. with verified severe carotid stenosis;

— transient ischemic attacks in the vertebrobasilar region;

- severe carotid stenosis with symptoms of damage to the opposite hemisphere of the brain;

- severe carotid stenosis with ipsilateral severe stroke with hemiplegia and/or coma;

Severe carotid stenosis with ipsilateral symptoms and severe concomitant pathology(cancer metastases, organic damage to the central nervous system, etc.).

There are several types of carotid endarterectomies - open, eversion, various options artery replacement using veins and prostheses (homo- and heterografts). The choice of surgical method depends on the degree of damage to the carotid region and its extent. The most optimal are direct and eversion endarterectomy - with the latter, the operation time is significantly reduced, and the geometric parameters of the reconstructed vessel are minimally changed.

To adequately protect the brain during carotid endarterectomy, it is necessary to carefully select patients and promptly surgical technique, general anesthesia, systemic heparinization, Doppler monitoring in the pre- and intraoperative period. In some cases, it is necessary to use a temporary intraluminal shunt, the indications for which are as follows:

1) contralateral occlusion of the internal carotid artery;

2) severe stenosis or occlusion of the vertebral or basilar artery with an incomplete circle of Willis (absence of PCoA or A1 segment).

3) low tolerance of the brain to ischemia even against the background of preventive extra-intracranial microanastomosis.

Indications for reconstruction of the vertebral artery:

Symptoms of unstable hemodynamics in the vertebrobasilar region:

— stenosis of the dominant vertebral artery more than 75 percent;

- stenotic process with the same degree of stenosis of both vertebral arteries;

- segmental occlusion of the second segment of the vertebral artery in the presence of hypoplasia of the other.

2. Clinic of stem dyscirculation of thromboembolic origin when identifying the source of embolism from the vertebral artery.

3. Stenoses of the carotid system, subject to reconstruction in the presence of pathology in the vertebrobasilar region, listed in paragraph 1.

4. Extravasal compression significantly affecting vertebral blood flow (cervical rib, Kimmerle anomaly, uncovertebral and other spondylogenic causes).

Surgical reconstruction of the pathology of the first segment of the vertebral artery consists of standard endarterectomy of the artery mouth through a supraclavicular approach, and if it is impossible to perform it (in case of extensive damage to the vertebral and/or subclavian arteries), it is necessary to use methods of moving the artery - vertebral-carotid anastomosis (bypass), etc. .

Indications for surgical treatment of lesions of the subclavian artery:

1. The presence of intracerebral “steal” phenomena, consisting of signs of ischemia in the vertebrobasilar region and/or upper limb. Signs of combined lesions of the carotid and vertebrobasilar arteries simultaneously.

The most common mechanism for the formation of these symptoms is any serious restriction of blood flow due to critical stenosis or embolism of the main arterial vessel as a result of ulceration of an atheromatous plaque.

2. Heterogeneous atherosclerotic plaques in the first segment of the subclavian artery in the absence of manifestations of intracranial arterial pathology, clinically manifested by vertebrobasilar discirculation.

3. Hemodynamically significant (75 percent or more) stenosis of the first segment of the subclavian artery.

4. Asymptomatic lesions of the first segment of the subclavian artery (>75 percent of its diameter) in patients who are indicated for mammary-coronary anastomosis to prevent the development of coronary-mammary-subclavian “steal” syndrome.

5. Revascularization of the subclavian artery is also indicated for patients who have undergone mammary-coronary anastomosis, and the progression of coronary artery disease is associated with the emerging phenomenon of coronary-mammary-subclavian “steal”.

6. Bilateral asymptomatic occlusions of the subclavian artery in order to create adequate main blood flow in patients who are indicated for systemic hemodialysis or subclavian (axial)-femoral bypass surgery.

The choice between transsternal and supraclavicular access depends on the location of the damaged segments of the main trunk. If the patient has an asthenic physique and a moderate diet, it is preferable to perform a carotid-subclavian anastomosis. In persons with a normosthenic or hypersthenic physique against the background increased nutrition It is preferable to use carotid-subclavian prosthetics.

