[Delayed complication of iliofemoral bypass surgery: giant false aneurysm of distal anastomosis]. / Pozdnee oslozhnenie podvzdoshno-bedrennogo protezrovaniya: gigantskaya psevdoanevrizma branshi proteza v oblasti distal'nogo anastomoza.

We report the results of open surgical correction of a giant false aneurysm of the distal anastomosis in long-term period after iliofemoral bypass surgery. Preoperative diagnostic procedures made it possible to determine the most appropriate treatment strategy. Aneurysm resection was followed by distal anastomosis repair on the right with prosthesis 10 mm. Postoperative imaging is presented. The authors concluded the effectiveness of revascularization strategy.

[Carotid endarterectomy in a patient with bilateral restenosis of stents in internal carotid arteries]. / Karotidnaia éndarteréktomiia u bol'nogo s dvustoronnim restenozom stentov vo vnutrennikh sonnykh arteriiakh.

The article deals with the results of surgical treatment of a male patient presenting with bilateral restenosis of stents in the internal carotid arteries 11 years after carotid angioplasty with stenting. Described herein are literature reports reflecting the state of the art of the problem, scarcity of studies, as well as some important issues still unresolved. Defined are the main indications for and contraindications to performing this type of reconstruction. The main stages of the operation are demonstrated. This is followed by describing a method of intraoperative protection of the brain, including invasive measurement of retrograde pressure. Besides, the most optimal terms of carrying out the second stage of treatment were determined, eventually demonstrating efficacy and safety of carotid endarterectomy for correction of this condition.

[Endovascular repair of a descending thoracic aortic aneurysm: one-year follow-up results]. / Protezirovanie niskhodiashchego otdela grudnoi aorty: rezul'taty godovogo nabliudeniia.

The article deals with the results of successful surgical management of a male patient with a ruptured thoracic aortic aneurysm, posing particular problems as to deciding upon the scope and stages of surgical reconstruction, accompanied by describing the dynamics of clinical and diagnostic parameters, as well as the main events of the postoperative period. This clinical case report was characterized by additional difficulties due to the occurrence of subtotal haemothorax. Also presented herein is a set of comprehensive measures making it possible to successfully complete open reconstruction of the thoracic portion of the aorta and to achieve a satisfactory outcome both during the in-hospital period and within one-year follow up. Besides, elucidated is the state-of-the-art of this problem in the world literature.

[Progression of precerebral atherosclerosis and predictors of ischemic complications in cardiac patients]. / Progressirovanie pretserebral'nogo ateroskleroza i prediktory ishemicheskikh oslozhnenii u patsientov kardiokhirurgicheskogo profilya.

OBJECTIVE: To identify predictors of progression of precerebral atherosclerosis in long-term period after coronary artery bypass surgery. MATERIAL AND METHODS: There were 97 procedures of carotid endarterectomy in patients after previous coronary artery bypass grafting for the period from 2006 to 2017. Inclusion criteria were previous CABG, no significant (over 60%) stenosis of internal carotid arteries at discharge after CABG. The control group included 447 patients without progression of precerebral atherosclerosis in long-term period after CABG. RESULTS: Careful monitoring of progression of precerebral atherosclerosis and therapeutic prevention of ischemic stroke are required in patients with mild-to-moderate ICA stenosis after CABG. The most significant predictors of progression of precerebral atherosclerosis after CABG were AF (OR=1.97, 95% CI 1.04-3.73), previous occlusion of stent (OR=7.89, 95% CI=2.3-27.0), chronic brain ischemia grade II or III (OR=22.45, 95% CI=11.9-42.3), chronic kidney disease (OR=15.8, 95% CI=5.04-49.5). CONCLUSION: It was revealed that the majority of predictors of adverse ischemic cerebral and myocardial events are indirectly associated with atrial fibrillation.

[Hybrid revascularization of the brain and myocardium: risk stratification for in-hospital complications]. / Gibridnaia revaskuliarizatsiia golovnogo mozga i miokarda: stratifikatsiia riska gospital'nykh oslozhnenii.

