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The presence of a combination of coronary artery disease (CAD) and peripheral artery disease (PAD) is associated with nearly double all-cause mortality rate, up to 4.6% per year, compared to the mortality rate for each of the conditions. Performing the first-stage intervention on the arteries of the lower limbs carries a high risk of the coronary blood flow worsening in the form of perioperative myocardial infarction, while isolated coronary artery bypass grafting (CABG) may exacerbate ischemia of the lower limbs. The following questions remain unresolved: What should be the sequence and timing of surgical interventions in the combination of CAD and PAD? Do simultaneous surgical interventions have advantages over staged interventions? What is the optimal graft choice for CABG? What is the optimal technique for myocardial revascularization? The aim. To study the features of myocardial revascularization in patients with multifocal atherosclerosis affecting both coronary arteries and arteries of the lower limbs. Materials and methods. We analyzed the treatment outcomes in 48 patients with combined coronary artery and lower limb artery disease from 2016 to 2023, as well as data from contemporary literature from 2018 to 2023, which covered over 14,000 patients. Surgeries were performed without cardiopulmonary bypass, both simultaneously and in stages. Venous and arterial grafts were used during the interventions. Results. The patients who underwent simultaneous operations demonstrated a higher incidence of wound complications (p < 0.001). The patients who underwent staged procedures experienced more severe limb ischemia requiring intervention (p < 0.001) than those who had simultaneous procedures. No cases of acute cerebrovascular accidents were noted in either group. In both groups, early postoperative periods were marked by rhythm disturbances, specifically paroxysms of atrial fibrillation, which were successfully managed conservatively. There were no hemorrhagic complications associated with prolonged heparinization during simultaneous procedures compared to staged interventions. The patients who underwent either simultaneous or staged myocardial revascularization and vascular reconstruction of the lower limbs rarely experienced complications related to vascular graft thrombosis. Conclusions. The choice of intervention sequence should prioritize CABG as the first step, both in simultaneous and staged interventions. Safe procedures for patients with multifocal atherosclerosis involving coronary and lower limb arteries require a multidisciplinary team. Simultaneous interventions help avoid ischemic complications associated with delaying the next stage of revascularization of other affected vascular territories. Delaying the revascularization of lower limb arteries in staged interventions may lead to the worsening of existing limb ischemia.

Aim. To establish the frequency of achieving target of blood pressure (BP) levels and lipid spectrum parameters (LS) in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL) with normal and elevated levels of lipoprotein (a) (Lp(a)) in real clinical practice.Material and methods. The study included 110 patients with AH and MFAL, median age was 59.0 (51.0; 64.3) years. Depending on the level of Lp(a), all patients were divided into 2 groups: group 1 — 72 patients (65.5%), Lp(a) level was ≤50 mg/dl (13.2 (3.7; 21.1)), group 2 — 38 patients (34.5%) Lp(a) level was >50 mg/dl (89.5 (62.5; 110.0)). The diagnosis of MFAL included damage to two or more arterial basins according to carotid artery, abdominal aorta and lower extremities arteries duplex scan. Patients of both groups received antihypertensive, lipid-lowering, and antiplatelet therapy.Results. Patients in groups 1 and 2 showed similar blood pressure levels and frequency of antihypertensive therapy use. In both groups, the majority of patients were on a free combination of antihypertensive drugs, only a third of patients used a fixed combination. In most cases, patients of both groups did not reach the target blood pressure levels (63.9% — group 1, 55.3% — group 2), despite the fact that the average blood pressure figures were relatively low (132;83 mmHg in each group). Drug control was also unsatisfactory in both groups, regardless of the level of Lp(a). However, all drug indicators were significantly worse in group 2, despite comparable lipid-lowering therapy, which more often included statin monotherapy. Combination therapy with lipid-lowering drugs was used in patients of groups 1 and 2 only in 20.8% and 10.5%, respectively. Parameters of low-grade inflammation high-sensitivity C-reactive protein and interleukin-6 did not differ between the groups and did not exceed the reference values.Conclusion. An increased level of Lp(a) may be accompanied by drug disorders and increased BP in patients with MFAL. Due to the lack of effective Lp(a) reducing therapy, the prevention of cardiovascular events in such patients should focus on BP and lipid spectrum correction. The use of fixed combinations, including antihypertensive and lipid-lowering drugs, can lead to improved adherence to therapy, increased BP and LS control.

Aim. To evaluate the prognostic value of GDF-15 in relation the development of bleeding and events in stable CAD patients, receiving combined antithrombotic therapy. Materials and methods. The data was obtained from the prospective registry REGATA, 343 CAD patients (249 males), median age 68 [IQR 62; 75] years) were enrolled. Patients with sinus rhythm and concomitant PAD received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid (31.8%) or clopidogrel (24.8%). Other 43.4% with concomitant atrial fibrillation (AF) received direct oral anticoagulants in combination with antiplatelet therapy after elective percutaneous coronary interventions. Median follow-up was 12 months [IQR 9.0; 18.0]. The safety end point was major and clinically relevant bleedings (type 2–5) according to the BARC classification. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA assay. Results. Frequency of BARC 2–5 bleedings was 16% (BARC 2 – 46; BARC 3 – 9; BARC 4–5 – 0), median GDF-15 level was 1185.0 pg/ml [850.0; 1680.0]. In patients with AF and concomitant MFA, the level of GDF-15 was significantly higher than in the subgroups of patients with only AF or MFA (p=0.0022). According to the quintile analysis, GDF-15 values in the top three quintiles of distribution (cut-off value 943 pg/ml) were associated with higher frequency of bleeding events: 23.2% versus 5.1%; p=0.0001. The multivariable logistic regression model demonstrated that bleeding events were independently associated with GDF-15 level943 pg/ml (OR 2.65, 95% CI 1.11–6.30; p=0.0275), AF (OR 2.61, 95% CI 1.41–4.83; p=0.0023) and chronic kidney disease (OR 1.92, 95% CI 1.03–3.60; p=0.0401). Clinical factors determining the risk of bleeding events also determined a GDF-15 elevation. Conclusion. Assessment of GDF-15 level may improve bleeding risk stratification in CAD patients with concomitant AF and/or PAD receiving combined antithrombotic therapy.

Aim. To determine the features of hemostasis system disorders and the possibility of their correction in patients with arterial hypertension (AH) and multifocal atherosclerotic lesions (MFA) with risk factors indicated.Materials and methods. The study included 135 patients (mean age 53.7 ± 7.76 years), including 80 patients with controlled AH stage and II (group 1) and 55 patients with controlled AH stage III who had ischemic stroke (group 2). Among all patients studied, 33 patients (24.4 %) were smokers. All 135 patients received comparable antihypertensive, antiplatelettherapy (acetylsalicylic acid at a dose of 100 mg/day), had MFA and target lipid spectrum values.Results. Procoagulant shifts are noted already in patients with AH stage I and II, especially in the presence of smoking. Such indices of global thrombodynamics test as initial clot growth rate, average clot growth rate, clot size significantly exceed the reference values and indicate high prothrombogenic potential in patient with AH and MFA. Prescription of dual antiplatelet therapy allows normalization of identified disorders. Presence of risk factors (smoking) aggravates existing hemostasis disorders in patients with AH and MFA.Conclusion. Smoking cessation, optimization of risk factors and complex antihypertensive, hypolipidemic and antithrombotic therapy are the basis of treatment of patients with AH and MFA and can be considered as priority measures to reduce morbidity and mortality in this patient population.