Indications for extra-intracranial anastomosis:

— thrombosis of the ICA with depletion of collateral circulation reserves;

- hemodynamically significant stenosis of intracranial segments in the basins of the middle, anterior or posterior cerebral arteries;

— as the first stage before carotid endarterectomy on the ipsilateral side in the absence of adequate collateral blood flow along the circle of Willis;

— for tandem lesions of the internal carotid artery with a low degree of cerebral tolerance to ischemia, when multi-stage surgical treatment is indicated;

— for bicarotid stenosis with tandem lesion of one of the carotids: first, the first stage is the restoration of adequate patency of the carotid artery contralateral to the tandem lesion, then the gradual application of EICMA.

X-ray endovascular angioplasty should be performed only with adequate technical equipment. It is preferable to use endovascular angioplasty for local stenoses.

A strict assessment of indications and contraindications for surgical treatment, detailing the stages of the operation, the presence of a technically highly equipped specialized surgical team, intraoperative monitoring of cerebral hemodynamics, adequate resuscitation aids are the main factors to minimize the risk of postoperative complications and adequately restore cerebral perfusion.

In conclusion, it should be noted that the treatment of acute and chronic cerebrovascular pathology, of course, should be carried out using generally accepted methods. There is no doubt the priority traditional therapy in the treatment of this category of patients.

Experience shows that there is a strictly defined category of patients with pathology of the vascular system of the main arteries of the head, which is undoubtedly at risk of developing a cerebral vascular accident or already suffers from cerebral dyscirculatory disorders, the optimal treatment of which can only be achieved surgically. International cooperative studies have confirmed the undoubted advantage of surgical treatment of stenotic lesions of the main arteries of the head to prevent the development of stroke or its progression.

Correct clinical approach for this group of patients may be decisive in preventing the development of the disease, preserving the quality of life, and even life itself, if the issue of diagnosis and indications for surgical treatment is resolved in a timely manner. The choice of indications for surgery, the most adequate surgical correction method, and the prevention of postoperative complications largely depends on the possibilities of a detailed study of the pathological process, its verification, a strict assessment of contraindications to it, and on the availability of a highly equipped specialized surgical team and adequate resuscitation aid.

Georgy MITROSHIN, Head of the Center

Cardiovascular Surgery Central Military Clinical Hospital named after.

A.A. Vishnevsky, Honored Doctor of the Russian Federation.

Valery LAZAREV, leading researcher

Vascular Department of the Research Institute of Neurosurgery

them. N.N. Burdenko RAMS, Doctor of Medical Sciences.

Gennady ANTONOV, head of department

angioneurosurgery of the Central Military Clinical Hospital named after A.A. Vishnevsky,

There are quite a lot of great vessels that provoke the development of atherosclerosis in any part of the body. The most common causes of this disease:

Symptoms of main atherosclerosis

Manifestations of main atherosclerosis of the cerebral arteries depend on the blood vessels of which organs are affected. Stenosis of the head and cervical arteries characterized by the following symptoms:

1. migraine headaches and dizziness;
2. noise and ringing in the ears;
3. fainting;
4. sleep disturbance, awakening and inability to sleep in the middle of the night, feeling sleep-deprived in the morning and tired during the day;
5. problems with short-term memory;
6. psycho-emotional disorders – increased anxiety, causeless tearfulness, irritability, nervousness;
7. impaired coordination of movements, gait, speech;
8. visual impairment.

Diagnosis of atherosclerosis of the great vessels

Attention! To prescribe competent treatment, a high-quality diagnosis of the disease is necessary. It is also necessary to identify the place of formation of plaques, their composition and size, the degree of damage to the walls of blood vessels and their narrowing.

Diagnostics includes the following activities:

How to treat cerebral vessels?

To treat the main type of disease, complex therapy is used with a combination of drug treatment, special diet, physical exercise, compliance healthy image life.

Medications

Drug treatment for main atherosclerosis of blood vessels is prescribed:

Surgical intervention

In cases where drug therapy does not lead to the desired result, when the vessel walls are narrowed by 50%, then treatment of MAG atherosclerosis is carried out by surgical intervention. The following types of operations are used to remove atherosclerotic blood clots:

Diets and proper nutrition

The diet for pathology of the great vessels is aimed at reducing low-density cholesterol in the body. Nutrition for main cerebral atherosclerosis is separate, fractional, 5-6 times a day in small portions. All dishes are prepared steamed, boiled or baked, with the addition of a minimal amount of salt.

