ABSTRACT
Recent years have witnessed several studies concerning optimal terms of performing carotid endarterectomy after endured acute cerebral circulation disorder (ACCD). However up to now there is no common opinion regarding feasibility and safety of performing carotid endarterectomy in the acute period of ischaemic stroke. The 2013 Russian National Guidelines on surgical management of diseases of extracranial arteries point to feasibility of performing carotid endarterectomy at terms within up to 2 weeks after endured ischaemic stroke (level B evidence). At the same time, there is no data concerning possibility of performing this type of operation in patients with neurological deficit scoring 4 points according to the Rankin scale. Analysing the results of 110 carotid endarterectomies performed in patients with haemodynamically meaningful stenosis of carotid arteries at terms varying from 2 to 14 days after the development of ipsilateral ACCD showed safety of the operation (the rate of postoperative cerebral circulation disorders amounted to 0.9% - 1 patient) and its efficacy in prevention of recurrent ischaemic complications, also determining regression of neurological symptomatology in the overwhelming majority - 86 (78%) patients. Despite the absence of recommendations on possibility to perform carotid endarterectomy in patients after endured ACCD with neurological deficiency scoring 4 points according to the modified Rankin scale we proved efficiency and feasibility of performing this type of operation in the cohort of patients concerned. There was not a single case of transformation of the ischaemic focus into haemorrhagic one. One patient developed fatal ACCD. During the follow up period (12 months) regression of neurological symptomatology was observed in 16 (66.7%) patients of 24 operated patients with baseline deficit of stage 4 according to the Rankin scale.
Subject(s)
Brain Ischemia , Endarterectomy, Carotid , Postoperative Complications/prevention & control , Stroke , Aged , Brain Ischemia/complications , Brain Ischemia/diagnosis , Brain Ischemia/physiopathology , Brain Ischemia/surgery , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/surgery , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/prevention & control , Cerebrovascular Circulation , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Patient Acuity , Retrospective Studies , Russia , Secondary Prevention , Stroke/complications , Stroke/diagnosis , Stroke/physiopathology , Stroke/surgery , Time FactorsABSTRACT
The authors confirmed efficacy of external carotid artery plasty in occlusion of the internal carotid artery. The findings of triplex scanning and transcranial dopplerography demonstrated a considerable increment in the blood flow through the middle cerebral artery in the operated zone, amounting to approximately 30% one year after surgical treatment. Twenty-two patients before and after surgery were subjected to single-photon emission computed tomography. The majority of patients after surgery were found to have improved perfusion of the previously ischaemized zone of the brain on the side of operation according to the data of single-photon emission computed tomography.