AIM: The study was aimed at determining efficacy of a new computer program of stratification of the risk for postoperative adverse cardiovascular events in patients with atherosclerotic lesions of coronary and carotid arteries. PATIENTS AND METHODS: Based on a mathematical analysis of the outcomes of treatment of patients with atherosclerotic lesions of coronary and carotid arteries over the period from 2011 to 2015, we created a program making it possible to determine a staged or simultaneous policy of revascularization, which was retrospectively and prospectively tested in our medical facility. RESULTS: Within the frameworks of a clinical example we carried out hybrid revascularization of the brain and myocardium in the scope of percutaneous coronary intervention and carotid endarterectomy. During the early postoperative hours, the development of myocardial infarction was registered. According to the program's calculations, in using other strategies of surgical treatment (carotid endarterectomy + coronary artery bypass grafting and carotid endarterectomy - coronary artery bypass grafting), the level of risk for the development of a complication was lowest. Thus, taking into consideration this risk stratification by a multidisciplinary team made it possible to avoid the development of complications. CONCLUSION: This program of decision-making regarding revascularization for atherosclerotic lesions of coronary and carotid arteries may be an additional tool in the armamentarium of the methods of determining therapeutic strategy for this patient cohort.

[Bentall-DeBono procedure with xenopericardial valved conduit: a 24-year follow-up data]. / Operatsiya Bentalla­De Bono s primeneniem ksenoperikardial'nogo konduita: rezul'taty 24-letnego nablyudeniya.

Long-term outcome of surgical treatment of a patient with severe aortic insufficiency and ascending aortic aneurysm is reported. The patient underwent Bentall-DeBono procedure with xenopericardial valved conduit. This technique is associated with no complications specific for Dacron conduits and ensures clinical compensation of heart failure, improves prognosis and quality of life.

[Personalized brain revascularization: computer modeling of the reconstruction zone for carotid endarterectomy]. / Personifitsirovannaya revaskulyarizatsiya golovnogo mozga: metod komp'yuternogo modelirovaniya zony rekonstruktsii dlya provedeniya karotidnoi endarterektomii.

OBJECTIVE: To develop a technique of computer modeling of hemodynamics before conventional CEE. MATERIAL AND METHODS: Classical CEE is performed according to conventional patch technique. Duplex parameters of stenosis and blood flow velocity in the carotid arteries were analyzed by using of a linear transducer 7-7.5 MG (Acuson 128XP scanner, Acuson, USA). Multispiral computed tomography with angiography and subsequent processing of data using the Clear canvas software were performed to visualize the main geometric characteristics of the carotid arteries and features of atherosclerotic plaque. RESULTS: Blood flow hemodynamics is essential in the occurrence of postoperative restenosis. Therefore, computer simulation of blood flow using CFD (Computational Fluid Dynamics) methods based on particular patient's data makes it possible to assess localization of zones with high risk of restenosis. CFD approach implies construction of blood flow parameters at absolutely every point of the vessel considering geometric shape of the vessel and flow characteristics at the entrance and exit from the vessel. Pressure curves at the inlet and outlet are constructed using blood flow velocity curves. Pressure curves are subsequently used in the CFD model. The result of blood flow CFD modeling is non-stationary three-dimensional fields of pressure and velocity in the investigated area. Visual analysis of blood flow dynamics in these fields makes it possible to judge possible problem areas along the blood flow and on the inner wall of the vessel. DISCUSSION: Patch technique of classical CEE is characterized by great risk of parietal thrombosis and hyperproliferation of neointima that explains more frequent development of restenosis. Computer modeling is valuable to consider some important technical aspects in implementation of various surgical techniques for carotid artery reconstruction. CONCLUSION: This result demonstrates an importance of achieving the optimal ratio of the diameter of common, internal and external carotid arteries. Modification of patch based on computer simulation is required for these purposes.

[In-hospital results of renal artery stenting in patients with multifocal atherosclerosis]. / Gospital'nye rezul'taty stentirovaniia pochechnykh arterii u patsientov s mul'tifokal'nym aterosklerozom.

OBJECTIVE: A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. MATERIAL AND METHODS: The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. RESULTS: Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. CONCLUSION: Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.

[Structure of in-hospital and remote complications of surgical treatment of stenotic lesions of coronary and carotid arteries]. / Struktura gospital'nykh i otdalennykh oslozhnenii khirurgicheskogo lecheniia stenoticheskikh porazhenii koronarnykh i sonnykh arterii.

