В 2020 г. мировое медицинское сообщество столкнулось с пандемией новой коронавирусной инфекции, вызванной SARS-CoV-2. На сегодняшний день накоплен значительный опыт, который прямо указывает, на то, что головной мозг наряду с органами дыхательной системы является органом-мишенью для новой коронавирусной инфекции. Причем ряд симптомов со стороны центральной и периферической нервной системы может сохраняться в течение нескольких недель, месяцев и более. Для обозначения подобных затяжных клинических состояний была введена новая дефиниция «постковидный синдром». Совет экспертов неврологов и реабилитологов собрался, чтобы, основываясь на практическом опыте и учитывая имеющуюся в доступе научную информацию о COVID-19, выработать унифицированные подходы к ведению пациентов с неврологическими осложнениями и последствиями новой коронавирусной инфекции. Экспертным советом была выработана резолюция, в которой сформулирована тактика ведения пациентов с неврологическими проявлениями COVID-19. Дано обоснование важности и целесообразности разработки и внедрения специальной программы диспансеризации больных, перенесших COVID-19, которая включала бы клинический осмотр с подробной оценкой когнитивных функций с целью раннего выявления возможного постковидного синдрома, нейродегенеративного процесса и последующей терапии.
Carotid stenosis is a multidisciplinary problem that requires the involvement of a specialists’ team, including cardiovascular surgeons, neurosurgeons, endovascular surgeons, cardiologists, neurologists, and internists. In this consensus statement, a group of experts considered the main stages of diagnosing carotid stenosis, as well as discussed, the necessary prevention methods and features of choosing the optimal treatment approach. The aim was to provide concise and structured information on the management of patients with carotid stenosis. This document was developed based on the updated clinical guidelines of the European Society for Vascular Surgery and the American Association for Vascular Surgery, taking into account the consensus opinion of Russian experts.
Objective . Sleep-disordered breathing (SDB) is a common cardiovascular risk factor. The aim of our study was to assess the occurrence and features of SDB in patients with acute supratentorial ischemic stroke. Design and methods . Patients 18-89 years of age with acute ischemic stroke admitted to the stroke intensive care unit within 24 hours after the symptom onset underwent respiratory monitoring during the first day of hospitalization. 1616 patients were screened between 2018 and 2021 years, respiratory monitoring was performed in 583 patients, and data from 281 patients [mean age 67 (30; 89) years, 146 males (52 %)] were included in the final analysis. Results . The mean respiratory disturbance index was 11,8 (0; 88)/h. SDB was detected in 182 patients (69,2 %), with mild severity in 28,6 %, moderate in 24,2 %, and severe in 47,2 %. Prevalent obstructive apnea type was observed in 71,1 %, central type in 14,2 %, and mixed type in 14,7 %. The TOAST stroke subtype distribution was the following: unspecified etiology was diagnosed in 52 %, cardioembolic in 26 %, atherothrombotic in 11 %, lacunar in 9 %, and other established etiology in 2 %. The majority of patients had mild stroke severity (89,4 %), moderate and severe stroke was diagnosed in 10,5 %. No significant differences in the main indices of the type and severity of sleep apnea were found in the groups based on severity and pathogenetic type of stroke. Conclusions . Our results correlate with the worldwide prevalence of SDB in patients with ischemic stroke (69,2 % and 71,1 %). Further analysis with inclusion of more patients with moderate and severe stroke is required, as well as a prospective study to assess the prognostic impact of SDB.
