[An evaluation of the hemodynamic efficacy of an extra-intracranial microanastomosis in unilateral occlusion of the internal carotid artery]. / Otsenka gemodinamicheskoi éffektivnosti ékstra-intrakranial'nogo mikroanastomoza pri odnostoronnei okkliuzii vnutrennei sonnoi arterii.

The physicians of the A. N. Bakulev Institute for Cardiovascular Surgery examined 64 patients with unilateral atherosclerotic occlusion of the internal carotid artery (ICA). TCDG and angiography were employed before and after establishment of EICMA. TCDG proved highly informative in assessment of collateral circulation (sensitivity 95.6%). Indications to EICMA should be based on overall account of initial stage of cerebrovascular insufficiency and collateral circulation. EICMA is indicated for patients with compensated and relatively compensated cerebrovascular insufficiency (transient ischemic attacks, minor apoplexy, dyscirculatory encephalopathy), residue sequelae of ischemic apoplexy stroke, baseline poor collateral circulation. Differentiated approach to EICMA establishment allows improved outcomes of the surgery and revision of common among angio-neurosurgeons attitude to the above surgery in ICA occlusion.

Evaluation of haemodynamic effects of extracranial-intracranial arterial bypass in unilateral internal carotid artery occlusion.

Sixty-four patients with unilateral atherosclerotic occlusion of the internal carotid artery were studied at the Bakulev Institute for Cardiovascular Surgery with transcranial Doppler (TCD) ultrasonography and angiography before and after extracranial-intracranial arterial bypass (EIAB). TCD assessed accurately the extent of the collateral circulation in 95% of cases. The haemodynamic effectiveness of EIAB depends on the preoperative state of the collateral circulation; the greatest effect was achieved in patients with the lowest levels. EIABs improved the outcome in patients in the present series; hence vascular and neurosurgeons may be persuaded of the benefit of this treatment in patients with unilateral atherosclerotic occlusion of the internal carotid artery.

[The epidemiology of occlusive lesions of the branches of the aortic arch]. / Epidemiologiia okkliuziruiushchikh porazhenii vetvei dugi aorty.

The most significant risk factors of the development of this pathology are: arterial hypertension, IHD, smoking. A group of patients younger than 50 was three times less that a group of patients 51-60 years old. Based on data of morbidity the authors counted the spread of occlusive lesions of the aorta arc branches in the population of men studied, which amounts 4.15%.

[The efficacy of the surgical treatment of occlusive lesions of the carotid arteries]. / Effektivnost' khirurgicheskogo lecheniia okkliuziruiushchikh porazhenii sonnykh arterii.

The authors from the A. N. Bakulev Institute of Cardiovascular Surgery analyze the results of surgical management of 154 males aged 40-60 years who suffered from carotid artery occlusions. The patients were divided into three groups of patients: (1) 28 patients with asymptomatic occlusions; (2) 36 with transient ischemic episodes (TIE), and (3) 90 with ischemic stroke. A set of techniques was used, which involved Doppler ultrasonography with spectral analysis of a Doppler ultrasonographic signal, study of regional brain blood flow from brain tissue 133Xe clearance by using the functional hypercapnic test, computed tomography and angiography. A total of 165 operations were performed. The outcomes of surgical management in the early postoperative period were studied in all patients. The long-term outcomes were analyzed in 130 patients who had been followed up for average 2.3 years. In the immediate postoperative period, the uncomplicated course was in 96.4% from Group 1, in 96.3% from Group 2, and in 94.4% from Group 3. Deaths occurred in 1.3%. In the late period, all patients from Group 1 had no signs of cerebrovascular insufficiency, an improvement was observed in 88.9 and 80.0% in Groups 2 and 3, respectively. No deaths occurred in all the groups in the late postoperative period. The paper discusses how the efficiency of surgical management is related to the cerebral hemodynamics and morphological changes in brain tissues in carotid artery occlusions.