[Autotransplantation of the internal carotid artery in patients with high localization of an atherosclerotic plaque]. / Autotransplantatsiia vnutrennei sonnoi arterii u patsientov s vysokim rasprostraneniem ateroskleroticheskoi bliashki.

Acute and chronic cerebral circulatory impairment is a very commonly encountered type of neurological diseases, annually affecting more than six million people worldwide. The absolute majority of all cases are associated with atherosclerosis of cerebral arteries. Surgical intervention in a stenotic lesion of the internal carotid artery (ICA) is a method of preventive treatment with confirmed efficacy. Eversion carotid endarterectomy (ECEA) is currently the most commonly used 'open' operation for this cohort of patients. It is connected with relative technical simplicity of the operative procedure, no foreign material in the wound, low risk of haemodynamic disorders in the zone of reconstruction owing to no considerable alteration in the ICA diameter, as well as favourable remote results. A disadvantage of ECEA is lack of visual control above the distal portion of the ICA and, as a consequence, limited application of the technique in cases of a highly located atherosclerotic plaque (by more than 2 cm above the bifurcation). Specialists of the Federal Centre of Cardiovascular Surgery in the city of Penza worked out a modification of the operative technique making it possible to widen the indications for using ECEA. Its essence consists in total resection of the stenosed portion of the ICA, performing eversion endarterectomy outside the wound, followed by reimplantation thereof with the help of two 'end-to-end' anastomoses, as during prosthetic repair. This technique was called autotransplantation of the ICA. Advantages of this technique are considered to include precision of removing the plaque and intimal ruptured fragments, which is easier and more convenient to achieve outside the wound; reliable fixation of the intima and non-stenosing residuals of the plaque by a distal anastomosis, as well as a possibility of using this technique in cases of high location of the plaque. The purpose of this study was to compare the immediate results_outcomes of ECEA and autotransplantation of the ICA in two groups comprising 108 and 72 patients, respectively. The measures assessed included the mean time of ICA cross-clamping during surgery, frequency of the development of perioperative strokes, haemorrhage, lesions of craniocerebral nerves, wound complications.

Protected carotid artery stenting and angioplasty via transfemoral versus transcervical approaches.

This prospective cohort study was taken to determine whether transcervical carotid artery stenting (CAS) with internal carotid artery (ICA) flow reversal is associated with a lower incidence of embolization and femoral access complication when compared with protected, transfemoral CAS in selected, high-risk patients. From 2002 to October 2004, the authors performed 55 carotid stentings and angioplasties. Among the 24 cases via transfemoral approach, 1 developed transient ischemic attack (TIA), 1 stroke, 1 asystolic cardiac arrest, 2 groin hematoma, 2 technical failure, and 1 restenosis. Among the 31 cases via transcervical approach, 2 patients developed TIAs, 4 bradycardia, 2 cervical hematoma, and 3 technical failures leading to open conversion and carotid endarterectomy. Transcervical CAS with ICA flow reversal eliminates the risk of aortic arch emboli, provides cerebral protection during predeployment manipulation across the carotid lesion, negates preprocedure mapping of the aortic arch configuration, and surpasses difficult aortic arch or transfemoral access.

External carotid artery reconstruction performed using an autologous internal carotid artery patch. Technical note.

The reconstruction of the external carotid artery (ECA) and obliteration of an occluded stump or atretic internal carotid artery (ICA) are described. In this method the occluded ICA is used as an autologous patch graft. Satisfactory ICA obliteration and expanded, smooth common carotid artery-ECA contour were obtained in three patients. Advantages of this procedure include ICA obliteration and precise patch placement by using an ideal, autologous, arterial graft.

[Reconstructive vascular surgery in stenosis and kinking of the internal carotid artery]. / Vosstanovitel'nye sosudistye operatsii pri kombinatsii stenoza i kinkinga vnutrennei sonnoi arterii.

Combination of stenosis and kinking of the internal carotid artery was revealed in 7.9% of 126 patients who underwent operation for stenosis of the bifurcation of the carotid artery. Among 9 patients with kinking of the internal carotid artery (ICA) 5 had a C-shaped kink, 2 - an S-shaped kink, and 2 patients looping of the artery. The combination led to a great measure to diminished volumetric cerebral blood flow (30-35 ml/min/g). The operations were performed under conduction anesthesia. Average time of ICA compression - 13 min. 26 sec. Retrograde pressure ranged from 42 to 88 mm Hg. In 2 cases the ICA was implanted into a new opening in the common carotid artery after eversion endarterectomy. The defect in the bifurcation was sutured. In 5 cases (4 with a C-shaped kink and 1 with an S-shaped kink) the artery was replanted into the former opening after eversion endarterectomy and resection of the kinked segment of the ICA. In 2 patients with looping of the artery the loop was resected with end to end anastomosis into the ICA and typical endarterectomy from the bifurcation of the carotid artery. There were no fatal outcomes. The results of operative treatment were good.

Operative management of the kinked carotid artery.

In instances in which coexistent significant carotid artery disease and internal carotid redundancy coexist, we have found that use of the resected autogenous internal carotid artery to be a convenient and satisfactory way of patching the frequently small distal internal carotid artery following resection of the redundant portion. There has been no morbidity associated with additional suture lines, and in follow-up care extending through 24 months, there have been no recurrent symptoms.