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- "Strokes are increasingly being diagnosed in young people due to stress and lifestyle issues"
"Strokes are increasingly being diagnosed in young people due to stress and lifestyle issues"
Stroke in Russia is rapidly getting younger: if 15 years ago the average age of patients was about 66 years, today it starts at 40. This was stated in an interview with Izvestia by Kirill Orlov, MD, Neurosurgeon, Head of the Research Center for Endovascular Neurosurgery at the Federal Center for Brain and Neurotechnology of the FMBA, Director of the Association of Endovascular Neurosurgeons. According to the expert, the key reasons for this alarming trend were chronic stress and an unhealthy lifestyle. The achievements of modern neurosurgery, the international interaction of doctors and the role of AI in diagnostics are described in the Izvestia material prepared for the Week of Knowledge about the Brain.
"The aneurysm is asymptomatic"
— Kirill Yurievich, what brain diseases are most common in patients in Russia?
— If we are talking about vascular diseases of the brain, then the most common disease is stroke. Approximately 80% of all types of stroke are ischemic (in this case, blood does not flow to the brain due to blockage or severe narrowing of the arteries. — Izvestia). In 20% of cases, patients are diagnosed with hemorrhagic stroke (cerebral hemorrhage. — Izvestia).
— According to research, stroke is now rapidly getting younger. What is the average age of such patients?
— The average age of patients diagnosed with ischemic stroke is older. It begins around the age of 45, most often around the age of 50-60. And hemorrhagic stroke, which is associated with vascular diseases, is "younger" — it occurs on average in patients aged 40 years.
According to official data, in 2010 the average age of stroke in Russia was approximately 66.7 years. Men suffered a stroke at an average age of 63.7 years, and women — at 69.4 years. Now, the proportion of patients younger than 45 is steadily increasing, which creates the effect of rejuvenation of the disease.
— Why is this happening?
— It is difficult to name unambiguous reasons why strokes have become more often diagnosed in younger people. This is mainly due to a lot of stress, poor lifestyle, poor nutrition and environmental degradation.
Hemorrhagic stroke can be caused by various diseases of the brain, primarily arteriovenous malformations (a pathology in which "tangles" of blood vessels appear between arteries and veins instead of capillaries. — "Izvestia") and aneurysms.
A GM aneurysm is a bulge on the vessel wall, similar to a hernia or balloon, which gradually inflates. And when it reaches a large size, the aneurysm wall cannot stand it — it bursts and hemorrhages occur. This is a rather dangerous disease because it is asymptomatic. And when a hemorrhage occurs, it is already a major vascular catastrophe.
— Are there any ways to recognize an aneurysm, even if the patient does not feel any symptoms?
— Yes, we are currently operating on a lot of unexploded aneurysms. About half of the patients who come to us have a history of aneurysms without rupture. They are diagnosed using magnetic resonance imaging (MRI).
Patients are scheduled for an MRI scan for some reason, most often they are treated with headaches, and during the study, they have aneurysms of GM. Then they come to us — before the breakup. Surgery of an aneurysm before rupture is radically different: it gives different results and provides good functional outcomes.
"We had surgery today, we can go home tomorrow"
— What modern methods of diagnosis and treatment of brain diseases are currently used?
— The most modern diagnostic method today is MRI. And the advanced treatment method is endovascular neurosurgery. It is performed without opening the skull — through a puncture in the femoral artery, surgery is performed on the vessels of the brain. This is the most non-traumatic method of treating GM vessels, which gives very good results. It can be used to treat almost any vascular disease.
Today, almost 100% of aneurysms can be cured by this method. It is effective, provides good prevention of hemorrhages, and does not require a recovery period. Today, the patient will undergo surgery, and tomorrow he can go home.
Endovascular neurosurgery is constantly developing, it is a fairly young science, and every year there are some new tools that can be used to treat patients. If we take the last 5-10 years, then flow-redirecting stents have appeared (a special design that blocks the flow of blood into the aneurysm. — Izvestia), intraaneurysmal flow descriptors (indicators reflecting the characteristics of blood flow in an aneurysm. — Izvestia).
If installing a flow-redirecting stent was a rare operation five or 10 years ago, now it has become routine: more and more aneurysms are treated using this technique. Everyone has mastered it, and endovascular treatment has become much more accessible.
— What are the advantages of endovascular surgery?
— Currently, in developed countries, up to 90% of unexploded cerebral aneurysms are treated endovascular. Cases of wider use of open microsurgery are associated, as a rule, with limited availability of necessary tools and consumables, as well as the lack of relevant experience and equipment among specialists.
If there are trained specialists, tools and equipment, then there is no reason to prefer microsurgical interventions to endovascular ones. As modern research shows, the latter, in the case of brain aneurysms, are not inferior in safety to open interventions, but they are better tolerated. This is especially true for older patients and somatically burdened patients (with chronic diseases of internal organs. — Izvestia).
In this regard, all patients with cerebral aneurysms, without exception, should first be considered as candidates for endovascular intervention. However, the most recent clinical guidelines for the treatment of cerebral aneurysms in Russia were released in 2016. They do not take into account the development of endovascular technologies over the past 10 years, therefore, when choosing a treatment, they should be considered together with more relevant data from the world literature.
The situation is similar with arteriovenous malformations. Given the rarity and complexity of this pathology, there are no clear recommendations for the treatment of such patients in the world literature. However, the concept, which is unofficially recognized, includes endovascular embolization (a minimally invasive procedure in which doctors insert a catheter through a puncture. — Izvestia), microsurgical removal and radiosurgery.
— What are the most difficult operations you've ever performed?
— Since we work in the federal center and we receive serious patients every day, complex operations are our routine work. They are performed even by young doctors. This happens every day, so it's hard to single out one thing. Lighter patients are usually operated on in vascular centers across the country.
"The brain requires training"
— What are the main challenges facing modern neurosurgery now? Is there a shortage of specialized doctors?
— Among the main challenges is the widespread introduction of modern treatment methods, since the number of centers that own them is limited. We are constantly training personnel for new centers, and we are training people in endovascular neurosurgery.
All the techniques that are currently used in the world are also represented in Russia. We work absolutely at the global level: there are no countries that would be ahead of us. However, it is necessary to implement these modern techniques everywhere so that patients can receive timely care in every corner of our country.
— How is international cooperation going now?
— International cooperation continues, there are no disagreements among doctors. There are certain issues, such as difficulties with flights, but we communicate via the Internet. We remain part of the global community, and our foreign colleagues are in touch with us, exchanging experiences and best practices.
— Is artificial intelligence used during diagnostics and operations?
— Artificial intelligence, of course, is not used during operations. To date, it cannot replace the surgeon's intelligence, it is still far from that. But AI is used in the diagnosis of, for example, ischemic stroke in remote regions where there are no qualified radiologists on a permanent basis. In this case, the images are processed automatically: you can consult and diagnose the disease.
— What should I do to keep my brain healthy for a long time?
— First of all, it is necessary to follow a healthy lifestyle. The brain, like muscles, requires training — it is important to engage in intellectual work, constantly keeping it in good shape. It can be reading books, playing chess, doing science or art. The greater the intellectual load, the better. And the most effective way to prolong life is positive emotions.
In addition, you should constantly train your memory. It can get worse with age, but it doesn't always happen that way. If you train your memory regularly, it doesn't get much worse over the years. There are professors who, when I was a young doctor, had an excellent memory, and now they have the same excellent memory.
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