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The article deals with problems of endovascular treatment of acute tandem and isolated occlusions of arteries of the anterior cerebral circulation, as well as the problem of reocclusions and new occlusions of these target arteries in the early postoperative period after thrombectomy.To determine the effect of reocclusions and new, previously not identified occlusions of the carotid artery and middle cerebral artery after cerebral thrombectomy on the outcomes of ischaemic stroke, as well as to substantiate feasibility of endovascular policy without simultaneous carotid stenting in thrombectomy in case of tandem occlusions of arteries of the anterior cerebral circulation.We studied the results of endovascular treatment of 52 patients with acute ischaemic stroke, including 26 patients with combined occlusions of the internal carotid and middle cerebral arteries (group 1) and 26 patients with isolated occlusion of the M1 segment of the middle cerebral artery or its equivalent (group 2). The groups were compared using the Chi-squared and Mann-Whitney test, and the effect of the factors was assessed by calculating the relative risk.Disability of patients in group 1 was significantly two-fold higher as compared with group 2. Differences in mortality and frequency of a good functional outcome (0-2 points on the Rankin scale) were, on the contrary, insignificant. Reocclusion of the internal carotid artery demonstrated no significant influence on outcomes of the disease in combined type of the lesion. Reocclusion of the target vessel after thrombectomy significantly decreased the probability of a good functional outcome in patients 1.7-fold (p0.05), as well as increased the relative risk of disability 4-fold in initially isolated occlusion of the middle cerebral artery (p0.05).Surgical policy aimed at thrombectomy from the middle cerebral artery in the presence of tandem occlusions of the internal carotid artery and middle cerebral artery without emergency carotid stenting is safe and efficient in acute period of ischaemic stroke. Reocclusion of the middle cerebral artery after performed thrombectomy related to its isolated occlusion increased the probability of patients' disability. Newly identified in the postoperative period occlusion of the internal carotid artery in thrombectomy from the middle cerebral artery also increased the risk of disability.Статья посвящена вопросам эндоваскулярного лечения острых тандемных и изолированных окклюзий артерий передней циркуляции головного мозга, а также проблеме реокклюзий и новых окклюзий этих целевых артерий в раннем послеоперационном периоде после тромбэктомии. Цель. Определить влияние реокклюзий и новых, ранее не определявшихся окклюзий сонной артерии и средней мозговой артерии после церебральной тромбэктомии, на исходы ишемического инсульта; обосновать целесообразность эндоваскулярной тактики без одномоментного каротидного стентирования при тромбэктомии в случае тандемных окклюзий артерий передней циркуляции головного мозга. Материалы и методы. Изучены результаты эндоваскулярного лечения 52 больных с острым ишемическим инсультом. В том числе 26 пациентов с сочетанными окклюзиями внутренней сонной и средней мозговой артерий (1 группа) и 26 пациентов с изолированной окклюзией М1-сегмента средней мозговой артерии или ее эквивалентом (2 группа). Группы сравнивали с применением Хи-квадрата и критерия Манна–Уитни, а влияние факторов оценивали расчетом относительного риска. Результаты исследования. Инвалидизация пациентов в 1 группе была достоверно в 2 раза выше, чем во второй. Различия в летальности и в частоте достижения пациентами хорошего функционального исхода (0–2 балла по шкале Рэнкина), напротив, были незначимыми. Реокклюзия внутренней сонной артерии не показала существенного влияния на исходы заболевания при сочетанном типе поражения. Реокклюзия целевого сосуда после тромбэктомии достоверно снижает вероятность хорошего функционального исхода пациентов в 1,7 раза (p0,05), а также увеличивает относительный риск инвалидизации в 4 раза при исходно изолированной окклюзии средней мозговой артерии (p0,05). Вывод. Хирургическая тактика, нацеленная на тромбэктомию из средней мозговой артерии, при наличии тандемных окклюзий внутренней сонной артерии и средней мозговой артерии без экстренного каротидного стентирования безопасна и эффективна в остром периоде ишемического инсульта. Реокклюзия средней мозговой артерии после выполненной тромбэктомии, связанной с ее изолированной окклюзией, увеличивает вероятность инвалидизации пациента. Вновь выявленная в послеоперационном периоде окклюзия внутренней сонной артерии при тромбэктомии из средней мозговой артерии также повышает риск потери трудоспособности.

