Aim: To identify potentially adverse characteristics of atherosclerotic carotid plaque in terms of stroke risk. Materials and Methods: The study is based on the analysis of US data obtained from 96 patients aged 47 to 84 years diagnosed with carotid stenosis. The patients were divided into 2 groups depending on the presence or absence of ischemic events. Examination methods: clinical, duplex US, brain MRI, statistical. In addition to the standard US criteria for the evaluation of carotid stenoses, superb microvascular imaging (SMI) and shear wave elastography (SWE) are used. Results: Statistically significant association of the following characteristics of plaques with the presence of ipsilateral ischemia focus was established: maximum thickness (p = 0,04), presence of microvascularization according to SMI data (p = 0,02), degree of carotid stenosis (statistically significant in the right carotid circulation [p = 0,04]), stiffness of the plaque according to SWE data (significantly in the right carotid circulation [p = 0,001]), type of plaque echogenicity according to Gray-Weale-Geroulakos classification (on the right carotid artery; p = 0,04). Conclusions: The presence of microvascularization according to SMI data and the low stiffness of the plaque according to SWE data can characterize the potential instability of the carotid plaque. These criteria should be added to the traditional US assessment of carotid plaques.

The aim of the present study was to assess the efficiency of yoga practice in addition to the standard medical therapy in patients with chronic heart failure (HF) and dyslipidemia. One hundred and two patients with chronic HF and dyslipidemia were divided into the control group (CG) – 54 patients and the yoga group (YG) – 48 patients. The CG was prescribed standard therapy for chronic HF (angiotensin converting enzyme inhibitors, β-blockers, aldosterone antagonists, digoxin, loop diuretics, statins, antiplatelet agents) and dyslipidemia. The YG additionally followed lifestyle modification in the form of 1 h daily practice of yoga for a period of 3 months. All patients completed the questionnaire reporting on their age, gender, medical history and treatment. The fasting blood samples were analyzed for total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, C-reactive protein, interleukin-8 and tumor necrosis factor -α on admission to the department and after 3 months of treatment. The pre-specified duration of the enrollment period was two years and during that time we interviewed 168 patients. Forty-two did not meet the inclusion criteria for the study, 24 patients refused to participate. A total of 102 patients were enrolled, of them, 54 were included into the control group and 48 into the yoga group. At baseline, there were no significant (p>0.05) differences between the groups in clinical characteristics of the patients. On admission to hospital the patients of both groups received standard therapy in comparable doses. By the end of the study, a significant (p<0.05) reduction in TC, TG and LDL-C levels was observed in both groups with a tendency to more considerable changes in YG. Correlation analysis revealed the positive correlation relationship between TC, LDL-C levels and cytokines. The present study has shown that the practice of yoga in addition to the standard therapy in patients with HF and dyslipidemia could be associated with lipid profile improvements.

The review summarizes available information regarding the method of Transcranial doppler sonography (TCD) usage to record microembolism in patients with carotid artery stenosis, search for information was carried out in literature 1997–2020 (PUBMED, MEDLINE). History overview of TCD with embolodetection implementation is presented, as well as ways of its technical and methodological improvement. Evidence-based studies of the method clinical relevance in atherosclerotic carotid stenoses and their surgical treatment are outlined. Observation results of the intraoperative cerebral embolization during carotid endarterectomy and carotid artery stenting are presented along with comparison of TCD-embolodetection data, neuroimaging and clinical outcomes. Individual centres and multicenter study ACES data on prognostic value of registration of embolic signals in asymptomatic carotid stenosis, risk assessment of vascular events in diffe-rent groups of patients and in varying degrees of stenosis of the vessel lumen was analyzed. The role of embolodetection in predicting repeated cerebrovascular disorders in symptomatic carotid stenosis and its importance for monitoring antiplatelet therapy is set out (multicenter study CARESS). The evidence of the reliability of TCD embolodetection as tool for verificarion of at-risk patients with carotid stenosis who may benefit ftom surgical treatment is presented. Recent advances in ultrasound and other imaging techniques for assessing unstable plague are outlined along with prospects for the use of TCD monitoting for cerebrovascular disorders forecasting.

