Abstract: Aim: was to study the impact of angiographic projection on patient and operator radiation dose during endovascular interventions aimed at diagnosing and treating cerebrovascular diseases. Materials and methods: in experiment, radiation dose rate of phantom model (cGy?cm2/s) and equivalent dose rate from scattered radiation (mSv/h) measured in the area of conditional location of operator were studied when the angle of the X-ray tube was changed in modes of digital subtraction angiography (DSA) and fluoroscopy. Radiation dose rate of endovascular surgeon (mSv/h) was assessed during 12 cerebral angiography procedures and 15 neuro-interventions in general angiographic projections. Values of the kerma-area product (Gy?cm2), fluoroscopy time (min), operator exposure dose (µSv) during 87 procedures of endovascular occlusion of aneurysm of cavernous and supraclinoid sections of internal carotid arteries (ICA) were retrospectively analyzed to indirectly assess the effect of angiographic projection on patient and surgeon occupational dose. Interventions were divided into 2 groups depending on the location of detected aneurysm. The 1st group included 35 operations in the right ICA, the 2nd group included 53 operations in the left ICA. Results: in experimental study, highest values of radiation dose rate of the phantom model were found in frontal projection with cranial angulation, lowest - in lateral and oblique projections; The highest average dose rates from scattered radiation in operator's area were found in left lateral projections whereas the smallest in right lateral projection in DSA mode and also in frontal and right lateral projections in fluoroscopy mode. When studying doses of scattered radiation during neuro-interventional procedures, it was found that when the position of the X-ray tube changes from 0° in the direction of left lateral projection, an increase in the average dose rate of the operator in the DSA mode is up to 2,6 times, with fluoroscopy - up to 2,4 times. The equivalent dose rate in left lateral projection is up to 1.5 times higher than in right lateral projection. In left oblique projection, there is an increase in dose rate up to 2,3 times compared to right oblique projection.When comparing radiation exposure indicators during aneurysm embolization procedures, a significant increase in operator exposure doses is observed in group of interventions in the left ICA. Conclusion: when performing neuro-interventional procedures, it is possible to achieve a significant reduction in radiation exposure to patient and operator without a significant loss in image quality along with maintaining optimal visualization of pathological changes by choosing angiographic projections with lower radiation doses.
Abstract: Introduction: pathological tortuosity of internal carotid arteries (ICA) is widespread; its frequency in population varies within 18-34%. Currently, there are several approaches for the determination of indications for surgical intervention in pathological ICA tortuosity. The main criteria are hemodynamic changes in the arterial flow and the presence of neurological symptoms, so an informative preoperative examination is an integral part in treatment strategy determination in patients' subsequent treatment. Aim: was to estimate the condition of carotid arteries and substance of the brain in isolated pathological tortuosity and in combination with stenotic lesions, based on results of CT angiography. Materials and methods: we analyzed results of examination and treatment of 70 patients. Ultrasound and CT angiography of brachiocephalic arteries were performed on a Philips iCT 256-slice multislice computed tomograph. During CT angiography, a non-contrast study, arterial and venous phases of contrast enhancement were performed with an intravenous bolus injection of 50.0 ml of isoosmolar iodinated contrast-agent at 4-5 ml/sec. Patients were divided into two groups: patients with isolated pathological carotid tortuosity (28 pts) and patients with a combination of carotid tortuosity and stenotic lesions (42 pts). We assessed the effect of carotid tortuosity on the severity of the brain tissue alterations using statistical analysis. Results: a lesser severity of changes in the substance of the brain was noted in patients in the group with isolated pathological tortuosity of ICA. In 9 cases, we did not detect focal lesions; in 15 cases, small foci of microangiopathy and individual cerebrospinal fluid cysts were noted, in 4 patients, we noted areas and zones of cystic-glial changes. S- and C-shaped deformation became the most frequent variants of tortuosity; the formation of 3 saccular aneurysms (two true and one false) was revealed. Manifestations of ischemic damage of the brain substance in the group of patients with a combination of ICA tortuosity and stenotic lesion were more pronounced. Thus, in 11 cases, zones and areas of cystic-glial changes were determined within the framework of past cerebrovascular accidents; in 20 patients, foci of microangiopathy expressed in varying degrees, as well as individual cerebrospinal fluid cysts, were noted. In 11 cases, no focal lesions were detected in the brain. Statistical processing showed a correlation between the condition of carotid arteries and the presence of focal brain damage - in the group with combination of pathological tortuosity and stenosis of ICA, more pronounced chronic ischemic brain damage was detected (p=0,012). Conclusion: CT-angiography was noted to be highly informative in assessment of condition of carotid arteries and brain substance in patients with isolated pathological tortuosity, as well as in combination with a stenotic lesion of internal carotid arteries. With a combination of pathological tortuosity and a stenosis in internal carotid arteries, data were obtained on a more pronounced damage of the brain substance. According to computed tomography, clinical manifestations of chronic cerebrovascular insufficiency were generally more pronounced compared to changes in the brain substance. However, there was a correlation between the increase in the degree of chronic cerebrovascular insufficiency and the aggravation of the state of the brain substance.