BACKGROUND: Problems concerning the choice of optimal revascularization strategy in patients with simultaneous atherosclerotic lesions of the coronary and brachiocephalic arteries still remain unsolved, since there are no randomized studies and there is uncertainty in Russian and foreign guidelines. AIM: The study was aimed at analysing the remote results of surgical treatment of 391 patients with concomitant lesions of the coronary and brachiocephalic arteries within the framework of a single-centre prospective registry. PATIENTS AND METHODS: Within the timeframe of our study, all patients were divided into 4 groups depending on the method of surgical treatment of the above-mentioned pathology of the coronary and brachiocephalic arteries. Group 1 patients underwent staged surgery in the scope of coronary artery bypass grafting followed by carotid endarterectomy. Group 2 patients endured coronary artery bypass grafting combined with carotid endarterectomy. Group 3 patients were subjected to hybrid revascularization consisting in percutaneous coronary intervention and carotid endarterectomy. Group 4 patients sustained staged surgery consisting of carotid endarterectomy followed by coronary artery bypass grafting. The clinical and demographic characteristics, period of follow up, as well as the results after the respective surgical intervention for each group are presented. RESULTS: We analysed the frequency and structure of adverse cardiovascular events depending on the time intervals within which complications had occurred resulting from a particular surgical policy used. DISCUSSION: The obtained findings demonstrated that adverse cardiovascular events in the total sample of patients were mainly observed in the remote period of follow up, which was related primarily to a progressive course of atherosclerosis, the presence of bilateral lesions of the internal carotid arteries, as well as the lack of protocols ensuring complete revascularization in multifocal atherosclerosis within a limited time interval. CONCLUSION: We made a conclusion on efficacy of the simultaneous strategy of revascularization by means of coronary artery bypass grafting combined with carotid endarterectomy in regard to decreased incidence of strokes in the remote period of follow up.

[Long-term results of surgical and conservative treatment of patients with occlusive-stenotic lesions of carotid arteries]. / Otdalennye rezul'taty khirurgicheskogo i konservativnogo lecheniia patsientov s okkliuzionno-stenoticheskimi porazheniiami sonnykh arterii.

OBJECTIVE: To compare long-term outcomes in patients after carotid endarterectomy and those who refused surgical correction and received only conservative treatment. MATERIAL AND METHODS: There were 1035 carotid endarterectomies performed at the Kemerovo Regional Clinical Hospital and Kemerovo Regional Clinical Cardiology Dispensary for the period 2014-2017. Surgery was refused by 136 patients for the same time. Thus, two groups of patients were formed: 1 - carotid endarterectomy group; 2 - conservative treatment group. INCLUSION CRITERIA: significant carotid stenosis, absence of severe neurological deficit (over 25 scores by the National Institutes of Health Stroke Scale), absence of concomitant diseases limiting long-term follow-up. RESULTS: Lethal outcome (p=0.0038) and fatal acute cerebrovascular accident (p=0.0005) were significantly more common in the 2nd group in long-term follow-up period. Thus, combined endpoint took the greatest values in patients who refused surgery compared with patients who received surgical treatment (p=0.0001). It should be noted that ischemic stroke de novo occurred in 9 (6.6%) patients of the 2nd group after 10.8 ± 2.5 months. This complication required subsequent hospitalization for carotid endarterectomy. CONCLUSION: Preventive role of carotid endarterectomy was convincingly proved in comparison with drug therapy regarding mortality and fatal ischemic stroke in patients with significant carotid stenoses within 2.5 years of follow-up period.

[Surgical repair of common carotid artery aneurysm insix years after carotid endarterectomy]. / Rezektsiya anevrizmy obshchei sonnoi arterii u patsienta spustya shest' let posle karotidnoi endarterektomii.

Surgical repair of common carotid artery aneurysm as an extremely rare complication of carotid endarterectomy in long-term period is described. Aneurysmectomywasfollowed by patch repair of the artery. It was concluded that this intervention is effective approach for this complication. The main causes of this adverse event are identified.

[Computer-assisted simulation of haemodynamic parameters of carotid artery bifurcation after carotid endarterectomy]. / Komp'iuternoe modelirovanie gemodinamicheskikh pokazatelei v bifurkatsii sonnykh arterii posle karotidnoi éndarteréktomii.

