[Surgical prevention of progressive cerebral ischemia after ischemic stroke]. / Khirurgicheskaya profilaktika progressirovaniya ishemii golovnogo mozga u patsientov posle insul'ta.

OBJECTIVE: To evaluate the effectiveness of carotid endarterectomy after ischemic stroke and to analyze postoperative neurological status. MATERIAL AND METHODS: There were 120 patients with carotid artery stenosis complicated by chronic cerebrovascular insufficiency (CVI). Patients with CVI grade I-III were included in the first group (n=70), 50 patients had previous ischemic stroke (the second group). Age of patients was 61-89 years. All patients underwent unilateral carotid endarterectomy. RESULTS: Over 36-month follow-up period, postoperative stroke occurred in 5 (7.2%) and 9 (18.3%) patients in both groups, respectively. The combined end-point (stroke + mortality) was significantly less common in group I compared to group II (10 (14.5%) and 15 (30%) cases, p>0.05). Positive changes in neurological status were found in the 2nd group (relief of focal neurological deficit, symptoms of cerebrovascular insufficiency, no progression of vascular dementia). Barthel score increased from 74.3 to 92.8 after carotid endarterectomy in the 2nd group. Baseline FAB score <11 was observed in 9% of patients in the 1st group and 22% in the 2nd group. No progression of dementia was observed in long-term period. CONCLUSION: Carotid endarterectomy is effective in prevention of primary and recurrent stroke. Moreover, this procedure slows down progression of chronic cerebral ischemia and cognitive impairment.

[Minimally invasive carotid artery surgery]. / Maloinvazivnaya khirurgiya sonnykh arterii.

OBJECTIVE: To determine the criteria for choosing a surgical approach and compare an effectiveness of carotid endarterectomy (CEAE) via 3 approaches. MATERIAL AND METHODS: The study included 120 patients who underwent CEAE via 3 different approaches. Intraoperative skin marking included lower jaw angle, skin fold closest to common carotid artery bifurcation. Carotid artery bifurcation and borders of atherosclerotic plaque were visualized using ultrasound. An effectiveness of each access was evaluated in accordance with the following criteria: neurological complications, cosmetic effect and quality of life after 1 and 12 months. The patients were divided into 2 groups. Group I - 80 patients with CEAE with access through the natural skin fold (NSF); group II - 40 patients with CEAE using the classical longitudinal access. The 1st group was divided into 2 subgroups. Subgroup I A - 39 patients with CEAE using mini-access via NSF; subgroup I B - 41 patients with CEAE using extended access via NSF. RESULTS: There were no strokes and transient ischemic attacks in a month after surgery in both groups. After 12 months, stroke occurred in 2 (%) patients of group II, cranial neuropathy - 8 (21%) patients in the same group. The best cosmic effect was achieved in subgroup I A after 1 and 12 months (37.1±6.7 scores). Mean score of physical health was 51.59±5.9 scores in subgroup I A, 46.03±7.53 scores - in subgroup I B, 38.84±5.28 scores - in group II. Index of mental health was 49.63±6.69, 45.68±5.6, and 48.59±7.29 scores, respectively. CONCLUSION: Considering these data, we developed a personalized computer program ensuring fast choice of optimal surgical approach.

[Advantages of minimally invasive approach for carotid endarterectomy]. / Preimushchestva mini-dostupa pri karotidnoi éndarteréktomii.

OBJECTIVE: To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). MATERIAL AND METHODS: There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). RESULTS: Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). CONCLUSION: Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.

[Meta-analysis of the results of eversion carotid endarterectomy and endarterectomy with patch plasty]. / Metaanaliz rezul'tatov éversionnoi karotidnoi éndarteréktomii i éndarteréktomii s plastikoi zaplatoi.

