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The significance of atherosclerotic changes in the endothelium of extracranial arteries in patients with atrial fibrillation and cerebral stroke

DOI: https://doi.org/10.29296/25877305-2020-09-12
Issue: 
9
Year: 
2020

I. Glukhov; S. Kolomentsev, Candidate of Medical Sciences; D. Serdyukov, MD S.M. Kirov Military
Medical Academy, Saint Petersburg

Objective: to investigate the significance of atherosclerotic changes in the endothelium of extracranial arteries in patients with atrial fibrillation (AF) and cerebral stroke (CS). Subjects and methods. The investigation was conducted using the results of examinations in 126 patients who had been treated in the Clinic of Nervous Diseases and Hospital Therapy. Results and discussion. The results of carotid artery (CA) ultrasound were used to form two groups: 1) patients without endothelial changes; 2) those with CA atherosclerosis. In Group 2, the National Institutes of Health Stroke Scale (HIHSS) scale scores for the severity of neurological symptoms was 15, which corresponded to severe neurological disorders; Group 1 more frequently showed moderate disorders (12 scores). The presented groups were comparable in terms of nutrition, smoking, and a history of hypertension, lower extremity atherosclerosis obliterans, and CS. Group 2 patients displayed left ventricular hypokinesia/akinesia (55.3 versus 33.3%; χ2=2.6; p=0.03) and intracardiac thrombosis (p>0.05). Conclusion. In patients with extracranial atherosclerosis and obvious heart rhythm disturbance, the risk for CS is 4–5 times higher than in those with AF and little altered CAs. In the former, CS is more commonly accompanied by severe neurological disorders and disability. In order to prevent cardioembolic and atherothrombotic complications, the patients with AF must undergo CA duplex scanning and, if atherosclerotic plaques are present, take anticoagulants and statins.

Keywords: 
cardiology
atrial fibrillation
carotid artery atherosclerotic changes
risk stratification
duplex scanning
intima-media complex
acute cerebrovascular accident
hypertension



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