[Surgical treatment of cervical neurovascular bundle tumors]. / Khirurgicheskoe lechenie bol'nykh s opukholyami sosudisto-nervnogo puchka shei.

OBJECTIVE: To determine the main principles of a patient-oriented individual approach to diagnosis and surgical treatment of cervical neurovascular bundle tumors considering the capabilities of neurosurgical hospital. MATERIAL AND METHODS: There were 92 patients with cervical soft tissue tumors affecting neurovascular bundle. Age of patients ranged from 9 to 81 years (mean 47). There were 65.1% women and 34.9% men. We found chemodectoma (47.4%), neurofibroma (15.8%), neurinoma (13.2%), papillary thyroid cancer (5.3%), salivary gland heterotopia (5.3%), salivary gland adenocarcinoma (5.3%), Hodgkin lymphoma (2.6%), hemangioendothelioma (2.6%) and cavernous lymphangioma (2.6%). Diagnostic algorithm included neurological examinations, Doppler ultrasound of supra-aortic arteries, transcranial ultrasound of cerebral vessels, MRI of cervical soft tissues, CT-AG, MR-AG, CT-perfusion, direct selective angiography. RESULTS: A total of 94 surgical interventions were performed. All surgeries were performed using surgical optics and neurophysiological monitoring of cranial nerves IX, X, XII. We chose resection technique depending on localization, histological features and blood supply of tumor. En-bloc resection was performed in 46 cases, removal of fragments - in 23 cases, intracapsular resection of tumor followed by resection of the capsule - in 26 cases. Total and subtotal resection was performed in 68 (72%) and 23 (24%) cases, respectively. Three (4%) patients underwent partial resection of infiltrative tumors for carotid artery decompression and histological analysis. In 76% of cases, baseline symptoms of disease regressed after surgery. Persistent moderate bulbar disorders were observed in 16 patients (17%). Ischemic complications with additional surgical interventions were observed in 2 cases. CONCLUSION: Patients with cervical soft tissue tumors require individual approach regarding choosing the optimal surgical treatment including possible preoperative embolization of tumor, en-bloc or intracapsular resection and carotid artery repair.

[Indocyanine green in liver transplantation]. / Primenenie indotsianina zelenogo (ICG) pri transplantatsii pecheni.

The purpose of this study was to evaluate the first own experience of using indocyanine green (ICG) in liver transplantation compared to literature data and to determine its potential for clinical practice. Liver transplantation is an effective option for patients with end-stage disease, but this procedure is associated with many problems such as graft rejection, graft dysfunction, surgical risk and postoperative management. Modern methods for assessing graft function have their limitations, so a more efficient method is needed. According to this review, ICG fluorescence is valuable for effective intraoperative blood flow control, assessment of graft function, intraoperative and postoperative monitoring of clinical status. ICG fluorescence can also predict clinical status of patients at all stages of liver transplantation. Routine ICG fluorescence method is advisable in liver transplantation to improve outcomes and optimize treatment process.

In vitro fertilization exacerbates stroke size and neurological disability in wildtype mice.

BACKGROUND AND PURPOSE: Assisted reproductive technologies (ART) induce premature vascular aging in human offspring. The related alterations are well-established risk factors for stroke and predictors of adverse stroke outcome. However, given the young age of the human ART population there is no information on the incidence and outcome of cerebrovascular complications in humans. In mice, ART alters the cardiovascular phenotype similarly to humans, thereby offering the possibility to study this problem. METHODS: We investigated the morphological and clinical outcome after ischemia/reperfusion brain injury induced by transient (45 min) middle cerebral artery occlusion in ART and control mice. RESULTS: We found that stroke volumes were almost 3-fold larger in ART than in control mice (P < 0.001). In line with these morphological differences, neurological performance assessed by the Bederson and RotaRod tests 24 and 48 h after artery occlusion was significantly worse in ART compared with control mice. Plasma levels of TNF-alpha, were also significantly increased in ART vs. control mice after stroke (P < 0.05). As potential underlying mechanisms, we identified increased blood-brain barrier permeability evidenced by increased IgG extravasation associated with decreased tight junctional protein claudin-5 and occludin expression, increased oxidative stress and decreased NO-bioactivity in ART compared with control mice. CONCLUSIONS: In wildtype mice, ART predisposes to significantly worse morphological and functional stroke outcomes, related at least in part to altered blood-brain barrier permeability. These findings demonstrate that ART, by inducing premature vascular aging, not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome. TRANSLATIONAL PERSPECTIVE: This study highlights that ART not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome. The findings should raise awareness in the ever-growing human ART population in whom these techniques cause similar alterations of the cardiovascular phenotype and encourage early preventive and diagnostic efforts.

