Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector563010.17750/KMJ2016-846Research ArticleThe structure of atherosclerotic plaques of the arteries estimated at ultrasonography in patients with acute ischemic strokeKhalilovI Gznr85@mail.ruZakirzhanovN Rznr85@mail.ruSharafislamovI Fznr85@mail.ruBayazovaN Iznr85@mail.ruYaroshkevichG Eznr85@mail.ruCity clinical hospital №7Kazan state medical academy1512201697684685018112016Copyright © 2016, Khalilov I.G., Zakirzhanov N.R., Sharafislamov I.F., Bayazova N.I., Yaroshkevich G.E.2016<p><strong>Aim.</strong> Evaluation of histological structure of an atherosclerotic plaque of the carotids received during carotid endarterectomy and its comparison to the data obtained at ultrasonography of carotids.</p><p><strong>Methods.</strong> 36 patients with the history of cerebral circulatory disorders aged from 50 to 75 years (24 males and 12 females) were examined. 22 patients (14 males and 8 females) had ischemic focus at CAT scan, 7 patients had recurrent ischemic stroke and the rest had transient ischemic attacks. We performed color duplex scanning of extracranial vessels. In addition to ultrasonography contrast intensifying was performed. Sulfur hexafluoride stabilized by phospholipid shell was used as a contrast. Transcranial Doppler with functional assays was carried out as well. Pathomorphological study of the plaques removed at carotid endarterectomy was conducted.</p><p><strong>Results.</strong> According to the results of ultrasonography conducted before the surgery and histological results, 28 plaques received during carotid endarterectomy were unstable. 60 to 90% stenoses of carotid bifurcation and internal carotids were revealed. Heterogeneous structure, disturbance of fibrous cap and ulcerations, presence of hypoechoic zones of various sizes were observed.</p><p><strong>Conclusions.</strong> The results of ultrasonography are in accordance with histological conclusion; this method is a reliable tool that provides new opportunities for prediction of embolic complications risk and proves the necessity for carotid endarterectomy.</p>atherosclerosisischemic strokeunstable plaquecarotid arteriesultrasonographycontrast intensifyingатеросклерозишемический инсультнестабильная бляшкасонные артерииультразвуковое исследованиеконтрастное усиление[Белл П.Р.Ф. Каротидная эндартерэктомия. Ангиол. и сосудист. хир. 1995; (3): 14-24.][Национальные рекомендации по ведению пациентов с заболеваниями брахиоцефальных артерий. Ангиол. и сосудист. хир. 2013; (2): 12-13.][Покровский А.В. Эверсионная каротидная эндартерэктомия. Ж. неврол. и психиатр. 2003; 9: 208.][Суслина З.А. Очерки ангионеврологии. М.: Атмосфера. 2005; 102-107.][Тимина И.Е., Бурцева Е.А., Скуба Н.Д. и др. Сопоставление структуры атеросклеротической бляшки в сонной артерии по данным комплексного ультразвукового и гистологического исследований. Ультразвуковая и функционал. диагн. 2004; (3): 81-87.][Цвибель В., Пеллерито Дж. Ультразвуковое исследование сосудов. М.: Видар. 2008; 163.][Bassiouny H., Sakaguchi Y., Mikucki S. et al. Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. J. Vascul. Surg. 1997; 26: 585-594. http://dx.doi.org/10.1016/S0741-5214(97)70056-9][Carr S., Farb A., Pearce W. et al. Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J. Vascul. Surg. 1996; 23: 755-766. http://dx.doi.org/10.1016/S0741-5214(96)70237-9][Fisher M., Paganini-Hill A., Martin A. et al. Carotid plaque pathology. Thrombosis, ulceration and stroke pathogenesis. Stroke. 2005; 36: 253-257. http://dx.doi.org/10.1161/01.STR.0000152336.71224.21][Husain T., Abbott C., Scott J., Gough M. Macrophage accumulation within the cap of carotid atherosclerotic plaques is associated with the onset of cerebral ischemic events. J. Vascul. Surg. 1999; 30: 269-276. http://dx.doi.org/10.1016/S0741-5214(99)70137-0][Kolodgie F.D., Narula J., Yuan C. et al. Elimination of neoangiogenesis for plaque stabilization: is there a role for local drug therapy? J. Am. Coll. Cardiol. 2007; 49 (21): 2093-2101. http://dx.doi.org/10.1016/j.jacc.2006.10.083][Libby P. Atherosclerosis: the new view. Sci. Am. 2002; 286: 46-55. http://dx.doi.org/10.1038/scientificamerican0502-46][Moore W., Barnett H., Beebe H. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad hoc Committee, American Heart Association. Circulation. 1995; 91: 566-579. http://dx.doi.org/10.1161/01.CIR.91.2.566][Shah F., Balan P., Weinberg M. et al. Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? Vascul. Med. 2007; 12: 291-297. http://dx.doi.org/10.1177/1358863x07083363][Weskott H.-P., Canestrini S., Chami L. et al. Contrast sonography. Uni-med. 2014; 19: 245-246.]