An Electro-Optical Method for Differential Diagnosis of Pathologies of Blood Supply to the Brain

This work is devoted to the development of a new simplified method for express diagnostics of cerebral blood supply disorders of a vertebrogenic and non-vertebral nature based on electrocardiogram and photoplethysmogram data. The research was conducted using the example of vertebral artery syndrome in osteochondrosis of the cervical spine and somatoform dysfunction of the autonomic nervous system, respectively. Several experimental studies into the dynamics of heart rate variability and differential indicators of the coordinated work of the heart and blood vessels were carried out according to the data of electrocardiography and photoplethysmography. Three experimental groups included healthy volunteers and volunteers with cerebral blood supply disorders connected with either the loss of plasticity and narrowing of brain blood vessels or their mechanical squeezing. According to the research results, statistically significant (with a significance level of less than 0.05) differences by a number of indicators were revealed between the experimental groups. A conventional discriminant analysis of the indicators of the coordinated work of the heart and blood vessels was carried out for all experimental groups in order to determine criteria for differentiating people with vertebrogenic disorders, non-vertebral disorders and healthy volunteers. It is concluded that three variables can be used for such differentiation, each of which describes the coordinated work of the heart and blood vessels in a specific way.

Chronic Brain Ischemia: From Risk Factors to Cerebrovascular Complications

Chronic cerebral ischemia is a polyetiological, chronic progressive dysfunction of the brain caused by diffuse and / or small focal damage to the brain tissue in conditions of prolonged insufficiency of cerebral blood supply. The review reflects the current understanding of chronic cerebral ischemia. The main pathogenetic mechanisms of the onset of chronic cerebral ischemia in patients with arterial hypertension, atherosclerosis and smoking are outlined.

Biomechanical Aspects of Closing Approaches in Postcarotid Endarterectomy

The carotid bifurcation tends to develop atherosclerotic stenoses which might interfere with cerebral blood supply. In cases of arterial blockage, the common clinical solution is to remove the plaque via carotid endarterectomy (CEA) surgery. Artery closure after surgery using primary closures along the cutting edge might lead to artery narrowing and restrict blood flow. An alternative approach is patch angioplasty which takes longer time and leads to more during-surgery complications. The present study uses numerical methods with fluid-structure interaction (FSI) to explore and compare the two solutions in terms of hemodynamics and stress and strain fields developed in the artery wall.

Cerebral misery perfusion due to carotid occlusive disease

PurposeCerebral misery perfusion (CMP) is a condition where cerebral autoregulatory capacity is exhausted, and cerebral blood supply in insufficient to meet metabolic demand.We present an educational review of this important condition, which has a range of clinical manifestations.MethodA non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease, using Pubmed and Sciencedirect.FindingsPatients with CMP may present with strokes in watershed territories, collapses and transient ischaemic attacks or episodic movements associated with an orthostatic component. While positron emission tomography is the gold standard investigation for misery perfusion, advanced MRI is being increasingly used as an alternative investigation modality. The presence of CMP increases the risk of strokes. In addition to the devastating effect of stroke, there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease (COD) and misery perfusion. The evidence for revascularisation in the setting of complete carotid occlusion is weak. Medical management constitutes careful blood pressure management while addressing other vascular risk factors.DiscussionThe evidence for the management of patients with COD and CMP is discussed, together with recommendations based on our local experience. In this review, we focus on misery perfusion due to COD.ConclusionPatients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many specialties. Early identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow, while avoiding potentially harmful treatment.