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

More than ten international randomized trials have been conducted to determine the effectiveness and safety of carotid artery stenting and comparing the latter with the results of carotid endarterectomy. However, some of them obtained conflicting data confirming both the advantage of carotid stenting (SAPPHIRE) and carotid endarterectomy (EVA-3S), as well as the equivalence of the two treatments (CAVATAS, SPACE, CREST). Also, unsatisfactory results of both single-stage and staged surgical approaches were shown in the treatment of patients with combined atherosclerotic lesions of the coronary and carotid arteries. The lack of clear international guidelines for the management of patients with lesions of several vascular beds makes it necessary to look for new methods of surgical treatment based on minimally invasive endovascular technologies. This review article analyzes the results of randomized trials comparing the results of carotid endarterectomy and carotid stenting in patients with carotid atherosclerosis. [ABSTRACT FROM AUTHOR]

Introduction. Thrombotic complications (TC) in different vascular systems dictate the fate of high-risk patients. In cardiological practice, patients with advanced atherosclerotic vascular disease (MFA) represent the most vulnerable group. Malignant neoplasm (MN) is one of the most significant risk factors for developing TCs, especially in the context of antineoplastic therapy. The presence of significant differences in the mechanisms of thrombogenesis in malignant neoplasms and atherosclerosis determines the appropriateness of a comparative study of markers of coagulation activation and endothelial damage in order to identify common features and differences specific to each pathology. Aim. To examine markers of coagulation activation and growth factors in active cancer and advanced atherosclerotic vascular disease, to identify their common features and differences specific to each pathology. Materials and methods. A total of 22 patients with MN (Group 1) and 58 patients with MFA (Group 2) were enrolled in the study. The assessed biomarkers included: von Willebrand factor (VWF), D-dimer, growth differentiation factor-15 (GDF-15) and vascular endothelial growth factor A (VEGF-A). Results. Patients with MN had an increased likelihood of disease progression within 6 months at D-dimer level > 1121 ng/mL (OR = 10.5; 95% CI 1.4–81.0, p = 0.014) or VWF > 189% (OR 10.5, 95% CI 1.36–81.0, p = 0.014); the likelihood of death within two years of follow-up at D-dimer level > 1121 ng/mL (OR = 7.0; 95% CI 0.97–50.57, p = 0.04), or VWF > 203% (OR = 10, 5, 95% CI 1.36–81.06, p = 0.014). In patients with MFA, the likelihood of prognosis determining events within one-year of follow-up was determined by increased levels of VWF > 157% (OR = 9.2, 95% CI 1.02–82.8, p = 0.048) and GDF-15 > 1548 pg/ml (OR = 5.7; 95% CI 1.09–29.5, p = 0.04). Conclusions. Endothelial damage and coagulation activation are more pronounced in patients with MN than in patients with MFA. In patients with malignant neoplasms, the outcomes were associated with D-dimer and VWF levels, and in patients with MFA – with VWF and GDF-15 levels.

Background. Hyperlipoproteinemia (a) is an independent and cause risk factor for atherosclerotic cardiovascular diseases (ASCVD). The correlation between lipoprotein (a) Lp(a) and inflammation in the vessel wall was actively studied during the past few years. C-reactive protein (CRP) plays an important role in ASCVD. Aim. To analyze the relationship between hyperlipoproteinemia (a), inflammatory markers, and the early development of stenosing atherosclerosis (AS) in several vascular pools. Materials and methods. 76 patients, 55 men aged 18 to 55 years and 21women 18 to 60 years, with the results of instrumental examination of coronary, carotid and lower extremities vascular pools were enrolled. Three groups: with stenosing (50%) AS of only one (group 1, n=29); two or three (group 2, n=21) vascular pools. 26 patients without coronary heart disease and AS were included in the control group. All patients in groups 1 and 2 and 65% of those in the control group took statins. The concentrations of Lp(a), CRP, lipids and blood count were determined. Results. The patients of the three groups did not differ in age. In the groups with AS (79% in group 1 and 85% in group 2), there were more men (relative to 54% in the control group). Diabetes mellitus was more common only in patients with multifocal AS. The absolute number of blood monocytes and leukocytes, the neutrophil-lymphocyte ratio, as well as Lp(a) level were higher in patients of groups 1 and 2 relative to the control. The maximum Lp(a) level (median [25%; 75%]) was observed in patients with lesions of two or more vascular pools vs the control group (49 [4; 96] mg/dL, vs 10 [4; 21] mg/dL, p=0.02). The CRP level was significant elevated in patients from group 2 7.2 [4.0; 9.7] mg/L, relative to group 1 2.5 [1.0; 4.7] mg/L, and the control group 2.9 [1.2; 4.9] mg/L, p0.05. The Lp(a) and CRP concentration, or the presence of diabetes mellitus in patients, regardless of other risk factors, were associated with severe stenosing AS in young and middle age. Conclusion. An elevated concentration of Lp(a) (30 mg/dL) determines the presence of both isolated and multifocal stenosing AS in the examined patients. A simultaneous increase in the concentration of both Lp(a) and CRP, as well as the presence of diabetes mellitus, are associated with the premature development of stenosing atherosclerotic lesions in several vascular regions at once. Measurement of these predictors in young and middle-aged patients makes it possible to use them as biochemical markers to assess the likelihood of multifocal lesions of the vascular pool.

Aim. To analyze factors affecting the availability of hybrid cerebral and myocardial revascularization by synchronous percutaneous coronary intervention (PCI) and carotid endarterectomy (CEA).Material and methods. This retrospective study included 263 patients with coronary and internal carotid artery involvement undergoing PCI and CEA during the period from 2011 to 2017.Results. The study revealed the following factors increasing the availability of revascularization: hybrid cerebral and myocardial revascularization, successful PCI using drug-eluting stents, postPCI TIMI flow grade 3, and radial access for PCI. The following factors reduced the availability: polyvascular disease >50% in three beds, prior PCI, left ventricular ejection fraction 9, emergency hospitalization and multiple emergency PCI of the coronary arteries in the long-term follow-up period.Conclusion. Comprehensive analysis of clinical, demographic, anatomical, angiographic, and perioperative factors made it possible to identify predictors that affect the availability of hybrid revascularization.