AIM: The study was aimed at comparing the results of eversion carotid endarterectomy and carotid endarterectomy with patch plasty in the immediate and remote postoperative periods. MATERIALS AND METHODS: The literature was retrieved by means of electronic databases, with the dates of publications ranging from 1970 to 2019. According to the inclusion and exclusion criteria we selected the literature making it possible to carry out a meta-analysis in the immediate and remote postoperative periods. The results were obtained with the help of the Stata 14 software package. Eventually, we retrieved and analysed a total of 2139 articles. Of these, ten were included into the study and contained 3568 patients subjected to 3672 operations (eversion carotid endarterectomy - 1718 and carotid endarterectomy with a patch - 1954). The results of the meta-analysis were as follows: the mean time of carotid artery cross-clamping for eversion carotid endarterectomy was shorter than that for carotid endarterectomy with a patch (4.1±2.9 min); the frequency of using intraoperative temporary bypass in eversion carotid endarterectomy turned out to be significantly less compared with carotid endarterectomy with patch plasty - 13.5% (91/672) and 62.0% (492/793), OR=0.183, 95% CI: 0.136-0.254, p<0.001; the incidence rate of ischaemic stroke in the immediate and remote postoperative periods was significantly lower after eversion carotid endarterectomy than that after carotid endarterectomy with patch plasty - OR=0.452, 95% CI: 0258-0.792, p=0.005 and OR=0.300, 95% CI; 0.155-0.579, p=0.000. The development of restenosis in the immediate and remote postoperative periods was observed less often for eversion carotid endarterectomy compared with carotid endarterectomy with patch plasty - OR=0.604, 95% CI: 0.422-0.864, p=0.006. CONCLUSION: Eversion carotid endarterectomy was associated with shorter time of carotid artery cross-clamping, lower frequency of intraoperative temporary bypass, lower number of cases of ischaemic stroke in the immediate and remote postoperative periods, as well as those of restenosis in the long-term postoperative period.

[Early carotid endarterectomy in patients after endured acute cerebral circulation impairment]. / Ranniaia karotidnaia éndarteréktomiia u patsientov, perenesshikh ostroe narushenie mozgovogo krovoobrashcheniia.

Recent years have witnessed a series of studies dedicated to assessment of optimal terms of performing carotid endarterectomy (CEA) after sustained acute cerebral circulatory impairment (ACCI). However, there is no commonly accepted opinion concerning feasibility and safety of early CEA in 'symptomatic' patients. The 2015 Guidelines of the American Heart Association suggest that surgical intervention should be performed within the shortest terms or during 2 weeks after a neurological event (class IIb, level B evidence). In the presented herein review of literature most authors demonstrated safety and efficacy of performing early CEA after endured ACCI. However, further prospective, randomized studies are needed in order to work out new standards of examination and to determine optimal surgical policy.

[An efficacy of carotid arteries repair for tortuosity combined with stenosis]. / Éffektivnost' rekonstruktivnykh operatsii na sonnykh arteriiakh pri sochetanii izvitosti i stenoza.

AIM: To assess an efficacy of carotid arteries reconstruction in patients with internal carotid artery stenosis combined with tortuosity. MATERIAL AND METHODS: 86 patients with ICA tortuosity and stenosis were enrolled. All patients were divided into groups depending on type of surgery: group I - open carotid endarterectomy (CEA) followed by obligatory repair with synthetic patch (31 (36%) patients); group II - eversion CEA with ICA resection, redressation and reimplantation into own ostium (35 (40.7%) patients); group III - ICA replacement (20 (23.3%) patients). Synthetic prosthesis and autovein were used in 13 (65%) and 7 (35%) patients respectively. The study included patients with ICA stenosis ≥60% (any type of plaque) and any degree of cerebrovascular insufficiency or ICA stenosis <60% (plaque type I-III) with CVI grade II-IV combined with S- or C-tortuosity, bend or loop with blood flow velocity over 110 cm/s and its turbulence. Only 6 (7.0%) out of 86 patients had no clinical signs of CVI/previous stroke. Asymptomatic/symptomatic patients ratio was following in all groups: group I - 12 (38.7%)/19 (61.3%); group II - 29 (82.9%)/6 (17.1%); group III - 10 (50%)/10 (50%). RESULTS: Within 6-month follow-up 22 (70.9%) out of 31 patients were asymptomatic in group I, 30 (85.7%) (p=0.9475) out of 35 - in group II, 9 (45%) (p=0.9511) out of 20 patients - in group III and 1 (5%) patient developed thrombosis of the reconstruction zone followed by ischemic stroke. After 12 months following patients were asymptomatic: 22 (70.9%) in group I, 30 (85.7%) (p=0.9475) in group II and 9 (45%) patients (p=0.9511) in group III. After 1 year 4 (33.3%) out of 12 patients with CVI grade IV had partial regression of focal neurological symptoms. CONCLUSION: Surgery for ICA tortuosity combined with stenosis confirmed its efficacy and safety for both asymptomatic and symptomatic patients. Significantly better results were observed in eversion CEA compared with conventional procedure and ICA replacement.