Products prohibited when sick:

• fatty meat, fish and mushroom broths;
• fatty meats - pork, chicken, duck;
• smoked sausages;
• chicken egg yolks;
• dairy products with a high fat content (sour cream, cream, cheeses);
• pasta, semolina and whole rice porridge;
• various spices and sauces, mayonnaise;
• mushrooms in any form, sorrel, radishes;
• rich and confectionery(cakes, pastries, ice cream, chocolate);
• strong coffee, cocoa, tea.

Products allowed for illness:

• vegetable, milk soups;
• puree soups;
• lean meat, poultry, fish and seafood;
• eggs (soft-boiled or egg white omelettes);
• low calorie milk, dairy products, low-fat cheese;
• vegetables and fruits;
• cereals.

Reference! Eggplants, grapefruit, and watermelon are especially effective for lowering cholesterol and preventing the development of blood clots.

Exercise therapy – a few simple exercises for every day

A specially selected exercise therapy complex improves peripheral blood circulation, restores motor skills, the functioning of the cardiovascular system, accelerates metabolism and cholesterol burning. Here are some simple exercises to stay healthy:

1. Stand straight, feet together. Place your bent arms on your shoulders, then slowly raising your arms up, raise your head, straighten your back and inhale. When exiting, carry out all steps in reverse order. Do the exercise 4-5 times.
2. Stand up straight, hold the back of the chair with one hand. Alternately raise your legs straight at the knees 4-5 times 90% of the ground, keep your body and head straight. The leg is raised as you exhale, lowered as you inhale.
3. Feet shoulder-width apart, hands on the belt. As you exhale, slowly tilt your torso alternately in one direction and then in the other. While inhaling - starting position. Repeat 4-5 times in each direction.

Why is MAG atherosclerosis dangerous?

Disturbances in the process of blood flow to the brain due to stenosis large vessels very seriously affects human health and can lead to irreversible consequences. The most common complications of main stenosis are the following pathologies:

• heart failure in acute or chronic form;
• acute oxygen deficiency in brain cells and tissues;
• dystrophic changes in the structure of the cerebral hemispheres and atrophy of the affected parts of the brain;
• rupture of arteries and blood vessels, stroke;
• acute vascular obstruction due to complete blockage of the lumen by a thrombus;
• deterioration of mental abilities;
• loss of memory, hearing, vision;
• fatal outcome.

According to the latest sad statistics, everything more people are diagnosed with atherosclerosis. If earlier this disease was considered age-related, now it is rapidly becoming younger. The most dangerous type of it is the MAG (main arteries of the head). The problem is associated with the deposition of cholesterol plaques in the blood vessels of the brain, neck and large arteries of the lower extremities. The disease is chronic and it is impossible to completely get rid of it. But measures can be taken to stop its rapid development. To do this, you need to remember the peculiarities of the course of the disease and the basic therapeutic techniques.

Features of atherosclerosis of the great vessels

The development of atherosclerosis is associated with the deposition of fat cells on the walls of arteries. At the beginning the clusters have small sizes and do not cause serious harm. If measures are not taken in time, the plaques grow significantly and block the lumen of blood vessels. As a result, blood circulation deteriorates.

Atherosclerosis of the main arteries of the head poses a serious danger to humans. As the disease progresses, the blood vessels in the neck and head, which are responsible for adequate blood supply to the brain, become blocked.

A severe form of the disease may be accompanied by destruction of the vessel wall and the formation of an aneurysm. Thromboembolism can worsen the situation. The rupture of such an aneurysm is fraught with serious health consequences, including death.

Depending on the severity of the disease, there are two main types:

1. Non-stenotic atherosclerosis. This term refers to a condition in which the plaque covers no more than 50% of the lumen of the vessel. This form is considered the least dangerous to human life and health.
2. Stenosing atherosclerosis. With this course of the disease, the vessel is blocked by plaque by more than half. This greatly impairs the blood supply to internal organs.

The earlier the disease is diagnosed, the greater the chance of treatment success. It is almost impossible to completely get rid of the disease, so each person needs to take measures to eliminate the factors that provoke atherosclerosis.

What factors cause the onset of the disease?

In order for the treatment of MAG atherosclerosis to be successful, it is necessary to identify and eliminate the cause of its occurrence. Among them are:

1. High blood pressure.
2. Excessive concentration of cholesterol in the blood.
3. Diseases of the endocrine system.
4. Excessive drinking and smoking.
5. Problems with glucose absorption.
6. Lack of physical activity.
7. Adherence to poor nutrition.
8. Age-related changes in the body.
9. Prolonged exposure to stressful situations.
10. Excess body weight.