Thiacalixarene based quaternary ammonium salts as promising antibacterial agents.

The search for new antibacterial and antiseptic drugs is an urgent problem due to the resistance of microorganisms to existing drugs. In this work, for the first time, the design of antibacterial and bactericidal agents based on quaternary ammonium compounds on thiacalixarene macrocyclic platform was proposed and implemented. A series of tetrasubstituted quaternary ammonium salts with different nature and length of the substituent (-N+(CH3)2R, R = CH2Ph, CnH2n+1, n = 1, 4, 8, 10) based on p-tert-butylthiacalix[4]arene in cone and 1,3-alternate conformations was obtained with excellent yields. The obtained compounds have a high antibacterial effect against Gram-positive (S. aureus, S. epidermidis, B. subtilis) bacteria comparable with commercial antiseptics chlorhexidine, miramistin and benzalkonium chloride. It was found that quaternary ammonium derivatives of thiacalix[4]arene in 1,3-alternate conformation more effectively inhibit the growth of the tested bacterial strains in comparison with compounds in cone conformation. Cytotoxicity studies on human skin fibroblast (HSF) cells demonstrated that all compounds were less toxic compared to reference drugs. The different type of interaction of the studied compounds with model DPPC lipid membranes explains different antibacterial activity and cytotoxicity of compounds. The compounds in cone conformation are adsorbed on the DPPC vesicles membrane surface, while the incorporation of lipophilic alkyl fragments of macrocycles in 1,3-alternate conformation into the membrane leads to "clumping" of DPPC vesicles. It was shown the saving of antibacterial activity of thiacalixarene derivatives in 1,3-alternate conformation on Gram-positive clinical strains. The obtained results allow viewing the described thiacalixarene based quaternary ammonium compounds as promising molecules in the development of the new antibacterial agents.

[Non-coding RNAs as therapeutic targets in spinal cord injury]. / Nekodiruyushchie RNK kak terapevticheskie misheni pri travme spinnogo mozga.

Spinal cord injury (SCI) may be followed by persistent motor dysfunction and somatosensory disturbances that negatively influences the quality of life of patients and creates a significant economic burden. Analysis of secondary biological processes associated with changes in genetic expression is becoming increasingly important every day in understanding the pathophysiology of spinal cord injury. The results of international sequencing of the human genome were analyzed in 2004. These data revealed about 20,000 protein-coding genes covering near 2% of the total genomic sequence. The vast majority of gene transcripts are actually characterized as non-coding RNAs (ncRNAs). These RNA clusters do not encode functional proteins and ensure post-transcriptional regulation of gene expression. The clusters may be small (approximately 20 nucleotides) known as miRNAs or the transcripts can enroll over 200 nucleotides defined as long non-coding RNAs (lncRNAs). Some modern studies describe transient expression of microRNA in case of spinal cord injury. These RNAs are associated with inflammation and apoptosis, functional recovery and regeneration. Large-scale genomic analysis has demonstrated the existence of multiple lncRNAs whose expression is associated with some processes of spinal cord injury. lncRNA can be divided into two categories depending on the position in relation to the coding genes: intergenic and intragenic. Intergenic lncRNAs is currently the most studied class. Intragenic lncRNAs can be subdivided depending on the overlap of the coding genes (antisense, intron, etc.). According to recent studies, long non-coding RNAs are abundantly present in the tissues of central nervous system and may be crucial in the pathogenesis of certain diseases of nervous system. At the cellular level, it has been shown that lncRNAs regulate the expression of protein-coding RNAs. Moreover, these molecules are involved into such processes as neuronal death, demyelination and glia activation. This review is devoted to the role of ncRNAs in the pathogenesis of spinal cord injury and their potential use as targets for the treatment of consequences of spinal cord injury.

