Effects of dipyridamole and its use in neurology

Dipyridamole has been on the pharmaceutical market since 1959 and, as a pyrimidyl-pyrimidine compound, has a variety of mechanisms of action. The very first action of dipyridamole was its antianginal effect. In subsequent years, attention was drawn to the antiplatelet properties of dipyridamole, which are related to inhibition of platelet phosphodiesterase as well as to blocking adenosine transport. Another important property of dipyridamole is its effect on the deformability of red blood cells, thereby improving microcirculation. Dipyridamole affects changes in the dynamics of platelet activity and vascular reactivity and causes improvement of cerebral perfusion. Due to its pronounced antiplatelet properties, the drug has been widely studied for the prevention of ischemic strokes and transient ischemic attacks, both as monotherapy and in combination with other drugs. Unlike other platelet antiaggregants, dipyridamole does not have a damaging effect on mucous membranes. Its antiplatelet effect is not accompanied with inhibition of cyclooxygenase activity and reduction of prostacyclin synthesis. In the treatment of cerebral circulation disorders, dipyridamole can be used to control the antithrombotic effect by selecting the optimal dose of the drug. Dipyridamole has antioxidant properties, enhances NO-mediated pathways, has indirect anti-inflammatory effects via adenosine and prostaglandin-2 as well as direct anti-inflammatory effects and several other effects. Dipyridamole is considered a safe drug based on decades of clinical experience. Its side effects are usually limited and transient. Given the diverse effects of dipyridamole, it can be used for a wide range of pathologies other than thrombosis prevention. Data on the efficacy and safety of dipyridamole in various diseases of the neurological spectrum are presented.

HEMORHEOLOGIC PROFILE AND MICROCIRCULATORY HEMOSTASIS IN PATIENTS WITH CEREBROVASCULAR DISEASE IN DIABETES MELLITUS

Diabetes mellitus is one of the most serious issues faced nowadays both by medicine and society in general, which is due to the wide spread of endocrine issues affecting nearly every country globally, the growing incidence rate, as well as the severity of complications that are hard to treat. Type 2 diabetes mellitus increases significantly the risk of developing acute cerebral blood circulation disorders, which urges further comprehensive studies focusing on the role played by the vascular-platelet relation and coagulation hemostasis in the development and progression of diabetic vascular complications. The results of our study, which involved 74 patients with acute cerebral circulation disorders against type 2 diabetes mellitus revealed alterations affecting the hemostasis system. This could be seen from activated vascular-platelet and coagulation links, decreased anticoagulant activity, and a slowdown in fibrinolysis. The severity of disorders induced by the alterations in the hemorheological profile and the microcirculatory hemostasis are associated with the duration of type 2 diabetes mellitus and the carbohydrate metabolism indicators (hyperglycemia, increased HbA1c levels and glycation end products).

Therapeutic correction of ischemic brain injuries in brachycephaly dogs

The article presents data on the features of cerebral circulation disorders in dogs of brachycephalic breeds. The anatomical breed prerequisites that overload the small circulatory system and, as a result, increase the state of hypoxia are listed. Data from neurological examinations and laboratory studies of such animals are presented. The effectiveness and expediency of using the drug Mexidol-Vet® in animals of this group have been proved. Recommendations for taking the drug to prevent relapses are given.

COMPARATIVE ANATOMY OF THE STRUCTURE OF THE VILLISIAN CIRCLE IN PERSONS WITH CEREBRAL CIRCULATION DISORDERS AND WITHOUT SIGNS OF PATHOLOGY

The study is devoted to the study of the anatomy of the Willis circle of people with and without cerebral circulation pathology. We studied 243 angiograms (men and women of different age groups from 18 to 72 years old). Of these, 120 patients had no signs of cerebrovascular pathology, 123 patients had various kinds of cerebral circulation disorders. Only in 32% of cases, when studying 120 MR-angiograms of persons without cerebral circulation disorders, a classical type of structure of the arterial bed was revealed. In 68% of the subjects, structural anomalies were found, namely: 23% hypoplasia of the anterior communicating artery, 21% aplasia or hypoplasia of one of the posterior communicating arteries, 17% combination of aplasia of the anterior communicating arteries and aplasia of one of the posterior communicating arteries, 4% aplasia of the anterior and both posterior connecting arteries, 3% parietal contact of both anterior cerebral arteries. A study of the Willis circle of patients with cerebrovascular pathology revealed: 2% have a classic variant of the structure, 53% have aplasia of one of the posterior communicating arteries, aplasia of both posterior communicating arteries 26%, 19% a variant in which aplasia of the anterior and posterior communicating arteries is combined. Based on the foregoing, the classical type of structure of the arterial circle of the brain is the most optimal option for ensuring collateral blood flow.

Results of carotid stenting for asymptomatic carotid artery stenosis

Objective: prospective analysis of 30-day outcomes from stenting procedure in patients with asymptomatic internal carotid artery stenosis depending on the type of implanted stent. Material and Methods: the study included 108 patients who underwent endovascular surgical treatment for asymptomatic internal carotid artery stenosis from 2012 to 2017. Depending on the type of implanted stent the patients were divided into 4 groups (the first (n = 37) – steel, the second (n = 32) -nitilon, the third (n = 20) – doublelayered stents, the fourth (n = 19) – double-layer stents with an inner layer of polyethylene terephthalate. Results: there was no mortality in the studied groups for 30 days after surgery. The cumulative incidence of cerebral circulation disorders within 30 days of carotid angioplasty and stenting was 9.7% (n = 10), with ischemic stroke occurring in 1.85% (n = 2) cases. Conclusion: carotid angioplasty and stenting is a safe and effective method of secondary prevention of cerebral circulation disorders with the level of perioperative complications not exceeding other preventive procedures.

Assessment of severity and pattern of irreversible organ damage in patients with systemic lupus erythematosus and systemic scleroderma

The article is devoted to the study of the degree and pattern of irreversible changes in the organs and systems of the body using the SLICC damage index in patients with systemic lupus erythematosus (SLE) and systemic scleroderma (SSc) with a disease duration of more than 5 years. Data were obtained from a high incidence of adverse changes in patients with SLE and SSc. In patients with SLE, adverse changes in the cardiovascular system, central nervous system in the form of acute cerebral circulation disorders and seizures, as well as venous thrombosis, damage to the organ of vision in the form of cataracts, proteinuria (more than 3.5 g per day) and alopecia prevailed. Patients with SSc more often developed lesions of the respiratory organs in the form of pulmonary fibrosis and pulmonary hypertension, the musculoskeletal system, skin and neuropathy of the cranial nerves and peripheral nerves.