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High lipoprotein(a) (LP(a)) level contributes as an independent risk factor to the development of cardiovascular diseases of atherosclerotic origin. The article contains data on the structural features of this particle, the genetic determination of its metabolism and content in blood plasma, and the pathogenic mechanisms of its proatherogenic, proinflammatory and prothrombotic effects. The authors analyzed epidemiological data on the frequency of elevated LP(a) levels in different population groups and its association with the risk of cardiovascular diseases. The data presented concern the indicators of LP(a) as a risk factor for the development of ischemic stroke (including recurrent stroke) and its individual pathogenetic subtypes, as well as the relationship between LP(a) levels and functional outcomes after cerebral accidents. Current recommendations for the treatment of patients with elevated LP(a) levels in the context of primary and secondary prevention of cardiovascular diseases are analyzed.

One of the possible measures that can enhance the quality of medical care, reduce the number of adverse outcomes, and also achieve target values for the use of reperfusion methods of treatment for acute ischemic stroke is to improve the system of care for patients with in-hospital ischemic stroke. One type of in-hospital stroke is perioperative stroke that develops during or 30 days after surgery. Since the publication in 2014 of the last fundamental work on the prevention of perioperative stroke, the approaches to primary and secondary prevention, diagnosis, conservative and reperfusion treatment of ischemic stroke have been seriously modified. The numerous changes have created the preconditions for a revision of existing approaches to providing care for patients with perioperative ischemic stroke. In 2021, updated documents from foreign researchers/associations on the perioperative ischemic stroke in non-cardiac and non-neurosurgical patients were published. The second part of our review presents current data on the perioperative antithrombotic prophylaxis, clinical and instrumental diagnosis, treatment and organization of care for perioperative ischemic stroke in this category of patients. The issues of using reperfusion treatment methods in non-cardiac and non-neurosurgical patients with perioperative stroke, such as systemic thrombolytic therapy and endovascular interventions, are discussed in detail, including the world experience of their “offlabel” use.

Perioperative ischemic stroke is a potentially fatal complication that greatly increases the risk of poor outcome in surgical patients. Despite the relatively low prevalence among patients undergoing non-cardiosurgical and non-neurosurgical interventions (about 0.1–1.0 %), the total number of annually developing perioperative ischemic strokes in patients of this profile is high due to the large number of operations performed in the world. Since the publication in 2014 of the last fundamental work on the prevention of perioperative stroke, approaches to primary and secondary prevention, diagnosis, conservative and reperfusion treatment of ischemic stroke have been seriously modified. The numerous changes that have taken place have created the prerequisites for revising existing approaches to providing care for perioperative ischemic stroke. In 2021, updated documents of foreign researchers/ associations on the problem of perioperative ischemic stroke in non-cardiac and nonneurosurgical patients were published. This review, which consists of two parts, presents current data that summarizes the most relevant information on this topic. The first part of the review outlines the general provisions on perioperative ischemic stroke (definition, risk factors, pathogenesis, predictive models), strategies for pre- and intraoperative prevention.

In-hospital ischemic stroke (IHIS) is one of the most critical competing diseases that can develop in patients during inpatient treatment. Causes associated with diagnostic and therapeutic measures may play an additional role in the pathogenesis of IHIS, in addition to traditional risk factors.Objective: to study the pathogenesis features and assess risk factors for IHIS.Patients and methods. The comorbidity, main and additional risk factors of IHIS in patients of therapeutic (n=112; 44.3%), surgical (n=125; 49.4%) and neurological (n=16; 6.3%) profiles were studied.Results and discussion. The proportion of perioperative stroke in the study was 37.2%. The frequency of atherothrombotic, cardioembolic, and lacunar subtypes of IHIS did not differ in groups of patients of different profiles. In the group of surgical patients, the proportion of strokes of another established etiology was 24.8% and was higher than in therapeutic (9.8%; p

Introduction. In the structure of the total mortality of the population, cerebral stroke ranks second and leads among the causes of disability. Despite the huge number of patients with diabetes and stroke, the mechanisms underlying this predisposition remain poorly understood. Morphological changes of the brain in diabetes-induced neuroinflammation are practically not described anywhere.Objective. To establish the patterns of pathomorphological changes of the brain associated with neuroinflammation in patients with type 2 diabetes mellitus who have suffered a stroke.Materials and methods. On the sectional material, changes in the brain and arteries were studied in 27 stroke deaths (6 men and 21 women), aged 60 to 97 years, average age 75 ± 7.2 years, who had type 2 diabetes mellitus, the comparison group consisted of 32 stroke deaths (14 men, 18 women) with dyscirculatory encephalopathy without type 2 diabetes aged 42 to 100 years (average age 68.5 ± 14.2 years). Light-optical and electron microscopic examination of the brain, immunohistochemical reactions were performed: indirect immunoperoxidase reaction with gliofibrillary protein, vimentin and macrophage immunophenotyping markers – CD-68, CD-163, CD-21, CD-23, CD-11c, HAM.Results. It has been established that neuroinflammation is characterized by macrophage-microglial activation, penetration of antigen-presenting cells through the damaged blood-brain barrier, damage to neuronal and glial cell pools. Pronounced macrophage infiltration was revealed using immunohistochemical methods of investigation with CD-68. Monocytic macrophages and antigen-presenting cells are located perivascularly, migrating through the damaged blood-brain barrier and expressing the CD-11c receptor. There is a phenomenon of changing the phenotype of macrophages from M2-type, with sanogenetic activity, to M1-type, responsible for inflammatory damage.Conclusions. Pronounced infiltration of brain tissue in stroke patients with type 2 diabetes mellitus by both resident macrophages and monocytic macrophages is associated with progressive neuroinflammation.

