Determination of barometric criteria for rupture of atherosclerotic plaques in the brachiocephalic arteries

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Abstract

The sequence of determining determination of the critical value of blood pressure for the occurrence of dissection of atherosclerotic intima of the internal carotid artery according to the experimental study. Atherosclerotic lesion of the brachiocephalic arteries was modeled on a vascular silicone phantom of the carotid arteries, in which the surgical material (intact annular area of atherosclerotic intima with plaque), obtained after eversion endarterectomy in a patient with atherosclerotic lesions, was placed and fixed in the region of the mouth of the internal carotid artery. A total of 30 models were created. To determine the critical values of the pressure on the intima with the plaque, at which it ruptures, balloon catheters were used, controlling the pressure with a manometer. The results were compared with the preoperative data of ultrasound and computed tomography examinations of patients. Dissection of the intima in the area of the plaque occurred in 6 cases at a pressure of 150–180 mm Hg; in 9 cases at 180–200 mm Hg, in 3 cases at a pressure of more than 200 mmHg, in 12 when exposed to more than 300 mm Hg. All patients, whose intima ruptured at a pressure of less than 200 mm Hg, had a fluid component of the plaque on preoperative examination, and in 6 patients, the critical pressure on the plaque was 150 mm Hg., there was also a thinned "cover" of the plaque. In the rest of the cases, the plaques were stable without a liquid component. Dissection of the intima in these cases did not occur when the exposure value was more than 300 mm Hg. The presence of a fluid component in an atherosclerotic plaque of the carotid artery in combination with a thinned «cover» of the plaque indicates the extreme danger of its destruction and embolism during a hypertensive crisis. The degree of stenosis of the carotid artery was found to be a less significant risk factor for unstable plaque rupture than the presence of a fluid component.

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About the authors

Dmitriy N. Maistrenko

A.M. Granov Russian research center for radiology and surgical technologies

Author for correspondence.
Email: dn_maystrenko@rrcrst.ru
ORCID iD: 0000-0001-8174-7461
SPIN-code: 7363-4840
Scopus Author ID: 57193120885
ResearcherId: AAA-9446-2020

doctor of medical sciences, Director

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Alexander S. Ivanov

A.M. Granov Russian research center for radiology and surgical technologies

Email: as_ivanov@rrcrst.ru
ORCID iD: 0000-0003-3357-5022

candidate of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Mikhail I. Generalov

A.M. Granov Russian research center for radiology and surgical technologies

Email: mi_generalov@rrcrst.ru
ORCID iD: 0000-0001-8980-5240

candidate of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Dmitry N. Nikolaev

A.M. Granov Russian research center for radiology and surgical technologies

Email: dn_nikolaev@rrcrst.ru
ORCID iD: 0000-0003-0501-7007

candidate of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Andrey A. Stanzhevsky

A.M. Granov Russian research center for radiology and surgical technologies

Email: aa_stangevsky@rrcrst.ru
ORCID iD: 0000-0002-1630-0564

doctor of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Oleg E. Molchanov

A.M. Granov Russian research center for radiology and surgical technologies

Email: oe_moltchanov@rrcrst.ru
ORCID iD: 0000-0003-3882-1720

doctor of medical science

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Anna N. Oleshuk

A.M. Granov Russian research center for radiology and surgical technologies

Email: an_oleschuk@rrcrst.ru
ORCID iD: 0000-0002-8437-1081

cardiovascular surgeon

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Denis M. Kokorin

A.M. Granov Russian research center for radiology and surgical technologies

Email: dm_kokorin@rrcrst.ru
ORCID iD: 0000-0002-4842-7711

doctor for X-ray endovascular diagnostics and treatment

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Alexey D. Maystrenko

A.M. Granov Russian research center for radiology and surgical technologies

Email: ad_maystrenko@rrcrst.ru
ORCID iD: 0000-0003-0335-4712

candidate of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Aleksey V. Soloviev

A.M. Granov Russian research center for radiology and surgical technologies

Email: av_soloviev@rrcrst.ru

candidate of medical sciences

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Arsen A. Chegemov

Vsevolozhsk Inter-District Clinical Hospital

Email: 4egemov@mail.ru
ORCID iD: 0000-0001-5074-1286

cardiovascular surgeon

Russian Federation, Vsevolozhsk

Aleksandr A. Stepanov

A.M. Granov Russian research center for radiology and surgical technologies

Email: aa_stepanov@rrcrst.ru
ORCID iD: 0000-0003-1613-1892

leading engineer

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

Semyon M. Eshchik

A.M. Granov Russian research center for radiology and surgical technologies

Email: sm_eschik@rrcrst.ru
ORCID iD: 0000-0003-0945-3383

engineer

Russian Federation, 197758, Saint Petersburg, Pesochnyi village, Leningradskaya street, 70

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Supplementary files

Supplementary Files
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2. Fig. 1.Received operational material. The annular area of the artery intima with plaque

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3. Fig. 2.An example of a common carotid bifurcation phantom, made according to computed thomography data of a particular patient

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4. Fig. 3.Outflow channel simulator (intracerebral arteries)

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5. Fig. 4.A stand assembled for research, including a phantom, an outflow channel simulator and a perfusion pump

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6. Fig. 5.Сomputed thomography of a patient with unstable atherosclerotic plaque. A single large cavity inside the plaque with a liquid component (black arrow) and a thinned «cover» (white arrow)

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7. Fig. 6.Сomputed thomography scan of a patient with unstable atherosclerotic plaque. A multi-chambered cavity inside an atherosclerotic plaque with a fluid component is determined (white arrow)

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8. Fig. 7.Сomputed thomography scan of a patient with a stable atherosclerotic plaque

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9. Fig. 8.Unstable plaque with stenosis of 65% of the lumen of the internal carotid artery. The arrow indicates the cavity where the liquid component was

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10. Fig. 9.Stable plaque of the carotid artery (homogeneous) with stenosis of 65%

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Copyright (c) 2021 Maistrenko D.N., Ivanov A.S., Generalov M.I., Nikolaev D.N., Stanzhevsky A.A., Molchanov O.E., Oleshuk A.N., Kokorin D.M., Maystrenko A.D., Soloviev A.V., Chegemov A.A., Stepanov A.A., Eshchik S.M.

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