Currently, two methods of coronary revascularization are used in coronary surgery – percutaneous coronary interventions and coronary bypass grafting. Technical capabilities allow using them both for the treatment of chronic coronary heart disease and in surgery for acute myocardial infarction.
The development of cardiosurgical and endovascular areas has gone through two main stages. The first was to develop and improve the methodology itself and the second was to create standards and recommendations governing the treatment of coronary heart disease based on experience and accumulated results. At the present stage, individual technical aspects are subject to even greater standardization, which relate to both the selection and preparation for surgical treatment and individual stages of revascularization.

The review presents data on optical coherence tomography angiography (OCTA) in the diagnostics of diseases of the anterior segment of the eye. In addition to qualitative assessment of pathological changes, the method gives quantitative characteristics of vascular density. OCTA is informative for anterior segment vasculature evaluation in burns, inflammatory diseases, ischemic injury, and for intratumoral vessels visualization.

Introduction. For the treatment of patients with hypoxemic form of respiratory failure, thermal oxygen-helium mixture (OHM) therapy is used.
The aim of the work is to study the effect of OHM on the state of the microcirculatory bed in viral pneumonia caused by COVID-19 in patients with aggravated and unaggravated anamnesis.
Materials and methods. There were 8 patients with an uncomplicated anamnesis, 11 with AH1–2 degree, 11 with AH1–2 degree and type II diabetes. The parameters of blood flow in the MVB were recorded with an ultrasound dopplerograph. OHM therapy (O2 – 30 %, He – 70 %, t=+95 ºС): 5 min breathing, 5 min rest – 3 cycles.
Results. Before the OHM therapy, the level of «basic perfusion» was increased in group 3: significantly high Vs (p=0.02) and Vd (p=0.006), low RI (p=0.015) relative to group 1, this indicates a reduced vascular tone and venous congestion. After the OHM session in patients of group 1, the speed of Vs and Vd increased, the indices RI and PI decreased. In group 2 – Vs, Vd and Vam increased, RI decreased. The effect is long lasting. In group 3, the effect was noted on day 5, short-term. Conclusions. OHM therapy has a positive effect.

Objective. To assess the effect of external carotid artery (ECA) endarterectomy on regional cerebral blood flow, cognitive function, and quality of life in patients with ICA occlusion.
Materials and Methods. From 2019 to 2020 year, 14 operations were performed on patients with ICA occlusion and hemodynamically significant ECA lesion. 14 patients, 12 men (85.7 %) and 2 women (14.3 %) underwent resection of the ICA, endarterectomy of the common carotid artery (CCA), and ECA. All patients had a history of stroke of 7±5.7 months. Neurological deficit according to the Rankin scale was 2 points in 11 patients (78.6 %) and 3 points in 3 patients (21.4 %). The mean age was 62.8±11.6 years. The preoperative period included ultrasound duplex scanning and computed tomography with the contrast of the brachiocephalic arteries. Single-photon emission computed tomography was used to assess cerebral blood flow before and after surgery. Cognitive status and quality of life were assessed by questionnaire survey.
Results. In the early postoperative period, there were no registered strokes. A decrease in hypoperfusion foci and an increase of cerebral blood flow by an average of 10,33 ± 6,70 ml/min/100 g were observed in 13 patients (92,8 %). The Montreal Cognitive Deficit Scale score was 3,92±3,6. Improvement of quality of life according to the Short Form-36 questionnaire was 9.27±14.75.
Conclusion. Endarterectomy of the external carotid artery at the internal carotid artery occlusion leads to a significant increase of regional cerebral blood flow in symptomatic patients, which in turn correlates with the regression of neurological deficit and improvement of quality of life. Continued work in this area will be a detailed analysis of the results of the treatment of patients with occlusion of the internal carotid artery for the period from 2018 to 2022 year.

Introduction. Rupture of cerebral aneurysms (CA) with the development of intracranial hemorrhage (ICH), complicated in some cases by vascular spasm and delayed cerebral ischemia (DCI), is due to the complex multifactorial genesis of the disease, including changes in the blood oxygen transport function (BOTF), activation of endothelial cells with a release of vasoregulators, reactive oxygen species, inflammatory proteins, as well as disturbances in the hemostasis system.
Purpose – to study the indicators of BOTF, primary and secondary hemostasis and the content of some vasoregulatory metabolites in the pre- and postoperative periods in patients with ruptured CA with the development of DCI and without DCI.
Materials and methods. The group with DCI included 45 patients; in the group without DCI were 14 people. Clinical-neurological and neuroimaging examinations were carried out, and parameters of BOTF, primary and secondary hemostasis, nitrate/nitrite, angiotensin-converting enzyme (ACE), and PAI-1 concentrations in venous blood were studied before and on days 10–12 after microsurgical clipping of the CA.
Results. We diagnosed mild neurological disorders according to the NIHSS scale, confirmed by neuroimaging studies of the brain in the group of DCI patients. It was shown an increase in thrombin-dependent platelet aggregation velocity to 30.6 (24.3; 32.4) AU/min at norm 21.8 (20.3; 24.9) (U, p=0.009) before surgery; and after surgery it was up to 37.4 (30; 44.7) relative to the norm (U, p=0.001). Before surgery, the following was observed: PT shortening to 11.6±0.7 sec at norm 13.2±1.1 (t, p˂0.001), fibrinogen concentration increasing to 4.35 (3.8; 4.8) g/L at norm 3.9 (3.6; 4.1) g/L (U, p = 0.01) and PAI-1 up to 3.9 (2.6; 4.8) ng / mL at norm 2 .7 (2.2; 4.1). After surgery, PT was 11.9±1.1 (t, p˂0.001); fibrinogen - 4.4 (3.9; 4.8) (U, p=0.024), PAI-1 - 4.6 (4.1; 6.7) (U, p=0.0004) respectively. Before surgery, p50 was increased to 28.1 (26.2; 31.6) mm Hg at norm 25.2 (24.3; 26.8) (U, p=0.025); after surgery, it was up to 28.5 (26.8; 30.7) (U, p=0.03) and the ratio of nitrates/nitrites to ACE was reduced to 0.12 (0.08; 0.15) at norm 0.22 (0.15; 0.32) (U, p˂0.001); after - up to 0.11 (0.08; 0.19) (U, p˂0.001) respectively.
Conclusion. There has been revealed significant disorders of primary and secondary hemostasis with fibrinolysis inhibition, a decrease in the affinity of hemoglobin to oxygen at the p50 rate and an imbalance of the content of vasoregulatory metabolites in patients with DCI before and after aneurysm clipping, which can be considered as significant factors in the development of DCI after aneurysmal ICH.