Abstract: Introduction: currently, chemoradiation therapy is widely used as the main method of specific treatment for locally advanced head and neck cancer. Previously it was believed that radiation damage of carotid arteries occurs only several years after treatment. Material and methods: article presents two case reports of internal carotid artery stenosis which arose directly during the course of chemoradiation of head and neck malignant tumors. In the first case, patient K., 54 years old, had laryngeal cancer (stage III: T3N1M0), in the second case, patient M., 40 years old, had tongue cancer (stage I: T1N0M0). Conlusion: article presents angiographically confirmed carotid artery stenosis arisen directly during chemoradiation and in early stages after its completion. The discussion presents data on the incidence of stenosing lesions of carotid arteries, cerebrovascular events among patients undergoing radiation therapy. It is necessary to draw attention of specialists to the problem of early stenosis of carotid arteries during radiation and chemoradiation therapy of head and neck tumors.
Abstract: Introduction: a case report of successful treatment of an extremely rare pathology (0,27-0,34%) - acute occlusion of both internal carotid arteries (ICA) is presented. Aim: was to show possibilities of endovascular surgery in the diagnosis and treatment of acute ischemic stroke (AIS) in patients with bilateral acute ICA occlusion. Materials and methods: a 38-year-old patient was hospitalized by ambulance with the diagnosis of AIS. Multispiral computed tomography (MSCT) revealed left ICA occlusion in the C2-C5 segment. Selective angiography of ICA was performed: right ICA - non-occlusive thrombosis C2-C3 segments; left ICA - thrombotic occlusion in C1 segment. Results: thrombaspiration was performed from the left ICA and right ICA; full recovery of antegrade cerebral blood flow was achieved in both ICA, according to the modified treatment in cerebral infarction score (mTICI) - 3. Patient was discharged after 28 days. At the time of discharge, the modified Rankin Scale (mRS) score was 3. 6 months after discharge mRS was 1. Conclusions: Selective angiography of both ICA in a patient with AIS enabled to detect right ICA thrombosis not detected by MCT, which in its turn changed the treatment tactics of the patient. Aspiration thromebctomy from both internal carotid arteries allowed to achiev full recovery of antergrade cerebral blood flow of both internal carotid arteries. References 1. The top ten cuases of death, WHO fact sheets 2020. https://www.who.int/ru/news-room/fact-sheets/detail/the-top-10-causes-of-death 2. Shapoval IN, Nikitina SYu, Ageeva LI, et al. Zdravoochranenie v Rossii. 2019 [In Russ]. https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2019.pdf 3. Aigner A, Grittner U, Rolfs A, et al. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017; 48: 1744-1751. https://doi.org/10.1161/STROKEAHA.117.016599 4. Gafarova AV, Gromova EA, Panov DО, et al. Social support and stroke risk: an epidemiological study of a population aged 25-64 years in Russia/Siberia (the WHO MONICA-psychosocial program). Neurology, Neuropsychiatry, Psychosomatics. 