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of Β-amyloid protein in the media and adventitia of small arteries and capillaries. It may be an independent disease, but is often combined with Alzheimer's disease (AD). This review will discuss up-to-date understanding of the pathophysiology, clinical manifestations of CAA, its diagnosis with neuroimaging and biomarkers. Cerebral microbleeds (CMBs) may be considered as neuroimaging markers of AD and CAA. The clinical significance of CAA is defined by the risk of intracerebral hemorrhages during thrombolytic therapy and warfarin therapy in patients with acute myocardial infarction, pulmonary embolism, ischemic stroke.

Objective. Mixed dementia (MD), characterized by a combination of Alzheimer's disease (AD) and cerebrovascular disease, is one of the most common and, at the same time, poorly diagnosed forms of dementia in the elderly. The aim of our study was to investigate features of AD with its combination with cerebrovascular disease on the basis of clinical, neuropsychological and neuroimaging data. Material and methods. Authors examined 79 patients with dementia: 30 patients with AD, 33 patients with MD and 16 patients with vascular dementia. Patients with MD were older, had more often frontal gait disorders (48.5%), postural instability (45%), pseudobulbar syndrome (60%). Results and conclusion. The neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, in some cases was closer to AD and in others to vascular dementia. A negative effect of vascular risk factors on medial temporal atrophy was found. Neuroimaging changes in MD were correlated with clinical manifestations. Proposed approaches to the diagnosis of MD help to determine more precisely the main directions of the treatment of patients and predict the course of the disease.

Cerebral microbleeds (CMBs) are a kind of the morphological changes of the brain associated with damage to small cerebral arteries detected on GRE MRI as small, round, well-defined, hypointense lesions, sized 3-10 mm, which indicate the deposition of hemosiderin. CMBs can be detected in cerebral microangiopathy of different origins (cerebral amyloid angiopathy, hypertensive arteriopathy, vasculitis, hereditary angiopathy) and may be a predictor of macrobleeds. This article discusses the clinical significance of CMBs in cerebrovascular, neurodegenerative diseases, cognitive disorders as well as the possibility of using antiplatelet agents and anticoagulants in patients with CMBs.

The paper concerns CT-semiotics of cavitary processes in the lungs. Their major forms are discussed with reference to underlying pathological changes. The most common manifestations of the diseases associated with the cavitary processes are described. CT is a highly informative method for the visualization of pulmonary cavitation and the surrounding chest structures; this method improves diagnostics of pulmonary pathology.

Immediate and long-term results of endovascular treatment of multivessel coronary artery disease by using different revascularization strategies were analyzed in 171 patients. Duration of follow up ranged from 12 to 18 months. Complete myocardium revascularization was performed in 63 patients, culprit vessel revascularization--in 86 pts and incomplete revascularization--in 22 pts. Results of this study showed that strategy of complete and culprit vessel revascularization in patients with multivessel coronary artery disease has comparable immediate and long-term results. Strategy of incomplete revascularization reduce immediate clinical success and lead to increased number of myocardial infarctions and needs of coronary artery bypass surgery in long-term follow-up period.

The study included retrospective analysis of the results of treatment in 529 patients with CHD and multiple coronary lesions divided into 2 groups. Group 1 included 280 patients who underwent surgical myocardial revascularization, group 2 comprised 249 patients after coronary stenting. The groups did not significantly differ in the occurrence of serious clinical complications (death, acute myocardial infarction) in both early and mid-late postoperative periods. Patients in group 2 more frequently suffered anginal attacks and required repeat myocardial revascularization. The main factor limiting clinical efficiency of endovascular procedures was coronary restenosis in roughly 34% of the patients.