Most often, the disease affects older men. It is especially important for them to monitor their health and adhere to correct principles proper nutrition and lifestyle.

Every person periodically needs to monitor blood pressure and cholesterol levels. A timely medical examination will help with this.

Symptoms of atherosclerosis

Atherosclerosis of extracranial arteries manifests itself with vivid symptoms. It will largely depend on the location of the plaques. If the damage occurs to the vessels of the brain, the following symptoms appear:

1. The appearance of tinnitus.
2. Intense headaches and dizziness.
3. Memory problems.
4. Uncoordination of movements, speech impairment. Other neurological abnormalities may also occur.
5. Sleep problems. A person takes a long time to fall asleep, often wakes up in the middle of the night, and during the day he is tormented by drowsiness.
6. Mental change. There is increased irritability and anxiety of the person, he becomes whiny and suspicious.

Atherosclerotic lesions can also be localized in the arteries of the extremities. In this case, the symptoms will be different. The following signs of the disease appear:

1. Decreased pulsation in the lower extremities.
2. Rapid fatigue physical activity. This is especially pronounced when walking long distances.
3. Hands become cold. Small ulcers may appear on them.
4. IN severe cases gangrene develops.
5. If the vessels of the lower extremities are affected, the person begins to limp.
6. The nail plates become thinner.
7. Hair loss is observed on the lower extremities.

Symptoms of MAG atherosclerosis can have varying degrees of severity. On initial stage The problem can only be identified through a medical examination.

If you notice the first signs of the disease, you should immediately consult a doctor. Only with a timely diagnosis will it be possible to stop the progression of the disease.

Making an accurate diagnosis

It is possible to identify damage to the main arteries of the head only during a full-fledged medical examination. Specialists need to determine the location of the problem, the parameters of the formed plaque, as well as the presence of connective tissue proliferation.

The following diagnostic techniques are used:

1. General and biochemical blood tests.
2. Ultrasonography. An examination of the vascular system, which is responsible for the blood supply to the brain, is carried out. The carotid and vertebral arteries are examined. The specialist determines their condition, diameter, and changes in lumen.
3. Magnetic resonance imaging. This is an examination that allows you to study in great detail the structure of the arteries of the brain, neck, and limbs. Modern equipment guarantees obtaining images in all possible projections. This technique is considered the most informative.
4. Angiography. Allows you to study all pathologies of the vascular system. A specialized contrast agent is injected into the patient's blood. After this, an X-ray examination is carried out.

The specific method of examination is chosen by the doctor individually for each patient. This takes into account the characteristics of the body, as well as the equipment available to the medical institution.

How is therapy carried out?

Non-stenotic atherosclerosis in the early stages is treatable. With an integrated approach and strict adherence to all the specialist’s instructions, it is possible to contain the development of the disease.

Today the following methods are the most effective:

1. Drug treatment. It involves taking specialized medications.
2. Surgical intervention. This procedure carries a risk to the life and health of the patient. It is used only in severe cases when all other treatment methods are ineffective. Non-stenotic atherosclerosis surgically treatment is inappropriate.
3. Lifestyle adjustments. To stop the development of the disease, it is necessary to give up bad habits, especially smoking. You should minimize the consumption of fatty, fried, smoked foods. You need to move more, play sports, join the pool. In this case, the loads should be moderate. It is best to consult a specialist.
4. Diet food. Experts recommend adhering to special dietary rules. This will help reduce the amount of cholesterol entering the body.
5. Exercise therapy. There is a specialized set of exercises that helps restore normal blood supply to all segments of the brain and limbs.
6. Health monitoring. It is necessary to regularly measure blood pressure and monitor the concentration of cholesterol in the blood. All concomitant diseases should be treated in a timely manner.

Successful treatment is only possible if all negative factors are eliminated. The patient should avoid stressful situations, eat right and walk more. fresh air. In this case, strict adherence to all doctor’s recommendations is mandatory.

