Стенозирующий атеросклероз артерий головного мозга: современные стратегии диагностики и лечения больных
Стенозирующий атеросклероз артерий головного мозга: современные стратегии диагностики и лечения больных
Широков Е.А. Стенозирующий атеросклероз артерий головного мозга: современные стратегии диагностики и лечения больных. Consilium Medicum. 2016; 18 (9): 37–44. DOI: 10.26442/2075-1753_2016.9.37-44
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Shirokov E.A. Stenosing atherosclerosis of cerebral arteries: modern strategies for diagnosis and treatment of patients. Consilium Medicum. 2016; 18 (9): 37–44. DOI: 10.26442/2075-1753_2016.9.37-44
Стенозирующий атеросклероз артерий головного мозга: современные стратегии диагностики и лечения больных
Широков Е.А. Стенозирующий атеросклероз артерий головного мозга: современные стратегии диагностики и лечения больных. Consilium Medicum. 2016; 18 (9): 37–44. DOI: 10.26442/2075-1753_2016.9.37-44
________________________________________________
Shirokov E.A. Stenosing atherosclerosis of cerebral arteries: modern strategies for diagnosis and treatment of patients. Consilium Medicum. 2016; 18 (9): 37–44. DOI: 10.26442/2075-1753_2016.9.37-44
В статье обобщены современные принципы ведения больных с атеросклерозом артерий головного мозга. Представлены методы диагностики атеросклеротических стенозов экстра- и интракраниальных артерий головного мозга. Особое внимание автор уделил методам оценки индивидуального риска сосудистых осложнений. В статье подробно отражены современные стратегии антитромбоцитарной терапии у больных с высоким риском ишемического инсульта.
The article summarizes the modern principles of management of patients with atherosclerosis of the cerebral arteries. The article presents methods of diagnostics of atherosclerotic stenosis of extra- and intracranial cerebral arteries. Special attention is paid to methods of assessing individual risk of vascular complications. The article covers in detail current strategies of antiplatelet therapy in patients with high risk of ischemic stroke.
Key words: atherosclerosis of the cerebral arteries, carotid stenosis, antiplatelet therapy, dual antiplatelet therapy, atherothrombotic stroke.
1. Инсульт. Современные подходы диагностики, лечения и профилактики: методические рекомендации. Под ред. Д.Р.Хасановой, В.И.Данилова. М.: ГЭОТАР-Медиа, 2014. / Insul't. Sovremennye podkhody diagnostiki, lecheniia i profilaktiki: metodicheskie rekomendatsii. Pod red. D.R.Khasanovoi, V.I.Danilova. M.: GEOTAR-Media, 2014. [in Russian]
2. Профилактика хронических неинфекционных заболеваний. Рекомендации. М., 2013. http://www.angiologia.ru/specialist/ cathedra/recommendations/2013/001.pdf / Profilaktika khronicheskikh neinfektsionnykh zabolevanii. Rekomendatsii. M., 2013. http://www.angiologia.ru/specialist/ cathedra/recommendations/2013/001.pdf [in Russian]
3. Доклад о состоянии здоровья населения и организации здравоохранения по итогам деятельности органов исполнительной власти субъектов Российской Федерации за 2014 год. http://static-0.rosminzdrav.ru / Doklad o sostoianii zdorov'ia naseleniia i organizatsii zdravookhraneniia po itogam deiatel'nosti organov ispolnitel'noi vlasti sub"ektov Rossiiskoi Federatsii za 2014 god. http://static-0.rosminzdrav.ru [in Russian]
4. Бойцов С.А., Якушин C.С., Марцевич С.Ю. и др. Амбулаторно-поликлинический регистр кардиоваскулярных заболеваний в Рязанской области (РЕКВАЗА): основные задачи, опыт создания и первые результаты. Рациональная фармакотерапия в кардиологии. 2013; 9 (1): 4–14. / Boitsov S.A., Iakushin C.S., Martsevich S.Iu. i dr. Ambulatorno-poliklinicheskii registr kardiovaskuliarnykh zabolevanii v Riazanskoi oblasti (REKVAZA): osnovnye zadachi, opyt sozdaniia i pervye rezul'taty. Ratsional'naia farmakoterapiia v kardiologii. 2013; 9 (1): 4–14. [in Russian]
5. Chimowitz M.I. The Feinberg award lecture 2013. Treatment of intracranial atherosclerosis: leaning from the past and planning for the future. Stroke 2013; 44: 9: 2664–69.