Introduction. Multifocal atherosclerosis (MFA) in patients with CHD is a key risk factor for thrombotic complications (TC). There are little data on the long-term prognosis in patients with multivessel CHD combined with carotid artery lesions.Objective. To assess prognostic negative outcomes (thrombosis and bleeding) in patients with CHD and MFA undergoing revascularization procedures – coronary artery bypass graft surgery and, in case of high risk of ischemic stroke, carotid endarterectomy.Materials and methods. A total of 189 patients with stable multivessel coronary artery disease who successfully underwent coronary bypass graft surgery and had concomitant atherosclerosis of the carotid arteries ≥50% were included in the study. The exclusion criterion was chronic use of oral anticoagulants. The choice of antithrombotic therapy after the surgical intervention was determined by the attending physicians. The efficacy endpoint was defined as the sum of TC including cardiovascular death, acute coronary syndrome, ischemic stroke, acute lower limb ischemia, and the need for emergency revascularization of the carotid or coronary basins. BARC bleeding types 2-5 were considered as a safety endpoint.Results. The median follow-up period was 37 months. [MR 25.0; 45.0]. The cumulative incidence of TC was 11.1%, BARC 2-5 bleeding was 4.8%. One or two antiplatelet agents were prescribed at discharge in 87.3% of cases, and in 12.7% – a combination of acetylsalicylic acid (ASA) and oral anticoagulant (OAC) for up to 6 months. The incidence of thrombotic complications was not significantly different in the mono- or dual antiplatelet therapy groups. The combination therapy group (OAC + ASA) was characterized by the highest number of comorbidities. When analyzing the TC for the first 6 months. (before anticoagulant withdrawal) there was no significant difference between the groups of antiplatelet therapy and the combination of ASA and OAC (Log-Rank, p = 0.4669). The proportion of patients who survived the entire follow-up period without developing TC was significantly higher in the group compared to the initial combination therapy group: 0.83 versus 0.50 (Log-Rank, p = 0.0101).Conclusion. Despite complete revascularization, the incidence of TC during the two years of follow-up was high. In the combination therapy group, anticoagulant withdrawal led to an increased incidence of TC.

Treatment of patients with combined coronary and carotid artery atherosclerosis is a difficult task due to the increased risk of surgical intervention in this cohort of patients. Lack of timely treatment can lead to a decrease in the quality of life of patients, as well as to death. In some cases with combined coronary and carotid artery atherosclerosis, the choice of surgical intervention may depend on vascular bed involvement. In a case report, open surgery was associated with a very high risk of perioperative complications; so the only way of myocardial revascularization was minimally invasive endovascular surgery. The article presents a case of the treatment of a patient with a combined multivessel coronary and bilateral carotid artery atherosclerosis.

The aim of the study was to study the effect of arterial stiffness and multifocal atherosclerosis on the 10-year prognosis of patients after coronary artery bypass grafting. Methods. Patients with coronary artery disease (n = 274) who underwent coronary artery bypass grafting (CABG), in whom cardio-ankle vascular index (CAVI) was assessed using the VaSera VS-1000 device and the presence of peripheral atherosclerosis in Doppler ultrasound. Groups were distinguished with normal CAVI (<9.0, n = 163) and pathological CAVI (≥9.0, n = 111). To assess the prognosis, coronary and non-coronary death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, repeated CABG, percutaneous coronary intervention, carotid endarterectomy, peripheral arterial surgery, pacemaker implantation were analyzed. Results. During the observation period, mortality was 27.7%. A fatal outcome from all causes was in 37 (22.7%) patients in the group with normal CAVI and in 39 (35.14%) in the group with pathological CAVI (p = 0.023). Death from cardiac causes was more common in the group with CAVI ≥ 9.0—in 25 cases (22.52%) than in the group with CAVI < 9.0—in 19 (11.6%, p = 0.016). The combined endpoint in patients with pathological CAVI was detected in 66 (59.46%) cases, with normal CAVI values—in 76 (46.63%) cases (p = 0.03). The presence of diabetes mellitus, multifocal atherosclerosis (p = 0.004), pathological CAVI (p = 0.063), and male gender were independent predictors of death at 10-year follow-up after CABG. The presence of multifocal atherosclerosis and pathological CAVI during the preoperative examination of patients were independent predictors of the combined endpoint development. Findings. Patients with coronary artery disease with pathological CAVI before CABG were more likely to experience adverse events and death in the long-term follow-up than patients with normal CAVI. Further studies are needed to investigate the possibility of correcting pathological CAVI after CABG after secondary prevention and the possible impact of this correction on prognosis. [ABSTRACT FROM AUTHOR]

Atherothrombosis is a leading cause of myocardial infarction and ischemic atherothrombotic stroke. It represents a stage of atherosclerosis which is a pathologic process throughout the circulatory system. However, atherosclerosis has specific development characteristics in different vascular beds. Multiple factors contribute to atherosclerosis formation and progression such as genetic factors, vessel hemodynamics, and vessel anatomy. A better understanding of differences in vessels would improve prevention and treatment of atherosclerosis and its complication. In this article we review features of atherosclerosis in carotid and coronary vessels. We discuss specific conditions of local hemodynamics in the areas of bifurcation which promote atherosclerotic plaque progression, and review characteristics of unstable plaques in carotid and coronary vessels. We analyze immunologic and inflammatory processes, extracellular matrix degradation and remodeling, cellular apoptosis and autophagy occurring during atherosclerotic plaque destabilization as well as the possibility of diffuse plaque instability in systemic atherosclerosis. We review association and interaction of atherosclerotic processes in coronary and carotid arteries, and its significance for a patient. Improvement in understanding of atherosclerosis pathogenesis can lead to advances in atherosclerosis prevention. Timely and effective interventions would promote prevention of myocardial infarction and ischemic stroke which is highly important taking into account high mortality and morbidity rates.

The review contains actual data on possible approaches aimed at improving the prognosis in a special category of patients with extremely high cardiovascular risk, as well as in patients with recent acute coronary syndrome combined with comorbidity, including multifocal atherosclerosis. Currently, there are no class I recommendations for such patients aimed at reducing the risk of adverse cardiovascular events. It is suggested that suppression of inflammation may be a new therapeutic goal in this category of patients. Given the importance of inflammation in the development and course of atherosclerosis, in recent years there have been repeated attempts to influence the various components of the pro-inflammatory cascade involved in atherogenesis, but not all of them have been successful. Special attention is given to the anti-inflammatory effects of colchicine, a drug that can improve cardiovascular outcomes in patients with proven atherosclerosis. The review provides numerous pathogenetic and clinical evidence for the effectiveness of colchicine in patients with various manifestations of atherosclerosis. It is concluded that colchicine is the most promising anti-inflammatory drug that can improve the outcome of cardiovascular diseases. Thus, there is a need to initiate new clinical trial protocols aimed at studying the anti-inflammatory potential of this drug in patients with extreme cardiovascular risk.

Background. Among the goals of pathogenetic therapy in patients with multifocal atherosclerosis, not only control of the intensity of atherogenesis, but also the elastic properties of the arterial system is becoming increasingly important, which opens up additional ways to reduce overall and cardiovascular mortality in this category of patients. Aim. To evaluate effectiveness of medication Vazosponin (ZAO Vifitekh, Russia), which is a source of plant saponins in a dosage 400 mg per day, on the indicators of the elasticity of the great arteries. Materials and methods. The study included 100 patients with multifocal atherosclerosis: those who had had myocardial infarction or percutaneous coronary intervention during the previous 2 1 2 months and who had stenosing atherosclerosis of peripheral arteries brachiocephalic arteries and/or arteries of the lower extremities. The main group MG (n=50) consisted of patients who received combined hypolipidemic treatment: atorvastatin in dosage 40 mg/day + Vazosponin 400 mg/day along with baseline treatment. The control group (CG) included 50 patients who received only atorvastatin in dosage 40 mg/day along with baseline treatment. The observation period for each patient was 90 days with 3 control points (on the 1st, 10th and 90th days of therapy), in which were evaluated the elasticity indicators of the main arteries pulse wave velocity, linear blood flow velocity, total peripheral vascular resistance, actual specific vascular resistance. Results. There was a decrease in pulse wave velocity in both groups by the 90th day of the study, with a significant advantage in the group of patients who received Vazosponin: in the CG the indicator decreased by 7.3% (p0.05), in the MG by 19.3% (p0.05). The decrease in linear blood flow velocity was 14.3% (p0.05), in the CG the indicator decreased by 5.7% (p0.05). The dynamics of peripheral vascular resistance indicators showed an obvious advantage in the group of patients who received plant saponins: in the MG of patients, a decrease in total peripheral vascular resistance was detected by an average of 11.0% (p=0.006) and actual specific vascular resistance by 39.3% (p=0.0008), while in the CG by 4.5% and 5.0%, respectively. Conclusion. The addition of Vazosponin to the basic therapy of patients with multifocal atherosclerosis made it possible to achieve an additional increase in the elasticity of the arterial system, a significant decrease in peripheral vascular resistance, and the elimination of the escape effect of basic therapy. The data presented make it possible to consider the possibility of using preparations of plant saponins in combination therapy of patients with multifocal atherosclerosis who have instrumentally verified violations of the elastic properties of the arterial system.