[Surgical treatment of patients with haemodynamically significant stenosis of the internal carotid artery and contralateral occlusion]. / Khirurgicheskoe lechenie bol'nykh s gemodinamicheski znachimym stenozom vnutrennei sonnoi arterii i kontrlateral'noi okkliuziei.

Presented herein is a review of the literature dedicated to the problem regarding surgical management of patients with haemodynamically significant stenosis of the internal carotid artery and collateral occlusion. Special consideration is given to the studies comparing perioperative and early postoperative outcomes of carotid endarterectomy in patients with the nosology concerned. The literature was retrieved by means of the following databases Scopus, Web of Science, Medline, and the Russian Science Citation Index.

[Ocular blood flow and carotid artery malfunction].

AIM: to evaluate ocular hemodynamics and informativity of estimated individual normal range of intraocular pressure (IOP). MATERIALS AND METHODS: A total of 12 patients (22 eyes) with carotid artery malfunction were examined. Ocular blood flow (OBF) and IOP were measured with Ocular Blood Flow Analyzer. Actual OBF was then compared with what is considered normal for a given axial length (AL). Individual normal range of IOP was calculated according to an original formula (described in previous publications). Doppler imaging of ocular vessels enabled blood flow velocity measurement. Morphological parameters and functional status of the retina and optic nerve were judged on automated perimetry (Octopus 900) and optical coherence tomography (Cirrus HD-OCT) findings. Statistical analyses were performed using Statistica 10 software. RESULTS: Generally, OBF showed no correlation with the grade of carotid artery stenosis (p < 0.05), however, was significantly reduced as compared to its AL-dependent norm in patients with greater than 85% narrowing of the internal carotid artery, which can cause misestimating of their individual normal range of IOP. A negative relationship was established between the blood flow velocity in short posterior ciliary arteries and the grade of internal carotid artery stenosis (p < 0.005). Ocular blood flow deficit relative to the AL-dependent norm correlated with ophthalmic artery resistance index. CONCLUSION: OBF-based estimation of individual normal range of IOP is inexpedient in patients with greater than 80% carotid artery stenosis due to its possible influence on ocular hemodynamics. In most cases of less than 80% carotid artery stenosis OBF is adequate or slightly reduced as compared to its AL-dependent norm and thus, has no significant impact on estimated individual normal range of IOP.

[Open operations or endovascular interventions in lesions of the first segment of the subclavian artery?].

MATERIAL AND METHODS: The study included a total of 110 patients presenting with stenoses of the first portion of the subclavian artery (SCA). Group One comprised 55 (50%) patients subjected to carotid-subclavian bypass grafting. The degree of stenosis varied from 65 to 95% (p>0.05), occlusion of the SCA was found in 28 (p<0.05) patients, permanent steal syndrome was observed in 39 (p>0.05) patients. Concomitant cardiac pathology was observed in 30 (55%) patients, with one (2%) patient having a history of stroke. Group Two was composed of 55 (50%) patients undergoing endovascular interventions. The degree of stenosis varied from 65 to 95%, with eight patients having occlusion of the SCA. Permanent steal syndrome was observed in 36 patients. Accompanying cardiac pathology was noted in 28 (51%) patients, with eight (15%) patients having a history of stroke (p<0.05). RESULTS: In Group One, six months after surgery, of 41 cases thrombosis was revealed in 2 patients. 2 years later, of 36 cases, thrombosis was detected in 7 patients. After 5 years, of 19 cases, thrombosis was revealed in 6. After more than 5 years, of 11 cases thrombosis was revealed in 6. In Group Two 6 months after surgery, of 46 cases, the stent ceased to function in 8 patients. After 2 years, of 41 cases, 21 were found to have developed thrombosis. After 5 years - of 20 cases, thrombosis was revealed in 16. Of 7 cases after more than 5 years the stent failed to function in 6. CONCLUSION: The operation of carotid-subclavian bypass grafting turned out more effective in the remote postoperative period.