Cardiovascular diseases (CVD) occupy the first place in the world among all causes of disability and death. Aspirin is an effective antithrombocyte agent, the efficiency and safety of which has been demonstrated by numerous studies. Despite its high effectiveness in treatment of acute myocardial infarction and secondary prophylaxis of CVD both in men and women, the use of aspirin for primary prophylaxis is still questionable. Presently, the appropriateness of aspirin application as a means of primary prevention of CVD in women older than 45 has not been clarified yet. The present article discusses this question.

The paper presents an analysis of correlations between long-term results of coronary arterial stenting and anticholesterol therapy with statins in 131 patients with chronic forms of coronary heart disease. The study revealed that anticholesterol therapy, when administered regardless the initial cholesterol level, improved the clinical condition of patients with initial hypercholesterolemia, and lowered the necessity of repeated endovascular procedures for restenosis and the progression of atherosclerotic changes. The necessity of repeated interventions is lowered by statin application rather than by normal levels of total cholesterol and low-density lipoproteins.

The article covers the results of medicamentous and endovascular methods of treatment of chronic coronary artery disease forms. The results demonstrate improvement in the clinical state, a decrease in drug requirements, an increase in physical tolerance and absence of myocardial ischemia signs during physical load testing in patients after endovascular or surgical myocardial revascularization. At the same time, the frequency of cardial complications and the need for repeated interventions increases. Administration of hypolipidemic therapy allows improvement of prognosis in patients after transluminal balloon coronary angioplasty and stenting.

The authors analyzed the results of aortocoronary bypass surgery in correlation with the condition of the shunts and the native blood vessels. According to this analysis, 92.9% of the shunts were passable within 7.2 +/- 0.8 months of the surgery. Twelve shunts (four arterial and eight venous ones) had been occluded by the time of the control examination. Another ten shunts (five arterial and five venous ones) had hemodynamically significant stenoses. Concurrent blood flow was revealed in eight patients. According to comparative analysis, in cases of arterial shunting a good condition of the shunts was found in 95.6% of cases, while in patients with venous shunts the shunts were in a good condition in 88.1% of cases. Depending on the type of connection, the passability was satisfactory in 91.2% of straight shunts, in 94.5% of sequential shunts, and in 71.4% of Y-shaped ones. Analysis of changes in the native coronary arteries revealed progression of atherosclerosis in the bypassed arteries proximally to the site of anastomosis in 27 (25.5%) patients. An increase in the degree of stenosis distally of the site of anastomosis was found in 8 (7.5%) of patients; in another 7 (6.6%) patients similar changes were revealed in non-bypassed arteries. The surgery led to the disappearance of anginous manifestations and a negative result of a physical load test in most patients.

The paper presents the results of treatment in patients with chronic heart disease by coronary stenting. Endovascular interventions have been found to be highly effective in attenuating the clinical manifestations, in improving the results of exercise tests, and in reducing needs for medical treatment. The late postoperative factors influencing the higher incidence of stent stenosis have been studied.