2019; 11(1): 12-20 [In Russ]. https://doi.org/10.14412/2074-2711-2019-1-12-20 5. Putaala J. Ischemic Stroke in Young Adults. Continuum. 2020; 26(2): 386-414. https://doi.org/10.1212/CON.0000000000000833 6. Si Y, Xiang S, Zhang Y. et al. Clinical profile of etiological and risk factors of young adults with ischemic stroke in West China. Clinical Neurology and Neurosurgery. 2020; 193. https://doi.org/10.1016/j.clineuro.2020.105753 7. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology. 2018; 17(9): 790-801. https://doi.org/10.1016/s1474-4422(18)30233-3 8. Chi X, Zhao R, Pei H, et al. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med. 2020; 3(1): 53-59. https://doi.org/10.1002/agm2.12105 9. Dietrich U, Graf T, Sch?bitzb WR. Sudden coma from acute bilateral M1 occlusion: successful treatment with mechanical thrombectomy. Case Rep Neurol. 2014; 6: 144-148. https://doi.org/10.1159/000362160 10. Pop R, Manisor M, Wolff V. Endovascular treatment in two cases of bilateral ischemic stroke. Cardiovasc Intervent Radiol. 2014; 37: 829-834. https://doi.org/10.1007/s00270-013-0746-4 11. Larrew T, Hubbard Z, Almallouhi E.et al. Simultaneous bilateral carotid thrombectomies: a technical note. Oper Neurosurg. 2019; 5(18): 143-148. https://doi.org/10.1093/ons/opz230 12. Storey C, Lebovitz J, Sweid A, et al. Bilateral mechanical thrombectomies for simultaneous MCA occlusions. World Neurosurg. 2019; 132: 165-168. https://doi.org/10.1016/j.wneu.2019.08.236 13. Braksick SA, Robinson CP, Wijdicks EFM. Bilateral middle cerebral artery occlusion in rapid succession during thrombolysis. Neurohospitalist. 2018; 8: 102-103. https://doi.org/10.1177/1941874417712159 14. Jeromel M, Milosevic Z, Oblak J. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case. Radiology and Oncology. 2020; 54(2): 144-148. https://doi.org/10.2478/raon-2020-0017
Abstract: Chemodectomas are rare, in most cases, benign neoplasms. They originate from the chemoreceptor cells of the carotid glomus in the bifurcation of the carotid artery. Chemodectoma treatment is surgical. Classical removal of the tumor carries a high risk of damage of arteries and nerves. We present a case report of high localization (C1) carotid chemodectoma removal in a hybrid operating room. Tumor was successfully removed after selective embolization of chemodectoma with protection of distal flow of the internal carotid artery. This approach helped to minimize intraoperative blood loss, as well as to shorten time of intervention. References 1. De Franciscis S, Grande R, Butrico L, et al. Resection of Carotid Body Tumors reduces arterial blood pressure. An underestimated neuroendocrine syndrome. International Journal of Surgery. 2014; 12: 63-67. https://doi.org/10.1016/j.ijsu.2014.05.052 2. Serra R, Grande R, Gallelli L, et al. Carotid body paragangliomas and matrix metalloproteinases. Annals of Vascular Surgery. 2014, 28(7): 1665-1670 https://doi.org/10.1016/j.avsg.2014.03.022 3. Luo T, Zhang C, Ning YC, et al. Surgical treatment of carotid body tumor: Case report and literature review. J. Geriatr. Cardiol. 