[Integrated assessment of hygienic condition of the oral cavity]. / Problemnye voprosy otsenki gigienicheskogo sostoyaniya polosti rta i ikh klinicheskoe reshenie.

THE AIM: To identify the problematic issues of assessing the hygienic state of the oral cavity and the clinical development of possible algorithms for their solution using our modified, highly sensitive (up to 150 CFU/ml versus 5·106-5·108 CFU/ml), objective (2-3% error) method fluorescence spectroscopy. MATERIAL AND METHODS: In a clinical study on 20 patients of working age, it was shown that the authors modified fluorescence spectroscopy method allows each patient to individually perform a comprehensive digital express indication and objective analysis of the oral hygiene state based on express registration and analysis of the entire aggregate of aerobic-anaerobic microflora of various oral biotopes (biotope teeth, lips, gums, cheeks, palate, tongue and saliva) online. RESULTS: Integral indicators of the hygienic state of the oral cavity in individuals with satisfactory oral hygiene before and after brushing have been obtained, which describe the hygienic state of both the oral cavity as a whole and individual biotope in their relationship. CONCLUSION: The results made it possible to substantiate a more objective quantitative methodology for assessing the hygienic state of the oral cavity for the implementation of its individually substantiated clinical use with the identification of the biotope (biotopes) of the mouth, which is the main source of its pollution.

[A 20-year experience in surgical treatment of steno-occlusive lesion of craniocervical arteries at the Burdenko Neurosurgical Center]. / Dvadtsatiletnii opyt khirurgicheskogo lecheniya stenoziruyushchei i okklyuziruyushchei patologii brakhiotsefal'nykh arterii v FGAU «Natsional'nyi meditsinskii issledovatel'skii tsentr neirokhirurgii im. akad. N.N. Burdenko¼.

INTRODUCTION: Surgical treatment of cerebral ischemia at the Burdenko Neurosurgical Center for the period from 1999 to 2019 is analyzed in the paper. The details of the treatment strategy in patients with steno-occlusive lesion of craniocervical arteries followed by cerebral ischemia developed over 20 years are discussed in the article. We have analyzed the features of surgical interventions on the major craniocervical arteries in a neurosurgical clinic and the results of this treatment. OBJECTIVE: To demonstrate management of various lesions of major cerebral arteries in modern neurosurgical vascular hospital. MATERIAL AND METHODS: In total, there were 3098 interventions on the major cerebral arteries in 2527 patients for this period. Mean age of patients ranged from 1.5 to 91 years (58±14 years). Interventions included open reconstructions of the carotid arteries (2031 surgeries), reconstructions of the vertebrobasilar arteries (135 surgeries), brain revascularization (658 surgeries), excision of the tumors of neurovascular bundle on the neck compressing carotid arteries (51 interventions). Endovascular interventions were performed in 223 cases and consisted of angioplasty and stenting of the extracranial segments of craniocervical arteries (185 surgeries), stenting of the intracranial arteries (30 surgeries) and endovascular thrombextraction (8 cases). Staged surgeries were performed in 541 patients (22.3%). RESULTS: Favorable outcomes were obtained in 87.6% of cases, satisfactory results - in 9% of patients. Clinical deterioration due to long-term postoperative complications and recurrent strokes occurred in 2.9% of cases. Postoperative morbidity rate was 4.6%, persistent neurological deficit developed in 2.6% of cases. Mortality rate was 0.5%. CONCLUSION: Surgical treatment of stenotic and occlusive lesion of the major cerebral arteries is an interdisciplinary problem. Solution of this issue is closely associated with technological progress, new discoveries in normal and pathological physiology, as well as clinical researches. Individualized choice of surgical approach is one the main modern trends of neurosurgical approach to this problem. At the same time, own surgical experience is the most important factor determining the results of arterial reconstructions.

