vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2023.3.CLIN.2vmireaviz-721Research ArticleКлиническая медицинаClinical medicineАтеросклероз сонных артерий: клиническое значение (обзор литературы)Atherosclerosis of the carotid arteries: clinical significance (a literature review)https://orcid.org/0000-0003-3472-9855ФедоринаМ. А.FedorinaM. A.

Федорина Марина Александровна, врач функциональной диагностики, ведущий специалист МНОЦ Кардиоваскулярной патологии и кардиовизуализации

ул. Чапаевская, д. 89, Самара, 443099

Marina A. Fedorina, Doctor of functional diagnostics, leading specialist in Cardiovascular Pathology and Cardiovisualization

89 Chapaevskaya str., Samara, 443099

selihovama@gmail.comhttps://orcid.org/0000-0003-0645-7645ДавыдкинИ. Л.DavydkinI. L.

Давыдкин Игорь Леонидович, д-р мед. наук, профессор, проректор по научной и инновационной работе, заведующий кафедрой госпитальной терапии с курсом поликлинической терапии и трансфузиологии

ул. Чапаевская, д. 89, Самара, 443099

Igor L. Davydkin, Dr. Sci. (Med.), Professor, Vice-Rector for Scientific and Innovative Work, Head of the Department of Hospital Therapy with a course of polyclinic Therapy and Transfusiology

89 Chapaevskaya str., Samara, 443099

i.l.davydkin@samsmu.ruhttps://orcid.org/0000-0003-4833-4563ГермановаО. А.GermanovaO. A.

Германова Ольга Андреевна, канд. мед. наук, доцент, директор международного НОЦ кардиоваскулярной патологии и кардиовизуализации

ул. Чапаевская, д. 89, Самара, 443099

Olga A. Germanova, Cand. Sci. (Med.), Associate Professor, Director of the International Center for Cardiovascular Pathology and Cardiovisualization

89 Chapaevskaya str., Samara, 443099

o.a.germanova@samsmu.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation2023280420231334146Copyright © Федорина М.А., Давыдкин И.Л., Германова О.А., 20232023Федорина М.А., Давыдкин И.Л., Германова О.А.Fedorina M.A., Davydkin I.L., Germanova O.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/721

Атеросклеротическое поражение сонных артерий увеличивает риск развития ишемического инсульта, при этом наблюдаются различные клинические проявления от бессимптомного течения до летального исхода. Церебральный кровоток зависит не только от степени стеноза, но и от проходимости коллатеральных путей, влияя на выраженность клинической картины. Разработаны критерии гемодинамической значимости стенозов сонных артерий и, основанные на них, показания для хирургического лечения. Но есть группа пациентов с бессимптомным каротидным стенозом и пограничными значениями при оценке гемодинамической значимости атеросклеротических бляшек, у которых сохраняется риск развития ишемического инсульта. Таким образом, существует необходимость оценки коллатерального церебрального кровообращения и влияния степени стеноза на церебральную перфузию. Так же интерес представляет оценка гемодинамики в месте каротидного стеноза и оценка церебральной ауторегуляции во время нагрузочного тестирования. Это поможет в отборе пациентов с бессимптомным каротидным стенозом, которые имеют повышенный риск инсульта, и у которых будет польза от реваскуляризации.

Сarotid atherosclerotic disease increase the risk of ischemic stroke, with various clinical manifestations from asymptomatic to fatal. Cerebral blood flow depends not only on the degree of stenosis, but also on the patency of the collateral tract, affecting the severity of the clinical picture. Criteria for the hemodynamic significance of carotid artery stenosis and, based on them, indications for surgical treatment have been developed. But there is a group of patients with asymptomatic carotid stenosis and borderline values in assessing the hemodynamic significance of atherosclerotic plaques, who remain at risk of ischemic stroke. Thus, there is a need to assess the collateral cerebral circulation, and the impact of the degree of stenosis on cerebral perfusion. Also of interest is the assessment of hemodynamics at the site of carotid stenosis and the assessment of cerebral autoregulation during exercise testing. This will help in selecting patients with asymptomatic carotid stenosis who are at increased risk of stroke and who would benefit from revascularization.

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The authors declare that there are no conflicts of interest present.