6. Goldstein LB, Amarenco P, Zivin J et al. Statin treatment and stroke outcome in the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke 2009; 40: 3526–31.
7. Park J, Ovbiagele B. Optimal combination secondary prevention drug treatment and stroke outcomes. Neurology 2015; 6 (84): 150–6.
8. Фонякин А.В., Гераскина Л.А. Артериальная гипертония и оптимизация медикаментозной профилактики ишемического инсульта. Кардиология. 2016; 56 (2): 5–11. / Foniakin A.V., Geraskina L.A. Arterial'naia gipertoniia i optimizatsiia medikamentoznoi profilaktiki ishemicheskogo insul'ta. Kardiologiia. 2016; 56 (2): 5–11. [in Russian]
9. Heart Disease and Stroke Statistics—2016. Update. A Report From the American Heart Association. Circulation 2016; 133 (4): е38–е360.
10. Широков Е.А. Традиционные и перспективные методы оценки риска инсульта. РМЖ. 2014; 22: 1649–854. / Shirokov E.A. Traditsionnye i perspektivnye metody otsenki riska insul'ta. RMZh. 2014; 22: 1649–854. [in Russian]
11. Meschia J, Bushnell C et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American heart association/American stroke association. Stroke 2014; 28: 1–79.
12. Weissgerber A, Scholz M, Teren A et al. The value of noncoronary atherosclerosis for identifying coronary artery disease: results of the Leipzig LIFE Heart Study. Clin Res Cardiol 2016; 105: 172–81.
13. Балашенко Н.С. Подбор индивидуальной дозы аторвастатина при лечении каротидного атеросклероза у больных с артериальной гипертензией I–II степени. Вестн. ВГМУ. 2014; 13 (5): 59–67. / Balashenko N.S. Podbor individual'noi dozy atorvastatina pri lechenii karotidnogo ateroskleroza u bol'nykh s arterial'noi gipertenziei I–II stepeni. Vestn. VGMU. 2014; 13 (5): 59–67. [in Russian]
14. Bogiatzi C, Spence J. Secondary prevention after symptomatic large artery extracranial disease. Ischemic Stroke therapeutics. A comprehension guide. Switzerland: Springer international publishing, 2016.
15. Kernan W, Obliagele B, Black H et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–236.
16. Giles MF, Albers GW, Amarenco P et al. Early stroke risk and ABCD2 score performance in tissue – vs time defined TIA. Neurology 2011; 77: 1222–28.
17. Сумароков А.Б., Широков Е.А., Бурячковская Л.И. Антитромбоцитарная терапия в профилактике некардиоэмболического инсульта. Основные положения современных рекомендаций. М., 2015. / Sumarokov A.B., Shirokov E.A., Buriachkovskaia L.I. Antitrombotsitarnaia terapiia v profilaktike nekardioembolicheskogo insul'ta. Osnovnye polozheniia sovremennykh rekomendatsii. M., 2015. [in Russian]
18. Добровольский А.В. Клопидогрел в лечении заболеваний сердечно-сосудистой системы. РМЖ. 2009; 8: 558–67. / 18. Dobrovol'skii A.V. Klopidogrel v lechenii zabolevanii serdechno-sosudistoi sistemy. RMZh. 2009; 8: 558–67. [in Russian]
19. Miedema MD, Huguelet J, Virani SS. Aspirin for the Primary Prevention of cardiovascular disease: in need of clarity. Published online: 11 January 2016. DOI: 10.1007/s11883-015-0555-0
20. Berger J, Lala A, Krantz M et al. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials Am Heart J 2011; 162 (1): 115.e112–124.e112.