Tumour Necrosis Factor-α Inhibition Improves Stroke Outcome in a Mouse Model of Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder where incidence and severity of myocardial infarction are increased. Data on the incidence and outcome of stroke are conflicting. Thus, we investigated outcome after Ischemia/Reperfusion (I/R) brain injury in a mouse model of RA and assessed for the role of the tumour necrosis factor-α (TNF-α) inhibitor Infliximab herein. We used a TNF-α reliant mouse model of RA. RA and wildtype (WT) animals were treated with vehicle (RA/WT) or Infliximab (RA Infliximab) for 4 weeks, before undergoing I/R brain injury. RA-animals displayed larger strokes and poorer neurological performance. Immunohistochemistry on brain sections revealed increased numbers of resident and peripheral innate immune cells (microglia and macrophages); increased Blood-Brain-Barrier (BBB)-disruption; decreased levels of the tight junction proteins (TJPs) claudin-5 and occludin; increased expression of matrix-metalloproteinases (MMP)-3 and -9 and enhanced lipid peroxidation. Treatment with Infliximab corrected these alterations. We show that RA associates to worse stroke-outcome via exacerbated BBB degradation by decrease of the TJPs claudin-5 and occludin. We identified MMPs-3 and -9 and increased oxidative stress as potential mediators thereof. Increased numbers of resident and peripheral innate immune cells (microglia and macrophages) may in turn contribute to all these effects. Infliximab-treatment restored the phenotype of RA-mice to baseline. Our data provide evidence clearly linking RA to adverse stroke-outcome in mice and indicate an approved TNF-α inhibitor as a potential strategy to reduce stroke-burden in this setting.

[Simultaneous reconstruction of the carotid and vertebral arteries using a temporary intraluminal shunt (a clinical case)]. / Odnomomentnaia rekonstruktsiia sonnoi i pozvonochnoi arterii s ispol'zovaniem vremennogo vnutriprosvetnogo shunta (klinicheskoe nabliudenie).

The article describes a case of one-stage surgical treatment of a patient with progressive chronic cerebral ischemia caused by combined steno-occlusive lesions of the carotid and vertebral arteries. The disease was complicated by intolerance to temporary occlusion of the carotid artery due to an incomplete circle of Willis. We performed extra-anatomic carotid-vertebral artery bypass with subsequent ipsilateral carotid endarterectomy. A temporary intraluminal shunt was used at the main stage of reconstructive surgery. We use this clinical case to analyze the issues of surgical treatment for combined lesions of the carotid and vertebral arteries and the techniques for prevention of associated ischemic complications.

[Creation of extracranial-intracranial microvascular anastomosis under regional anesthesia (a case report and a review of the literature)]. / Sozdanie ékstra-intrakranial'nogo mikrososudistogo anastomoza v usloviiakh regionarnoĭ anestezii (klinicheskoe nabliudenie i obzor literatury).

The article describes a case of successful surgical treatment of an 81-year-old male patient with symptomatic occlusion of the internal carotid artery that led to severe impairment of cerebral hemodynamics and was accompanied by severe gait and equilibrium disorders. Given the patient's age and his positive medical history, he underwent surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia, with spontaneous breathing and a baseline level of consciousness being maintained. In the postoperative period, the patient achieved a marked clinical effect in the form of complete regression of syncopal conditions and gait disorders associated with recovery of cerebral perfusion in the right MCA territory. The article discusses the indications for surgical treatment and the technical details of surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia.

[Carotid endarterectomy in patients with symptomatic occlusions of the contralateral internal carotid artery]. / Karotidnaia éndarteréktomiia u bol'nykh s simptomaticheskimi okkliuziiami protivopolozhnoi vnutrennei sonnoi arterii.