2013; 10: 116-118. https://doi.org/10.3969/j. issn.1671-5411.2013.01.018 4. Sajid MS, Hamilton G, Baker DM. A multicenter review of carotid body tumor management. Eur. J. Vasc. Endovasc. Surg. 2007: 34(2): 127-130. https://doi.org/10.1016/j.ejvs.2007.01.015 5. Knight TTJr., Gonzalez JA, Ray JM, Rush DS. Current concepts for the surgical management of carotid body tumor. Am. J. Surg. 2006; 191: 104-110. https://doi.org/10.1016/j.amjsurg.2005.10.010 6. Scudder CL. Tumor of the inter carotid body. A report of one case, together with one case in the literature. Am J Med Sci. 1903; 126: 384-9. 7. Dickinson PH, Griffin SM, Guy AG, McNeill IF. Carotid body tumor: 30 years experience. Dr J Surg. 1986; 73: 14-6. https://doi.org/10.1002/bjs.1800730107 8. Amato B, Serra R, Fappiano F, et al. Surgical complications of carotid body tumors surgery: a review. Int Angiol. 2015; 34(6.1): 15-22. 9. Lim JY, Kim J, Kim SH, et al. Surgical treatment of carotid body paragangliomas: outcomes and complications according to the Shamlin classification. Clin Exp Otorhinolaryngol. 2010; 3(2): 91-5. https://doi.org/10.3342/ceo.2010.3.2.91 10. Amato B, Bianco T, Compagna R, et al. Surgical resection of carotid body paragangliomas: 10 years of experience. American Journal of Surgery. 2014; 207(2): 293-298. https://doi.org/10.1016/j.amjsurg.2013.06.002 11. Sahin MA, Jahollari A, Guler A, et al. Results of combined preoperative direct percutaneous embolization and surgical excision in treatment of carotid body tumors. Vasa. 2011; 40(6): 461-6. https://doi.org/10.1024/0301-1526/a000149 12. Thakkar R, Qazi U, Kim Y, et al. Technique and role of embolization using ethylene vinylalcohol copolymer before carotid body tumor resection. Clin. Pract. 2014; 4(3). https://doi.org/10.4081/ср.2014.661 13. Carroll W, Stenson K, Stringer S. Malignant carotid body tumor. Head Neck. 2004; 26(3): 301-306. https://doi.org/10.1002/hed.20017 14. Shamblin WR, Remine WH, Sheps SG, Harrison EG. Carotid body tumor (chemodectoma). Clinicopathologic analysis of ninety cases. Am J Surg. 1971; 122(6): 732-739. https://doi.org/10.1016/0002-9610(71)90436-3 15. Arya S, Rao V, Juvekar S, Dcruz AK. Carotid body tumors: objective criteria to predict the Shamblin group on MR imaging. AJNR Am J Neuroradiol 2008; 29(7): 1349-54. 16. Wu J, Liu S, Feng L, et al. Clinical analysis of 24 cases of carotid body tumor. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015: 50(1): 25-27. https://doi.org/10.3174/ajnr.A1092 17. Базылев В.В., Шматков М.Г., Морозов З.А. Стентирование сонных артерий как этап в лечении пациентов с билатеральным поражением каротидного бассейна и сопутствующим поражением коронарного русла. Кардиология и сердечно-сосудистая хирургия. 2012; 5(5): 39-48. Bazilev VV, Shmatkov MG, Morozov ZA. Carotid artery stenting as a stage in treatment of patients with bilateral carotid lesions and concomitant coronary affection. Kardiologiya i serdechno-sosudistaya khirurgiya. 2012; 5(5): 39-48 [In Russ]. 18. Базылев В.В., Шматков М.Г., Морозов З.А. и др. Сравнение показателей качества жизни пациентов, перенесших каротидную эндартерэктомию и стентирование сонных артерий. Диагностическая и интервиционная радиология. 2017; 11(11): 54-58. Bazylev VV, Shmatkov MG, Morozov ZA, et al. Comparison of Indicators of quality of life in patients undergoing carotid endarterectomy and carotid stenting. Diagnosticheskaya i Interventsionnaya radiologiya. 2017; 11(11): 54-58 [In Russ].