21. Газизов Р.М., Ацель Е.А. Применение ацетилсалициловой кислоты для первичной и вторичной профилактики сердечно-сосудистых заболеваний. РМЖ. Медицинское обозрение. 2014; 11: 827–31. / Gazizov R.M., Atsel' E.A. Primenenie atsetilsalitsilovoi kisloty dlia pervichnoi i vtorichnoi profilaktiki serdechno-sosudistykh zabolevanii. RMZh. Meditsinskoe obozrenie. 2014; 11: 827–31. [in Russian]
22. Ikeda Y, Shimada K, Teramoto T et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA 2014; 312 (23): 2510–20.
23. U.S. Preventive Services Task Force. Aspirin to prevent cardiovascular disease (CVD) and cancer: consumer guide (draft recommendation). http://www.uspreventiveservicestaskforce.org/Home/GetFileByID/2292. Accessed on September 28, 2015.
24. Инсульт: руководство для врачей. Под ред. Л.В.Стаховской, С.В.Котова. М.: Медицинское информационное агентство, 2013. / Insul't: rukovodstvo dlia vrachei. Pod red. L.V.Stakhovskoi, S.V.Kotova. M.: Meditsinskoe informatsionnoe agentstvo, 2013. [in Russian]
25. Diener HC, Sacco R, Yusuf S. PRoFESS Study Group. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes trial (PRoFESS). Cerebrovasc Dis 2007; 23: 368–80.
26. CAPRIE Steering Committee. A randomized, blinded, trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE). Lancet 1996; 348: 1329–39.
27. Фонякин А.В., Гераскина Л.А. Профилактика ишемического инсульта. Рекомендации по антитромботической терапии. Под ред. З.А.Суслиной. М.: ИМА-ПРЕСС, 2014. / Foniakin A.V., Geraskina L.A. Profilaktika ishemicheskogo insul'ta. Rekomendatsii po antitromboticheskoi terapii. Pod red. Z.A.Suslinoi. M.: IMA-PRESS, 2014. [in Russian]
28. Kennedy J, Ryckborst K et al. for the FASTER investigators: Fast Assessment of Stroke and Transient Ischemic Attack to prevent Early Recurrence (FASTER): a randomized controlled pilot trial. LancetNeurol 2007; 6: 961–9.
29. Amarenco P, Davis S, Jones R et al. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke 2014; 45: 1248–57.
30. Chen Z, Sandercokc P et al. Indications for Early Aspirin Use in Acute Ischemic Stroke A Combined Analysis of 40 000 Randomized Patients From the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke 2000; 31: 1240–9.
31. Li Z, Wang Y et al. Treatment effect of clopidogrel plus aspirin within 12 haurs of acute minor stroke or transient ischemic attack. J Am Heart Ass 2016. DOI: 10/1161/JAHA.115.003038.
32. National clinical guideline for stroke, 4th edition. London: Royal College of Physicians, 2012.
33. Мазур Н.А., Ломоносова А.А., Золозова Е.А. и др. Возможности коррекции высокой остаточной реактивности тромбоцитов на терапии дезагрегантами. Рос. кардиол. журн. 2012, 4 (96): 74–8. / Mazur N.A., Lomonosova A.A., Zolozova E.A. i dr. Vozmozhnosti korrektsii vysokoi ostatochnoi reaktivnosti trombotsitov na terapii dezagregantami. Ros. kardiol. zhurn. 2012, 4 (96): 74–8. [in Russian]
34. Naylor A. Time to rethink management strategies in asymptomatic carotid artery disease. Nat Rev Cardiol 2012; 9: 116–24.
35. Turan TN, Lynn MJ, Nizam A et al. SAMMPRISS investigators. Rational, design, and implementation of aggressive risk factor management in the Stenting and Aggressive Medical Management for Prevention of Recurent Stroke in intracranial Stenosis (SAMMPRIS) trial. Circ Cardiovasc Qual Outcomes 2012; 5: e51–e60.