The main aim of the study was to investigate the effect of carotid endarterectomy on the prognosis of chronic cerebral ischemia in patients with symptomatic occlusions of the contralateral internal carotid artery, assess risks of surgical complications, and substantiate the staged surgical approach for treatment of patients with this pathology. The article analyzes the experience in surgical treatment of 83 patients with symptomatic ICA occlusions who underwent surgery for contralateral carotid artery stenosis. In 40 patients, only carotid endarterectomy (CEA) was performed on the side of hemodynamically significant stenosis (group 1). In 43 (52%) cases, apart from CEA, extracranial-intracranial (EC-IC) bypass was performed at the second stage (23 cases, group 2) or the first stage (19 cases, group 3). A surgical treatment approach was chosen based on clinical symptoms, severity of contralateral carotid artery stenosis, and the magnitude of perfusion deficiency in the territory of carotid occlusion. The conducted analysis revealed that patients with symptomatic occlusions and contralateral carotid artery stenoses represented a heterogeneous group with a different efficacy of carotid endarterectomy and with risks of perioperative complications. As cerebrovascular insufficiency in the territory of carotid occlusion and a related neurological deficit worsen, the risks of complications of contralateral carotid endarterectomy increase, and its clinical efficacy decreases. In these cases, cerebral revascularization on the ICA occlusion side should be performed at the first stage.

[Perfusion criteria of the EICMA efficacy in patients with symptomatic occlusion of the internal carotid artery]. / Perfuzionnye kriterii effektivnosti operatsii EIKMA u bol'nykh s simptomaticheskoi okklyuziei vnutrennei sonnoi arterii.

AIM: To investigate changes in cerebral perfusion in patients with unilateral internal carotid artery occlusion before and after surgical revascularization of the brain, depending on the clinical efficacy of surgical treatment. MATERIAL AND METHODS: The study included 60 patients with unilateral ICA occlusions who underwent placement of an extra-intracranial microvascular anastomosis (EICMA). All patients underwent a CT perfusion study before and after cerebral revascularization. In addition, the degree of neurological deficit was evaluated before surgery and during follow-up (3 and 8-10 months) using the NIHSS score. RESULTS: All patients were divided into 3 groups, depending on the results of surgical treatment: objective improvement (43 patients), no changes (14 patients), and worsening of clinical symptoms (3 patients). In each group, the absolute and relative perfusion parameters (MTT, CBV, and CBF) were analyzed to identify the perfusion criteria for the EICMA efficacy. A significant relationship between the clinical efficacy of EICMA and a baseline perfusion deficit and its change after anastomosis placement was found. CONCLUSION: Placement of EICMA is effective treatment for patients with symptomatic ICA occlusions and an increase in the blood transit time in the hemisphere ipsilateral to occlusion by more than 40% compared to that in the opposite side provided that perfusion is recovered in more than one area of the MCA territory (in accordance with the ASPECTS scale).

[Criteria of the efficacy of surgical brain revascularization in patients with chronic cerebral ischemia].

PURPOSE: The article analyzes results of surgical revascularization in patients with symptoms of chronic cerebral ischemia caused by occlusion of the carotid arteries. MATERIAL AND METHODS: We analyzed 404 surgeries for placement of extra-intracranial microvascular anastomoses (EICMAs) performed in 376 patients between 2000 and 2015. All patients underwent detailed neurological and neuropsychological examinations before surgery and throughout the follow-up period using the neurological deficit scale (NIHSS). Additionally, the medical history data, technical features of surgery, and results of instrumental tests were recorded. For a more detailed study of the cerebral circulation, a SCT perfusion examination was conducted in 58 patients before and after placement of EICMA. RESULTS: All patients were divided into 3 groups, depending on the surgical treatment outcomes: improvement (53%), without significant changes (43%), and worsening of clinical symptoms (4%). A statistical analysis revealed that the efficacy of EICMA surgery ranged from 22 to 79% and was reliably confirmed by hemodynamic and anamnestic factors as well as by technical details of surgery. CONCLUSION: When determining the indications for surgical revascularization in patients with ischemic stroke consequences, the patient's age, occlusion duration, location and size of ischemic lesions should be considered. Also, the choice of the acceptor artery and blood flow through the created anastomosis are of great importance.