Computer-aided simulation appropriately using the method of computational fluid dynamics (CFD) makes it possible to determine the elevated-risk zones of most probable formation of restenosis. The main idea of the method described in our article consists in a possibility of creating by the model of the geometrical shape of the vessel and characteristics of the flow at inlets and outlets the parameters of flow in each point of a vessel. The curves of velocity are used to create the curves of pressure at inlets and outlets, which are used in a CFD model. The resulting from CFD simulation of blood flow are nonstationary three-dimensional fields of pressure and velocity in the area under study. Visual examination of the dynamics of these fields makes it possible to judge about possible problem zones inside the area of flow and on the internal wall of the vessel. This article also presents a clinical case report illustrating the use of this technique.

[Predictors of long-term complications after carotid endarterectomy]. / Prediktory oslozhnenii v otdalennom periode posle karotidnoi éndarteréktomii.

AIM: To analyze the predictors of complications within 3 years after carotid endarterectomy (CEE). MATERIAL AND METHODS: The study included 1035 patients after CEE for the period 2011-2016. Long-term follow-up period was 42.4±18.6 months (≈ 3.5 years). The endpoints were such unfavorable cardiovascular events as death, myocardial infarction, stroke/transient ischemic attack, redo revascularization. Statistical analysis was carried out by using of Statistica for Windows 8.0 software package (StatSoft Inc., USA). Stepwise logistic regression was applied to identify risk factors of adverse outcomes and death in long-term postoperative period. RESULTS: Comprehensive analysis of numerous factors (anamnestic, instrumental-diagnostic, surgical) allowed us to identify predictors of long-term unfavorable outcomes in patients with occlusive-stenotic lesions of carotid arteries. Risk factors of long-term complications were SYNTAX score ≥33 (high risk), unstable plaque in the contralateral ICA, occlusion of contralateral ICA, LVEF <39%, ICA cross-clamping >40 min, previous CABG. CONCLUSION: These data are extremely important and can be used to create prognostic models. The last ones are necessary to determine optimal treatment strategy in patients with occlusive-stenotic lesions of supra-aortic vessels.

[Results of coronary artery bypass grafting in patients of different age groups]. / Rezul'taty koronarnogo shuntirovaniia u patsientov raznykh vozrastnykh grupp.

BACKGROUND: Myocardial revascularization involves a wide range of invasive strategies aimed at treating ischaemic heart disease in patients of different age groups. AIM: The purpose of the present study was to analyze the outcomes of coronary artery bypass grafting in patients depending on age. PATIENTS AND METHODS: A total of 905 patients enrolled in our study were subdivided into groups based on age-related characteristics (young age, middle age, old age, senile age). The endpoints of follow up were as follows: myocardial infarction, acute impairment of cerebral circulation, death and haemorrhagic complications. RESULTS: It should be mentioned that the groups were comparable by the majority of the parameters studied. No statistically significant differences in the frequency of the development of complications in the postoperative period were observed. However, amongst patients over 75 years old, revision of the mediastinum for haemorrhage was performed more often. DISCUSSION: Patients of different age groups undergoing coronary artery bypass grafting are extremely heterogeneous by the clinical, anamnestic, instrumental and intraoperative characteristics. A high frequency of haemorrhagic complications amongst patients over 75 years old may be explained by a more aggressive approach to the regimens of anticoagulant/antiaggregant therapy resulting form the presence of atrial fibrillation. In its turn, this fact determines the probability of a high frequency of the development of adverse cardiovascular events. An individual approach to the choice and scope of the strategy of revascularization in patients of different age groups is the fundamental principle for an optimal outcome of coronary surgery. CONCLUSION: The obtained findings and analysis of the statistical data are indicative of the necessity of personified selection of the technique of a surgical intervention for each particular patient, which will make it possible to decrease the rate of adverse cardiovascular events in the postoperative period.

[In-hospital outcomes of transcutaneous coronary intervention and carotid endarterectomy in hybrid and staged regimens]. / Gospital'nye rezul'taty chreskozhnogo koronarnogo vmeshatel'stva i karotidnoi éndarteréktomii v gibridnom i poétapnom rezhimakh.