Aim. Identifying persons who are distinguished by an increased frequency of stenosing atherosclerosis of the coronary arteries also affects the process of identifying the features of the analyzed disease. Material and methods. The main research method was the method of hierarchical analysis of categorical variables. At the same time, they differentiated into 3 clusters depending on the age and duration of the disease. The age of the analyzed patients is from 61 to 75 years. For diagnostics, a general assessment of the clinical condition, coronary angiography, and echodopleroscopy of a number of carotid and lower limb arteries were performed. The research base is the Regional Vascular Center of Ufa. Results. The work revealed that the age-related feature of 65+ is a stable lesion of the coronary vessels. At the same time, it was determined that both men and women suffer from this. Conclusion. It has been shown that this is characterized by an increased frequency of stenosing-type remodeling.

Aim.Study of the remodeling of the carotid arteries with violation of intracardiac hemodynamics in patients with MFA, and the estimation of the main parameters of dyslipidemia, apoptosis, and oxidative stress in patients with high vascular risk older age group (6175 years) in a Regional vascular center of Ufa. Materials and methods.Depending on the predominant lesion of the vascular pool, patients were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and lower limb arteries confirmed by coronary angiography, ultrasound Doppler of the main arteries of the head and lower extremities. 96 of them were IPA with a primary lesion of the heart (1st cluster), the 96 IPA with a predominance of lesions of the carotid arteries (2nd cluster), 96 patients with ischemia of lower extremities (3rd cluster). At the hospital stage, electrocardiography, echocardiography, magnetic resonance imaging of the chest and abdomen, ultrasound of the OBP and kidneys, if necessary, ultrasound of the pelvis were performed. Determination of 8-ON-deoxyguanosine, annexin-5 (An-5) and Aan-5 in blood by ELISA was performed in all patients with MFA, as well as standard biochemical screening for lipidogram examination. Results.We have found that most often in different combinations and with different degrees of severity according to our data are observed: Clinical manifestation of atherosclerotic heart disease (cluster 1) mainly due to its history in combination with stage III hypertension with increasing thickness of intima-media complex and stenosis of the right WASP, left ventricular dilatation, as well as a higher concentration of Aan-5IgMand LP-A as a risk factor for coronary heart disease, atherosclerosis, atherothrombosis. 2. Hemodynamically significant violations of the main arteries of the head in patients of the 2nd cluster mainly with acute ischemic cerebral circulation, in which there was a development of left ventricular hypertrophy with an increase in the size of the left atrium and the presence of atherosclerotic plaque of the right and left WASP. The higher prevalence of stroke was combined with a marked cognitive deficit among patients of cluster 2 with the lowest level of An-5, an increase in total cholesterol and low-density lipoprotein cholesterol. 3. The total severity of the condition in patients with hemodynamic ischemia with clinical manifestation of vascular lesions of the lower extremities was accompanied by a predominant increase in stable angina with FC2, lerish syndrome with occlusion of the iliac, superficial femoral arteries, the presence of insulin-independent type 2 diabetes, which in this group was established in 59.4% of cases, combined with a higher concentration of the marker of oxidative stress 8-ON-deoxyguanosine and hypertriglyceridemia. Conclusion.The construction of a three-cluster model in patients at high vascular risk of the elderly age category showed the interaction of cardio-carotid comorbid background on the clinical diversity of systemic vascular lesions in MFA with the development of remodeling of the main arteries and disorders of intracardiac hemodynamics associated with laboratory changes in the assessment of the main parameters of dyslipidemia, apoptosis markers, oxidative stress.

This article covers current views on the role of subclinical carotid atherosclerosis as a biomarker and equivalent of coronary heart disease. It focuses on the detection of subclinical multifocal atherosclerosis in lowto moderate-risk patients, which enables disease diagnosis, its verification, restratification of patients, identification of highand very high-risk individuals, and implementation of a complex of therapeutic and preventive measures, including aggressive lipid-regulating pharmacotherapy.

Modern data on comorbidity in coronary artery disease (CAD) are presented in the article, as well as its frequency, dependence on the age, clinical and prognostic significance, and increasing relevance for practical health care. The positions of one of the components of cardiovascular comorbidity – multifocal atherosclerosis – are presented. The existing approaches to the detection and clinical assessment of multifocal atherosclerosis, as well as to the management of the high risk of ischemic events in such patients, are outlined. The main positions on the prevention of the risk of cardiovascular complications in patients with CAD and atherosclerosis of the peripheral arteries using a combination of the anticoagulant – rivaroxaban and the antiplatelet agent – acetylsalicylic acid, are highlighted on the basis of the results of clinical studies. Promising possibilities of using such a therapeutic approach to the management of comorbid patients in routine clinical practice are presented.

The review article presents current positions about prevalence of multifocal atherosclerosis and type 2 diabetes mellitus in patients with coronary artery disease (CAD). Existing approaches to the assessment and management of high risk of ischemic events in such patients are identified. Based on the results of clinical trials, the main positions have been identified on risk prevention of cardiovascular complications in patients with combination of multifocal atherosclerosis and type 2 diabetes mellitus. The results of the COMPASS study on the use of a combination of rivaroxaban 2.5 mg twice a day and a low dose of acetylsalicylic acid in patients with CAD and/or multifocal atherosclerosis are presented, which is accompanied by a significant reduction in the risk of cardiovascular events. This approach demonstrated a increase in the risk of massive bleedings, but mainly in the first year of treatment and without significant subsequent increase. At the same time, in the group of combination therapy rivaroxaban and acetylsalicylic acid there was no increase in the frequency of the most severe bleeding - fatal, intracranial and into the critical organs, compared to the group of monotherapy of acetylsalicylic acid. These two facts show a perfectly acceptable level of hemorrhagic risk for translation into real clinical practice. Hemorrhagic risk management capabilities were considered in a CoMPASS study by prescribing proton pump inhibitors to patients. The data on the COMPASS sub-analysis on evaluation of effectiveness and safety of combined antithrombotic therapy in patients with CAD and/or multifocal atherosclerosis and type 2 diabetes mellitus are presented. They showed the possibility of usage such approach in patient management in routine clinical practice. Patients with very high risk of ischemic events: ischemic heart disease and multifocal atherosclerosis, as well as type 2 diabetes mellitus, particularly need to improve approaches to antithrombotic therapy.