The study was undertaken to comparatively assess the results of stenting and transluminal balloon angioplasty (TBAP) of coronary arteries in patients with chronic forms of coronary heart disease concurrent with restenosis of primary TBAP. The data on 77 patients undergone endovascular procedures for restenosis of prior primary TBAP of coronary arteries at the Moscow Research and Practical Center of Interventional Cardioangiology in March 1997 to May 2003 were analyzed. Group 1 comprised 35 patients with a stent implanted at the site of coronary restenosis; Group 2 included 42 patients undergone repeated TBAP. These groups did not significantly differ in main clinical and functional characteristics, the extent coronary bed lesion, the number of diseased arteries and the morphological type of a coronary lesion (p0.05). The angiographic success of secondary TBAP, as well as coronary stenting was 100%. Survival was 100% in the late period. A control examination revealed the clinical picture of angina on exertion in 57.1% and 76.2% of the patients in Groups 1 and 2, respectively (p = 0.039). In the late period, a satisfactory angiographic result of coronary stenting was revealed in most cases (74.3 and 35.7% in Groups 1 and 2, respectively); restenosis was detected in 20 and 59.5% of cases, respectively (p0.01); occlusion in 5.7 and 4.8% (p0.05). Need for repeated interventional and surgical (aortocoronary bypass surgery) procedures was significantly less after coronary stenting than that after repeated TBAP (20 and 40.5%, respectively). In the late period, the factors significantly increasing a risk for in-stent restenosis were hypercholesterolemia (cholesterolor = 5.5 mmol/l); the length of restenosis of an operated segment wasor = 18 mm and that of a stentor = 20 mm. It is expedient to use coronary endroprosthesis to reduce the incidence of repeated restenosis and needs for repeated procedures for myocardial revascularization in the late period.

The problem of stent thrombosis in patients with myocardial infarction is reviewed with consideration of possible mechanisms and causes of in-stent thrombus formation during first 30 days after the procedure. Roles of the patient factor, factor of the stented vessel, stent in self, stent deployment technique, and management after stenting are discussed.

The diagnosis of bulky formations of the parathyroid glands (PTG) has become possible since current high-resolution techniques of visualization, such as ultrasound study (USS), computed tomography (CT), magnetic resonance imaging (MRI), were introduced into practice. The presence of clinical and/or laboratory signs of hyperparathyroidism (HPT) is a signal to initiate a goal-oriented search for abnormal PTG formations. The complex diagnosis of HPT involves the methods of detecting osteoporosis ranging from routine X-ray study of the hand and foot to more in-depth techniques: dichromatic X-ray absorptiometry (DXA) and quantitative CT (QCT). USS is an excellent method for screening if abnormal PTC changes are suspected; however, negative USS results in the presence of clinical and/or laboratory signs of HPT should not stop a diagnostic search. CT with intravenous contrast bolus specifies the site and structure of an formation, has some advantage in detecting retrosternal tumors. Due to its high tissue contrast, three-dimensional images, none ionizing radiation and osseous structural artefacts, MRI becomes a preferable tool for studying PTG when they are typically or atypically located. Needle biopsy is required when noninvasive methods cannot characterize the pattern of an abnormal PTG formation properly or their results are contradictory.

The authors highlight X-ray symptom complexes (XRSC) (emphysematointerstitial, parenchymatointerstitial, and pneumonic) which are characteristic of exogenous allergic alveolitis (EAA). The above XRSC are comparable with the clinical types of EAA. The semeiotics typical of each XRSC and the value of radiation diagnostic methods in specifying changes in lung tissue and intrathoracic lymph nodes, the activity of the process are presented. Each study (classical X-ray, CT, radionuclide scintigraphy) has its own advantages and resolution limits. Radiation studies in the diagnosis of EAA should be used purposefully in combination with other studies (immunology, external respiratory function test, bacterial cytology, morphology) by taking into account the clinical manifestations of the disease.

Effectivity of radiodiagnosis has been analyzed in 158 patients with adrenal disease, among them 112 and 117 hormone-active tumors, while 46 subjects had 54 hormone-inactive tumors. Computed tomography proved more sensitive in detection of hormone-active tumors and hyperplasia of the adrenals than ultrasonography (97% versus 62%). Radioimmunoassay of the blood outflowing from the adrenals adjuvant to their venography appeared informative in 18 out of 21 procedures. Computed tomography was also more effective in identification of adrenal hormone-inactive tumors (adenomas, metastases, cancer, etc.), its sensitivity being 100% against 44% for ultrasonography. In large-size tumors aortography only warrants determination of the tumor organic origin reliably. The diagnostic model is proposed for adrenal diseases. It uses stage-by-stage and purposeful application of radiologic investigations.