The aim of this study was comparative assessment of in-hospital outcomes after hybrid and staged surgical management of patients presenting with haemodynamically significant lesions of the coronary (CA) and brachiocephalic arteries (BCA) treated by means of either endovascular or surgical techniques. Over the period from 2010 to 2017, we operated on a total of 197 patients with stenotic lesions of the carotid and coronary arteries. The strategy of revascularization included transcutaneous coronary intervention (TCI) and carotid endarterectomy (CEA). Of these, 73 (37%) patients underwent staged revascularization of the brain and myocardium in various sequence (TCI-CEA or CEA-TCI), with a mean interval between the operations amounting to 9.89±7.36 months. Unfavourable outcomes were regarded as the development of such significant cardiovascular events as myocardial infarction (MI), acute impairment of cerebral circulation, death, repeat unplanned revascularization. For hybrid strategy (TCI+CEA) the index period of assessing the outcomes was the single in-hospital period, whereas for the staged strategy it was the time period beginning from the in-hospital period of the primary operation and ending by the in-hospital period of the second stage. The groups were comparable by the absolute majority of the parameters. More than half of the patients were elderly males. One third had a history of MI. The findings of coronary angiography most often revealed lesions of 1-2 CAs. The average parameters of carotid artery stenosis, according to the BCA angiography varied from 74.9 to 82.6%, with bilateral occlusive stenotic lesions being revealed in every third patient. In connection with more frequent involvement of 1-2 CAs the patients underwent implantation of 1-2 stents. In our sample we used a total of 247 stents. Of these, 119 were uncoated and 128 were drug-eluting stents. No between-group significant differences in the development of unfavourable cardiovascular events during the in-hospital postoperative period were revealed. However, despite this, a pronounced negative tendency of the complication rate was noted in the group of staged revascularization. Non-optimal time intervals between the stages of the operations in a third of cases exceeded one year on the patient's own initiative. Nearly a quarter of patients did not come for the second stage of revascularization. An important finding of our study was no increase in the risk of stent thrombosis in hybrid operations compared with the staged approach, despite administration of a loading dose of clopidogrel after CEA, but not before TCI. Another significant result was the fact of greater availability of revascularization of the myocardium and the brain within the framework of the hybrid strategy as compared with the staged one, which may play an important role in prevention of ischaemic unfavourable events in the remote period of follow up.

[In-hospital outcomes of carotid endarterectomy depending on severity of contralateral lesion]. / Gospital'nye rezul'taty karotidnoi éndarteréktomii v zavisimosti ot razlichnoi vyrazhennosti kontralateral'nogo porazheniia.

AIM: To compare in-hospital outcomes of carotid endarterectomy (CEE) in patients with different lesion of contralateral internal carotid artery (ICA). MATERIAL AND METHODS: There were 730 CEE procedures in patients with bilateral ICA lesion for the period 2011-2016. All patients were divided into 4 groups depending on contralateral ICA stenosis grade: group 1 - stenosis up to 60% (42.6%, n=311); group 2 - 60-90% (18.7%, n=137); group 3 - 90-99% (25.9%, n=189); group 4 - occlusion (12.7%, n=93). Endpoints were unfavorable cardiovascular events including death, myocardial infarction (MI), stroke/TIA, significant hemorrhage by BARC scale (Bleeding Academic Research Consortium). RESULTS: In-hospital mortality and incidence of MI, stroke/TIA were similar in all groups. However, there were no cardiovascular complications in patients with critical contralateral stenosis or occlusion. Bleeding followed by redo surgery was the most frequent complication. Overall incidence of adverse cardiovascular events did not exceed 1.23%. CONCLUSION: There was no correlation between contralateral ICA stenosis and incidence of in-hospital adverse events including death, MI, stroke/TIA. Currently, technique of CEE is well developed that is associated with low incidence of postoperative complications.

[Carotid endarterectomy: three-year results of follow up within the framework of a single-centre register]. / Karotidnaia éndarteréktomiia: trekhletnie rezul'taty nabliudeniia v ramkakh odnotsentrovogo registra.