In patients with atherosclerotic lesions of two or more systems or multifocal atherosclerosis (MFA), the risks of ischemic events are extremely high. MFA leads not only to cardiovascular outcomes, but also to a decrease in the patient’s quality of life, life expectancy, and in most cases to disability. The prevalence of this pathology and the importance of preventing adverse outcomes are often underestimated. This literature review examines the problem of MFA in the context of key studies on the prevalence, course of multivessel disease and the reduction of the risk of cardiovascular events in this group of patients, with an emphasis on antiplatelet and anticoagulant therapy.

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.

Aim. To study the features of atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM) and to identify factors associated with multifocal atherosclerosis. Materials and methods. The study included 140 patients (77 men and 63 women) with CAD (mean age 62.0 (56.0-66.0) years). The first group included 70 people with CAD and T2DM, and the second group included 70 patients with CAD without T2DM. All patients underwent duplex scanning of the carotid and lower limb arteries (LLA). Local vascular stiffness of the common carotid artery (CCA) was assessed by ultrasound scanning. The Peterson elasticity modulus, distensibility and strain of the CCA were determined. The ankle - brachial index (ABI) was measured by the Doppler method. Results and discussion. In the group of patients with T2D, there were statistically more patients with atherosclerotic plaques in both carotid arteries and LLA. Also among patients with T2DM the severity of stenosis of carotid arteries and LLA at all levels was significantly greater. Local carotid stiffness was higher in the first group of patients. The proportion of individuals with reduced ABI

The treatment of coronary artery disease (CAD) in patients with combined pathology of peripheral arteries who are to perform endovascular or surgical interventions is a difficult task. The most important issues are the adequate diagnostics of artery systems’ lesions, determining the most optimal strategy and stages of treatment. This makes a multidisciplinary approach with the involvement of various specialists the most optimal.Aim. Based on multidisciplinary approach, to determine the prevalence of CAD and treatment strategy in patients with lesions of the aorta and peripheral arteries.8Material and methods. The study included 693 patients with pathology of the aorta and peripheral arteries: 171 (32,5%) were female, and 522 (75,3%) were male. The age of patients ranged from 29 to 93 years, an average — 67,2+8,8 years. Also 32,5% of patients (n=223) were older than 71 years. Cardiac complaints were present only in 203 (29,3%) patients, while 490 (70,7%) were asymptomatic. The majority of 693 patients had an isolated lesion of the internal carotid artery (ICA) (n=196, 28,3%), a combined lesion of the ICA and lower limb arteries (n=93, 13,4%), a combined lesion of the iliac and superficial femoral arteries (n=70, 10,1%) and femoral arteries lesions (n=60, 8,6%).Results. Finally, 554 (79,9%) of 693 patients had lesions of at least one coronary artery more than 50%, while 368 (66,4%) of them were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57,0%) patients underwent myocardial revascularization operations: 21 (6,7%) — coronary artery bypass grafting and 295 (50,3%) — percutaneous coronary intervention. Surgical and endovascular operations for pathology of the aorta and peripheral arteries were performed in 486 (70,1%) of 693 patients. Unlike with 260 (53,5%) patients, in 226 (46,5%) patients, in addition to vascular surgery, myocardial revascularization was performed. As a result of 923 (564 endovascular and 359 surgical) operations performed in 580 patients at the hospital stage, 3 (0,51%) of them had a fatal outcome. In other 2 (0,56%) cases, there was stroke: in one case after ICA prosthetics, in the other case — thrombosis of the ICA after the carotid endarterectomy. Acute myocardial infarction at the hospital stage was not detected in any of the patients.Conclusion. In 79,9% of patients with atherosclerosis of the aorta and peripheral arteries, at least one coronary artery lesion of more than 50% is detected. In 66,4% of patients with pathology of the aorta and peripheral arteries and with lesions of the coronary arteries of more than 50%, there are no cardiac complaints. In 45,6% of patients hospitalized with a diagnosis of atherosclerotic lesions of the aorta and peripheral arteries, myocardial revascularization is required. A multidisciplinary approach is an effective and safe treatment strategy for patients with pathology of the aorta and peripheral arteries of atherosclerotic origin and concomitant CAD.

Introduction: We present our experience in the treatment of senile patient with multifocal atherosclerosis and severely impacted quality of life Clinical case: We describe a clinical case of a 86 years old patient with critical limb ischemia who received a femoroperoneal bypass with resection of the fibula in 2023 on the left lower extremity and perfect early result with dramatic improvement of the symptoms. Due to critical limb ischemia of the right lower extremity the patient received femoropopliteal bypass with prosthesis in 2024. During his second stay in the hospital the patient complained of chest pain and dispnea with massive elevation of troponin level. He was diagnosed with NSTEMI and but refused intervention at the time. Ten days later he is admitted in the cardiology unit in Gotse Delchev with clinical signs of right lower extremity ischemia. The treating physician performed thrombolysis with percutaneous angioplasty of the bypass with full restoration of the blood flow to the foot. Blood transfusion was also performed due to low haemoglobin level. Nevertheless the patient had anuria and progressing hypotension which led to patient's death 48 hours later. Discussion: In the recent years we observe an increasing number of patients with uncontrolled hypertension, diabetes, chronic renal disease. These patients are usually unsuitable for standard endovascular or open surgery procedures due to lack of outlet vessels. The only viable options for them is extraanatomical bypass surgery of deep venous arterialisation. Conclusion: Multidisciplinary approach is always needed in patients with multifocal atherosclerosis and failed attempts for revascularisation. In cases with other surgical options distal peroneal bypass with resection of the fibula offers the only appropriate solution for limb salvage. [ABSTRACT FROM AUTHOR]

Aim. To study the prognostic significance of atherosclerosis of one and several vascular systems in patients with high and very high cardiovascular risk (CVR).Material and methods. The study included 171 patients with high (26,9%) and very high (73,1%) CVR. All patients underwent duplex ultrasound of the carotid and lower limb arteries. The composite endpoint (CE) was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results. The follow-up period lasted 31,1 (17,8; 47,9) months. CE events occurred in 29 (16,9%) patients: cardiovascular death — 3 (1,75%) patients; nonfatal myocardial infarction — 7 (4,09%) patients; nonfatal stroke — 6 (3,51%) patients; coronary revascularization — 13 (7,60%) patients. Cumulative survival of patients with high and very high CVR with atherosclerotic plaques in the same vascular system did not significantly differ from that in patients with intact peripheral arteries (p=0,977). The event-free survival of patients with combined lesions of the carotid and lower limb arteries was significantly lower in comparison with patients with one vascular system involvement (p=0,011). The combined lesion of the carotid and lower limb arteries was associated with an increase in the relative risk (RR) of adverse cardiovascular events (RR, 3,15 (95% CI, 1,02-9,74; p=0,046), adjusted for sex, age, and peripheral arterial disease symptoms.Conclusion. In patients with high and very high CVR, atherosclerotic lesion of two vascular systems of peripheral arteries is associated with an increase in the RR of adverse cardiovascular events, adjusted for sex, age, and peripheral arterial disease symptoms. The presence of atherosclerotic plaques in one vascular bed was not associated with an increase in the risk of CE events.

Current review article, based on foreign and Russian studies, guidelines of the European and North American cardiological and surgical communities, summarizes the expert positions on the place of multidisciplinary “Heart Team” approach in the selection of management strategy for patients with various types of coronary artery disease. The positions of modern clinical guidelines regarding percutaneous coronary intervention and coronary artery bypass grafting in acute coronary syndrome are given. Prospective positions for optimizing the decisionmaking process by a multidisciplinary team when considering difficult patients are presented.