Introduction:Over the last decade, the number of patients with cerebrovascular diseases in Ukraine has grown by 1.5 times. This negative trend is based on the significant increase of vascular risk factors - arterial hypertension, dyslipidemia, sedentary lifestyle, excessive weight/obesity, diabetes mellitus, tobacco smoking, etc. - prevalence among the population of the country, their early development and combination of several vascular risk factors, which makes prevention of cerebrovascular diseases at their early stages a priority. The aim: Study of endothelial vasomotor function in patients with initial symptoms of chronic cerebral ischemia. Material and methods:The study included 260 patients of the main group (mean age 50.6±70.9) with initial manifestations of CCI and 30 persons of similar age of the control group. All the patients underwent a clinical neurological examination, MRI of the brain, ultrasonography with the establishment of flow-mediated endotelium-dependent dilatation (FMD) index based on the results of brachial artery compression test, as well as laboratory tests of endothelin-1 and nitrite levels. The patients were subdivided into 3 groups based on their MRI of the brain data: without structural changes of the brain (group 1), with initial vascular structural changes (group 2), with initial structural changes and mild cerebral atrophy (group 3). Results:Reliable differences of FMD index were established in the groups with different degrees of structural brain damage, and in comparison with the control group (р<0.001). Considerable downward trend of FMD index with increase of the number of existing vascular risk factors (VRF) was identified (p<0.05). An associative link with the presence of arterial hypertension (AH), its degree and FMD index (p<0.05) was established. It was shown that a thickened intima-media complex (ІМC) of common carotid arteries >0.9 mm had a significantly lower predetermination to FMD (р=0,001). Statistically significant lower FMD indices were registered in persons with endothelial vasomotor function disorder according to the biochemical markers: with endothelin level increase and nitrite level decrease (р<0.001). Conclusions:An associative link with the presence of endothelial dysfunction according to FMD index were established with different degrees of structural brain damage, with the presence of AH, with ІМC of common carotid arteries >0.9 mm, with endothelial vasomotor function disorder according to the biochemical markers: with endothelin level increase and nitrite level decrease.

Objective. To evaluate the effectiveness of brain evoked potentials for the objectivization of early cognitive disorders (CD) induced by cerebral and regional hypoperfusion.Materials and methods. The influence of hypoperfusion in vertebrobasilar territory (VBT) on characteristics of cognitive functions in 52 patients with chronic brain ischemia was studied. The following methods were used: clinico-neurological, MRI, SPECT, duplex ultrasound scanning (DUS), EEG, and brain evoked potentials (EP).Results. The patients were split into two groups by DUS scan findings: 1 – those having structural lesions in vertebral arteries (VA), and haemodynamically significant disorders in VBT and 2 – those having none. The examination of patients of the 1st group showed the following findings: high frequency of blood flow velocity decrease in VA; the tendency of decreasing in volumetric cerebral blood flow in brain segments and hemispheres according to SPECT data; prevalence of ataxia, coordination and long tract signs; high frequency of early CD in the domains of attention and memory; EP index changes. The patients with blood flow decompensation in VBT (according to DUS findings) showed changes in brainstem auditory EP parameters (BAEP): increase of III, IV, V latency peaks and III-V interpeak interval. According to the cognitive EP (CEP) study, the patients of the 1st group consistently demonstrated higher frequency of N2 peak amplitude decrease, and P300 peak latency increase.Conclusions. Based on DUS scan findings, it is clinically appropriate to distinguish a group of patients with structural and haemodynamically significant disorders in VA. The deviations from the normal indices of CEP and BAEP correlate with CD occurring as a result of cerebral and regional hypoperfusion in VBT.