The purpose of the study was to determine the incidence rate and structure of cardiovascular complications in patients presenting with lesions of the carotid arteries and multifocal atherosclerosis, having endured carotid endarterectomy (CEA), during a three-year period within the framework of a single-centre register. The study included a total of 1,035 patients subjected to CEA over the period from 2011 to 2016. The duration of the long-term follow up averagely amounted to 42.4±18.6 months. The outcome measures assessed were as follows: death, myocardial infarction (MI), acute cerebral circulation impairment (transitory ischaemic attack) [ACCI (TIA)], clinically significant haemorrhage according to the BARC scale, unplanned repeat revascularization. In the remote period of follow up, the mortality rate did not exceed 2.3%. Of the unfavourable outcomes, most frequently observed turned out to be ACCI (TIA), with less often observed being MI. Two times a year, all patients underwent duplex scanning of the carotid arteries, whose findings revealed haemodynamically significant restenosis in 3.28% of cases. The average period of formation of restenosis amounted to 14.0±3.1 months after the operation. Three patients underwent repeat CEA and a further 16 patients endured stenting of the internal carotid artery (with 2 patients having developed intraoperative TIA). In the remote period, no cases of secondary restenosis were revealed this group of patients. It was determined that restenosis more often developed in patients having sustained classical.

[In-hospital outcomes of reconstructive interventions on the aortofemoral segment in patients with multifocal atherosclerosis]. / Gospital'nye iskhody rekonstruktivnykh vmeshatel'stv na aorto-bedrennom segmente u patsientov s mul'tifokal'nym aterosklerozom.

The purpose of the study was to analyse the in-hospital results of surgical treatment in a total of 275 patients presenting with atherosclerotic occlusive and stenotic lesions of the aortofemoral segment within the framework of a single-centre prospective register. The authors performed a detailed analysis of prognostic significance of a wide spectrum of clinico-instrumental, anatomo-angiographic and perioperative factors, followed by revealing the causes of an unfavourable prognosis during the in-hospital period. Based on the obtained findings, they determined significant risk factors for an unfavourable outcome: clinicodemographic (chronic renal insufficiency, grade IV chronic lower limb ischaemia) and surgical (cross-clamping of the aorta for more than 30 min). A high frequency rate of preventive coronary revascularization appeared to have become a protective mechanism making it possible to prevent the development of myocardial infarction in the studied cohort of patients.

[Five-year outcomes of aorto-femoral vascular reconstructions in patients with multifocal atherosclerosis]. / Rezul'taty rekonstruktivnykh vmeshatel'stv na aortobedrennom segmente u patsientov s mul'tifokal'nym aterosklerozom.

AIM: To analyze long-term results of surgical treatment of atherosclerotic occlusive-stenotic lesion of aorto-femoral segment within the single-center prospective register. MATERIAL AND METHODS: The study included 275 patients who underwent aorto-femoral reconstructive interventions for the period 2011-2014. Inclusion criterion was indications for aorto-femoral surgery due to severe atherosclerotic lesions of the infrarenal aorta and/or ilio-femoral arteries. Mean follow-up was 54±11.6 months. RESULTS: Prognostic significance of various clinical-instrumental, anatomical-angiographic and perioperative variables has been comprehensively analyzed. Five-year outcomes and cardiovascular morbidity were assessed in consecutive patients after reconstructive procedures on the aorto-femoral segment. Multidisciplinary approach to determine optimal revascularization strategy and certain tactical and technical algorithms are necessary to improve the outcomes in these severe patients.

[Simultaneous operation in a patient with stenosis of the extracranial portion and an intracranial aneurysm of the internal carotid artery]. / Simul'tannaia operatsiia u bol'nogo so stenozom ékstrakranial'nogo otdela i intrakranial'noi anevrizmoi vnutrennei sonnoi arterii.

Presented herein is a clinical case report concerning surgical treatment of a patient with a rare combination of two pathologies, i. e., a haemodynamically significant stenosis of the extracranial portion and a sacciform aneurysm of the communicative portion of the right internal carotid artery on the background of multifocal atherosclerosis. The patient underwent a simultaneous operation consisting in clipping of the sacciform arterial aneurysm of the communicative portion of the right internal carotid artery and carotid endarterectomy on the right. The chosen surgical policy ensured effective prevention of the development of ischaemic stroke and rupture of the arterial aneurysm, whose risks would have been high in staged treatment and sequentially performing two operations.