The review article summarized the positions of experts on the clinical and prognostic significance of multifocal atherosclerosis in patients with different forms of coronary heart disease and the impact of this phenomenon on overall cardiovascular risk based on the foreign and domestic studies, the guidelines of the European and North American Cardiological and Surgical Associations. It also presents the review of the modern clinical guidelines for antithrombotic therapy in patients with peripheral atherosclerosis. The review presents prospects for the optimization of antithrombotic therapy based on a recent clinical study.

Aim. Analysis of the prevalence and structure of hospital and five year postsurgical complications in patients with occlusion of the first portion of subclavian artery and multifocal atherosclerosis.Material and methods. To the study, 45 patients included, who had underwent carotid­subclavian shunting during 2008­2015y.Results. In hospital period of follow­up there were no significant adverse cardiovascular events. Among the comlications, in several cases there were vocal cords paresis, paresis of the diaphragm dome, limphorrhea. The study shows that significant cardiovascular events occurred only in long term of the disease period and were related to the following stage of revascularization.Conclusion. The obtained results underscore the significance of risk stratification and selection of the optimal strategy of revascularization in the cohort of patients, that is impossible unless an approach is personified.

Analysis of in-hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis. This comparative, retrospective, open study for the period from January 2013 to April 2020 included 1719 patients operated on for occlusive-stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEA were used as revascularization strategies. The criteria for inclusion in the study were: 1. Presence of coronary angiography within six months before the present CEE; 2. A history of myocardial revascularization in patients with severe coronary lesions. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1–871 (50.7 %) patients – with the presence of hemodynamically significant stenosis of the coronary arteries (CA) with a history of myocardial revascularization; Group 2–496 (28.8 %) patients – with the presence of hemodynamically insignificant lesions of the coronary artery (up to 70 %, not inclusive, and the trunk of the left coronary artery, up to 50 %, not inclusive); Group 3–352 (20.5 %) patients – without signs of atherosclerotic lesions of the coronary artery. In group 1, the observation period was 56.8±23.2 months, in group 2–62.0±15.6 months, in group 3–58.1±20.4 months. During the hospital observation period, there were no significant intergroup differences in the number of complications. All cardiovascular events were detected in isolated cases. The most common injury was damage to the cranial nerves, diagnosed in every fifth patient in the total sample. The combined endpoint (CET), including death + myocardial infarction (MI) + acute cerebrovascular accident/transient ischemic attack (stroke/TIA), was 0.75 % (n =13). In the long-term follow-up period, when comparing survival curves, group 3 revealed the largest number of ischemic strokes (p = 0.007), myocardial infarction (p = 0.03), and CCT (p = 0.005). There were no intergroup differences in the number of deaths (p =0.62). The results of the study showed that there was no significant intergroup difference in the development of complications at the hospital postoperative stage. However, in the long-term follow-up period, a group of patients with isolated lesions of the ICA demonstrated a rapid increase in the number of MI, stroke/TIA, and a combined endpoint, which was apparently associated with low compliance and progression of atherosclerosis in previously unaffected arteries. [ABSTRACT FROM AUTHOR]

Aim. Analysis of clinical and demographic, anatomic and angiographic, instrumental and perioperational factors of adverse prognosis in inpatient period for various surgical managing strategies in patients with multifocal atherosclerosis.Material and methods. The analysis is done, of surgical treatment results in 391 patient with combination lesion of coronary and brachocephalic arteries under the frame work of single center prospective registry. According to the presence of in-hospital complications (HC) all patients were selected to 2 groups: I — patients with HC (n=84); II — patients with no HC (n=307). In this selection, 4 revasculariztion tactics were realized: staged surgery within the procedures of coronary bypass and carotid endarterectomy (CEE) with various sequence (n=222, 56,8%); combinational operation of coronary bypass and CEE (n=141; 36%); hybrid revascularization within percutaneous coronary intervention and CEE (n=28; 7,2%).Results. The wide spectrum of prognostically significant factors was analized in details, including clinical and instrumental, anatomic and angiographic, perioperational factors. Adverse prognosis factors were found, and protecting parameters defined that decrease the risk of adverse cardiovascular events occurence. Predictors of adverse prognosis in post-operation period were found: clinical and demographic — older age; high surgical risk by EuroScore II ≥3; chronic renal failure; cerebrovascular — chronic cerebral ischemia III grade; the unclosed Willis circle; unstable atherosclerotic plaque or subtotal stenosis of the internal carotid arteria unilateral with operation; subtotal stenosis or occlusion of internal carotid artery contralateral.Conclusion. The results can be applied in algorithms development for selection of surgical tactics in multifocal atherosclerosis patients.

SUMMARY. The article presents various aspects of enhanced external counterpulsation in treatment of patients with various cardiovascular diseases, including coronary heart disease, and also discussion on the possibility of widespread use of this method in clinical practice. The review also presents the evidence base of enhanced external counterpulsation use, and requirements for the safe and effective use of this method in patients with vascular diseases.

Background: The number of disorders caused by atherosclerosis of various arterial tree is constantly increasing worldwide. Multifocal atherosclerosis (MFA) remains to be an important problem limiting effectiveness of coronary bypass grafting.Aim: To compare one-year rates of unfavorable cardiovascular events in patients, who underwent coronary bypass grafting, depending on the degree of non-coronary stenoses (stenoses of extracranial arteries and lower limb arteries).Materials and methods: Two hundred and thirty two patients, that underwent coronary bypass graft surgery in 2006 due to clinical manifest coronary atherosclerosis, were included into the study. Oneyear outcome (10–12 months) was assessed with the following endpoints: coronary and non-coronary death, myocardial infarction, stroke, angina pectoris and severe chronic heart failure (III–IV functional classes). One-year combined outcome after coronary bypass grafting was considered unfavorable if these events were registered.Results: After initial assessment, patients were divided into 2 groups depending on the degree of coronary atherosclerosis; thereafter, each group was subdivided into subgroups depending on presence or absence of MFA. Compared to patients without MFA, those with hemodynamically significant stenosis (≥ 50%) of non-coronary arteries had higher rates of unfavorable one-year outcomes (р = 0.001). They had higher rates of stroke (20% (5) and 5.8% (12) of patients, respectively, р = 0.03) and of recurrent angina (р = 0.001). Patients with hemodynamically non-significant stenoses (≥ 30%) also had significantly higher rates of unfavorable events, compared to patients without stenoses: myocardial infarction, in 12 (11%) and 3 (2%), respectively (p = 0.006), stroke, in 14 (13%) and 3 (2%) (p = 0.001). Eighty four (79%) patients with MFA had clinical manifestations of angina pectoris, whereas among those without MFA, only 23 (18%) of patients (p = 0.0001). Severe chronic heart failure was significantly more frequent in the MFA group, than in patients with isolated coronary atherosclerosis (38 (36%) and 21 (17%) patients, respectively, p = 0.002). In the MFA group, 10 (9%) patients died, while in the group without MFA there was one death (0.8%) (p = 0.003).Conclusion: Taking into account non-coronary stenoses of ≥ 30%, compared to only hemodynamically significant stenoses of ≥ 50%, produces more significant differences in clinical and historical characteristics of patients.

