[Relation between ultrasonographic and morphological characteristics of atherosclerotic plaques of carotid sinus]. / Sviaz' ul'trazvukovykh i morfologicheskikh kharakteristik ateroskleroticheskikh bliashek karotidnogo sinusa.

The authors revealed relation between the structure of an atherosclerotic plaque (ASP) and intensity of the ultrasound signal reflected form the ASP. Our prospective pilot study included a total of 90 patients (71 men and 19 women aged from 47 to 79 years, with the median age 62 years) presenting with atherosclerotic stenosis of the carotid sinus (CS) and undergoing treatment at the Research Centre of Neurology (Moscow) from April 2015 to March 2016. All patients underwent ultrasonographic examination followed by morphological study of the structure of the plaques removed during carotid endarterectomy (CEA). It was revealed that intensity of the ultrasound signal from an ASP depended on the morphological structure of the ASP components: the foci of atheromatosis were associated with an ultrasound range of 1.1-5.6 dB, those of fibrosis - with the range 23.1-30.5 dB, and those of calcinosis - with the range 42.3-44.7 dB (presented are the values from the 15th to 85th percentiles). It was determined that an increase of intensity of the ultrasound signal reflected from the foci of atheromatosis and fibrosis in the ASP was associated with the presence of small calcificates therein, and a decrease of intensity of the ultrasound signal from the portions of fibrosis in the ASP - with large accumulation of lipophages or newly formed vessels in these portions.

[Carotid endarterectomy and stenting in patients with internal carotid artery stenosis and contralateral occlusion]. / Karotidnaia éndarteréktomiia i stentirovanie u bol'nykh s gemodinamicheski znachimym stenozom vnutrennei sonnoi arterii i kontralateral'noi okkliuziei.

AIM: To determine surgical risk factors and to compare early outcomes after carotid endarterectomy and carotid stenting in patients with internal carotid artery stenosis and contralateral occlusion. MATERIAL AND METHODS: 132 patients were enrolled. 62 and 70 patients underwent carotid endarterectomy and carotid stenting respectively. Early postoperative results were compared depending on type of surgical intervention and presence of risk factors. RESULTS: Significant difference between groups was only found for incidence of neuropathy of the cranial nerves. It was established that cardiac comorbidities are risk factors for adverse events after carotid endarterectomy. Stable (homogeneous) atherosclerotic plaque with clear contour and no ulceration is optimal for carotid stenting.

[Carotid revascularization in type 2 diabetes mellitus. Significance of chronic hyperglycaemia]. / Karotidnaia revaskuliarizatsiia u bol'nykh sakharnym diabetom 2 tipa. Znachenie khronicheskoi giperglikemii.

Patients with type 2 diabetes mellitus (type 2 DM) are typically prone to the development of cerebral atherosclerosis. Presented herein are the results of examination of patients suffering from ischaemic cerebrovascular diseases on the background of type 2 DM subjected to open surgical or endovascular interventions. In patients with cerebrovascular pathology and type 2 DM, atherosclerosis progresses on the background of chronic hyperglycaemia combined with dyslipidaemia, leading to increased incidence of the development of cerebral circulatory impairments and detection of the indications for carrying out angioreconstructive operations on the internal carotid arteries. The presence of type 2 DM is associated with increased risk for the development of ischaemic lesions of the brain matter while performing carotid endarterectomy and endovascular interventions which are associated with higher values of glycaemia (8.0 mmol/l) and glycated haemoglobin (7.8-8 %) prior to the operation.

[Brainstem auditory evoked potentials in neurophysiological assessment of brain stem dysfunction in patients with atherostenosis of vertebral arteries]. / Akusticheskie stvolovye vyzvannye potentsialy v neirofiziologicheskoi otsenke disfunktsii stvola mozga u patsientov s aterostenozom pozvonochnykh arterii.