[An anastomosis between the internal carotid and vertebral arteries in the treatment of a patient with bilateral carotid arteries occlusions].

The article presents a case of successful surgical treatment of a patient with progressive chronic cerebral ischemia due to occlusions of both internal carotid arteries combined with occlusion of the vertebral artery in the first and second segments. We describe a surgical technique that includes an auto arterial carotid-subclavian bypass in the third segment of the vertebral artery, with an extracranial portion of the occluded internal carotid artery (after preliminary thromboendarterectomy) being used as a shunt. Previously, the patient had undergone surgery for creating bilateral EICMA. We analyzed the indications for each phase of the surgery with allowance for the peculiarities of compensatory collateral circulation and possible complications of the surgical treatment.

[Combined surgical treatment of cavernous internal carotid artery pseudoaneurysm]. / Kombinirovannoe khirurgicheskoe lechenie lozhnoi anevrizmy kavernoznogo otdela vnutrennei sonnoi arterii.

We describe a clinical case of surgical treatment of a cavernous internal carotid artery (ICA) pseudoaneurysm that developed due to damage to the artery during transsphenoidal resection of pituitary adenoma. Clinically, the aneurysm presented with episodes of profuse epistaxis that required tight nasal packing. Given the presence of an open circle of Willis, the patient underwent staged surgery that included the creation of a high-flow extra-intracranial anastomosis, subsequent endovascular ICA occlusion at the pseudoaneurysm level using balloon-assisted coiling, and endoscopic debridement of the nasal cavity. The combined surgical treatment of this rare complication successfully excluded the pseudoaneurysm from the bloodstream, which led to complete regression of nasal bleeding.

Post-ischaemic silencing of p66Shc reduces ischaemia/reperfusion brain injury and its expression correlates to clinical outcome in stroke.

AIM: Constitutive genetic deletion of the adaptor protein p66(Shc) was shown to protect from ischaemia/reperfusion injury. Here, we aimed at understanding the molecular mechanisms underlying this effect in stroke and studied p66(Shc) gene regulation in human ischaemic stroke. METHODS AND RESULTS: Ischaemia/reperfusion brain injury was induced by performing a transient middle cerebral artery occlusion surgery on wild-type mice. After the ischaemic episode and upon reperfusion, small interfering RNA targeting p66(Shc) was injected intravenously. We observed that post-ischaemic p66(Shc) knockdown preserved blood-brain barrier integrity that resulted in improved stroke outcome, as identified by smaller lesion volumes, decreased neurological deficits, and increased survival. Experiments on primary human brain microvascular endothelial cells demonstrated that silencing of the adaptor protein p66(Shc) preserves claudin-5 protein levels during hypoxia/reoxygenation by reducing nicotinamide adenine dinucleotide phosphate oxidase activity and reactive oxygen species production. Further, we found that in peripheral blood monocytes of acute ischaemic stroke patients p66(Shc) gene expression is transiently increased and that this increase correlates with short-term neurological outcome. CONCLUSION: Post-ischaemic silencing of p66(Shc) upon reperfusion improves stroke outcome in mice while the expression of p66(Shc) gene correlates with short-term outcome in patients with ischaemic stroke.

[Surgical management of patients with pathological deformities of carotid arteries].