[Assessment of efficacy of reconstructive operations on carotid arteries in combination of stenosis and pathological tortuosity]. / Otsenka éffektivnosti rekonstruktivnykh operatsii na sonnykh arteriiakh v sochetanii stenoza i patologicheskoi izvitosti.

OBJECTIVE: The purpose of this study was to assess efficacy of reconstructive operations on carotid arteries in patients presenting with stenosis of the internal carotid artery (ICA) combined with its pathological tortuosity. MATERIAL AND METHODS: We analysed our experience in surgical treatment of 84 patients with pathological tortuosity of the ICA combined with atherosclerotic stenosis. The study included patients with ICA stenosis ≥60% (any type of the atherosclerotic plaque) and with any degree of cerebrovascular insufficiency (CVI), or with ICA stenosis <60% (type I-III atherosclerotic plaque) with degree II-IV CVI in a combination with either S- or C-shaped tortuosity of the ICA, kinking or coiling, with the linear blood flow rate ≥110 cm/s and turbulence of blood flow. Only six (7.1%) patients of the 84 (100%) presented with no clinical signs of CVI and were found to have a past medical history free from episodes of cerebral circulation impairments. The ratio of asymptomatic/symptomatic patients was as follows: in group 1 - 12 (58.7%)/19 (61.3%), in group 2 - 27 (81.8%)/6 (18.2%), and in group 3 - 10 (50%)/10 (50%). RESULTS: Six months after surgery, the asymptomatic/symptomatic patients ratio was as follows: in group 1 - 22 (70.9%)/9 (29.1%), in group 2 - 28 (84.8%)/5 (15.2%), p=0.045, and in group 3 - 9 (45%)/11 (55%), p=0.024. In group 3, one (5%) patient developed thrombosis of the reconstruction zone with the development of ischaemic-type acute cerebral circulation impairment. Twelve months after surgery the ratio in the groups did not change. Of twelve patients with degree IV chronic CVI, four (33.3%) were found to have partial regression of the focal neurological symptomatology. CONCLUSION: Surgical method of treatment of patients with ICA stenos combined with pathological tortuosity proved efficient and safe both for asymptomatic patients and patients with clinical manifestations of CVI. Significantly better results were observed in the group subjected to eversion carotid endarterectomy with resection of the excessive ICA, with brining down and reimplantation into the ostium as compared with carotid endarterectomy with a patch and as compared with ICA resection with prosthetic repair.

[Combined anaesthesia in reconstructive operations on carotid arteries].

MATERIAL AND METHODS: The authors analysed the protocols of anaesthesia in a total of 100 patients operated on carotid arteries. Depending upon the method of anaesthesiological management, the patients were subdivided into 4 groups comparable by age, gender, physical status, and the scope of the intervention. Group One patients received only propofol-fentanyl total intravenous anaesthesia (TIVA). Group Two, Three and Four patients received combined anaesthesia which was as follows: in Group Two - TIVA based on propofol and fentanyl with superficial cervical plexus block (SCPB), in Group Three - combined anaesthesia based on sevoflurane in a combination with SCPB, and in Group Four - combined anaesthesia based on isoflurane and fentanyl in a combination with SCPB. Analysing the results, we assessed the parameters of arterial pressure, BIS values, also calculating the doses of the anaesthetics and demand for narcotic analgesics during anaesthesia. The quality of the postoperative period was evaluated according to the 5-point vertebral rating scale (VRS). RESULTS: Comparing the need in fentanyl for maintaining general anaesthesia revealed considerably higher doses thereof in Group One patients. Analysing the dynamics of the parameters of mean arterial pressure showed their higher stability in Groups 2, 3 and 4, which was conditioned by better antinociceptive protection with SCPB added. The degree of the postoperative pain syndrome within 48 hours according to the VRS in Group One patients was higher as compared with that in Groups Two, Three and Four patients who additionally received SCPB. CONCLUSION: TIVA based on propofol and fentanyl combined with SCPB provides better analgesia in the area of the operation and decreases the demand for narcotic analgesics. Combined anaesthesia provides better stability of the haemodynamic parameters at the stages of surgery, also decreasing the degree of postoperative pain.

[Results of surgical treatment of patients with internal carotid artery kinking depending on methods of its reconstruction].

