[Carotid endarterectomy or carotid stenting: optimal therapeutic decision-making for patients with carotid artery stenoses].

The work was aimed at comparatively studying the outcomes of carotid endarterectomy and carotid stenting for optimal therapeutic decision-making in patients presenting with carotid artery stenoses. We examined and treated a total of one hundred and sixty-seven patients. In the group of endarterectomy, we performed a total of 91 operations in 85 patients, and in the group of carotid stenting, a total of 87 stenting procedures were carried out on the internal carotid artery with cerebral protection in 82 patients. This was followed by analysing both short- and long-term outcomes with a follow-up period ranging from 1 year to 3 years. We examined the following postoperative parameters: «stroke + lethality¼, incidence of transitory ischaemic attacks, as well as the rate of craniocerebral neuropathy and acute myocardial infarction. In the remote period we evaluated the prevalence rate of the parameter «stroke + myocardial infarction + lethality¼, as well as restenosis recurrence. In the carotid-endarterectomy group, the predictors of unfavourable surgical outcomes were contralateral occlusion (p=0.048) and cardial pathology (p=0.0245). In the group of carotid stenting, these predictors turned out to be a heterogeneous atherosclerotic plaque with an uneven or ulcerated contour (p=0.004), and the degree of cerebrovascular insufficiency (p=0.005).

[Assessing efficacy and risk factors of carotid endarterectomy and carotid stenting in patients with symptomatic stenoses of internal carotid arteries in early postoperative period].

The present work was aimed at comparative assessment of efficacy and risk factors of carotid endarterectomy and carotid stenting in patients suffering from symptomatic stenoses of the internal carotid arteries, with due regard for the degree of the accompanying cardiac pathology, the presence of contralateral occlusion, and severity of chronic cerebrovascular insufficiency. We examined and treated a total of 142 patients diagnosed with stenoses of the internal carotid arteries and symptoms of chronic cerebrovascular insufficiency. In the cohort of those subjected to carotid endarterectomy we performed a total of 76 operations in 73 patients, and in the group of carotid stenting 71 operations of stenting of the internal carotid artery with cerebral protection in 69 patients. Postoperatively we assessed the following parameters: «stroke+lethality¼, incidence of transitory ischaemiс attacks, incidence rate of cerebrovascular neuropathy, and acute myocardial infarction. In the carotid endarterectomy group, we revealed increased risk for the development of neuropathy of the craniocerebral nerves (OR=0.0564, 95% CI 0.9953, P=0.049). In the group of stenting, we revealed increased risk for the development of transitory ischaemia.

[Intravascular ultrasound investigation with virtual hystology in the study of coronary artery lesions].

Spectral analysis of radiofrequency data obtained at intravascular ultrasound study allows to carry out more detailed analysis and morphological assessment of plaque components. In the course of preliminary investigations in vitro 4 types of reflected signals were revealed. According to results of spectral analysis of radiofrequency data these signals correspond to histological plaque components. Color coding was assigned to various components (fibrotic, fibrolipid, necrotic core, and calcinosis). Based on cluster technique invasive diagnostic intravascular ultrasound study with virtual histology allows to identify plaques of different types. It has become possible to detect criteria of plaque vulnerability. At present criteria of increased vulnerability based on histopathological studies appear to be widening of necrotic core, presence of fibrous capsule, inclusions of calcinosis, positive remodeling of coronary vascular bed, degree of stenosis, and localization of lesion.

[Diagnosis and surgical treatment of aneurysms of the popliteal artery].

Nineteen patients with aneurysms of the popliteal artery have been operated. Indications and type of surgery were determined on the basis of the clinical picture, angiography and duplex scanning data. There were 19 surgeries: ligation of afferent and efferent vessels of aneurysm with auto-venous grafting (8), resection of aneurysm with auto-venous grafting (5), dissection of aneurysm with auto-venous grafting and coverage with duplication from aneurysmatic walls (3), endovascular grafting of aneurysm (2), ligation of afferent vessel of aneurysm (1). In early postoperative period after open surgical revascularizations thrombosis was seen in 4 (25%) patients. One patient died on day 20 after surgery due to decompensation of severe concomitant disease. The patient who has undergone ligation of afferent vessel without revascularization has discharged after compensation of acute ischemia.