Novosti
Khirurgii
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Year 2014 Vol. 22 No 2

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.171   |  

V.N. OCHKOLYAS 1, G.YU. SOKURENKO 2

THE EVALUATION OF EXPRESSION OF CEREBRAL ISCHEMIA AFTER SURGICAL TREATMENT OF THE INTERNAL CAROTID ARTERY PATHOLOGY BY DETERMINING THE AUTOANTIBODY LEVEL TO NR2A SUBUNIT OF NMDA GLUTAMATE RECEPTORS

FSEE HPE First Saint-Petersburg I.P. Pavlov State Medical University 1
FSBE All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov RMES 2 ,
Saint-Petersburg
The Russian Federation

Objectives. Study of the NMDA glutamate receptors reaction on the change of the cerebral blood flow in the internal carotid artery basin in patients with cerebral ischemic disease.
Methods. 92 patients with hemodynamically significant stenosis of the internal carotid artery have been examined. The patients were divided into 2 groups: patients with a sufficient structural and functional potential of the cerebral blood flow compensation and patients with a low structural and functional potential of the cerebral blood flow compensation. The determination of antibody level to NR2A was carried out before the operation (the 1st period of control), 30 minutes after ICA clamping (the 2nd period of control), 3 hours after the operation (the 3rd period of control), 3 days (the 4th period of control) and 14 days (the 5th period of control) and 4 weeks after the operation (the 6th period of control). The immunoassay method for the semiquantitative determination of the antibodies level to NR2A subunit of NMDA receptors of glutamate was applied.
Results. It has been established that the alteration of NMDA glutamate receptors prevailed in the group of patients with a low potential of structural and functional compensation of the cerebral blood flow. Deterioration of the cerebral blood flow during the period of carotid artery clamping is considered as a factor objectively aggravating the degree of hypoxia in the affected vascular pool and amplifying the degree of alteration of NMDA glutamate receptors. Wherein the longer the clamping of the ICA, the greater destructive effect on the NMDA glutamate receptors occurs via the implementation of excitotoxicity mechanisms.
Conclusions. Objective estimation of the cerebral ischemia degree as well as the evaluation of the adjuvant therapy efficacy is known as one of the primary conditions for the treatment of patients with ischemic brain. In this regard the level of AAT to NR2A subunit of NMDA glutamate receptors is considered as an objective criterion for the effectiveness of the cerebral blood flow and allows evaluating both the cerebral ischemic disease course and the effectiveness of the therapeutic measures.

Keywords: ischemic stroke, carotid endarterectomy, NMDA glutamate receptors
p. 171 178 of the original issue
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Address for correspondence:
197022, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. L. Tolstogo, d. 6-8, FGOU VPO Pervyi Sankt-Peterburgskii meditsinskii universitet imeni akademika I.P.Pavlova, kafedra nevrologii i neirokhirurgii,
e-mail: ovn@ihb.spb.ru; dumpo@rambler.ru
Ochkolias Vladislav Nikolaevich
Information about the authors:
Ochkolyas V.N. PhD, an associate professor of the neurology and neurosurgery chair with the clinic, FSEE HPE The First I.P. Pavlov State Medical University of St. Peterburg.
Sokurenko G.Yu. MD, professor, Chief physician of the clinic 2 of FSBE All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov, MES of Russia, St. Petersburg
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