To early diagnose the signs of cerebral diabetic angiopathy the complex clinical, laboratory and in- strumental study of patients with type 2 diabetes mellitus type was carried out. The comparative analysis of the main statistical indicators between the patients with diabetes type 2 without arterial hypertension and the group of patients with discirculatory encephalopathy without diabetes was made. Neurological symptoms are revealed statistically significantly more frequently and are typical for patients with diabetes mellitus type 2. The authors determined the average time and have identified biochemical predictors of lesions of the vascular wall of cerebral arteries in di- abetes mellitus type 2 without concomitant hypertension. Association between duration of diabetes, changes in ul- trasonic indices PI and RI in the development of vascular complications was established. The authors identified a direct correlation between the index values of PI in ICA (r=0.52, p=0.04) and RI in MCA (r=0.58, p=0.03) and the degree of destruction of the white matter of the brain MRI. The authors noted the necessary to normalize lipid ex- change, fibrinogen and possibilities of ultrasonic Doppler-graphy in the early diagnosis of microangiopathy in pa- tients with diabetes mellitus for the prevention of vascular complications.
The risk of ischemic stroke in inpatients is higher than in the general population. This is due to both the greater comorbidity of inpatients and the presence of additional risk factors, the most studied of which are iatrogenic interventions. At the same time, the higher the probability of developing an ischemic stroke, the more risk factors the patient has. An important link in the pathogenesis of in-hospital ischemic stroke is the activation of the hemostasis system, which is an obligate consequence of a typical pathological process underlying diseases and injuries that led to hospitalization: blood loss, inflammation, mechanical tissue damage, dehydration, etc. In foreign literature, this condition is attributed to the group of acquired thrombophilia, in domestic literature the term hypercoagulation syndrome has become more widespread. Iatrogenic effects can also play an important role in the pathogenesis of hypercoagulation syndrome. It is characterized by increased readiness for thrombosis, clinical and laboratory signs of hypercoagulation, activation of various factors and components of coagulation, decreased fibrinolysis, but without the development of acute thrombosis. Hypercoagulation syndrome is rarely assessed in routine practice as a risk factor for ischemic stroke, however, it can act as an additional and main risk factor for the development of all subtypes of ischemic stroke (according to the TOAST classification), including the ESUS concept. In this regard, it is advisable to distinguish in its structure: chronic (existing before hospitalization: hereditary and/or acquired) and acute (situational, developed as a result of the underlying disease, its complications or iatrogenic effects) hypercoagulation syndromes. To designate a group of acute pathological conditions predisposing to the development of hypercoagulation syndrome, systemic and/or local thrombotic complications, including in-hospital ischemic stroke, and requiring increased preventive measures, it seems pathogenetically justified, understandable and convenient to use the term situational hypercoagulation conditions (1 table, bibliography: 19 refs)
Diagnostics and treatment of the neurogenic cardiovascular disorders in α-synucleinopathies are difficult due to the early-onset of autonomic deficiency and masking under other diseases. The paper discusses the development and progression mechanisms of manifestations of neurogenic cardiovascular pathology. The main forms include neurogenic orthostatic hypotension, neurogenic hypertension in supine position (recumbent neurogenic hypertension) and its nocturnal variant. The existing and promising diagnostic approaches and related difficulties are presented. The possible relationship of cardiovascular disorders in α-synucleinopathies and their manifestations is shown. A possible diagnostic algorithm and possible non-drug and drug treatment and prevention approaches in neurogenic cardiovascular deficiency in α-synucleinopathies are presented. The importance of a multidisciplinary approach is emphasized.
Hospitalized patients are at higher risk of ischemic stroke than in the general population in the population. Inhospital ischemic stroke is one of the most serious complications developing in the hospital, and it is associated with a greater number of adverse outcomes compared with community-acquired stroke. According to the literature, there are several reasons for this fact. The most common pathogenic subtype of in-hospital ischemic stroke is cardioembolic subtype, characterized by extensive ischemic damage to brain tissue. Approximately 50% of hospitalized patients have proven the fact of cardiac embolic source. Also in-patients are characterized by the greater comorbidity and a higher risk of somatic diseases, which also have an adverse effect on the course of a stroke. And finally, in-hospital stroke is characterized by delays at all stages of urgent medical care compared to patients admitted to hospital with a diagnosis of stroke urgently through the emergency department. The most common reasons for these delays include the obvious difficulties of clinical diagnostics, the complexity of in-hospital logistics, lack of early recognition of stroke symptoms skills and lack of understanding of the paradigm of «time-to-brain» in choosing of the treatment strategy by physicians with other medical specialties. Lost time, in addition to the existing contraindications for thrombolytic therapy system, is the main reason for the low number of procedures thrombolysis in patients with in-hospital stroke. As a consequence, the treatment of patients with in-hospital stroke requires more economic cost. These patients have longer periods of hospitalization, and after discharge they often require the continuation of treatment in rehabilitation centers and social support measures. Researchers agree that improvement of the quality of care for patients with in-hospital stroke requires designing of special protocols on the similarity of those that are designed to assist patients urgently admitted with a diagnosis of stroke, as well as holding regular sessions with staff on the practicing of hospitals stroke diagnostic skills and the course of action of medical personnel in case of stroke.