Thirty-one patients with insulinoma of the pancreas verified during operation were examined. The localization of the tumor was detected by ultrasonic examination in 9.7%, by X-ray computed tomography in 38.9%, by angiographic study in 32.1%, and by endoscopic retrograde pancreatocholangiography in 11.1% of cases. Complex use of the methods allowed the localization of the tumor to be determined in 48.4% of cases. The smallest diameter of insulinoma diagnosed during ultrasonic examination and endoscopic retrograde pancreatocholangiography was 1.5 cm, X-ray computed tomography and angiography demonstrated tumors measuring 1.0 cm in diameter. The diagnostic efficacy of the methods increases when the tumor is located in the body and tail of the pancreas. The examination scheme for patients with suspected insulinoma must include ultrasonic study and X-ray computed tomography; when their results are negative angiography must be resorted to.

Comprehensive ultrasonic and x-ray computer-aided tomographic (RCAT) examinations were carried out in 97 patients with 120 pyo-inflammatory foci in the abdominal cavity and retroperitoneal space. On the whole the sensitivity of ultrasonic examinations was 68%, that of RCAT 88%. RCAT was superior to ultrasonic examinations in the diagnosis of extra-organic (inter-intestinal, subdiaphragm, etc.) involvement, pancreonecrosis, and splenic abscesses. The advantages of this method were not so evident in the detection of liver and kidney abscesses and of gauze postoperative foreign bodies. Potentialities of an ultrasonic method were somewhat superior in localization of a pathologic focus in the pancreas in differentiation from a common cyst. Ultrasonic examinations should be widely used as a primary method and should to a certain measure determine the necessity of RCAT use in the diagnosis of pyo-inflammatory diseases of the abdominal cavity and retroperitoneal space organs.

Based on diagnostic data in 35 patients with abdominal aortic aneurysm, which were obtained during ultrasonic scan echography, X-ray computed tomography and radioopaque angiography, and on their comparison with intraoperative findings, a diagnostic algorithm for examinations has been developed, which enables errors in the diagnosis to be excluded. The major diagnostic technique for abdominal aortic aneurysms has been found to be X-ray computed tomography which provided no errors in the assessment of the extent of aneurysms and the presence of their complicating components in all 35 patients. In high aneurysms of the abdominal aorta and suspected stenoses in the visceral, renal, and iliac arteries, X-ray computed tomography should be supplemented by radioopaque angiography to clarify the status of aortic branches.

Ultrasonic and computer-aided tomographic examinations of 2457 patients with suspected diseases of the abdominal cavity organs have revealed splenic involvement in 48. The sensitivity of ultrasonic technique for the detection of splenic diseases has made up 70.8%, that of computer-aided tomography--95.8%. Invasive interventions monitored by these two methods were carried out in 26 patients; in 10 of these transcutaneous puncture drainage was carried out for cysts (2), hematoma (1), and abscesses of the spleen (7). In one patient with multiple abscesses of the spleen the drainage was found insufficient for complete cure and he had to be subjected to splenectomy, in the rest cases surgery did not have to be resorted to. Therefore, ultrasonic and computer-aided tomographic examinations of the spleen, used together with various invasive interventions, result not only in correct diagnosis and differential diagnosis of this organ's disease, but permit various therapeutic measures and help achieve cure without laparotomy.

Pancreatic insulinomas were intraoperatively revealed in 15 patients. X-ray computed tomography (CAT) revealed the tumor in only 6 (40 %) patients. The mean size of detectable insulinomas was 2.4 cm, that of undetectable ones 1.2 cm. X-ray CAT diagnosis is facilitated in case of a superficial localization of the tumor on the body or tail of the gland .

USI and CT were performed in 14 patients with textile foreign bodies left in the abdominal cavity and retroperitoneal space during operation on the biliary tracts (6 cases), kidneys (4 cases), pancreas (2), stomach (1), and during appendectomy (1). A decisive sign in USI that enabled one to detect gauze foreign bodies, was a stable echogenic zone corresponding to a proximal body contour with a solid acoustic shadow behind. Extra-organic localization of these changes contributed to making diagnosis. A certain amount of fluid could be seen around a foreign body during an exudative reaction. In CT, diagnosis was based on the detection of a formation with a capsule containing calcinates and air masses.

