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Characteristics of multi spiral angiography in patients with multi focal atherosclerosis
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Zufarov Mirjamol Mirumarovich, MD, PhD, FACC. Deputy Director of High Technology Head of the department of Interventional Cardiology and Cardiac Arrhythmias' The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional Cardiology
and Cardiac Arrhythmias'» Makhkamov Najmiddin Kozimivich, MD., Intervention Cardiologist The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional
Cardiology and Cardiac Arrhythmias'» Babadjanov Sandjar Abdumurodovich, MD., Intervention Cardiologist The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional
Cardiology and Cardiac Arrhythmias'» E-mail: mbshakur@mail.ru
Characteristics of multi spiral angiography in patients with multi focal atherosclerosis
Abstract: Development and improvement of diagnostic methods provide definition of location and expression degree of atherosclerotic lesion in cases of multi focal atherosclerosis with greater accuracy. As a result of the study we noted a great prevalence of calcinosis of vascular lumen in patients with MFA, especially in the elder age group. Keywords: multi focal atherosclerosis, diagnostics, vascular calcinosis.
Ischemic heart disease (IHD) and brain insult were and still tion of a plaque. Oppositely in case of vast calcification of vascular are the main reason of population lethality and invalidization [1]. lumen there is high possibility of presence of unstable plaques Playing a leading role in the pathogenesis of these diseases, in the tend for rapture [5].
majority of cases atherosclerosis causes lesion of several vascular Many authors think that calcinosis of carotid arteries indi-
lumens [2], and that demands a complex assessment of altera- cates stability of a plaque and it is linked with presence of clinical tions in vascular lumen, definition of the tactics and strategy of symptoms of ischemic lesion of brain [9]. In other studies there revascularization. Traditionally the methods used for that are was no data about the link of carotid plaques' calcification with fo-radiological diagnostic ones (ultra sound, x-ray selective angiog- cal alterations of the cerebral white matter [7]. Besides the qualita-raphy, computer tomography, magnetic resonance imaging) [3]. tive analysis of the structure of non-coronary plaques there is also Taking into account the variability of morphology for roent- quantitative assessment of calcinosis by means of MSCT method genologic visualization methods the most available ones are cal- analogic to coronary arteries [8].
cinated atherosclerotic plaques due to high roentgen density. It is Aim: to assess the character of MSCT-angiography peculiari-
calcinosis that serves to be a marker of not only terminal but also ties in patients with MFA.
early stages of atherosclerosis; and MSCT method is the best for Materials and methods: The work was based on the study
quantitative assessment of vascular lumen calcinosis from the of the check up and endovascular therapy results in 47 patients point of view of validation and verification, reflecting the prog- with multi focal lesion of coronary and extra cranial arteries. In the nosis of the lesion of cardiac vascular system [4, 6]. At the same definition of the indications to stenting of inner carotid arteries we time we cannot state that expressed calcinosis indicates stabiliza- took into account the following: clinical manifestations ofvascular-
Section 6. Medical science
cerebral failure, hem dynamic significance of stenosis, presence of narrowings in counter-lateral ICA and vertebral arteries, and atherosclerotic alterations in the other arterial lumens.
The age of the patients varied from 56 to 80 years old (average 58.2±1.2 years). Among them 38 (80.8%) patients were male and 9 (19.14%) female. Degree of narrowing of ICA varied from 70% to 95%, and average was 86.7 ± 8.2%.
28 (62.2%) patients in anamnesis had (acute disorders of cerebral circulation) ADCC, 17 (37.7%) patients had common cerebral symptoms of blood circulation disorders including vertebral basillary system. 2 (4.25%) patients out of the total number had bicarotid bilateral lesion of ICA, 6 (12.7%) had occlusion of counter lateral ICA. 8 (17%) patients had stenosis ofvertebral arteries (VA), 3 (6.38%) patients had diagnozed occlusion of a vertebral artery.
The majority of the patients had severe associate diseases, linked with multi focal atherosclerosis. Tension angina of the III functional class (FC) was noted in 40 (85.1%) patients, IV FC in 7 (14.8%) patients, myocardial infarction in anamnesis was registered in 28 (59.5%) patients, arterial hypertension was observed in all patients. 42 (89.3%) out ofall patients had diabetes melitus in history; 18 ofthem (42.8%) had insulin-dependent mild form subcompensation stage.
MSCT-angiography was done according to standard method in 47 patients. Among them there were two patients with arythmia (atrial fibrillation and often extra systol). For the decrease of heart rate we applied fi-blockers 1 hour before per oral test. Some of the patients had empiric mean delay of scanning after the start of contrast substance injection — 17-20 hours. For the choice of the optimal stage of cardiac cycle in the permormance of image retrospective reconstructions we used the recommendations of the manufacturer firm. In complience with these recommendations an "ideal window" was within 40% — 55% interval RR on ECG and it drpends on the heart rate. Every patient had from one to three reconstructions.
Statistical processing of the data was performed with the help of Statistica 6.0 program package using Mann-Whitney criteria and Spirmen's non-parametric correlation analysis. The differences were considered to be statistically significant with p < 0.05.
Results of the study. The majority of the patients (83.0%) in MSCT-angiography had steady type of coronary blood supply, less — sinistral and dextral types (12.8% and 4.3% respectively). In 63.8% of the patients the structure of the coronary lumen was usual, while in 36.2% of the patients we revealed other variants of the structure such
as trifurcation of the lrft coronary artery branch or its absence, hypoplasia of the segments of the right coronary and round artery.
In MSCT-angiography atherosclerotic plaques which do not cause significant hem dynamic narrowings we revealed in 61.7% patients in 101 arteries, 190 segments. These narrowings were mostly located in proximal (51.1%) and medial (29.8%), less in distal (6.4%) segments and lateral branches (10.6%).
Hem dynamic significant stenosis were detected in 44 patients in 62 arteries, 83 segments, among which medial ones occupied 46.8%, proximal — 29.8%, distal — 6.4%, and lateral branches 10.6%.
High frequency of atherosclerosis in proximal and medial segments of coronary vessels was conditioned by the greater tendency for pressure of systolic peaks.
For the definition of the factors effecting the change of plaque density in carotid and coronary lumen we performed regression analysis in relation with the traditional risk factors for the development of atherosclerosis and IHD. As a result both lumens have shown reliable strong link of the plaque density only with age (r=0.562) and presence of associate diabetes melitus (r=0.448).
X- ray density of the plaques in coronary arteries measured in Haunsfield units in the groups was not reliably different independently of the age. And the equivalent plaque density was reliably lower in 45-60 years old patients.
Mostly it occurs because of the increase of the amount of calcinated PCA in patients above 60. In 45-60 years old patients the amount of calcinated PCA was 0.40±0.07, and above 60 years old — 1.12±0.22. Progressing calcinosis of carotid lumen in the elder age group is linked with large number of traditional factors: AH, smocking, dyslipidemia, disorders of carbohydrate exchange.
In performance of MSCT-angiography of coronary arteries and PCA in the studied group we registered no patient with unfavorable phenomena or side-effect to injection of roentgen contrast substance.
Conclusion. Development and improvement of diagnostic strategies provide definition of the location and expression degree of the atherosclerotic lesion in multi focal atherosclerosis. The working out of the common principles of monitoring of that category of patients should help optimization of the diagnostic approach and the choice of the tactics of the further surgery. Thus, as a result of the study we noted a great prevalence of vascular lumen calcinosis in the patients with MFA, especially in the elder age group.
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