[Remote results of surgical management of chronic cerebrovascular insufficiency].

The work was aimed at studying the remote results of reconstructive operations performed on brachiocephalic arteries in a total of 1,483 patients presenting with chronic cerebrovascular insufficiency. The findings obtained from our experience confirmed that carotid endarterectomy up to now remains the gold standard of treatment for both symptomatic and asymptomatic patients suffering from haemodynamically significant lesions of carotid arteries, requiring, however, timely performance and consequent active follow up of the patients involved.

[Surgical aspects of treatment for bilateral atherosclerotic lesion of carotid arteries].

The present study was aimed at determining surgical policy and terms of intervention in bilateral atherosclerotic lesions of carotid arteries. Depending on the treatment policy, a total of 114 patients were subdivided into two groups. Group One patients underwent the traditional procedure and carotid reconstruction was performed on the side with more pronounced stenosis or in the carotid basin with ischaemic stroke where an ischaemic episode had occurred, with the total rate of complications related to ischaemic stroke or death amounting to 4.4%. In Group Two patients in order to determine the side subject to carotid reconstruction we primarily used a newly developed policy for determining the most affected carotid basin. For this purpose we worked out a special scale making it possible to determine the degree of the lesion of the carotid basin from each side. Using this policy we managed to decrease the complication rate in Group Two patients to 2.1%. According to our data the optimal terms for performing carotid endarterectomy on the opposite side vary from 2 to 3 months.

[Our experience in surgical management of internal carotid artery ocсlusion].

Analysed in the article are the outcomes of surgical management in a total of 42 patients diagnosed as having occlusive lesions of the internal carotid artery. Also studied is efficacy of the operation - resection and ligation of the internal carotid artery, endarterectomy from the common and external carotid arteries with the application of a dilating patch onto the external carotid artery in occlusion of the internal carotid artery in patients with endured ischaemic stroke, depending on severity of neurological deficit and the time having elapsed since the operation performed. Also investigated are peculiarities of cerebral haemodynamics in patients with occlusion of the internal carotid artery and haemodynamic alterations during the stages of surgical treatment. The obtained findings confirm efficacy of reconstructive operations in both prevention of relapsing stroke and surgical rehabilitation.

[Damage to craniocerebral nerves in reconstructive surgery of carotid arteries].

Reconstructive operations on aortic arch branches appear to be the most efficient method of preventing acute and chronic impairments of cerebral circulation. Iatrogenic lesions of the craniocerebral nerves deteriorate the course of the immediate, and especially the remote postoperative period, decreasing quality of life and social status of the patients after endured carotid reconstructions. The authors analysed herein the outcomes in a total of 562 patients after endured carotid artery surgery for atherosclerosis or pathological tortuosity. The authors examined the incidence rate, patterns and risk factor of damage to the craniocerebral nerves in all the patients. Comprehensive prevention of damage to the craniocerebral nerves was carried out in a total of 412 patients from the Study Group and was aimed at excluding or decreasing intensity of the eff ect of the eliminable risk factors. The proposed measures made it possible to decrease the rate of lesions of craniocerebral nerves from 18.7 to 6.9% and to substantially improve the postoperative patients' quality of life.

[Diagnostics and strategy of surgical treatment of multifocal atherosclerosis].

The study included 148 patients with different combinations of multifocal atherosclerosis. The inclusion criteria were clinical manifestations of chronic cerebrovascular insufficiency concomitant with diseases of other arterial basins. The treatment strategies were chosen based on the results of examination by non-invasive methods for vascular visualization. Contrast agents were used only for curative purposes. The patients were divided into 2 groups depending on surgical strategy. Patients of group 1 underwent one-step reconstruction of several affected basins, those in group 2 step-by-step revascularization of different arterial basins with the use of X-ray endovascular interventions. The former approach was applied at the initial stage of the work. It creating a high risk of complications, the latter approach was preferred in the subsequent period. The incidence of complications in group 2 was 4.05% and the lethality rate 1.49%. These values were significantly higher in patients of group 1.

[Results of reconstructive surgery for carotid artery occlusion in ischemic stroke survivors].

The authors report results of reconstructive surgery in 316 patients with carotid artery (CA) occlusion operated after ischemic stroke. Its efficiency is estimated with reference to the degree of neurologic deficiency and treatment schedule. The results confirm effectiveness of reconstructive surgery on CA for the prevention of stroke relapses and promotion of surgical rehabilitation.