36. Waters M, Hoh B, Lynn N et al. Factors associated with recurrent stroke in the medical group of the SAMMPRIS trial. JAMA Neurol. DOI: 10,1001/jamaneurol.2015.4315. Published online January 4, 2016.
________________________________________________
1. Insul't. Sovremennye podkhody diagnostiki, lecheniia i profilaktiki: metodicheskie rekomendatsii. Pod red. D.R.Khasanovoi, V.I.Danilova. M.: GEOTAR-Media, 2014. [in Russian]
2. Profilaktika khronicheskikh neinfektsionnykh zabolevanii. Rekomendatsii. M., 2013. http://www.angiologia.ru/specialist/ cathedra/recommendations/2013/001.pdf [in Russian]
3. Doklad o sostoianii zdorov'ia naseleniia i organizatsii zdravookhraneniia po itogam deiatel'nosti organov ispolnitel'noi vlasti sub"ektov Rossiiskoi Federatsii za 2014 god. http://static-0.rosminzdrav.ru [in Russian]
4. Boitsov S.A., Iakushin C.S., Martsevich S.Iu. i dr. Ambulatorno-poliklinicheskii registr kardiovaskuliarnykh zabolevanii v Riazanskoi oblasti (REKVAZA): osnovnye zadachi, opyt sozdaniia i pervye rezul'taty. Ratsional'naia farmakoterapiia v kardiologii. 2013; 9 (1): 4–14. [in Russian]
5. Chimowitz M.I. The Feinberg award lecture 2013. Treatment of intracranial atherosclerosis: leaning from the past and planning for the future. Stroke 2013; 44: 9: 2664–69.
6. Goldstein LB, Amarenco P, Zivin J et al. Statin treatment and stroke outcome in the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke 2009; 40: 3526–31.
7. Park J, Ovbiagele B. Optimal combination secondary prevention drug treatment and stroke outcomes. Neurology 2015; 6 (84): 150–6.
8. Foniakin A.V., Geraskina L.A. Arterial'naia gipertoniia i optimizatsiia medikamentoznoi profilaktiki ishemicheskogo insul'ta. Kardiologiia. 2016; 56 (2): 5–11. [in Russian]
9. Heart Disease and Stroke Statistics—2016. Update. A Report From the American Heart Association. Circulation 2016; 133 (4): е38–е360.
10. Shirokov E.A. Traditsionnye i perspektivnye metody otsenki riska insul'ta. RMZh. 2014; 22: 1649–854. [in Russian]
11. Meschia J, Bushnell C et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American heart association/American stroke association. Stroke 2014; 28: 1–79.
12. Weissgerber A, Scholz M, Teren A et al. The value of noncoronary atherosclerosis for identifying coronary artery disease: results of the Leipzig LIFE Heart Study. Clin Res Cardiol 2016; 105: 172–81.
13. Balashenko N.S. Podbor individual'noi dozy atorvastatina pri lechenii karotidnogo ateroskleroza u bol'nykh s arterial'noi gipertenziei I–II stepeni. Vestn. VGMU. 2014; 13 (5): 59–67. [in Russian]
14. Bogiatzi C, Spence J. Secondary prevention after symptomatic large artery extracranial disease. Ischemic Stroke therapeutics. A comprehension guide. Switzerland: Springer international publishing, 2016.
15. Kernan W, Obliagele B, Black H et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–236.
16. Giles MF, Albers GW, Amarenco P et al. Early stroke risk and ABCD2 score performance in tissue – vs time defined TIA. Neurology 2011; 77: 1222–28.
17. Sumarokov A.B., Shirokov E.A., Buriachkovskaia L.I. Antitrombotsitarnaia terapiia v profilaktike nekardioembolicheskogo insul'ta. Osnovnye polozheniia sovremennykh rekomendatsii. M., 2015. [in Russian]
18. Dobrovol'skii A.V. Klopidogrel v lechenii zabolevanii serdechno-sosudistoi sistemy. RMZh. 2009; 8: 558–67. [in Russian]
19. Miedema MD, Huguelet J, Virani SS. Aspirin for the Primary Prevention of cardiovascular disease: in need of clarity. Published online: 11 January 2016. DOI: 10.1007/s11883-015-0555-0
20. Berger J, Lala A, Krantz M et al. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials Am Heart J 2011; 162 (1): 115.e112–124.e112.