Abstract: Introduction: сarotid chemodectoma is a benign, slowly growing, vascularized tumor that is one of the most common paragangliomas of head and neck. It is localized in the area of anterior surface of neck - in the area of carotid artery bifurcation. Despite the relative knowledge of the disease, surgical treatment of patients with these newgroth is difficult due to development of intraoperative hemorrhagic complications. Aim: was to assess possibilities of primary embolization in the complex treatment of patients with chemodectoma. Materials and methods: 70-year-old female patient was examined and treated. She was admitted with complaints on painless, pulsating, gradually progressive newgrowth of neck. After examination, carotid chemodectoma was diagnosed. The first stage was selective embolization of branches of the external carotid artery (ECA) feeding the tumor. Open chemodectomectomy was performed three days after embolization. Results: analysis of literature sources and our case report showed that the volume of blood loss during an open operation for removal of chemodectoma using previous embolization is insignificant. This aspect also leads to a reduction of time of the intervention. Conclusions: preoperative chemodectoma embolization significantly reduces the volume of blood loss and reduces the risk of developing other complications. References 1. Qaqish N, Gaillard F. Carotid body tumor. 2020. https://radiopaedia.org/articles/carotid-body-tumour 2. Martins R, Bugalho MJ. Paragangliomas/Pheochromocytomas: clinically oriented genetic testing. Int J Endocrinol. 2014; 2014: 794187. 3. Shamsi ZA, Shaikh FA, Wasif M. Hypoglossal Nerve Paraganglioma Depicting as Glomus Tumor of Neck. Iranian Journal of Otorhinolaryngology. 2021; 33(115): 113-117. 4. Lv H, Chen X, Zhou Sh, et al. Imaging findings of malignant bilateral carotid body tumors: A case report and review of the literature. Oncol Lett. 2016; 11(4): 2457-2462. 5. Hoang VT, Trinh CT, Lai AKh, et al. Carotid body tumor: a case report and literature review. J Radiol Case Rep. 2019; 13(8): 19-30. 6. Wieneke JA, Wieneke AS. Paraganglioma: Carotid Body Tumor. Head Neck Pathol. 2009; 3(4): 303-306. 7. Cobb AN, Barkat A, Daungjaiboon W, et al. Carotid Body Tumor Resection: Just as Safe without Preoperative Embolization. Ann Vasc Surg. 2018; 46: 54-59. 8. Jackson RS, Myhill JA, Padhya TA, et al. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2015; 153(6): 943-50.
Abstract: In recent years, with the growth of number of patients with multifocal atherosclerosis, revascularization of the brain and myocardium through hybrid intervention is gaining popularity. Although, in the world literature there are practically no results of significant randomized researches concerning percutaneous coronary intervention and carotid endarterectomy in hybrid mode, this technique is becoming more and more preferable and promising in comparison with other methods of treatment. Aim: was to demonstrate results of revascularization of the brain and myocardium with staged and hybrid strategies, on the base of evaluation of advantages and disadvantages of these strategies on the example of case reports. Materialsand methods: article presents two case reports, demonstrating different approaches to surgical treatment in patients with combined lesions of arteries of the brain and myocardium. Both patients were over 65 years age, at the time of treatment, had a history of acute cerebral circulation disorders, coronary heart disease and arterial hypertension. At the outpatient stage, they received antiplatelet, hypotensive, and hypolipidemic therapy. During further examination, both patients were found to have unilateral hemodynamically significant stenoses of internal carotid arteries and isolated stenoses of coronary arteries. In first case, patient was selected for hybrid surgical tactics in the volume of carotid endarterectomy and stenting of coronary artery, which was performed with a further favorable prognosis. In the second case, tactics was determined in favor of a staged procedure: first performing carotid endarterectomy, then stenting the affected coronary artery. However, taking into account subjective and objective factors, none of planned interventions were performed. Results: hybrid revascularization allows to perform correction in two arterial of different regions in a short period of time using surgical and endovascular techniques. An important advantage of this method is the one-time performance, that means correction of MFA manifestations for one hospitalization, or even one anesthesia, with increasing in the availability of revascularization. In the first case report, the successful implementation of a hybrid approach in the treatment of combined vascular pathology in an elderly patient with a burdened anamnesis and significant comorbidities was demonstrated. Within one day, we managed to complete the planned volume of myocardial and brain revascularization and avoid the development of adverse events both in the early postoperative and long-term follow-up periods. The second clinical example clearly shows disadvantages of staged strategy, when the patient is at risk of developing adverse cardiovascular events while waiting for staged interventions, or for subjective reasons may refuse to be hospitalized in a clinic for performimg a particular operation, that as a result, led to negative dynamics and fatal outcome due to acute stroke. Conclusions: thus, demonstrated case reports show significant potential and effectiveness of hybrid myocardial and brain revascularization using percutaneous coronary intervention and carotid endarteectomy in treatment of patients with combined lesions of two vascular regions. This method of treatment is especially promising in patients with burdened anamnesis and additional risk factors. It not only prevents adverse cardiovascular events in brain and myocardium, but also has greatest availability and implementation of the planned volume of treatment, completely excluding the influence of subjective factors (change of tactics, failure of patient to attend the next stage of treatment, etc.). References 1. Bajkov VYu. Combined atherosclerotic lesion of coronary and brachiocephalic arteries - choice of surgical tactics. Bulletin o f Pirogov National Medical & Surgical Center. 2013; 8 (4): 108-111 [In Russ]. 2. Shevchenko YuL, Popov LV, Batrashev VA, Bajkov VYu. Results of surgical treatment of patients with combined atherosclerotic lesions of coronary and brachiocephalic arteries. Bulletin o f Pirogov National Medical & Surgical Center. 2014; 9 (1): 14-17 [In Russ]. 3. Tarasov RS, Kazantsev AN, Ivanov SV et al. Personalized choice of the optimal revascularization strategy in patients with combined lesions of coronary and brachiocephalic arteries: results of testing an automated decision support system in clinical practice. Russian Cardiology Bulletin. 2018; 13 (1): 30-39 [In Russ]. 4. Kazanchyan PO, Sotnikov PG, Kozorin MG, Lar'kov RN. Surgical treatment of multifocal lesions in impaired blood circulation of several arterial territories. Russian Journal of Thoracic and Cardiovascular Surgery. 2013; (4): 31-38 [In Russ]. 5. Zaharov PI, Tobohov AV. Tactics of surgical treatment of generalized atherosclerosis with combined hemodynamically significant defeat of coronary and carotid arteries. Yakut medical journal. 2013; 2 (42): 52-55 [In Russ]. 6. Charchyan ER, Stepanenko AB, BelovYuV, et al. One-Stage Carotid and Coronary Artery Surgeries in Treatment of Multifocal Atherosclerosis. Cardiology. 2014; 54 (9): 46-51 [In Russ]. 7. 2018 ESC/EACTS guidelines on myocardial revascularization. Russian Journal o f Cardiology. 2019; 24 (8): 151-226 [In Russ]. 8. ESC/ESVS Recommendations for the diagnosis and treatment of peripheral arterial disease 2017. Rossijskij kardiologicheskij zhurnal 2018; 23 (8), 218-221 [In Russ]. 9. Tarasov RS, Kazantsev AN, Ivanov SV, et al. Surgical treatment of multifocal atherosclerosis: coronary and brachiocephalic pathology and predictors of early adverse events development. Cardiovascular Therapy and Prevention. 2017; 16 (4): 37-44 [In Russ]. 10. Tarasov RS, Ivanov SV, Kazantsev AN etal. Hospital results of different strategies of surgical treatment of patients with concomitant coronary disease and internal carotid arteries stenoses. Complex Issues o f Cardiovascular Diseases. 2016; 5 (4): 15-24 [In Russ]. 11. Shilov AA, Kochergin NA, Ganyukov VI. Hybrid myocardial revascularization in multivessel coronary disease. Current state of the issue. Interventional cardiology. 