AIM: To assess brain stem dysfunction in patients with hemodynamically significant stenosis of vertebral arteries (VA) using short latency brainstem auditory evoked potentials (BAEP). MATERIAL AND METHODS: The study group included 50 patients (mean age 64±6 years) with hemodynamically significant extracranial VA stenosis. RESULTS: Patients with hemodynamically significant extracranial VA stenosis had BAEP abnormalities including the elongation of interpeak intervals I-V and peak V latency as well as the reduction of peak I amplitude. After transluminal balloon angioplasty with stenting of VA stenoses, there was a shortening of peak V latency compared to the preoperative period that reflected the improvement of brain stem conductive functions. CONCLUSION: Atherostenosis of vertebral arteries is characterized by the signs of brain stem dysfunction, predominantly in the pontomesencephal brain stem. After transluminal balloon angioplasty with stenting of VA, the improvement of brain stem conductive functions was observed.

[Ischaemic lesions of cerebral after carotid stenting].

Carotid angioplasty with stenting is a reliable method of primary and secondary prevention of ischaemic stroke in patients with stenosing lesions of the internal carotid artery. However, carrying out such operations is sometimes associated with risk for the development of intraoperative impairments of cerebral circulation due to arterioarterial embolism in cerebral arteries, as well as vasospasm. Presented herein are the results of following up a total of 64 patients with pronounced atherosclerotic lesions of internal carotid arteries (>70%) - "symptomatic" and "asymptomatic", undergoing carotid stenting. Acute foci of ischaemia in the brain after stenting according to the findings of diffusion-weighted magnetic resonance tomography were revealed in 40% of cases, and in only 6% of patients they manifested themselves by symptoms of acute cerebral circulatory impairment. We revealed a direct correlation between the number, size of infarctions in the brain, and the appearance of neurological symptomatology. Intraoperative monitoring of blood flow in the middle cerebral artery during stenting makes it possible to predict the appearance of acute foci of cerebral ischaemia, to specify the genesis of perioperative stroke, as well as to evaluate clinical significance of vasospasm and material microembolism. The obtained findings should concentrate neurologists' attention on active postoperative follow up of patients subjected to carotid angioplasty with stenting in order to perform adequate personified neuroprotective correction, including preventive one.

[Intraoperative monitoring of cerebral blood-flow and condition of cerebral at open and endovascular interventions in carotid system].

The aim of our research is to study hemodynamic and embolic situation during the carotid endarterectomy (CEA), carotid angioplastic and stenting (CAS), and to reveal the prognostic significance of the data provided by intraoperative monitoring of the brain blood flow in exposing acute ischemic lesions in brain. Intraoperative monitoring of blood flow in artery ophthalmic vas carried out with 60% of patients, in the middle cerebral artery-with 40% during the main stages of CEA, and with 64 patients in the middle cerebral artery during CAS. The comparison of the data of intraoperative monitoring of blood flow in middle cerebral artery with the result of brain diffusion-weighted magnetic resonance imaging (DW-MRI) 24 hours after the operation shows, that solid microembolic signals and vasospasm are prognostic signals (sensibility and specifics make up 95%) in the development of acute ischemic cerebral lesions. The monitoring of blood flow in artery ophthalmic is of the greatest diagnostic value in estimation of the hemodynamic situation, but it is of the lowest practical value in detecting microembolic signals. According to the data of the intraoperative blood flow monitoring in middle cerebral artery in group CEA the development of acute ischemic cerebral lesions were predicted with 11,1% of patients and the cause of postoperative stroke, developed by 2,9% of the patients, was specified. According to the result of DW-MRI, acute ischemic cerebral lesions were diagnosed with 21% of patients, that is, 18% of ischemic cerebral lesions were asymptomatic. In group CAS ischemic cerebral lesions were prognosed with 30% of patients, actually they were later detected with 40,6% of cases by means of DW-MRI. According to the data of intraoperative of blood flow monitoring the cause of the development of postoperative stroke was specified in 6,2% of cause; in 34,4% of cause the acute ischemic cerebral lesions were asymptomatic.

[Results of proximal vertebral arteries endovascular interventions].