The aim of our study was to evaluate the results of the surgical treatment for patients with critical limb ischemia (CLI) and stenotic lesions of the brachiocephalic arteries. Methods and Results: We examined 72 patients (68/87.2% men and 4/7.3% women) aged from 46 to 78 years (mean age, 62.2±4.3 years) with CLI and stenotic lesions of the brachiocephalic arteries. Conservative treatment was performed in 17(23.6%) patients and surgical treatment in 55(76.4%). It has been carried out 73 surgical operations: femoral popliteal bypass (5/6.8%), lumbar sympathectomy (4/5.5%), thrombectomy of occluded aortofemoral graft (2/2.7%), limb amputation (4/5.5%), iliofemoral bypass (4/5.5%), aortofemoral bifurcation bypass (10/13.1%), endovascular surgery (1/1.6%), limb amputation at thigh level - 4(5.5%), thrombectomy of occluded distal arteries (4/5.5%), femoro-femoral cross-over bypass (1/1.6%), resection of popliteal artery aneurysm and prosthesis of the popliteal artery (1/1.6%), semi-closed loop endarterectomy of occluded arteries of the lower limbs (8/10.9%), carotid endarterectomy (23/31.5%), and carotid-subclavian bypass (2/2.7%). After the surgical intervention, we observed the disappearance or reduction of pain, restoration of sensitivity and motor activity, and healing of trophic ulcers in 75% of patients. In the late postoperative period, we detected the progression of limb ischemia in 4(5.5%) patients; in connection with that, we performed limb amputation at thigh level. Ischemic stroke with a lethal outcome developed in one patient (1.4%). Conclusion: In patients with multifocal atherosclerosis, multilevel reconstructive surgical interventions must be performed in stages, due to the high operational risk, and risk of complications, secondary amputations and lethality in the postoperative period.

Aim. To assess clinical and predictive value of serum IL-18 in ST elevation myocardial infarction.Material and methods. Totally, 132 patients included, hospitalized to Kemerovo cardiovascular dispensary due to STEMI with

Aim. To study the influence of noncoronary atherosclerotic stenosis on life quality (LQ) in patients with IHD.Material and methods. Totally 804 patients studied with IHD, that were selected into 4 groups according to presence of noncoronary stenosis (30% and more). To the group without noncoronary stenosis 472 patients were included. Stenotic subgroups (multifocal — MFA) consisted of: 1 group (n=73) — coronary arteries (CA) + extracranial arteries (BCA) + lower extremities arteries (LE), 2 group (n=154) — CA + BCA, and 3 group (n=105) — CA + LE. LQ was assessed with SF-36 questionnaire, depression level — with the questionnaire “Depression scale”Results. In MFA groups the level of depression was significantly higher than in patients without MFA (p

Aim. To assess the occurence of hemodynamically non-significant multifocal atherosclerosis (from 30% and more), renal dysfunction and their influence on the outcomes of in-hospital period of patients underwent coronary bypass surgery (CABG).Material and methods. The perioperational period of 720 patients analyzed, who were operated in 2011-2012 y. Before CABG all patients were assessed by colored duplex scanning of extracranial arteries and arteries of lower extremities to reveal the signs of multifocal atherosclerosis (MFA), also the creatinine concentration was measured in 1 day before and 7 days after CABG, and GFR was calculated by MDRD equation. The prevalence of worse outcomes was assessed after the operation (myocardial infarction, stroke, acute renal failure, remediastinotomy, death) during in-hospital period.Results. The prevalence of hemodynamically non-significant MFA (30% and more) in patients with CHD after CABG was 48%. Renal dysfunction (RD), by a decrease of GFR

Aim. To evaluate the efficacy of CCAPC in complex treatment of the patients with multifocal atherosclerosis and involvement of the heart and lower extremities arteries.Material and methods. Totally 74 patients included (66 men and 8 women), mean age 63,2±9,3 y.: 32 (43%) with IIa stage and 42 (57%) with IIb stage of lower extremities ischemia; 58 (80%) with II functional class of angina and 16 (20%) with III functional class (by CCS). CCAPC was performed on a “CARDIOPULSAR” software-hardware complex. The protocol of the study consisted in 30 procedures by 60 min. per day. Efficacy of CCAPC was assessed by the changes in EchoCG, 6-minute walking test, DPW, ABI, LDF, activity index DASI, Edinburgh questionnaire of intermittent claudication.Results. The regression of clinical symptoms was found in all patients after the treatment by CCAPC in cardiosynchronized angioregimen: the significant increase of exercise tolerance was found as DPW, ABI, DASI values, microcirculation parameters by LDF. The assessment of EchoCG parameters (EDS, ESS, EDV, ESV, LVEF) and functional class of angina revealed that after the course of CCAPC coronary blood flow did not change significantly. All patients had a subjective improvement: physical activities increased, dyscomfort in lower extremities decreased as the feelings of chills and cold.Conclusion. CCAPC is a novel important non-invasive effective and safe method of multifocal atherosclerosis treatment involving the heart and lower extremities vessels.

Aim. To study the results of primary percutaneous coronary intervention in ST elevation myocardial infarction patients (STE MI) in multivessel disease (MD) according to the multifocal disease (MFA) (peripheral lesion ≥30%).Material and methods. Current study concerns on the evaluation of hemodynamically significant and nonsignificant lesion influence on the prevalence of cardiovascular adverse events in 227 patients during 12 months after primary percutaneous intervention (PCI). The first group consisted of STEMI patients, MD of coronary vessels and MFA, underwent primary PCI (n=63) (STEMI+MFA), second group consisted of patients without MFA (n=164) (STEMI).Results. In STEMI+MFA patients comparing to those without MFA (peripheral arteries lesions more than 30%) there were worse in-hospital and long term outcomes of primary PCI by the prevalence of combined endpoint (death, MI, culprit lesion intervention): 17,4% vs. 6,7% and 30,2% vs. 13,4%, resp. (p

The purpose of the research was to examine the relationship between cellular and humoral immunoreactivity and the severity of atherosclerotic lesions of coronary arteries in patients with stable angina. We examined 68 patients with stable angina (mean age 60.2±10.3 years). The patients underwent coronary angiography in addition to numbers of immunological studies including the determination of the levels of circulating immune complexes, the leukocyte migration-inhibitory index (LMI) in presence of various antigens, the concentration of myocardial antigens in the blood as well as antibodies to them. We established a direct correlation between the level of circulating immune complexes and the development of hemodynamically significant coronary stenosis (r=0.32; p<0.05), as well as their amount (r=0.28; p<0.05) and the length of stenosis (r=0.32; p<0.05). We also found a correlation between the level of circulating immune complexes and the degree of stenosis of particular segments of coronary arteries (r=0.36-0.26; p<0.05). The titer of myocardial antigens associated with the total number of coronary occlusions (r=0.51; p<0.05), the number of hemodynamically significant stenosis (r=0.58; p<0.05) and the degree of coronary stenosis (r=0.57-0.46; p<0.05). The number of occlusions of the lumen of coronary arteries statistically significantly associated with the leukocyte migration-inhibitory index (LMI) stimulated by phytohemagglutinin(r=0.41; p<0.05). The study showed that cellular and humoral immunoreactivity are involved in the pathogenetic mechanisms of progression of atherosclerotic lesions of the coronary arteries. This should be considered when developing new technologies for treating cardiovascular diseases. [ABSTRACT FROM AUTHOR]