The present paper aims to improve ultrasound diagnosis of diseases of blood vessels of the head and neck in Ukrainian health care institutions by discussing and adopting the standards for examination.The practical guidelines for ultrasound duplex scanning of blood vessels of the head and neck have been developed on the basis of analysis of foreign sources on recommendations and standards in this field, taking into account the experience of national specialists.We have presented for discussion the indications for the examination, the basic stages of the structural pathology diagnosis, assessment of hemodynamic changes in major vessels of the head and neck for obligatory and additional testing, proposals on formalization of the examination protocol.The approval and implementation of the standards into clinical practice in Ukraine will make it possible to avoid inconsistency in conducting and interpreting ultrasonography and angiology tests.

Background. Represented by physical and mathematical model of cerebral hemodynamics, considered as a flow system. Objective. Development of cerebral blood flow quantification procedure according to scintigraphy data with 99m Tc-HMPAO. Methods. Analytical, numerical and experimental study of the kinetics 99mTc-HMPAO in brain. Results. For the purpose of quantitative assessment of volumetric cerebral blood flow according to the data of scintigraphy with 99m Tc-HMPAO, it was suggested to view the brain as a flow system. This allows calculating volumetric cerebral blood flow after numerical determination of the model parameters according to the results of indirect angiography and establishment of effective blood dilution volume in brain using single-photon emission-computed tomography. In this case, the suggested blood flow calculation procedure does not require any a priori knowledge of hemodynamics in a certain reference area. Conclusions. Preliminary clinical studies allow characterizing the suggested approach to calculation of volumetric cerebral blood flow absolute values as appropriate.

Introduction. The influence of cardiovascular risk factors has a long asymptomatic course, since the vessels are the main target body. Functionally and structurally restructuring of vessels mainly target bodies in terms of the most supple period is like prevention of irreversible changes in organs and tissues and the development of cardiovascular events. We conducted a study whose purpose was to investigate the presence and assessment of the nature of relationships between indicators immunoreactivity to structural components of cardiovascular and cerebrovascular reactivity in carotid and vertebral-basilar basins in response to the multidirectional metabolic and myogenic stimuli in patients with initial manifestations of chronic cerebral ischemia (ChCI).Material and methods. We have examined 55 people of middle age 51,3 ± 7,0 years with initial manifestations of the ChCI. All patients performed general clinical, clinical-neurological, clinical and instrumental and clinical laboratory tests. The level of auto antibodies (auto AB) antigens to platelets, cardiomyocytes and vascular endothelial serum of patients was determined by the method Poletayeva O.B. (Russia). Indicators of cerebrovascular reactivity (CVR) received during trans cranial ultrasound scan using multidirectional metabolic and myogenic functional stress stimulus (FSS). Results and discussion. There was a statistically significant association between (index of reactivity) IR infringement in response to hyperkapnia trial in carotid basin and a deviation of up to autoAB NOS (X2(1)= 3.6 ; VKramer = 0.354, p = 0.05) and plasminogen / angiostatin (X2(1)= 6.22; VKramer = 0.463, p = 0.013). It was found association between IR deviation in response to hypokapnia trial in carotid basin and a deviation of autoAB to rheumatoid factor (X2(1)= 7.03; VKramer = 0.493, p =0.008, Fisher's exact test = 0.016) and the association between deviation IR hypokapnia on trial in carotid pool and adeviation of autoAB to plasminogen / angiostatin (X2(1)=6.75;VKramer = 0.482, p = 0.009, Fisher's exact test = 0.05). Violation CVR in response to the multidirectional FSS metabolic and myogenic orientation in carotid and vertebral-basilar basins associated with the rejection of аverage individual level of immunoreactivity (X2(1)= 6.39; VKramer = 0.478, p = 0.011, Fisher's exact test = 0.026) and violation of autoAB to plasminogen / angiostatin (X2(1)= 4.77; VKramer = 0.406, p = 0.029).Conclusions. It was found that the ability CVR is in conjunction with a violation of the structural and functional integrity of the cardiovascular system, such as endothelial function directed to the regulation of the structural integrity of the vascular system, hemostasis and inflammation.