OBJECTIVE: To evaluate immediate and long-term clinical and ultrasound efficacy of proximal vertebral arteries stenting. We studied 74 subjects (age 61+/-10 years) who underwent transluminal balloon angioplasty with stenting of vertebral arteries (77 vessels). Technical success (i.e., residual stenosis < 20%) was achieved in 95% patients. No events (acute stroke, myocardial infarction, or death) were recorded during the procedure or in early postoperative period. Clinical improvement was seen in 81% patients presented with symptoms of vetebrobasilar insufficiency at the baseline (n = 52). Sixty six patients (89%) were followed up in the late postoperative period (6 to 54 months after the intervention). No events of acute stroke were recorded in the vertebrobasilar circulation. Relapse of vertebrobasilar symptoms after temporary improvement was seen in 13% patients. Stent restenosis/occlusion was diagnosed in 36% patients although no relationship was revealed between the alteration of stent patency and relapse of clinical symptoms. Restenosis correlated with initial stenosis of > or = 70% (p < 0.05) and type of stent material. Use of cobalt chromium stents was associated with 2-fold decrease of restenosis rate vs non cobalt chromium stents (24% vs 50%, respectively, p < 0.05). Therefore, stenting of proximal vertebral arteries yields good technical and clinical results. High restenosis rate is a major problem of endovascular treatment of atherosclerosis and needs further evaluation.

[Surgical management of patients with lower limb critical ischaemia induced by lesions of infrainguinal arteries].

The authors analyse their experience in surgical management of 325 patients diagnosed with lower limb critical ischaemia (LLCI) secondary to lesions of infrainguinal arteries. Of these, 216 (66.5%) patients (Group 1) were subjected to isolated bypass grafting operations defined as either "reconstructive", or "direct revascularisations". A further 35 (10.8%) patients (Group 2) underwent concomitant revascularizations accompanied simultaneously or in a stagewise manner (but within the time frame of one hospitalization) by reconstructive and palliative operations (e. g., femoropopliteal bypass grafting and lumbar sympathectomy), and 74 (22.7%) patients (Group 3) were subjected to only palliative operations alone (lumbar sympathectomy and revascularizing osteotrephination), i.e., "indirect revascularizations". The remote outcomes of surgical management were followed up within the terms of up to 5 years in 306 (94.2%) of the 325 patients operated on for LLCI. Of these: in 205 (94.9%) of the 216 Group 1 patients, in 33 (94.3%) of the 35 Group 2 patients, and in 68 of the 74 (91.9%) Group 3 patients. Amongst the Group 1 patients (n = 205) over the 5-year follow-up period we had performed a total of 70 (34.1%) amputations of the postoperative extremity and encountered 121 (59.0%) cases of thromboses of the bypass grafts. Of the Group 2 patients (n = 33), over the 5 year follow-up, the postoperative extremities were amputated in 7 (21.2%) patients. Thromboses of the bypass grafts over the same time period were noted to have developed in 11(33.3%) patients. Amongst Group 3 patients (n - 68) the postoperative extremities were saved in 37, with the limb salvage rate thus amounting to 54.4%.

Long-term results of venous blood flow arterialization of the leg and foot in patients with critical lower limb ischemia.

This paper analyzes the long-term results of venous blood flow arterializations of the leg and foot, performed in 67 patients with critical lower limb ischemia at the Department of Vascular Surgery, Russian Scientific Center of Surgery, over the period from 1996. Indications for surgery were occlusions of the arteries of the femoropopliteotibial segment, which excluded the possibility of performing reconstructive bypass graftings. Analysis of the long-term results of venous blood flow arterialization of the leg and foot evidences its high efficacy. The use of such operation in patients with initial critical lower limb ischemia enables amputation of the involved limb to be avoided in 64% of cases and ensures the high level of physical and social adaptation of the patient for the nearest 2-3 years.

[A comparative analysis of long-term outcomes of femoropoplietal autovenous bypass <> grafting and the reversed vein].

Presented herein is a comparative analysis of the remote results obtained ofter a total of 215 operations of femoropoplietal autovenous bypass grafting performed by a reversed vein (n=105) and <> technique (n=110). The patients from the both groups matched well by all criteria of the comparative analysis. Over a 5-year period, the cumulative patency rate of the <> grafts amounted to 56.4%, and that by the reversed autovein equalled 47.6 %. The preservation rate in the both groups during the same time period amounted to 77.3 % and 67.7 %, respectively. The main factor exerting a statistically reliable influence on the patency of the femoropoplietal grafts was found to be the level of the establishment of the distal anastomosis. When the distal anastomosis was established, above the knee-joint fissure, no statistically significant differences in the patency of the grafts performed by of the reversed autovein and those carried out according to the <> technique were revealed. Placing the distal anastomosis below the knee-joint fissure appeared to offer apparent advantages of autovenous grafting performed according to the <> technique.