Non-cardioembolic stroke and transient ischemic attack (TIA) are heterogeneous conditions, some variants of which are associated with a high short-term and long-term risk of cardiovascular events. The article presents clinical portraits of patients in high and very high risk groups: 1) patients with extracranial atherosclerosis and severe stenosis/subocclusion/occlusion or CT signs of atherosclerotic plaque instability; 2) all patients with intracranial atherosclerosis, especially those with symptoms of hemodynamic compromise or multiple infarcts; 3) all patients with mobile/ulcerative atheroma of the aortic arch. For the timely identification of these subtypes, it is necessary to use clinical and radiological clues with necessary diagnostic search. In addition, the following patients with TIA may be at high or very high risk: those with an ABCD2 score of ≥4 points or an ABCD3-I score of ≥8 points; with TIA in the vertebrobasilar basin, "crescendo" or "limb shaking" type, orthostatic TIA, as well as patients with warning capsular and bridge syndromes. Assigning a patient to one of the considered categories requires the immediate administration of enhanced secondary prevention, which will be discussed in the second part of this article.
On May 14, 2024, a meeting of the Expert Council of Leading Lipid Metabolism Disorder Specialists to discuss several issues related to elevated lipoprotein(a) [Lp(a)] blood level (i. e., an important risk factor for atherosclerotic cardiovascular diseases [ ASCVD]) was held in Moscow. The Expert Council Resolution includes following key points: 1) both terms «lipoproteid(a)» and «lipoprotein(a)» may be used currently; 2) Lp(a) measurement units should be universal (without conversion formulas). It is now acceptable to present Lp(a) levels in different units: nmol/L, mg/dL; 3) for a more comprehensive assessment of the risk of new, future cardiovascular complications, including its restratification in primary prevention, it is recommended to measure Lp(a) as part of a standard lipid profile; 4) Lp(a) measurement is mandatory in patients with STEMI/non-STE acute coronary syndrome, ischemic stroke/transient ischemic attack or with verified atherosclerosis of peripheral arteries, as well as in those with a family history of ASCVD; 5) we recommend these statements to be considered for inclusion to the next revision of Lipid Metabolism Disorders Clinical Guidelines (including Medical Care Quality Assessment Criteria), as well as in the next revision of clinical guidelines such as Ischemic Stroke and Transient Ischemic Attack in Adults, STEMI/non- STEMI, and Stable Ischemic Heart Disease. Keywords: atherosclerotic cardiovascular diseases, lipoprotein(a), Expert Council. For citation: Voevoda M.I., Ezhov M.V., Konovalov G.A., Zheleznyakova I.A., Pokrovsky S.N., Alieva A.S., Barbarash O.L., Vorobyev A.S., Gornyakova N.B., Kashtalap V.V., Kalacheva O.S., Korennova O.Yu., Polyakova E.A., Shalnova S.A., Shakhnovich R.M., Yanishevsky S.N. New opportunities to use a lipoprotein(a) blood test in real-life clinical practice. Resolution of the expert council. RMJ. 2024;9:40–44. DOI: 10.32364/2225-2282-2024-9-7
