medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-44-53medsovet-6391Research ArticleДИСЛИПИДЕМИЯDISLIPIDEMIAОсобенности атеросклеротического поражения в каротидных и коронарных артерияхFeatures of atherosclerosis in carotid and coronary arterieshttps://orcid.org/0000-0003-4918-3795КонстантиноваЕ. В.KonstantinovaE. V.

Константинова Екатерина Владимировна, д.м.н., доцент кафедры факультетской терапии имени академика А.И. Нестерова лечебного факуль-тета, профессор кафедры интервенционной кардиологии и кардиореабилитации; врач-кардиолог

17997, Москва, ул. Островитянова, д. 1

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 3156-9983

Ekaterina V. Konstantinova, Dr. Sci. (Med.), Associate Professor of the Department of Faculty Therapy named after Academician A.I. Nesterova Faculty of General Medicine, Professor of the Department of Interventional Cardiology and Cardiac Rehabilitation; cardiologist

1, Ostrovityanov St., Moscow, 117997

8, Lenin Ave., Moscow, 119049

 

katekons@mail.ruhttps://orcid.org/0000-0001-5509-8023БогдановаА. А.BogdanovaA. A.

Богданова Александра Андреевна, к.м.н., доцент кафедры интервенционной кардиологии и кардиореабилитации; заведующая отделением функциональной диагностики

17997, Москва, ул. Островитянова, д. 1

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 3991-9420

Alexandra A. Bogdanova, Cand. Sci. (Med.), Associate Professor at the Department of Interventional Cardiology and Cardiac Rehabilitation; Head of Department of Functional Diagnostics

1, Ostrovityanov St., Moscow, 117997

8, Lenin Ave., Moscow, 119049

doc.aabogdanova@gmail.comhttps://orcid.org/0000-0001-6177-6329СагателянА. А.SagatelyanA. A.

Сагателян Арпинэ Артуровна, аспирант кафедры интервенционной кардиологии и кардиореабилитации

17997, Москва, ул. Островитянова, д. 1

SPIN-код: 7294-6495

Arpine A. Sagatelyan, Postgraduate Student of the Department of Interventional Cardiology and Cardiac Rehabilitation

1, Ostrovityanov St., Moscow, 117997

sagatelyan.arpine@yandex.ruhttps://orcid.org/0000-0003-4247-2260КовайкинА. И.KovaikinA. I.

Ковайкин Артем Игоревич, врач-терапевт

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 1307-4124

Artem I. Kovaikin, Doctor

8, Lenin Ave., Moscow, 119049

mega.kovaykin@mail.ruhttps://orcid.org/0000-0002-3952-6865ПершинаЕ. С.PershinaE. S.

Першина Екатерина Сергеевна, к.м.н., заведующая Центром лучевой диагностики

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 7311-9276

Ekaterina S. Pershina, Cand. Sci. (Med.), Head of the Radiology Department

8, Lenin Ave., Moscow, 119049

pershina86@mail.ruhttps://orcid.org/0000-0002-2870-3301ГиляровМ. Ю.GilyarovM. Yu.

Гиляров Михаил Юрьевич, д.м.н., заведующий кафедрой интервенционной кардиологии и кардиореабилитации; заместитель главного врача по терапевтической помощи

17997, Москва, ул. Островитянова, д. 1

119049, Москва, Ленинский проспект, д. 8

SPIN-код: 7713-6726

Mihail Yu. Gilyarov, Dr. Sci. (Med.), Head of the Department of Interventional Cardiology and Cardiac Rehabilitation

1, Ostrovityanov St., Moscow, 117997

8, Lenin Ave., Moscow, 119049

gilarov@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Государственная клиническая больница № 1 имени Н.И. ПироговаРоссияPirogov Russian National Research Medical University; City Clinical Hospital No. 1 named after N.I. PirogovRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГосударственная клиническая больница № 1 имени Н.И. ПироговаРоссияCity Clinical Hospital No. 1 named after N.I. PirogovRussian Federation2021151020210144453Copyright © Константинова Е.В., Богданова А.А., Сагателян А.А., Ковайкин А.И., Першина Е.С., Гиляров М.Ю., 20212021Константинова Е.В., Богданова А.А., Сагателян А.А., Ковайкин А.И., Першина Е.С., Гиляров М.Ю.Konstantinova E.V., Bogdanova A.A., Sagatelyan A.A., Kovaikin A.I., Pershina E.S., Gilyarov M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6391

Атеротромбоз является как самой частой причиной инфаркта миокарда, так и причиной развития ишемического атеротромботического инсульта и представляет собой одну из стадий атеросклеротического процесса. Являясь генерализованным процессом, атеросклероз имеет в целом схожие этапы прогрессирования и развития и в при этом характерные особенности формирования в различных сосудистых бассейнах. На возникновение и прогрессирование атеросклеротического процесса могут влиять наследственные факторы, особенности локальной гемодинамики, различия в структуре органных артерий и другие факторы. Лучшее понимание природы и причины этих различий может способствовать совершенствованию профилактики и  лечения атеросклероза и  его осложнений. В  статье рассматриваются вопросы особенностей атеросклеротического поражения в  каротидных и  коронарных артериях. Обсуждаются особые условия локальной гемодинамики, возникающие в  области бифуркаций артерий, способствующие формированию и  прогрессированию атеросклеротических бляшек. Рассматриваются характерные черты, свойственные склонным к повреждению нестабильным бляшкам в коронарных и сонных артериях. Анализируется роль иммуновоспалительных процессов, процессов разрушения и перестройки внеклеточного матрикса, апоптоза и аутофагии клеток в процессе дестабилизации атеросклеротических бляшек и возможная системность процесса нестабильности при генерализованном атеросклеротическом поражении артерий. Рассматриваются вопросы взаимосвязи и взаимовлияния атеросклеротического поражения коронарных и каротидных артерий и значимость для пациента наличия у него мультифокального атеросклероза. Лучшее понимание патогенеза атеросклеротического процесса может привести к дальнейшему усовершенствованию профилактических мер. Своевременная и эффективная профилактика будет способствовать более эффективному предотвращению случаев развития инфаркта миокарда и ишемического инсульта, имеющих не только большую медицинскую, но и социальную значимость, с учетом высокой смертности и инвалидизации пациентов.

Atherothrombosis is a leading cause of myocardial infarction and ischemic atherothrombotic stroke. It represents a stage of atherosclerosis which is a pathologic process throughout the circulatory system. However, atherosclerosis has specific development characteristics in  different vascular beds. Multiple factors contribute to atherosclerosis formation and progression such as genetic factors, vessel hemodynamics, and vessel anatomy. A better understanding of differences in vessels would improve prevention and treatment of atherosclerosis and its complication. In this article we review features of atherosclerosis in carotid and coronary vessels. We discuss specific conditions of local hemodynamics in the areas of bifurcation which promote atherosclerotic plaque progression, and review characteristics of unstable plaques in carotid and coronary vessels. We analyze immunologic and inflammatory processes, extracellular matrix degradation and remodeling, cellular apoptosis and autophagy occurring during atherosclerotic plaque destabilization as well as the possibility of diffuse plaque instability in systemic atherosclerosis. We review association and interaction of  atherosclerotic processes in  coronary and carotid arteries, and its significance for a patient. Improvement in understanding of atherosclerosis pathogenesis can lead to advances in atherosclerosis prevention. Timely and effective interventions would promote prevention of myocardial infarction and ischemic stroke which is highly important taking into account high mortality and morbidity rates.

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The authors declare that there are no conflicts of interest present.