[Indications for using an intraluminal temporary bypass in operations on carotid arteries].

The review is dedicated to the most commonly used method of protecting the brain in carotid endarterectomy, i. e. using an intraluminal temporary bypass (ITB), also containing the information concerning the constructions of ITBs, various points of view regarding practical application thereof, as well as the methods of monitoring the functions of the brain in order to solve the problem concerning feasibility of using an ITB.

[Cerebral metabolism in carotid endarterectomy (oxygenation, electrolytic balance, glucose consumption)].

The purpose of this study was to evaluate regional oxygenation, glucose metabolism and electrolytic balance of the brain in patients with an atherosclerotic lesion of the carotid arteries in the perioperative period. A total of 42 patients presenting with various combinations and degree of manifestation of occlusive-and-stenotic damages to the brachiocephalic arteries were examined. Regional oxygenation of the brain (rS02) was assessed using the unit INVOS 3100 (Somanetics Corp., USA) at rest, with the patient lying upon the back and breathing atmospheric air and oxygen, and while changing the assumed body position. The acid-base state, gases, electrolytic composition and the level of glucose in the arterial blood and blood outflowing from the brain were analysed with the help of the unit STAT profile 5 Analyzer (NOVA Biomedical, USA). Four variants of perioperative alterations in oxygenation of the brain were determined, with the respective comparative characteristics thereof given. The authors have shown that the rS02 at rest prior to surgery was determined in unilateral stenosis of the internal carotid artery on the side of the lesion, while in bilateral stenosis - on the side of the greater lesion of the internal carotid artery. A decrease in the rS02 value in patients with the internal carotid artery narrowed by 70% and more during the orthostatic test is characteristic of subcompensation of the cerebral blood flow. Decompensation thereof manifests itself by a positive reaction of rS02 to oxygen inhalation. Patients with the initially low values of rS02 during reperfusion of the brain were found to have diminished glucose utilization, while in the normal rS02, glucose metabolism was noted to increase.

[Lumbar sympathectomy in treatment of obliterating diseases of lower limbs: state of the art]. / Primenenie poiasnichnoi simpatéktomii v lechenii obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei -- sovremennyi vzgliad na problemu.

The article deals with analysing examination and surgical treatment of 80 patients with predominant lesions to the distal arterial bed of the lower extremities, who were operated on at the RRSC from 1996 to 2003 with various degree on the background of chronic obliterating diseases of lower limbs arteries. All the patients were subdivided into two groups according to the outcomes of the epidural block: Group I -- with positive outcomes consisted of 36 (45 %) patients, and Group II -- with a negative outcome -- included 44 (55 %) patients. The patients from the both groups underwent the following operations: lumbar sympathectomy combined with direct and indirect methods of revascularisation, as well as lumbar sympathectomy as an independent therapeutic method. To solve the problem concerning feasibility of either done, or concomitant lumbar sympathectomy, we devised assessment of microcirculation state (alterations in volumetric blood flow indices in epidural block in relation to the indices at rest, as well as in the immediate or remote postoperative period) and peripheral haemocirculation (dynamics of the onkle brachial index values on the background of epidural block test, nitroglycerine test in relation to the ARI at rest both in the short-, and long-term postoperative period) by data of scintigraphy and dopplerography of the lower limbs.

[Surgical treatment of patients with critical lower limb ischemia due to affection of arteries of the femoral-popliteal-tibial segment]. / Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei pri porazheniiakh arterii bedrenno-podkolenno-bertsovogo segmenta.

Experience of surgical treatment of 325 patients with critical lower limb ischemia due to affection of infrainguinal vessels are analyzed. Comparative analysis of efficacy of direct, indirect and combined revascularizations was carried out, quality of life of patients in long-term period after surgery was evaluated.

