Age and Sex Differences in Cerebral Circulation in Patients with Cerebral Atherosclerosis and Diabetes mellitus
Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.
The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.
Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).
Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both common carotid arteries: in women with CA stages I-II, the rate of cerebral blood flow was higher than in men.Conclusions. For patients with stage III CA and T2DM, age and sex differences in the parameters of cerebral circulation both in the vessels of the carotid and in the vessels of the vertebro-basilar basins have not been established. Elderly patients with stage I–II CA and T2DM, in comparison with middle-aged patients, are characterized by a statistically significantly higher LSBFV in the vessels of the carotid basin and lower in the vessels of the vertebro-basilar basin. The rate of cerebral blood flow in female patients with stage I–II CA and diabetes mellitus is statistically significantly higher in both common carotid arteries, in contrast to the corresponding LSBFV indicators in male patients.
Kristensen T, Hovind P, Iversen HK, Andersen UB. Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack. Clin Physiol Funct Imaging. 2018;38:617–621. doi: 10.1111/cpf.12456.
Lan W-C, Chen Y-H, Liu S-H. Non-invasive imaging modalities for the diagnosis of coronary artery disease: the present and the future. Tzu Chi Med J. 2013;25:206–212. doi: 10.1016/j.tcmj.2013.04.004.
Loizou CP. A review of ultrasound common carotid artery image and video segmentation techniques. Med Biol Eng Comput. 2014;52:1073–1093. doi: 10.1007/s11517-014-1203-5.
Menchón-Lara RM, Sancho-Gómez JL, Bueno-Crespo A. Early-stage atherosclerosis detection using deep learning over carotid ultrasound images. Appl Soft Comput J. 2016;49:616–628. doi: 10.1016/j.asoc.2016.08.055.
Naqvi TZ, Lee M-S. Carotid Intimamedia thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging. 2014;7:1025–1038. doi: 10.1016/j.jcmg.2013.11.014.
Onanno LIB, Arino SIM, Ramanti PLB, Ottile FAS. Validation of a computer-aided diagnosis system for the automatic identification of carotid atherosclerosis. Ultrasound Med Biol. 2019;41:509–516.
Ovbiagele B, Goldstein LB, Higashida RT, Howard VJ, Johnston SC, Khavjou OA, et al. Forecasting the future of stroke in the united states: a policy statement from the American heart association and American stroke association. Stroke. 2013;44:2361–2375. doi: 10.1161/STR.0b013e31829734f2.
Ricotta JJ, Pagan J, Xenos M, Alemu Y, Einav S, Bluestein D. Cardiovascular disease management: the need for better diagnostics. Med Biol Eng Comput. 2008;46:1059–1068. doi: 10.1007/s11517-008-0416-x.
Saba L, Sanfilippo R, Sannia S, Anzidei M, Montisci R, Mallarini G, et al. Association between carotid artery plaque volume, composition, and ulceration: a retrospective assessment with MDCT. Am J Roentgenol. 2012;199:151–156. doi: 10.2214/AJR.11.6955.
Yamauchi K, Enomoto Y, Otani K, Egashira Y, Iwama T. Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging. J Neurointerv Surg. 2018;10:579–582. doi: 10.1136/neurintsurg-2017-013259.
Zhang X, Jie G, Yao X, Dai Z, Xu G, Cai Y, et al. DSA-based quantitative assessment of cerebral hypoperfusion in patients with asymmetric carotid stenosis. Mol Cell Biomech. 2019;16:27–39. doi: 10.32604/mcb.2019.06140.
Zhao S, Gao Z, Zhang H, Xie Y, Luo J, Ghista D, et al. Robust segmentation of intima-media borders with different morphologies and dynamics during the cardiac cycle. IEEE J Biomed Health Inform. 2018;22:1571–1582. doi: 10.1109/JBHI.2017.2776246.
Кузнецова С.М., Кузнецов В.В., Егорова М.С., Шульженко Д.В. Особенности церебральной гемодинамики у больных атеротромботическим и кардиоэмболическим ишемическим инсультом в восстановительный период. Международный неврологический журнал, 2011; №2 (40), 18–22.