The aim of the study was to assess how the use of the International Classification of Functioning, Disability and Health (ICF) affects the formulation of a rehabilitation diagnosis.
Materials and methods. Three patient groups were formed: the first group (n=130) did not use the ICF, the second (n=130) used the paper-based ICF, and the third (n=54) used the ICFreader software.
Results. The use of ICF leads to more rehabilitative problems in the diagnosis that can be solved within the rehabilitation course. The highest number of clinically insignificant function domains was found in group 1. The number of activity and participation domains and environmental factor domains was significantly higher in groups two and three compared to group one. In group two the team spent between 8 and 15 minutes for the initial discussion per patient and between 2 and 5 minutes for repeated discussions.
Conclusion. Applying the ICF in paper form and using the ICF-reader software leads to more rehabilitative problems in the rehabilitation diagnosis, which can be solved within the rehabilitation course.

Introduction. Insulin therapy used during acute myocardial infarction (AMI) is associated with a high risk of hypoglycemia and high glycemic variability. Therefore, the search for optimal therapeutic approaches which affect both cardioprotection and glycemic correction is relevant. It is known that agonists of glucagon-like peptide-1 (aGLP1) exhibit a protective effect on the myocardium and are involved in the normalization of carbohydrate metabolism. The combined use of аGLP1 exenatide and insulin can be more effective and safe but not insufficiently studied.
The aim of this study was the comparative investigation of the effect of exenatide, insulin, and their combination on the volume of myocardial damage and the level of glycemia in the myocardial ischemia/reperfusion (I/RP) model in rats with experimental diabetes mellitus (DM2).
Materials and methods. Neonatal streptozotocin diabetes was modeled in male Wistar rats on the 4th–5th day of life. At the age of 3 months, I/RP was fulfilled in animals with confirmed hyperglycemia. Experimental groups were formed depending on the time of therapy with insulin, exenatide, or their combination; before or after ischemia. Ischemia lasted for 40 min, while reperfusion was 120 min. The size of the myocardium necrosis zone and the changes in glycemia level and its variability were determined.
Results. Insulin reduced glycemia, but it increased glycemic variability by 60 % and caused hypoglycemia in 32–37 % of animals. Exenatide reduced blood glucose concentration to the level of fasting glycemia and glycemic variability by 1.5–2 times compared with insulin. Exenatide given before ischemia reduced the area of necrosis by 2.2 times. The combined use of insulin and exenatide was accompanied by the absence of hypoglycemia and a decrease in the necrosis zone by 3.2 times compared to the control.
Conclusion. The combined use of aGLP1exenatide and insulin in experimental conditions of I/RP+DM2 is the most effective and safe. This makes promising their joint use in patients with DM2, both at high risk of AMI and those undergoing AMI.

It is now, known that liver diseases, including cirrhosis, are associated with a higher cardiovascular risk compared with the general population. The management of patients with cirrhosis and acute coronary syndrome is associated with the risk of various complications. The clinical case presented in the publication showed significant risks that have direct and indirect influence on the outcome and further prognosis of a patient with myocardial infarction and cirrhosis, namely: ischemic risks, hemorrhagic risks, surgical and somatic risks.

The brain is characterized by a well-developed vascular network and consumes a significant proportion of cardiac output relative to its mass. Normally, the metabolic needs of the brain significantly depend on the intensity of the functioning of its various departments, which requires constant regulation of the level of local blood flow. On the other hand, the state of systemic hemodynamics can have a significant impact on organ blood flow. Moreover, the importance of accurate and prompt regulation of cerebral blood flow is determined by the lack of energy reserves or substrates for its autonomous production in the nervous tissue and the huge role of the central nervous system in ensuring all physiological processes. In this regard, the organ cerebral blood flow has complex physiological mechanisms of regulation, which are implemented at various levels. At the same time, myogenic reactions are isolated, which occur when the degree of stretching of the smooth muscle cells of the vascular wall changes under the influence of pressure in the lumen of the vessel, as well as under the influence of local humoral effects, including those exerted by metabolites, on vascular tone at the level of the neurovascular unit. This review considers in detail the role of the neurovascular unit in the regulation of cerebral blood flow and the provision of the so-called neurovascular conjugation – a flexible dynamic correspondence between the level of local neuronal activity and the delivery of oxygen and nutrients. The mechanisms and essential importance of neurovascular coupling in the regulation of local cerebral blood flow, which ensures the development of functional hyperemia, as well as the performance several other functions, such as the delivery and removal of metabolites, temperature regulation, and the formation of cerebrospinal fluid, are demonstrated.