2015; (41): 22-29 [In Russ]. 12. Alekyan BG, Karapetyan NG. Hybrid surgery in treatment of coronary heart disease. Russian journal of Endovascular surgery. 2017; 4 (1): 5-17 [In Russ]. 13. Khubulava GG, Kozlov KL, Sedova EV et al. Importance and role of endovascular techniques in the diagnosis and treatment of generalized atherosclerosis in patients of elderly and senile age. Clinical gerontology. 2014; 20 (5-6): 35-40 [In Russ]. 14. Tarasov RS, Kazantsev AN, Ivanov SV et al. Choosing a strategy for brain and myocardial revascularization in patients with atherosclerosis of internal carotid and coronary arteries: a place for personified medicine. Russian journal of Endovascular surgery. 2018; 5 (2): 241-249 [In Russ]. 15. Frota dos Reis PF, Linhares PV, Pitta FG, Lima EG. Approach to concurrent coronary and carotid artery disease: Epidemiology, screening and treatment. Rev Assoc Med Bras. 2017; 63(11): 1012-1016. 16. Tomai F, Pesarini G, Castriota F et al. Early and Long-Term Outcomes After Combined Percutaneous Revascularization in Patients With Carotid and Coronary Artery Stenoses. Cardiovascular interventios. 2011: 560-8. 17. Zhang J, Dong Z, Liu P et al. Different Strategies in Simultaneous Coronary and Carotid Artery Revascularization - A Single Center Experience. Arch Iran Med. 2019; 22 (3): 132-136. 18. Drakopoulou M, Oikonomou G, Soulaidopoulos S et al. Management of patients with concomitant coronary and carotid artery disease. Expert Review o f Cardiovascular Therapy. 2019: 1-32.
Abstract Aim: was to evaluate the effectiveness of carotid arterial revascularization by stenting of internal carotid arteries ( Materials and methods: in FSBI «Treatment and rehabilitation center» of the Ministry of Health of Results: when analyzing 30 days after stenting, there were no fatal outcomes. In one case (0.96%) after stenting of the subtotal stenosis of the In the long-term period (4 years and 7 months), the number of undesirable events was 2%. In one case (0.96%), the patient died of ischemic stroke on the ipsilateral side after 3 years and 2 months after stenting. In another case, patient after 1 year and 2 months had an ischemic stroke on the side of the operation. Thus, the total number of complications associated with When evaluating results of stenting by the SPECT method, the state of cerebral perfusion was assessed using perfusion maps in two modes and by axial perfusion sections. In all observations after stenting, improvement of cerebral perfusion was noticed, regardless of the side and severity of Comparing results, obtained by the number of undesirable events (strokes, restenosis and death) with the four-year data of the analysis of the international CREST study, the complication rate in our group is significantly lower (3.8% versus 8.6% in the CREST stenting group and 8.4% in carotid endarterectomy group CREST). Conclusion: carotid stenting is an effective method of treatment of atherosclerotic lesions of main cerebral arteries in patients with previous stroke. The effectiveness of this type of treatment is confirmed by a positive clinical result and with the help of modern diagnostic methods, in particular SPECT. References 1. Damulin IV, Parfenov VA, Skoromets AA, Yah NN. Circulatory disorders in the brain and spinal cord. In the book: «Diseases of the nervous system. A guide for doctors». Yakhno N.N., Shtulman D.R. (ed.). 2003; 231302 [In Russ]. 2. Thom T, Haase N, Rosamond W et al. Heart disease and stroke statistics - 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113:e85-151. 3. Kleindorfer D, Panagos P, Pancioli A et al. Incidence and short term prognosis of transient ischemic attack in a population-based study. Stroke. 2005;36: 720-723. 4. Gusev EI, Skvortsova VI, Stakhovskaya LV. The problem of stroke in the Russian Federation: a time of active joint action. Zhurn. nevrol. and a psychiatrist. 2007; 8: 4-10 [In Russ]. 5. Gusev EI, Skvortsova VI, Stakhovskaya LV. Epidemiology of stroke in the Russian Federation. appendix of the Journal. nevrol. and a psychiatrist. them. SS Korsakova. 2003; 8: 4-9 [In Russ]. 6. Pinchuk EA. «Epidemiology and secondary prevention of ischemic stroke in a large industrial and cultural center» Diss. Cand. med. sciences. Ekaterinburg, 2004;136-137 [In Russ]. 