Атеросклероз сонных артерий: клиническое значение (обзор литературы)

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.

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