Cerebrovascular diseases and atherosclerotic carotid stenosis: surgical and pharmacological approaches to therapy


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Cerebrovascular diseases (CVDs) are the leading cause of death and the presence of persistent neurological deficits and physical disorders in adults. According to the World Health Organization expert estimates, stroke is the second largest cause of death in the world. As early as mid-20th century, a relationship between atherosclerotic lesions of the internal carotid artery (ICA) and the development of ipsilateral stroke was established, while it was suggested that the removal of atherosclerotic plaque could prevent a stroke. Today it is known that approximately 15-20% of all ischemic strokes occur due to the presence of atherosclerotic carotid stenosis (ACS). It is also the cause of cerebral embolism, transient ischemic attacks, and thromboembolic strokes. A moderate ACS corresponds to a decrease in the diameter of the ICA by 50-69%. In severe or extremely severe ACS, a decrease in the diameter of the ICA corresponds to 70-99%. About 10% of patients have a combination of ACS and contralateral carotid artery occlusion. Carotid artery ultrasound dopplerography can be used as a screening test for the diagnosis of ACS. Carotid endarterectomy has been the gold standard of surgical treatments for ACS for over 60 years. The basic principles of optimal pharmacotherapy include the use of antiplatelet agents, control of arterial hypertension and diabetes mellitus, as well as lowering lipids with statins, the use of nootropic drugs, and smoking cessation as a lifestyle modification. The article considers the use of vinpocetine and piracetam in patients with CVDs.

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Sobre autores

A. Belyaev

N.V. Sklifosovsky Research Institute of Emergency Medicine

Email: anton-kb83@mail.ru
Junior Scientist

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