Abstract: Introduction: the role of intracerebral stenosis of brain arteries in the development of postoperative strokes in patients with extensive atherosclerosis remains unresolved, and in clinical practice, magnetic resonance angiography (MRA) of cerebral arteries is not carried out routinely to predict the risk of postoperative cerebrovascular disorders. Aim: was to identify factors of MRA of intracerebral arteries essential for prognosis of ischemic strokes in postoperative period of angiosurgical interventions and in acute period of myocardial infarction (AMI), from the quantitative processing of brain MRA recruited from the MRI — MRA register. Materials and methods: results of brain MRA of 195 patients with extensive atherosclerosis carried out before cardio- or angiosurgical interventions were analyzed. Of these, three had an ischemic stroke after carotid endarterectomy, three — after CABG operations, and five — after surgical treatment of thoracic aortic aneurysms, on 2-5 day after surgery. We also studied results of brain MRA in five patients who developed an episode of ischemic brain stroke in the acute period of acute myocardial infarction. In all cases of circulatory disorders were localized in the region of middle cerebral artery (MCA). Everyone was given a time-of-flight MRA with reconstruction of three-dimensional anatomical picture of cerebral arteries. The index of gradient of narrowing of arterial lumen (GNL) of artery was calculated as the ratio of the difference in the area of artery at stenosis and at nearest proximal non-stenosed level, to the distance between them, along the course of the vessel: GNL={(Snorm–Sstenosis)/Dnorm–stenosis}, mm2/mm. Results: analyzing the visual picture of brain MRA in patients, the sign of critical narrowing of MCA for >50% was observed in all five patients with acute ischemic stroke concomitant with acute myocardial infarction. In all 11 patients who developed postoperative stroke, the visual picture of MCA stenosis was bilateral, more pronounced on the side of the ischemic disorder after the operation. When using the GNL index, it was obvious that ischemic stroke developed only when the stenosis was more sharp than GSP >1,05 mm2/mm. Of five patients who showed signs of MCA stenosis but did not have postoperative stroke, four took doses of 250 mg/day or more of ethylmethylhydroxypyridine succinate (mexidol) for more than a month at the outpatient stage. The sensitivity of MRA preoperative sign of MCA stenosis in relation to postoperative ischemic stroke was 100% in all groups, the specificity and diagnostic accuracy was 97,5%, the predictability of a positive conclusion was 62,5-75%, and the predictability of a negative conclusion was 97-99%. Conclusion: technology for evaluating the gradient of narrowing of arterial lumen in the area of atherosclerotic stenosis of intracerebral arteries in patients with extensive atherosclerosis allows predicting the risk of postoperative stroke. Gradient of narrowing of arterial lumen index for atherosclerotic middle cerebral artery over 1,05 mm2/mm in patients with extensive atherosclerosis predicts increased risk of strokes in postoperative period, or as a complication of acute myocardial infarction. Long-term preoperative injection of mexidol probably reduces the risk of postoperative stroke in extensive atherosclerosis.
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