[Surgical treatment of the internal carotid artery atherosclerotic occlusion].

Internal carotid artery occlusion is the cause of carotid territory transient ischemic attacks or infarction approximately in 15% of patients. Extracranial-lntracranial (EC-IC) Bypass Study and Carotid Occlusion Surgery Study (COSS) failed to show a benefit of EC-IC bypass over medical therapy in patients with symptomatic carotid artery occlusion. Weak sides of COSS were investigators reliance on post hoc analysis, use of specific thresholds in the definition of impaired cerebral hemodynamics and high perioperative morbidity. In selected subset of patients with medically refractory ischemic symptoms, EC-IC bypass, can provide benefit from surgery performed with sufficiently low perioperative morbidity. The potential of functional and cognitive improvement after cerebral revascularization needs further investigation.

[Surgical correction of cerebral blood flow steal syndrome by aortic branches stenosis].

Results of surgical treatment of 119 patients with cerebral/coronary blood flow steal syndrome were analyzed. Vertebro-subclavian steal syndrome was registered in 91.5%. 80 patients were treated with the use of endovascular methods, open procedure was performed in 62 cases. Physiological blood flow was successfully reconstructed in 95.8%. Postoperative lethality was 5,1% after open operations, there were no deaths among patients, treated endoscopically. Bypass thrombosis was registered in 3.4% of patients treated by traditional method; restenosis or occlusion occurred after 34.3% of endovascular operations. Endovascular operations should be a method of choice in treatment of patients with severe occlusion of branches of aorta and cerebro-vascular insufficiency. By impossibility of subclavian artery or brachiocephal trunk recanalization with the use of endovascular techniques, open procedure should be performed.

[Aneurysmal degeneration of the autovenous carotid-subclavian bypass: experience with the treatment, review of literature].

The authors describe an experience gained with successful surgical treatment of a 73-year-old patient with a genuine aneurysm of the autoveinous carotid-subclavian bypass, iwelve years ago the patient was operated on for stenosing atherosclerosis of the coronary and left subclavian arteries (SCA). Aneurysm emergence was consequent on the use of v.saphena magna as a bypass in the given <> and was not associated with appreciable circulatory disorders in the left upper limb. However, its further existence was conjugated with the risk of rupture and bleeding. Examination (duplex scanning, angiography) confirmed the diagnosis of aneurysm. Besides, critical stenosis of segment I of the left SCA and opening of the left internal carotid artery (ICA) were verified as well. The patient was operated on: the first stage involved angioplasty and stenting of segment I of the left SCA; the second stage involved carotid endarterectomy on the left, resection of bypass aneurysm together with its disengagement. On control angiography performed 11 months later the patency of the reconstructed arteries appeared satisfactory; stenosis was not recorded. The given case demonstrates a modern approach to the treatment of patients with coexistent vascular pathology (atherosclerotic stenosis plus aneurysm).