[Genetic engineering potential and perspectives in the management of critical ischemia]. / Vozmozhnosti i perspektivy lecheniia kriticheskoi ishemii s ispol'zovaniem genno-inzhenernykh tekhnologii.

The paper presents a new approach to management of lower limb critical ischemia which implements recent advances in molecular biology and genetic engineering technologies. A new original compound incorporating angiogenin gene was developed to activate neoangiogenesis processes after injection into living tissues. Experimental data evidence a potential efficacy of new method for complex management of critical ischemia.

[Successful treatment of a patient with internal carotid aneurysm]. / Uspeshnoe lechenie bol'noi s anevrizmoi vnutrennei sonnoi arterii.

Presented herein is a clinical report of the surgical treatment of a female patient with left internal carotid aneurysm. Patient M, aged 58 years was hospitalized to the Department of Vascular Surgery, RSCS RAMS, with complaints of a pulsatile formation in the area of the neck on the left, persistent headaches, frequently occurring dizziness, and multiple episodes of loss of consciousness. The patient has been ailing for 20 years. Examination discovered a rounded pulsatile formation about 3 cm in diameter in the left lateral area of the neck in the internal carotid projection. Duplex scanning revealed aneurysm of the left internal carotid artery measuring 2,3 cm x 3.8 cm. Computerized tomography confirmed aneurysm of the left internal carotid artery. On December 10, 2002 the patient underwent resection of aneurysm of the left internal carotid artery followed by establishment of an end-to-end anastomosis. The immediate postoperative period was uneventful. The patient was discharged home in a satisfactory condition.

[Indications for carotid endarterectomy and its outcomes]. / Pokazaniia k karotidnoi éndarteréktomii i ee rezul'taty.

The paper analyzes a correlation between the sonographic and morphological characteristics of the structure of atherosclerotic plaques and the severity of cerebrovascular insufficiency. This significantly expands indications for surgical treatment in patients with carotid atherosclerosis. In the authors' opinion, not only the degree of carotid stenosis, but also the structure of a plaque is an important criterion for assessing indications for surgical treatment. The outcomes of carotid endarterectomy are comparatively evaluated in relation to the mode of carotid plastic repair. A role of intraoperative cerebral oximetry is shown.

[Surgical treatment of carotid chemodectomas]. / Khirurgicheskoe lechenie bol'nykh karotidnoi khemodectomoi.

49 patients have been examined and 38 of them operated in RRCS RAMS for carotid hemadectomas (CH). CH is a rather rare tumor developing from the carotid gland locating in bifurcation of the common carotid artery. It is slowly growing tumor which is scantily active and rarely metastasizes. In 35 of the 38 operated patients radical ablation of the tumor was carried out. In the rest 3 patients radical removal of the tumor was impossible due to its dissemination and malignancy. The classification was used according to which all the tumors were distributed in 3 groups in dependence on the character of their growth. The basic principle of their division was the relation of CH to the carotid arteries. The use of this classification allowed to define individual surgical tactics. As a result of the treatment 97.4% of the patients were discharged with improvement. During the follow-up period (94 +/- 5 months) there were no relapses detected in these patients.

[The perioperative diagnosis of cerebral ischemia during reconstructive operations on the carotid arteries (initial experience in using transcranial oximetry)]. / Perioperatsionnaia diagnostika tserebral'noi ishemii pri rekonstruktivnykh operatsiiakh na sonnykh arteriiakh (pervyi opyt primeneniia transkranial'noi oksimetrii).

Intraoperative monitoring of cerebral ischemia during surgery on the brachiocephalic arteries is carried out by several methods: transcranial dopplerography, electroencephalography, recording of the somatosensory evoked potentials, puncture measurement of intravascular pressure, etc. However, not all these methods are sufficiently informative, reliable, and safe. One of the methods meeting these requirements is noninvasive cerebral oximetry. The study was carried out by the Invos-3100 device (Somanetics, USA). The method of cerebral oximetry is based on optic spectroscopy using infrared light in the 650-1100 nm waveband. Monitoring was carried out in 34 patients with involvement of the brachiocephalic arteries. The results persuasively prove high informative value and safety of the method.