Computed tomography was performed before and after telelithotripsy to evaluate changes in renal parenchyma induced by the procedure in 34 patients with nephroliths. Piezolith-2300 lithotriptor ("Wolf", FRG) was employed. The images showed no serious parenchymal injuries or paranephric hematomas, on the one hand, but density changes in the parenchyma, on the other hand. These were of 3 types: focal reduction in 3, diffuse reduction in 4 and diffuse increase of the density in 2 patients. As shown by comparison with literature data, telelithotripsy on "Piezolith-2300" causes minimal changes in renal parenchyma and perirenal fat. In view of this, the procedure is recommended for wide clinical and outpatient practice.

The paper discusses the data on 229 cases of lung pathology including 85 with cancer. Sensitivity and specificity were 89.4 and 86% for standard X-ray procedures and 91.8 and 90.3% for computed tomography, respectively. Combined application of the methods was followed by a rise in the parameters to 94.1 and 93%, respectively. Computed tomography proved useful for early detection of lung metastases.

The paper is concerned with analysis of the results of X-ray investigation of 45 patients with aneurysms of the distal part of the arch and descending part of the thoracic aorta. Errors were made in 16 of 35 patients (35.6%) before admittance to hospital. X-ray investigation helped to establish correct diagnosis of aneurysm of the aorta in 42 of 45 patients (93.3%) on the basis of the detection of intense additional shadow formation in left pulmonary field, inseparable from the aortic shadow. The use of a new method of ultrasound diagnosis--duplex scanning--made it possible to establish the presence of aneurysm and to determine its sizes as well as to visualize the relation of the left subclavicular artery to aneurysm in 17 of 21 patients. CT-semiotics of aneurysms of the descending part of the thoracic aorta consisted in its dilatation over 3.5 cm, wall calcification, thrombosis of the cavity and change of the adjacent structures. Basing on the analysis of these signs correct diagnosis was established in 34 of 35 examinees (97.1%).

Possibilities of noninvasive radial diagnostics were studied in examination of 27 patients with dissecting aneurysms of the aorta. Classical X-ray examinations of chest organs have diagnosed aorta wall dissection in 2 of 24 patients. In 19 patients the diagnosis of aorta dissection was suspected. The ultrasound examination gave correct diagnosis in 3 of 4 patients examined. The non-contrast computed tomography has revealed dissecting aneurysms in 8 of 24 patients, an investigation with the intravenous injection of the contrast substance--in 13 of 15 patients. The diagnosis was based upon the detection of 2 canals of the aorta with the dissected intima between them, thrombosis of the false aorta canal and accumulation of the liquid in the pleura and pericardium cavity. When planning operative procedures it becomes necessary to perform aortography.

The paper is concerned with the results of x-ray and CT investigations conducted in 62 patients with suspected aneurysm of the thoracic aorta. The diagnosis was confirmed in 56. Of them 38 patients were operated on, 2 died without surgical intervention. X-ray investigations permitted differential diagnosis of mediastinal formations in 91.5% of cases. However in 2 cases when the combined method of intravenous administration of a contrast medium by means of a syringe was not used, aneurysmal aortic dilatation was not detected by CT. This method was found to be effective for diagnosis of complications of aneurysms of the thoracic aorta (calcinosis, aortic wall stratification and thrombosis of aneurysmal cavity).

Altogether 70 patients with thoracic aortic aneurysms were investigated. Of them 23 (32.9%) were investigated with prior diagnostic errors. In 13 patients the diagnosis of thoracic aortic aneurysm was made during erroneously performed thoracotomies (12 patients) and laparotomies (one patients). Diagnostic errors leading to bad tactical mistakes, were caused by insufficient patients' examination and wrong interpretation of x-ray findings.