21. Gazizov R.M., Atsel' E.A. Primenenie atsetilsalitsilovoi kisloty dlia pervichnoi i vtorichnoi profilaktiki serdechno-sosudistykh zabolevanii. RMZh. Meditsinskoe obozrenie. 2014; 11: 827–31. [in Russian]
22. Ikeda Y, Shimada K, Teramoto T et al. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA 2014; 312 (23): 2510–20.
23. U.S. Preventive Services Task Force. Aspirin to prevent cardiovascular disease (CVD) and cancer: consumer guide (draft recommendation). http://www.uspreventiveservicestaskforce.org/Home/GetFileByID/2292. Accessed on September 28, 2015.
24. Insul't: rukovodstvo dlia vrachei. Pod red. L.V.Stakhovskoi, S.V.Kotova. M.: Meditsinskoe informatsionnoe agentstvo, 2013. [in Russian]
25. Diener HC, Sacco R, Yusuf S. PRoFESS Study Group. Rationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes trial (PRoFESS). Cerebrovasc Dis 2007; 23: 368–80.
26. CAPRIE Steering Committee. A randomized, blinded, trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE). Lancet 1996; 348: 1329–39.
27. Foniakin A.V., Geraskina L.A. Profilaktika ishemicheskogo insul'ta. Rekomendatsii po antitromboticheskoi terapii. Pod red. Z.A.Suslinoi. M.: IMA-PRESS, 2014. [in Russian]
28. Kennedy J, Ryckborst K et al. for the FASTER investigators: Fast Assessment of Stroke and Transient Ischemic Attack to prevent Early Recurrence (FASTER): a randomized controlled pilot trial. LancetNeurol 2007; 6: 961–9.
29. Amarenco P, Davis S, Jones R et al. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke 2014; 45: 1248–57.
30. Chen Z, Sandercokc P et al. Indications for Early Aspirin Use in Acute Ischemic Stroke A Combined Analysis of 40 000 Randomized Patients From the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke 2000; 31: 1240–9.
31. Li Z, Wang Y et al. Treatment effect of clopidogrel plus aspirin within 12 haurs of acute minor stroke or transient ischemic attack. J Am Heart Ass 2016. DOI: 10/1161/JAHA.115.003038.
32. National clinical guideline for stroke, 4th edition. London: Royal College of Physicians, 2012.
33. Mazur N.A., Lomonosova A.A., Zolozova E.A. i dr. Vozmozhnosti korrektsii vysokoi ostatochnoi reaktivnosti trombotsitov na terapii dezagregantami. Ros. kardiol. zhurn. 2012, 4 (96): 74–8. [in Russian]
34. Naylor A. Time to rethink management strategies in asymptomatic carotid artery disease. Nat Rev Cardiol 2012; 9: 116–24.
35. Turan TN, Lynn MJ, Nizam A et al. SAMMPRISS investigators. Rational, design, and implementation of aggressive risk factor management in the Stenting and Aggressive Medical Management for Prevention of Recurent Stroke in intracranial Stenosis (SAMMPRIS) trial. Circ Cardiovasc Qual Outcomes 2012; 5: e51–e60.
36. Waters M, Hoh B, Lynn N et al. Factors associated with recurrent stroke in the medical group of the SAMMPRIS trial. JAMA Neurol. DOI: 10,1001/jamaneurol.2015.4315. Published online January 4, 2016.
Авторы
Е.А.Широков
ФГБОУ ВО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
ЗАО Центр эндохирургии и литотрипсии. 111123, Россия, Москва, ш. Энтузиастов, д. 62 Evg-747747@yandex.ru
________________________________________________
E.A.Shirokov
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
Сlosed joint-stock company Center of endosurgery and lithotripsy. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 62 Evg-747747@yandex.ru