It was analyzed the results of surgical treatment of 60 patients with internal carotid artery kinking operated in the department of vascular surgery of acad. B.V. Petrovsky Russian Scientific Center of Surgery of RAN. Indications for surgery included symptoms of cerebrovascular insufficiency (CVI) and instrumentally confirmed hemodynamically significant kinking of ICA. Criteria for surgical treatment were linear flow velocity gradient more than 2 and turbulent blood flow in the kinking segment diagnosed by ultrasonic scanning. All patients were divided into 2 groups depending on methods of surgery. The first group included 36 (60%) patients who underwent resection of ICA with orifice bringing down. The second group included 8 (13%) patients after ICA replacement and 16 (27%) cases with eversion endarterectomy, resection of ICA and orifice bringing down. The analysis of immediate surgery results did not reveal significant differences in dynamics of CVI and velocity parameters in reconstructed ICA (p>0.05). The index "stroke+mortality from stroke" was higher in the second group (p<0.05). Thrombosis of ICA reconstruction area has been developing more frequent (p<0.05) after ICA replacement (8%) in comparison with resection of ICA with orifice bringing down (0) and eversion endarterectomy, resection of ICA and orifice bringing down (0). Our data show that resection of ICA with orifice bringing down is preferable for surgical treatment of ICA kinking. ICA replacement is associated with significantly more frequent complications. Eversion endarterectomy with resection of ICA is optimal in case of combination of kinking with stenosis of ICA.

[The results of carotid endarterectomy in patients with carotid arteries stenosis and chronic ischemic optical neuropathy].

It was estimated an efficiency of surgical and conservative treatment of patients with atherosclerotic carotid arteries stenosis and chronic ischemic optical neuropathy. The first group included 30 patients after carotid endarterectomy. The second group included 20 patients who underwent conservative treatment. The methods of investigation included determination of visual acuity, autorefractometry, direct and inverse ophthalmoscopy under mydriasis, computer static perimetry, assessment of functional status of optic nerve by using of threshold of electric sensitivity and lability, ultrasonic scanning of eyes arteries and carotid arteries. Follow-up terms were baseline, in one month and in one year after surgery or conservative treatment. Improvement of visual acuity on 0.1 and more in 1st/2nd groups was 9/2 (p=0.1629), in one year - 12/1 (p=0.0075). Improvement of field of vision: in 1 month in 1st/2nd groups it was 12/3 (p=0.0692), in 1 year - 17/1 (p=0.0002). The dynamics of neurological status: there was equal ratio of asymptomatic/symptomatic patients at baseline in subgroups. In the 1st group it was 19/11 vs. 16/4 in the 2nd group (p=0.3451). In 1 year after two kinds of treatment significant changes were revealed. There was 26/4 in the 1st group vs. 13/7 in the 2nd group (p=0.0902) with improvement only after carotid endarterectomy - 19/11 at baseline vs. 26/4 in 1 year (p=0.0716). Insignificant deterioration was diagnosed after conservative treatment - 16/4 vs. 13/7 (p=0.4801).

[Efficacy of carotid endarterectomy in patients with stenosis of carotid arteries and acute vision impairment].

The article deals with comparing efficacy (improved function of the eye) of surgical and conservative treatment of patients presenting with atherosclerotic stenosis of carotid arteries and acute vision disorders. The surgery group (carotid endarterectomy) comprised a total of 49 patients and the conservative-treatment group consisted of 50 subjects. Methods of examination included: determining visual acuity (VA), autorefractometry, direct and reverse ophthalmoscopy under the conditions of mydriasis, contactless computed tomography, computer-assisted static perimetry, assessment of the functional state of the optic nerve (ON) with determination of the parameters of the threshold of electric sensitivity and lability of the optic nerve by phosphene, ultrasonographic scanning of ophthalmic arteries and carotid arteries. The terms of examination were as follows: at baseline, one months and one year after surgery or conservative treatment. The results (by the groups) were as follows: in amaurosis fugas - improvement of VA by 0.1 and more: 15 and 0 (p<0.001), disappearance of fits of amaurosis fugas: 16 and 3 (p<0.001), widening of the fields of vision: 16 and 0 (p<0.001), improvement of the condition of the optic nerve: 16 and 0 (p<0.001), maximal increase of systolic blood velocity in the arteries of the eye (Vs): by 30% and 0. In occlusion of the central retinal artery and its branches - improvement of VA by 0.1 and more: 8 and 1 (p=0.005), widening of the fields of vision: 6 and 2 (p = 0.112), improved condition of the optic nerve: 14 and 0 (p<0.001), increase in the Vs: 40% and 0. In acute ischaemic neuropathy - improvement of VA by 0.1 and more: 9 and 2 (p<0.001), widening of the fields of vision: 9 and 3 (p=0.004), improved condition of the optic nerve: 11 and 0 (p<0.001), increased Vs: 40% and 0. Total - improvement of VA by 0.1 and more: 32 and 2 (p<0.001), widening of the fields of vision: 31 and 8 (p<0.001), improved condition of the optic nerve: 41 and 0 (p<0.001), Vs increase: 40% and 0. Carotid endarterectomy effectively improves the functional state of the eye in patients with stenosis of carotid arteries and acute vision impairments.