In this article we present a clinical case about the possibility of a one-stage treatment of a patient with critical stenotic lesions of the left internal carotid artery and the terminal abdominal aorta with the transition to the ileum-femoral segment. The first stage was the endovascular revascularization of the ileum-femoral segment and the distal abdominal aorta and after the access was made, we was made a stenting of the internal carotid artery. [ABSTRACT FROM AUTHOR]

Local expression of rennin-angiotensin system (RAS) components significantly increases in patients with arterial hypertension and atherosclerosis with or without elevation of RAS activity in the blood. Our objectives was to assessment and compare the expression level of angiotensin II type 1 receptor in the smooth muscle cells in arteries of patients with multifocal atherosclerosis and the role of local angiotensin II receptor type 1 (AT1R) expression in the disease progression. The study results suggest that the tissue RAS activity increases inhomogeneously among patients. It was interestly that AT1R expression levels in intact arteries does not differ of those in atherosclerotic arteries. Most of patients had expression of angiotensin II type 1 receptor in smooth muscle of arteries; strong elevation had 43,8% — 50,0%. Our study suggest of role of local RAS activity, but we proposed existence of another than only angiotensin II type 1 receptor mechanisms of low or high susceptibility of arteries to atherosclerosis in patient with multifocal atherosclerosis.

AIM. To study the prognostic value of multifocal atherosclerosis (MFA) in patients with diabetes mellitus (DM) at high risk for myocardial ischemia who need coronary angiography (CAG). MATERIALS AND METHODS. The investigation included 148 patients: 25 with type 1 DM (DM1), 73 with type 2 DM (DM2), and 50 without DM who had undergone CAG. Duplex ultrasound scanning of lower limb vessels and brachiocephalic and renal arteries was carried out in all the patients. RESULTS. Involvement of two or more vascular beds was noted in 60% of the patients with DM1, in 68.4% of those with DM2, and in 34% of those without DM (p < 0.05). Regression analysis showed that the risk factors of MFA were defined to be myocardial infarction (MI) in the history (OR=2.4; p=0.02), DM (OR=3.9; p=0.0002), smoking (OR=2.4; p=0.05), elevated creatinine (OR=6.5; p=0.002) and fibrinogen (OR=6.8, p=0.004) levels. Among the DM patients, there were 26.5% of those who had achieved a main assessment criterion (a combined end point (CEP)), such as death, urgent hospitalization for heart failure, nonfatal MI, nonfatal stroke, lower extremity amputation, double creatinine levels, and achievement of end-stage renal failure during a 24-month follow-up. In patients without carbohydrate metabolic disturbances, this indicator was 12% (p=0.01). During the prospective study, a total of 6.1% of patients died in the DM group; all the patients in the non-DM group completed the study. Calculation of survival rates by the Kaplan-Meier method indicated that the DM patients with concurrent atherosclerotic lesion had achieved CEP significantly more frequently than the comparison group. Such differences were absent among the persons without carbohydrate metabolic disturbances. CONCLUSION. The regression analysis has shown that prior MI, DM, smoking, creatinine and fibrinogen levels are factors associated with the development of MFA in the examined groups. In the patients with DM, concurrent atherosclerosis of two or more vascular beds is an important factor for the progression of cardiovascular and renal diseases.

54 patients, who were in the surgical department for subsequent carotid endarterectomy, were analyzed. Depending on long-term one-year prognosis all patients have been divided into two groups: with unfavorable (34 individuals – 62.9 %) and favorable (20 individuals – 37.1 %) prognosis. Interleukin-12 in serum was investigated in all patients in preoperative period. It was proved that patients who had such cardiovascular events as stroke, transient ischemic attack, myocardial infarction, death, and courses deterioration of multifocal atherosclerosis in any arterial region, increase or clinical presentations onset of ischemia in any organ during the first year after surgical procedure had significantly higher level of interleukin-12 in serum.

The study included 125 patients aged 40 to 84 years, with multifocal vascular lesions. All patients were divided into three clinical groups, depending on the localization of vascular lesions with stenotic atherosclerosis. According to the correlation analysis, there is a direct correlation between the presence of clinical manifestations of cerebral insufficiency and the age of patients. In multifocal vascular lesions, chronic forms of cerebral ischemia (dyscirculatory encephalopathy) were recorded in 69.2% of patients who had a cerebral infarction, and in 87.0% of patients with TIA in the anamnesis. The most common concomitant pathology in patients with multifocal vascular disease is hypertension of various degrees and stages (92.8% of patients), type 2 diabetes (20.0%). In the study, a direct relationship was established between the degree of hypertension and the acute disorders of cerebral circulation. Infarctions of the brain in patients with multifocal vascular lesions occurred in 72.8%, mainly in the carotid basin, which is 3.2 times higher than the frequency of myocardial infarction in the vertebrobasilar basin. With simultaneous atherosclerotic lesions of the vessels of the brain, heart and lower limbs, there was no TIA as an independent form, but a clinical transition to a cerebral infarction was immediately noted. Repeated heart attacks took place in 28% of patients in the general group, mainly with simultaneous atherosclerotic lesions of the brain and heart vessels (31.0%) or all three basins (26.3%). In atherosclerotic lesions of the vascular basins of the brain and heart, CHD is manifested earlier (58.6%), and in the case of cerebral and lower extremity vessels, ischemia of the lower extremities (73.7%). The time interval between repeated cerebral infarctions was shorter in patients who continued to smoke 4.5 times. [ABSTRACT FROM AUTHOR]

In our investigation we studied the effect of complex medical treatment on the dynamics of the ankle-brachial index and extent of endothelial dysfunction in patients with multifocal atherosclerosis (peripheral arterial disease and chronic ischemic heart disease). Arterial insufficiency of the lower extremities and endothelial dysfunction were revealed in patients included in the study. The severity of arterial insufficiency of the lower extremities and endothelial dysfunction was more significant in patients with diabetes mellitus. The complex medical treatment provides the significant reduction of arterial insufficiency of the lower extremities and improves endothelial function in patients with multifocal atherosclerosis, including patients with diabetes mellitus.

Objectives: to study types of lesions of the aortic arch branches of the patients with concomitant lesions of the aortic arch branches, terminal part of the abdominal aorta and lower limb arteries. Material and methods. analyzed the results of examination of 181 operated patients with concomitant lesions of aortic arch branches and lower limb arteries. All patients were divided into three groups: Group one -- patients who underwent the first stage of the reconstruction carried out in the aortic arch branches (number of patients -- 31 (17.1%)); Group two -- patients who underwent the first stage of reconstruction of a terminal portion of the abdominal aorta and lower limb arteries (number of patients -- 120 (66.4%)); and Group three -- patients who were operated simultaneously on both arterial basins (number of patients -- 30 (16.5%)). Results The analysis of angiosemiotics of aortic arch branches shows, four types of lesions that influences to choice of surgical tactics: -- only stenoses in carotid and vertebral- subclavian segment; -- stenoses in carotid and occlusion vertebral -- subclavian segment; -- occlusion in carotid and stenosis in vertebral- subclavian segment; -- Occlusion in the carotid and vertebral- subclavian segment. Conclusions Analysis of the results of our study shows, that the recommendated classification well reflects the degree of severity of aortic arch branches lesions and usably to choice of surgical tactics. [ABSTRACT FROM AUTHOR]