PECULIARITIES OF THE BRAIN CIRCULATION
AND MICROCIRCULATION RESTORATION
IN PATIENTS WITH ALZHEIMER'S DISEASE
IN IMMEDIATE AND LONG-TERM PERIOD
FOLLOWING TRANSLUMINAL LASER
I.V. Maksimovich, M.Yu. Gorshkov, S.M. Masyuk (Moscow)
Purpose: the study of the peculiarities of the brain circulation and microcirculation restoration in patients with Alzheimer's disease, in immediate and long-term (2-5 years) period following transluminal laser angioplasty.
Alzheimer's disease is widespread in the leading countries worldwide. According to the recent data, this disease holds 3rd place after CHD and oncological diseases in USA. By the year 2006 about 4-4.5 million Americans suffered this ailment. This disease is registered in 10% of USA population in the age of 65, and in 50% - in people over 85 years of age. The mortality of this disease is rather high and reaches 300-400 thousand per year.
In spite of such disease prevalence, there were very few trials in medical practice worldwide directed on the study of brain circulation and microcirculation peculiarities in given group of patients and their correlation with structural changes in the brain. Earlier in our studies we mentioned that in Alzheimer's disease, almost in 100% of cases, the specific changes of distal circulation and microcirculation are seen, which we called "Alzheimer-type circulatory enceph-alopathy". These changes manifest as major looping in the distal portions of the anterior and middle cerebral arteries, reduction of capillary bed with the development of extensive hypovascularization zones in fronto-parietal and temporal areas which are accompanied by early arteriovenous shunts. At the same time, the patients were revealed to have pathologic changes of the vein branches, which contribute to venous congestion in corresponding vascular territories. The patients had a disturbance linear indices of cerebral blood flow velocity and pulse volume. The presence of these vascular disorders permits to draw a rather clear correlation with characteristic atrophic changes of the cerebral matter in respective areas.
43 patients with various forms of memory disorders from 34 to 80 years of age (mean age was 65) who were previously diagnosed with Alzheimer's disease were examined, and 40 patients underwent surgery. The examination included: CT or MRI, scin-tigraphy, rheoencephalography (REG), multi-gated angiography (MUGA) scan of the brain.
Transluminal laser angiography was performed within 1-12 years following the first manifestations of the disease. In the long-term postoperative follow-up the brain CT or MRI as well as scintigraphy and REG were performed in all patients 6 months apart; delayed cerebral angiography was performed in 4 patients in 2-4 years after surgery. Results of the study:
Following translumi-nal laser angioplasty of the anterior and middle cerebral arteries the restoration of capillary supply, which was accompanied by the reduction of arteriovenous shunts, was observed in all of 40 patients. Normalization of venous circulation was observed in 38 patients (95%). Partial normalization of venous circulation was observed in 2 (5%) patients. Improvement of linear indices of cerebral blood flow velocity and pulse volume was seen in 39 (97.5%) patients. A favorable clinical changes over time defined by memory and intellect improvement, reduction of cognitive disorder was noted in all of 40 patients.
In long-term postoperative follow-up, already in 6 months after surgery, all patients had CT signs of narrowing of sub-arachnoid cavity, convexital sulci and lateral ventricles. The enlargement of the volume of temporal lobes amounted up to 8-12%. The process of brain tissue reparation went on growing better in further examinations, and in 2-3 years after the treatment the dimensions of temporal lobes reached age-specific norm in 32 patients (80%). Repeated angiographic examinations showed preservation of collateral revascularization of the brain, normal capillary circulation and reduction of arteriovenous shunts in all of 4 patients. In one case, in 4 years after the treatment, the 60-years-old patient developed subtotal atherosclerotic stenosis of the proximal part of the anterior cerebral artery trunk, which was treated by repeated transluminal laser angioplasty. In another case, worsening of cognitive disorder accompanied by CT signs of partial increase in brain tissue atrophy was observed in 77-years-old female patient with severe form of Alzheimer's disease and more than 14 years of disease history in 2 years after the surgery.
Good clinical result - almost complete memory and intellect restoration was seen in 17 (42,5%) patients, satisfactory clinical result - incomplete memory and intellect restoration - in 13 (32.5%) patients, relatively satisfactory clinical result - partial memory and intellect restoration was seen in 10 (25%) patients.
Acquired data suggest that transluminal laser angioplasty performed at different stages of Alzheimer's disease provides consistent and continuous effect which is defined as:
1. Restoration of distal cerebral circulation and
microcirculation, i.e. elimination of signs of the
Alzheimer-type circulatory encephalopathy.
2. Decrease in brain tissue atrophy and tissue
3. Reduction of symptoms of the disease and resto
ration of memory, intellect as well as of patients'
quality of life.
In the treatment of patients in advanced stages of the disease the recurrence is possible in long-term follow-up, which is obviously related to previously occurred changes in the brain tissue.
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