[Immediate and remote results of surgical treatment of patients presenting with pathological tortuosity of internal carotid arteries and accompanying ocular ischaemic syndrome].

The article deals with the data concerning the efficacy of reconstructive operations and conservative treatment in patients presenting with pathological tortuosity of internal carotid arteries. The study included a total of 63 patients. The diagnostic algorithm was as follows: studying the haemodynamics of the internal carotid arteries, assessing the neurological status, and the methods of examining the eye. The patients were subdivided into two groups: Group One consisted of operated on patients (n=37) and Group Two comprising patients treated conservatively (n=26). The patients according to the neurological status were subdivided as follows: an asymptomatic course in 25 (39.7%) patients, transitory ischaemic attacks in 18 (28.6%) patients, dyscirculatory encephalopathy in 12 (19 %) patients, and stroke in 8 (12.7%) patients. Ophthalmological symptomatology was predominantly manifested by fits of amaurosis fugax in 19 (30.2%) patients and processes of maculodystrophy in 49 (77.8 %) patients. We assessed the immediate (day 30) and remote (1 year) results of conservative and surgical treatment. Group One patients demonstrated cessation of the amaurosis fugax attacks, improvement of the acuity of vision by 0.1 and more, enlargement of the borders of the field of vision, disappearance of scotomas, as well as arrest of the processes of maculodystrophy. Patients with transitory ischaemic attacks and dyscirculatory encephalopathy changed to the category of asymptomatic patients. In Group Two patients the dynamics of the neurological status was negative and the patients continued to experience fits of amaurosis fugas. The dynamics of the opthalmological symptomatology was weakly pronounced.

[Prevention of ischemic stroke in patients with asymptomatic lesions of carotid arteries].

Based on the data from both Russian and foreign literature, analysed herein are the methods of surgical and medicamentous prevention of ischaemic stroke in patients presenting with asymptomatic lesions of carotid arteries. This is followed by discussing haemodynamic parameters of the blood flow in the carotid arteries and their effect on cerebrovascular symptomatology. Also presented herein are the data concerning efficacy of different modalities of antithrombocytic therapy, followed by presenting own results regarding surgical management for stenoses and pathological kinking of carotid arteries in the patient cohort concerned.

[Outcomes of carotid endarterectomy and stenting in patients with carotid artery stenosis].

Analysed in the article are the outcomes of treating a total of 156 patients diagnosed with carotid artery stenosis. Of these, carotid endarterectomy was performed in 82 patients and stenting of carotid arteries was carried out in the remaining 74 patients. The incidence rate of perioperative stroke in the carotid endarterectomy group amounted to 3.6%, being in the stenting group 4.8%, P = 0.57. Multifactorial analysis was used to reveal risk factors for each method. Thus, in the carotid endarterectomy group, the risk factors for cerebrovascular complications appeared to be contralateral occlusion in patients with a history of stroke endured within less than six previous months (P<0.05), as well as the age over 75 years amongst the patients requiring placement of a temporary intraluminal bypass graft (P<0.05). For carotid stenting, risk factors of cerebrovascular complications included a hypoechogenic heterogeneous type of an atherosclerotic plaque (P<0.05) and ulceration of its surface (P<0.05). The presence of the patient's baseline functional class III angina of effort appeared to be a risk factor for the development of cardiovascular complications for carotid endarterectomy (P<0.05). No cardiovascular risk factors for carotid stenting were revealed. Based on the assessment of the risk factors thus detected, the authors worked out an algorithm of choosing an optimal treatment policy for patients presenting with carotid artery stenosis.