A content of C-reactive protein (CRP) in the blood serum was determined in 36 patients in acute period of a ruptured intracranial arterial aneurysm (AA). It was significantly more, than in a control group, and have exceeded 10 mg/I in 1 - 4th day of the disease. The level of CRP have had differ, depending on severity of cerebral vasospasm (CVS), determined in accordance to the ultrasound investigation data. In a pronounced CVS in majority of patients the level of CRP in the blood serum have had exceed 10 mg/l, and have secured elevated in a spinal liquor on the 7 - 10th day of the disease, differing from this index in patients with moderately pronounced CVS or without it. In patients with severe invalidization or those, who have died, the level of CRP was trust-worthy higher.

Objective – to estimate the peculiarities of the cognitive function disorders and cognitive evoked potentials (CEP) changes in patients with cerebrovascular deseasis (CVD) in post-operative period and period of recovery.Methods and subjects. 42 patients with chronic cerebral circulation impairment were examined. The patients were operated about the hemodynamic significantly stenosys in internal carotid or/and vertebral artery. The first clinical group included 20 patients, who had acute ischemic stroke; the second group comprised 22 patients without data on ischemic stroke in anamnesis. The methods used: clinical, neurological; neuropsychological testing (NPT), MRI, ultrasound study of the cerebral blood flow, EEG mapping, CEP P300.Results. All studies were conducted in the period of recovery 6 months – 2 years after operation: carotid endarterectomy (14), endovascular angioplasty with stenting (12). Positive changes in blood flow in the area of stenosis, and in the affected intracranial artery and its branches were observed after surgical removal of stenosis. As evidence of cognitive impairment using the results of the NPT decrease by 1.5 σ or more, as a sign of slowing of mental processes – significant increase of the latent period of P300 to 2 σ or more, a significant reduction in the amplitude and increase asymmetry of these indicators. It confirms the correlation of negative effect on the NPT-CEP indicators and next factors: elderly age, decreased blood flow in the proximal segments of the middle cerebral artery by more than 20% of the age norms, absence (significant decrease) in reserve capacity of cerebral blood flow, site of the lesion in the right hemisphere, the presence of seizures.Conclusions. Complex methodology of NTP-CEP allows to educe violations of cognitive functions for patients with CVD in the dynamics of surgery treatment and to control renewal.

Objective: Analyze the changes of -1β, -4, -6 interleukin indices in blood serum of patients during the acute period of intracranial arterial aneurysm (AA) rupture.Materials and methods: Levels of -1β, -4, -6 interleukins in the serum were analyzed in 37 patients during the acute period of intracranial arterial aneurysm (AA) rupture with the help of immune-enzyme analysis: in 27 patients on the 1–4th day since the manifestation of the disease; in 22 patients — on the 7–10th day after the haemorrhage (in 10 — recurrent). Clinical and instrumental examination of all the patients included brain CCT, cerebral angiography, ultrasonography; microsurgical exclusion of aneurysm was carried out according to indications.Results: The interleukin indices in the serum of patients with SAH were higher than those in the control group mainly on the 7–10th day after the SAH episode.The interleukin-6 level was 20–30 times higher compared to the average index of the control group. There was a reliable increase of its level in patients with cerebral vasospasm (VS) compared to those without VS (p<0,05). The interleukins-1β and -4 indices were moderately (2–5 times) increased in comparison with those in the control group, they did not differ significantly in patients with VS and without it. In patients likely to have grave incapacitation or fatal outcome interleukin-6 levels were significantly higher both during the first 4 days of the disease (p<0,05), and on the 7–10th day.Conclusions: The increased levels of -1β, -4 та -6 interleukins during the first 10 days after AA rupture indicate that there exist active inflammatory processes in this period of the disease, which gives grounds for the use of antiinflammatory therapy. A connection established between the increase of interleukin-6 level, presence of cerebral VS, as well as severity of the disease may be evidence of this cytokine’s significance in SAH.

