Aim. To study the signs of instability of atherosclerotic plaques (ASP) in the carotid arteries in elderly patients with acute coronary syndrome (ACS) in the comparative aspect of duplex ultrasound scanning (DUS) and computed tomography angiography (CT).Material and methods. 27 patients with ACS (75 years and over) were included in the study. The signs of instability of ASP were assessed according to DUS and CT.Results. The signs of instability of ASP according to DUS were detected in 85,7%, according to CT — in 84,6%. The following signs were detected with DUS and CT: the presence of irregular plaque surface including signs of ulceration — 6,4 and 11,6% (p=0,021), positive remodeling — 3,8 and 3,8% (p=0,998), signs of local calcification — 23 and 25,9% (p=0,536), heterogenous structure — 55,1 and 46,8% (p=0,045), hypoechogenic component and low-density areas — 11,5 and 11,6% (p= 0,998). The correlation analysis showed high comparability of DUS and CT: irregular plaque surface with ulceration (K=0,624, p=0,02), positive remodeling (K=1, p<0,001), calcification (K=0,858, p<0,001), heterogenous structure (K=0,754, p<0,001), the presence of hypoechogenic component and low-density areas (K=1, p<0,001).Conclusion. The study of elderly patients with ACS found high comparability of DUS and CT in the definition of the signs of instability of ASP in the carotid arteries. It is possible to use DUS as a routine method for assessing carotid atherosclerosis in patients of this group, which can reduce the risk of complications during CT, shorten the examination time, and minimize economic costs.

Aim    To study the relationship between severities of the carotid artery injury and the atherosclerotic process in coronary arteries of elderly patients with acute coronary syndrome (ACS).Material and methods    The study included 110 patients aged >75 years. Based on the degree of maximal carotid stenosis according to data of duplex scanning (DS), all patients were divided into group I, (>50% stenosis) and group II (<50% stenosis).Results    According to coronary angiographic data, multivessel disease was observed in 63.6 % of patients. Patients of group I more frequently had three-vessel coronary artery disease than patients of group II (35.8 and 5.3 %, р<0.001). Coronary angiography and DS showed that 82.7 % patients (in group II, not all carotid stenoses were hemodynamically significant) had a combined damage of coronary and carotid arteries; carotid artery stenoses of >50% were associated with three-vessel coronary artery disease. A correlation between atherosclerosis of carotid and coronary arteries was found. Considering this correlation, a scale was introduced that suggested the severity of coronary atherosclerosis based on DS of carotid arteries. The score was assigned by assessing the degree of maximal stenoses in carotid arteries. A ROC analysis has determined a threshold score suggestive of the severity of coronary atherosclerosis: score <6, absence of >70% coronary stenosis; score >6, likely presence of >70% coronary stenosis (sensitivity, 70 %; specificity, 89 %).Conclusion    Combined coronary and carotid artery disease was detected in 82.7% of elderly patients with ACS. A correlation between the severity of atherosclerosis in carotid and coronary arteries was found. DS of carotid arteries can be extensively used in evaluation of elderly patients with ACS, which will allow additional stratification of patients at high risk of cerebrovascular and recurrent cardiovascular diseases.

Aim. To study features of atherosclerosis and signs of instability of atherosclerotic plaque in the carotid arteries by ultrasound duplex scanning of elderly patients with myocardial infarction or unstable angina.Material and methods. The study included 87 patients with ACS and 78 patients without ACS aged 75 and over. Ultrasound duplex scanning of carotid arteries was carried out with Philips EPIQ5 ultrasound system and L12–3 linear array transducer on the 2–5 day from the moment of hospitalization. Quantitative and structural indicators of atherosclerosis of the carotid arteries were assessed .Results. The frequency of detection of atherosclerotic plaques in carotid arteries in elderly patients with ACS was signifi cantly higher than in patients without ACS – 78 and 67 % (p=0,179). Patients with ACS compared with the group without ACS more often had signs of instability of atherosclerotic plaque: heterogenous structure – 28,8 and 19,3 % (p=0,017), hypoechogenic component – 39,2 and 9,9 % (p<0,001), irregular surface – 46,3 and 8,2 % (р<0,001), local calcifi cation –14,2 and 7 % (р=0,001). At the same time, ulcerated atherosclerotic plaques were found only in the group of patients with ACS – 1,9 % (р=0,412). The incidence of atherosclerotic plaques in carotid arteries among men was higher in the group with ACS compared to patients without ACS – 36,2 and 23,4 % (р=0,003); among women the data are higher in the group without ACS compared with the group of patients with ACS – 76,6 and 63,8 % (р=0,003).Conclusion. Atherosclerotic plaques in carotid arteries among elderly patients are more common in the group of patients with ACS. As the same time, among this group atherosclerotic plaques with signs of instability were significantly more common found.