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Page 2 of 11 Yaroustovsky et al. Vessel Plus 2019;3:9 I http://dx.doi.org/10.20517/2574-1209.2019.02

Keywords: Lipid disorders, hyperLDLemia, high Lp(a)emia, multifocal atherosclerosis and its complications, atherogenic index,
H.E.L.P.-apheresis, cascade lipid-filtration

INTRODUCTION
Despite the progress in diagnostics and therapy of cardiovascular diseases, atherosclerosis and related events
(myocardial infarction, stroke, and peripheral vessels damage) are still the leading causes of morbidity and
mortality. As assessed by World Health Organization, cardiovascular mortality ranges from 48% to 56% all
[1,2]
over the world .
The pathogenesis of atherosclerosis includes disorders of lipid and carbohydrate metabolism, hemostasis and
immune systems. Dyslipidemia (mainly presented as hypercholesterolemia type IIa and IIb) is the risk factor
[3-6]
of atherosclerosis and related events . The process of atherosclerosis can be triggered even in childhood
and can evolve throughout life. It is so important to timely evaluate the existing hemostatic disorders, screen
[7]
risk factors, make the right choice of the treatment, and take early preventive measures .
Treatment of lipid metabolism disorders mainly involves conventional tactics (diet, statins, fibrates,
cholesterol absorption inhibitors and, etc.). In most cases hyperlipidemia can be quite adequately corrected
with the conventional therapy. It is known that statins had beneficial effects on cardiovascular pathology and
mortality. However, there are some cases noted for lack of efficiency and resistance to lipid-lowering therapy
(monotherapy or combination with medications of multiple effects), intolerance to the pharmacological
therapy and development of side effects.

On the other hand, there are combinations of different types of dyslipidemia [hyperLDLemia, hyperLp(a)
emia]. Low density lipoprotein (LDL) is well-established risk factor for atherosclerosis that can be treated
by lipid-lowering drugs. Lipoprotein(a) [Lp(a)] is independent risk factor for atherosclerotic cardiovascular
[8]
diseases, that cannot be corrected by dietary changes or medication . Lp(a) occurs in isolation or in
combination with other types of dyslipidemia, that increases atherogenic properties of them [9-12] . In such
cases extracorporeal therapy is an additional and/or alternative approach with proved efficiency. In nowadays
apheresis techniques are used for patients with incurable dislipidemia, hyperLp(a)emia, hyperviscosity
syndrome with high fibrinogenemia, high risk of cardiovascular events with damaged vessels [13-16] . An
alternative therapeutic option of hypercholesterolemia can be plasmapheresis.

The first extracorporeal treatment of hypercholesterolemia was performed in 1967 by plasma exchange in
[17]
patients with familial hypercholesterolemia . In the late ‘70s - early ‘80s in Great Britain, Thompson (1980)
managed to reach regression of coronary artery atherosclerosis when lipids’ level was lowered aggressively by
plasmapheresis [18,19] .

Since then methods, equipment and understanding of extracorporeal therapy have changed significantly.
Our goal is to eliminate a large amount of atherogenic substances from the circulation and to change the
ratio of lipid in the direction of antiatherogenic. After all, the removal of atherogenic lipids in a large amount
(up to 60%-80% per one session) can create conditions for the “release” of cholesterol from plaques. This can
be considered as one of the specific mechanisms of influence on the development of atherosclerosis [20,21] . This
problem is managed by lipoprotein apheresis [22-24] .

Current lipoprotein apheresis methods are based on different technologies (filtration, adsorption,
precipitation), and their main aim is to remove atherogenic lipoproteins from the circulation [14,25-27] . They
are cascade lipid-filtration, heparin-extracorporeal LDL-precipitation, direct adsorption of lipoprotein,