What medications are used for therapy

Today, several groups of drugs have been developed that give positive effect in the treatment of atherosclerosis of the great vessels of the brain:

1. Antiplatelet agents. Drugs of this type prevent blood platelets from sticking together, which reduces the risk of developing thrombosis. Such drugs are prohibited for use in cases of renal and liver failure, pregnancy, peptic ulcer and hemorrhagic stroke. The most popular drugs in this group are Thrombo-ass, Cardiomagnyl, Plavix, and so on.
2. Drugs that reduce blood viscosity. They help blood pass through narrowed areas better. These include Sulodexide. Phlogenzyme and others.
3. Preparations based on nicotinic acid. They are designed to improve blood circulation.
4. Medicines that reduce the concentration of cholesterol in the blood. With their help, non-stenotic atherosclerosis can be effectively treated. Among them are Crestor, Torvacard and others.
5. Means to enhance collateral circulation. This group includes Solcoseryl, Actovegin and some others.
6. Medicines to relieve symptoms. These may be anti-inflammatory and analgesics.

Drug therapy will take at least two to three months. Specific dosages and duration of therapy are determined by a specialist for each patient.

Patients suffering from acetylsalicylic acid. These drugs will help minimize the risk of thrombosis.

Treatment with surgical methods

In severe cases, cerebral atherosclerosis is treated with surgery. This technique is used for stenotic type of disease. There are three main methods of performing the operation:

1. Shunting. During this operation, the surgeon creates an additional blood flow path near the damaged area. Thus, it is possible to restore normal blood flow.
2. Stenting. This operation involves the installation of a special implant, with the help of which it is possible to restore normal blood flow.
3. Balloon angioplasty. The procedure involves inserting a specialized balloon into the vessel. Pressure is applied to it, which expands the affected vessel.

The specific technique is selected by a specialist based on the patient’s health status, as well as in which segment of the vascular system the lesion is localized.

Physiotherapy

Non-stenotic atherosclerosis responds well to treatment if the main therapy program is supplemented with physical therapy. It is best to conduct a lesson with a specialist.

But you can do some exercises yourself:

1. Walk with measured steps around the room. At the same time, make sure that your blood pressure does not rise.
2. Stand up straight. Exhale smoothly and tilt your head back. At the same time, try to bend as much as possible cervical region spine. Stay in this position for a couple of seconds. After this, slowly return to the starting position. Repeat a similar procedure with your head tilted forward.
3. Stand up and straighten your spine as much as possible. Place your hands on your chest. On the count of one, raise your arms up, reaching to the ceiling. On the count of two, return to the starting position. Repeat this exercise 12 times.
4. Stand up straight. Make slow body bends to the left and right side. Make sure that the tilt is done while exhaling, and returning to the starting point while inhaling.
5. Sit on a high-backed chair. Try to relax. On a count of one, move one leg to the side. Return to the original position. Similar actions repeat with the other leg.

By repeating such exercises regularly, you can ease the course of the disease. They allow you to stimulate blood circulation and increase the tone of the vascular wall.

Traditional treatment methods

You can supplement the main therapy program with the help of traditional medicine. They cannot act as the only method of therapy.

Among the most effective recipes against atherosclerosis can be distinguished:

1. Dissolve a teaspoon of birch buds in a glass of boiling water. Boil the resulting mixture for 25 minutes. After this, leave the product for a couple of hours to infuse. You need to take the prepared composition three times a day in an amount of 100 ml.
2. Pour a glass of water over a teaspoon of dried hawthorn flowers. This composition must be boiled for about 25 minutes. After this, it can be filtered. Wait until the broth cools down. It is taken half a glass three times a day.
3. Squeeze the juice from one onion. Combine it with natural honey. For one spoon of juice you need one spoon of honey. Add a little water to make the mixture liquid. You need to take this remedy one spoon three times a day.

Such simple remedies will help increase efficiency traditional treatment. Sometimes they can provoke allergic reactions, so you should consult your doctor before using them.

Dietary diet

During treatment, patients with atherosclerosis are advised to follow a special diet. This is the only way to reduce the amount of cholesterol in the blood. The following recommendations must be followed:

1. It is recommended to consume foods enriched with iodine, such as seaweed.
2. A complete abstinence from animal fats is indicated. The lack of protein can be filled with legumes.
3. Eat more foods that have a diuretic effect. These include watermelons, apples, melons and others.
4. The diet should include more vegetables, fruits, nuts, and berries.
5. Eating chicken and turkey is allowed. Fatty varieties meat, as well as offal, are strictly prohibited.
6. You will have to give up sweets, coffee, strong tea, chocolate, canned foods.

Following the principles of proper nutrition will help stop the development of the disease and enhance the effect of medications. At the first manifestations of atherosclerosis, you should immediately seek help from a specialist. The sooner the problem is identified, the greater the likelihood of maintaining health.