Вступ. Хірургічне лікування розриву артеріальних аневризм (АА) головного мозку немає альтернативи та включає як мікрохірургічні, так і ендоваскулярні втручання. У деяких клінічних ситуаціях мікрохірургічне кліпування АА є єдиним можливим і адекватним методом лікування. Одними з найбільш небезпечних та складних є АА заднього півкола артеріального кола великого мозку, а саме біфуркації основної артерії (ОА) та Р1 сегмента задньої мозкової артерії (ЗМА). Матеріали і методи. Представлений результат хірургічного лікування АА початкового відділу ЗМА зліва. Використано технологію транскраніального кліпування шийки АА під динамічним контролем ультразвукової допплерографії (УЗДГ) прохідності артерій головного мозку з використанням гнучкого інтраопераційного датчика катетерного типу з частотою 16 МГц. Застосований мікрохірургічний доступ до біфуркації ОА, Р1 сегмента ЗМА та блокування шийки АА через каротидно-окуломоторний трикутник зліва під контролем УЗДГ з опто-каротидного трикутника. Оперативну тактику планували на підставі комплексної оцінки результатів нейровізуалізуючих методів дослідження (МРТ, КТ головного мозку, ЦАГ, УЗДГ) з відповідним контролем після операції. Результати та їх обговорення. Оперативне втручання здійснене у плановому порядку на тлі задовільного стану пацієнтки. Застосований комбінований мікрохірургічний доступ до початкового відділу ЗМА. Використання УЗДГ забезпечило інтраопераційний контроль радикальності проведеного втручання та оцінку гемодинамічної ситуації в судинах відповідної зони після хірургічних маніпуляцій. Висновки. Технічні можливості мікрохірургічного вимкнення АА ЗМА з кровотоку є основою диференційованого використання інтракраніальних методів вимкнення АА за недоведених переваг чи технічних труднощів застосування ендоваскулярного методу за умови індивідуального планування хірургічної тактики та відповідного технічного забезпечення.

Introduction. Surgical treatment of brain ruptured arterial aneurysms (AA) has no alternative and includes both microsurgical and endovascular interventions. In some cases AA microsurgical clipping is the only possible and adequate method of treatment.The most dangerous and difficult AA are aneurysms of cerebral arterial posterior semi-ring, in particular, located on basilar artery (BA) bifurcation and R1 segment of posterior cerebral artery (PCA).Material and methods. The result of surgical treatment of AA of left PCA initial part is given. Transcranial clipping of AA neck was performed under dynamic ultrasonic Doppler examination (UDE) control using flexible intraoperative sensor of catheter-type with frequency 16 MHz. Microsurgical access to BA bifurcation, R1 segment of PCA was used, aneurysmal neck blockage was made through left carotid-oculomotor triangle under UDE control from optic-carotid triangle. The operation was planned on the base of neurovisualizing methods results complex assessment (MRI, CT, cerebral angiography, UDE) with appropriate control after operation.Results and their discussion. Surgical treatment was performed routinely, the patient’s general state was satisfactory. The combined microsurgical access to initial PCA segment was used. Intraoperative UDE ensured the possibility to estimate hemodynamic situation in vessels of the appropriate zone after surgical intervention, and to control the extent of radicalism of operation.Conclusion. Technical possibilities of PCA AA microsurgical direct exclusion are the basis of differentiated application of intracranial methods at unproved advantages or technical difficulties of endovascular method under condition of surgical tactics planning and corresponding technical providing.

The case of endovascular surgical treatment of giant aneurysm of cavernous part of internal carotid artery by stream-directive stent Silk implantation as an example of new advanced technology for brain giant aneurysms’ treatment is given. The results of control investigation 3 months after operation showed high efficacy of applied endovascular technology and satisfactory result of surgical treatment. This method requires further research.