Vol 3, No 1 (2009)

Acute stroke is one of the most important complications of corоnary artery bypass grafting surgery (CABG) and valve replacement in the setting of assisted circulation. Therefore the cerebral protection becomes the crucial part of preoperative care. We performed prospective randomized controlled trial to estimate the efficacy of cytoflavin in 103 patients (94 men, 9 women) with ischemic heart disease (ICD) and acquired valve disease who undergone CABG and valve replacement surgery. The patients were divided into 4 groups. Group 1 (main) consisted of 32 patients with ICD (mean age 55.7±7.9 years) who underwent CABG and received 20 ml of cytoflavin i.v. in 3 consecutive days before and 3 days after surgery. Group 2 (control) included 40 patients with ICD (mean age 48.2±12.6 years) and CABG without cytoflavin. Thirteen patients with valve disease (mean age 53.1±8.4 years) were randomized in Group 3 (main); they underwent valve replacement and were treated with cytoflavin using the same regimen (20 ml i.v. in 3 days before and 3 days after surgery). Group 4 (control) was comprised of 18 patients with valve disease (mean age 48.2±12.0 years) and surgery without cerebral protection with cytoflavin. One month after the intervention significant improvement (p<0.05) was observed in Group 1 vs. Group 2 in the dynamic modality of cognitive performance, recent memory and long-term memory, and clear trend to improvement in the same variables in Group 3 vs. Group 4. Moreover, in Group 2 (CABG without treatment) significant deterioration was observed in long-term memory (p=0.028), along with the distinct trend towards worsening in Group 4 in recent and long-term memory. As an effective antioxidant, cytoflavin renders reliable neuroprotective effect in patients whо underwent CABG in the setting of assisted circulation and improves cognitive functioning and emotional well-being. Cytoflavin ameliorates absolute characteristics of long-term and recent memory in patients after valve replacement surgery. Cytoflavin improves absolute parameters of cognitive evoked potentials (P300) decreasing the latency and increasing the amplitude in patients after CABG and valve replacement. Cytoflavin is recommended for use in patients with ICD and acquired valve disease who underwent CABG and valve replacement in the setting of assisted circulation.

In the study “Register of Stroke”, which was hold on in Seversk (Tomsk region) with the population of 111 500 residents, the age-standardized stroke incidence was 3.99 cases in 2002 and 3.76 cases in 2003 per 1000 persons, and the lethality was 1.03 and 1.02, respectively (European population was used as a standard). Lethality in all types of stroke was 25.9%, that was lower compared to other regions of Russia. In multiple regression analysis arterial hypertension, heart diseases and smoking were the main risk factors of stroke in Seversk. 94.5% of patients were treated in specialized neurological clinics. Clinical predictors of fatal outcome (death) were detected.

We present clinical and morphological study of intracranial dissection of carotid artery and its branches led to massive brain infarct in practically health 23-year old female patient. Clinical picture was presented with sudden development of right sided hemiplegia, aphasia and left sided headache. Magnetic resonance image and ultrasound study showed increasing occlusion of the left intracranial internal carotid artery (ICA), middle (MCA) and anterior cerebral artery (ACA). On 11 day of disease lethal exit occurred. Autopsy study showed that the lumen of ICA, ACA and MCA was filled with a dense dark-red mass suggested to be intra-arterial thrombi. However microscopic study demonstrated that this mass was the hemorrhage in the arterial wall (intramural hematoma) which completely occluded its lumen. At the different levels of extraand intracranial arteries microscopy revealed pronounced dysplastic changes in the arterial wall (fibromuscular dysplasia), which were the main cause predisposed to arterial wall dissection and development of intramural hematoma. Presented observation demonstrates that dissection with intramural hematoma formation may be the cause of intracranial occlusion. On differential diagnosis with thrombosis one should take into consideration the absence of clinical and laboratory thrombophylic manifestations as well as atherosclerotic changes in cerebral arteries in patient with artery dissec- tion.