The existing system of medical care for patients with acute cerebrovascular accident of atherothrombotic genesis, namely lipid metabolism disorders, the modern evidence base for lipid-lowering therapy in this category of patients and the feasibility of interdisciplinary interaction of cardiologists and neurologists were discussed at a meeting of the expert council of cardiologists and neurologists in Moscow on 2021 July 7.

Hippocampus plays an important role in the cognitive mnestic functions. It coordinates emotional process, defines the intensity and specificity of behavioral, neuron and hormone reactions. Structural changes in hippocampus neurons can result in learning and memory disorders. The objective: to investigate morphometric parameters of hippocampus fields in rats after abdomen surgery with exposure to sevoflurane. Subjects and methods. The experimental research was performed using Wistar rats (n = 15). Rats from the experimental group (n = 7) had abdomen surgery with anesthesia with sevoflurane with the consequent continuous exposure to it (6 hours, 2 vol. % of sevoflurane, air flow – 1 l/min.). During 21 days rats from both groups had a number of behavioral tests. In 12 hours after the last behavioral test (on the 22-th day after the start of the experiment) the rats were decapitated with consequent brain extraction. The obtained materials were fixed in 10% neutral formalin on phosphate buffer (pH 7.4) for 24 hours minimum. Preparations of CA1, Ca2, Ca3, and Ca4 fields were studied under light microscope DM-750 (Leica, Germany) using the computer image analysis software of ImageScope M with 400-fold magnification. Results. The tests showed that cytoarchitectonics of hippocampus field was intact, pyramidal neurons had a large rounded nucleus with one, two or more distinct nucleoli. No pericellular and perivascular edema was detected. In the experimental group, all fields of the hippocampus had structural and functional changes. It manifested through both quantitative and qualitative signs of neuronal damage, especially in the Ca1 field. Segments of pyramidal neurons were disorganized, morphologically modified neurons were found: hyperchromatic shriveled neurons with no nucleus or poorly visible nucleus of the irregular shape. The appearance of morphologically changed neurons and disorganization of hippocampal layers led to changes in the width of pyramidal neurons segments. Conclusion. Morphological changes of hippocampal structures of rats after surgery and anesthesia may be the cause of cognitive functions decline during the postoperative period.

The dynamics of cerebral blood flow in acute ischemic strokewas studied with allowance for a pathogenic classification ofstroke. Analysis of the ultrasound parameters demonstrated thatparticular attention should be given to quantitative, rather thanqualitative, parameters of blood flow. The dynamics of cerebralblood flow in different etiologies of cerebral stroke is reflectedin specific changes in the linear velocities, which relates a strokesubtype to the factors determining the need for extended monitoring.Clinical and instrumental assessment of the developmentof hemodynamic disorders during reperfusion after stroke bymeans of Doppler ultrasound demonstrated that, depending onthe etiology of ischemic stroke, recovery of the intracerebral hemodynamicsparameters to normal values occurs differently andhas its features that, if timely detected, may affect correction ofthe strategy and tactics of treatment. Based on these data, we suggesta differentiated algorithm of extended Doppler monitoringof cerebral blood flow in acute ischemic stroke.

The multicentral pilot clinical trial of gliatilin in treatment ofacute ischemic stroke was held in 20062008 in Russia. The trialinvolved 122 patients, who received basic treatment and gliatilinduring 3 months after the stroke onset (115 days 2000 mg perday, 1630 days 1000 mg per day, 3190 days 800 mg perday). All patients underwent clinical examination (includingrepeated NIHSS, Rankin scale, Barthel index assessment), laboratoryand ultrasound examination, computer tomography ormagnetic resonance imaging during 24 hours after the strokeonset. 25 patients underwent repeated multimodal magnetic resonanceimaging (T1-, T2-, diffusion-, perfusion-weighted imaging).The results of examination of patients who received basictreatment alone were taken from literature. The trial resultsshow, that treatment of acute ischemic stroke with gliatilin promotesneurological recovery and increase of patients self-careability, which is probably concerned with the smaller final volumeof brain infarct.

Objective: to assess the feasibility of ARBs to reduce hypoperfusion of the brain that develops in patients with arterial hypertension of 1-2 degrees. Material and methods. A study of changes in the ultrasonic Doppler index (RI resistivity index and pulsatility index PI) and the structure of neurological symptoms in patients with arterial hypertension of 1-2 degrees (n=86) due to 53-week olmesartan medoxomil reception (Cardosal®). Results. Patients with arterial hypertension of 1-2 degrees have diagnosed diffuse neurological symptoms and mild cognitive impairment. Doppler ultrasound revealed an increase in peripheral resistance index in the internal carotid and middle cerebral arteries, compared with patients without hypertension. Through 53 weeks therapy of olmesartan medoxomil (Cardosal®) observed a statistically significant decrease in peripheral vascular resistance (p