The Studing of Shear Stress and Endotelial Dysfunction in Young Patients with Spondylogenic Vertebro-Basilar Insufficiency

Vertebrobasilar system contains structures that are crucial for keeping a person alive. Therefore, study of the blood dyscirculation in this area in relation to autonomic provision is an important part of practical neurology. One of the magistral arteries of the neck (vertebral artery) goes through transverse foramina to the cranial cavity and nourishes the сerebellum (involved in motor control beside the balance), vestibular apparatus (equilibrium-related function), limbic system (supports a variety of functions including artery and vein tone, emotion, short-term memory and viscera functions) and other vital centers located in the brainstem. Vertebrobasilar insufficiency (VBI) is a broad classification describing the condition when there is an insufficient delivery of blood flow via the vertebral and/or basilar arteries to the brain. In young patients (younger 45 years old) more prominent is spondylogenic mechanism of VBI. Thus, the so-called spondylogenic vertebrobasilar insufficiency (SVBI) represents a big deal interest. To understand and be ready to diagnose vertebrobasilar ischemia at the early stages we can't underestimate the meaning of biochemical changes which are present in the organism of patients. Studying of interactions between the blood lipid metabolism and state of endothelium has considerable scientific and practical interest. It happens because development of the endothelial dysfunction (ED) plays an essential role in vascular disorders progressing. Research objective is to study the state of shear stress in causal VA and endothelial dysfunction in patients of young age with the SVBI. Materials and methods. We examined 240 patients with manifestations of SVBI on the background of neurovascular and radicular syndromes of cervical osteochondrosis of a vertebral column. Patients from 18 to 44 years old (median age of 28.5±3.8 years) were included in this study. All patients underwent an ultrasonic dopplerography and transcranial dopplerography of cerebral vessels with functional loading tests (head rotations), with the aim of assessing spondylogenic influence on vertebral arteries, functional X-ray examination of the neck, MRI cervical part of vertebral column, duplex scanning of neck vessels. As basic index of turbulent blood flow influence on the endothelium (ISD) was calculated. ISD=VS/VD, де VS – systolic blood flow in VA, VD – diastolic blood flow in VA. The concentration of endothelin-1 in the blood by immunoenzymatic method was done, імуноферментного аналізу, the concentration of вміст S-NO by spectrofluorometric method was checked. Endothelial index was calculated this way: IMB=ЕN-1/ S-NO, where ЕN-1 - the concentration of endothelin-1 in the blood, S-NO - the concentration of S-nitrozotiolum in the blood. 3 groups of patients were formed: Group 1 consisted of 104 patients with an angiodystonic stage of SVBI; Group 2 consisted of 76 patients with an angiodystonic-ischemic stage of SVBI; Group 3 consisted of 60 patients with an ischemic stage of SVBI. Results. As a result of examination of 240 patients with verified diagnosis vertebro-basilar insufficiency (VBI) of spondylogenic origin, the patterns of shear stress changes in causal vertebral arteries (VA) were studied. The usage of ration endotelin-1/S-NO at different stages of VBI as a marker of disbalance between vasoconstrictors and vasodilatators was done. Obtained data makes possible to expand the understanding of the pathogenetic mechanisms of the development of VBI on the background of spondylogenic disorders. The generalization of the revealed regularities allows to make a conclusion about the clinical informativity of shear stress patterns and ration endothelin-1/S-NO of causal VA at the different stages of development of VBI for further usage in the system of clinical and instrumental diagnostics of early manifestations in young patients.