Biomarkers of chronic cerebral ischemia as a prospect for personalization of the surgical approach in its treatment. Literature review

Abstract

Introduction . Chronic cerebral ischemia is a multifactorial pathological condition characterized by a gradual reduction in cerebral blood flow and the development of focal neurological deficits, ranging from cognitive impairments to motor and speech disorders. Furthermore, against the background of existing chronic ischemia, there is an extremely high risk (due to the depletion of adaptation and autoregulation mechanisms) of developing an acute ischemic stroke, with an extremely low rehabilitation potential. The current concept of surgical treatment for such patients is primarily preventive in nature, aimed at mitigating identified risks of acute ischemic stroke; at the same time, inhibiting the development of chronic cerebral ischemia is not currently considered a goal of surgical revascularization of the brain. Objective of the study : Based on the analysis of literature data, to study the prospects for using biomarkers of chronic cerebral ischemia to personalize the approach to surgical treatment of patients with this disease. Materials and methods. An analysis of literature data available in domestic and foreign scientific libraries was carried out. Conclusions : studying the role of angiogenesis factors, glutamate and its receptors, and neuroinflammatory proteins to assess their role in identifying chronic cerebral ischemia, predicting its course, and evaluating the risks of developing acute ischemic stroke is a promising area of medical science that requires the creation of databases, the proper selection of patients, and timely and high-quality laboratory and instrumental examinations. Promising markers for a detailed study of their role in shaping a new concept for determining indications for surgical treatment in patients with chronic cerebral ischemia include the concentration of glutamate in blood serum, antibodies to the NR2 subunit of the NMDA glutamate receptor, stromal cell-derived factor 1 (SDF-1), and hypoxia-inducible factor 1 (HIF-1), as well as an giogenesis factors such as vascular endothelial growth factor (VEGF) and MMP-9.