Surgical management of pathological deformities of the internal carotid arteries, a cause of chronic brain ischemia, is discussed. This pathology is very common and is found in 25% of all individuals who underwent preventive medical examination according to the ultrasonography data. Most deformities do not pose any threat to patients, while some of them may cause ischemic stroke and chronic brain ischemia. The study included 165 patients with the known follow-up history who had been operated on at the N.N. Burdenko Neurosurgical Institute since 2001. A total of 196 reconstructive interventions of carotid arteries were analyzed. The indications for surgical management of pathological deformities based on clinical symptoms and identification of the signs of vascular wall dysplasia are thoroughly discussed. The local and cerebral hemodynamics during pre- and postoperative period are analyzed. The results of pathomorphological examination of the resected fragments of the deformed arteries are presented; they show that the changes are identical to those in patients with fibromuscular dysplasia. The follow-up history of the patients was recorded; it showed a sustained regression of transitory ischemic strokes and cerebral symptoms in most cases (69%). For proper indications for surgical management, reconstructive surgical interventions are a reliable and effective method for treating chronic brain ischemia and preventing recurrent ischemic strokes in patients with deformities of carotid arteries.

[Carotid endarterectomy in patients with high surgical risk].

Aim of the study to examine the risk factors for carotid endarterectomy (CEA) and their effect on the results of surgical treatment in patients with chronic cerebral ischemia. The study included 340 patients who were operated in the institute from 2007 to 2011. All patients underwent CEA in various modifications. Based on the classification of surgical risk CEA proposed by Sundt, patients were divided into 4 groups. In the following analysis, we evaluated perioperative outcomes of surgical treatment in the third and fourth groups, respectively, compared the frequency of the installation of temporary intraluminal shunt (TIS) during the surgery, depending on the severity of angiographic risk factors and neurological anamnesis. Perioperative ischemic complications in the third group was 4.2%, 6.4% in the fourth respectively. In both groups, TIS required in 15% of operations. In patients undergoing surgery under regional anesthesia, shunts were used two times less frequently than in patients under general anesthesia (8.8% vs. 19.8%). Correlation between the severity of angiographic risk factors and tolerance to hypoperfusion of the brain, caused by a temporary clamping of the ICA revealed. In case occlusion of the contralateral ICA temporary shunts have been installed in 40%, with contralateral stenosis in 15% and without angiographic and risk factors in 80% of cases. The findings coincide with the results of similar studies published in the literature. Taking into account our and foreign data should be noted that CEA in patients with high surgical risk by Sundt is accompanied by an increased incidence of perioperative ischemic complications and requires more differentiated approach to the tactics of surgical treatment, and choice of the method of neurophysiological monitoring during surgery.

[Surgical treatment of patients with chronic cerebral ischemia due to occlusion of the common carotid arteries].

The paper contains information about surgical occlusion of the common carotid arteries--one of the causes of chronic cerebrovascular ischemia. For the period from 2003 to the present time have been treated 25 patients with a clinical picture of cerebral ischemia due to occlusion of the common carotid artery. Performed a total of 48 surgical procedures among which subclavian-external carotid and common carotid bypasses, retrograde carotid thromboendarterectomy. In 7 cases revascularization of the brain was performed as a second stage. Choice of reconstruction type based on preoperative investigation results and intraoperative data. No persistent complications or mortality were observed. Positive clinical dynamics was noted in 80% of cases. Crossability of reconstruction area at the annual catamnesis was 84%. Prosthetic vascular graft thrombosis occurred most often (up to 40%) in patients with type 2 occlusion and in the presence of severe collateral perfusion. In patients with 1st type of occlusion of the common carotid artery reconstructive surgery have shown to be a reliable and effective treatment for chronic cerebral ischemia and prevention of recurrent ischemic stroke.

[The case of simultaneous use of direct and endovascular techniques for the reconstruction of occluded brachiocephalic trunk].

The article provides an example of successful surgical treatment of progressive chronic cerebral ischemia due to occlusion of the brachiocephalic trunk and critical stenosis of the right internal carotid artery (more than 85%). We describe a hybrid method of surgical treatment, which include direct access to the neurovascular bundle, retrograde endovascular recanalization following angioplasty and stenting of the brachiocephalic trunk during temporary occlusion of the distal internal carotid artery and carotid endarterectomy. We provide an analysis of indications for each phase of operation considering the features of compensatory collateral circulation in the basin of the occluded brachiocephalic trunk and the possible complications of surgery.