7. Kadykov AS. Prevention of repeated ischemic stroke. AS Kadykov, NV Shakhparonova. Consilium medicum. 2006; 2: 96-99 [In Russ]. 8. Pokrovsky AV, KiyashkoVA. Ischemic stroke can be prevented. Rus. med. Journal. 2003; 11 (12): 691-695 [In Russ]. 9. Parfenov VA, Gurak SV. Repeated ischemic stroke and its prevention in patients with arterial hypertension. Zhurn. nevrol. and psychiatrist. them. SS Korsakova. Stroke. 2005; 14: 3-7 [In Russ]. 10. Sacco RL, Adams R, Albers G et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke. 2006; 37: 577 - 617. 11. Touze E, Varenne O, Chatellier G et al. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005; 36:2748-2755. 12. Kjellstrom T, Norrving B, Shatchkute A. Helsingborg Declaration 2006 on European Stroke Strategies. Helsingborg Declaration 2006 On European Stroke Strategies; pp. 9-12. Cerebrovasc Dis. 2007; 23(2-3): 231-41. 13. European Carotid Surgery Triallists Collaborative Group: NRC European Carotid Surgery Trial; Interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991; 337:1235-1243. 14. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effects of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991; 325:445-453. 15. Asymptomatic Carotid Atherosclerosis Study. Clinical advisory: Carotid endarterectomy for patients with asymptomatic internal carotid artery stenosis. Stroke. 1994; 25:2523-2524. 16. Brott TG, Hobson RW 2nd, Howard G, Roubin FS, et al. "CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1;363(1):11-23. 17. Brown MM, Mas JL, Ringleb PA, Hacke W. Carotid artery stenting versus surgery: adequate comparisons? Lancet Neurol. 2010 , 9:341-342. 18. Volzhenin VE, Dolinina EG, Dontsov AE et al. The state of cerebral blood flow according to SPECT, MRI and MPA. Thes. doc. 2nd Congress of the Russian Society of Nuclear Medicine. Modern problems of nuclear medicine and pharmaceuticals. Obninsk, 2000; 174-175 [In Russ].
Abstract: Aim: was to develop a compleх ultrasound assessment of atherosclerotic plaque instability in correlation with morphological evaluation. Material and methods: research included 121 patients with stenosis of left/right internal carotic artery (ICA) of 50% and more (due to NASCET scale): 80 men and 41 women, mean age 56,0 years. All patients underwent standart and contrast-enhanced ultrasonic scanning (CEUS), bilateral duplex monitoring of cerebral blood flow with registration of microembolic signals (MES). All patients in period up to 3 days after hospitalization - underwent carotid endarterectomy with histological examination of atheroscleroitc plaque. Results: analysis of relationship between ultrasound and histological characteristics showed a moderate association between the intensity of contrast agent accumulation and the degree of plaque vascularization (Cramer's V 0,529; p<<0,000;) number of lipofages (Cramer's V 0,569; p<<0,001). There were no significant differences between the degree of plaque vascularization and the degree of plaque stenosis (p<0,05). We revealed significant differences between the number of MES and the intensity of atherosclerotic plaque blood supply (<<0,001). Discussions: intensive accumulation of contrast agent in a plaque is associated with the process of angiogenesis and inflammation, and contrast-enhanced ultrasound examination of the plaque is promising for assessing its instability and the possible risk of developing cerebral vascular complications. Neovascularization intensity detected by contrast-enhanced ultrasound is associated with the number of detected microparticles in the cerebral blood flow, and does not depend on the degree of stenosis. Conclusions: method of comprehensive assessment using CEUS and Doppler detection of microembolic particles can be effective in stratifying the risk of possible ischemic stroke in asymptomatic patients, for optimizing indications for surgical treatment of atherosclerotic plaque, and evaluating the effectiveness of lipid-lowering and statin therapy. References 1. Liapis CD, Bell PR., Mikhailidis D., Sivenius J.et al. ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009 Apr; 37(4 Suppl):1-19. 2. Nicolaides AN, Kakkos SK, Kyriacou E, Griffin M, et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification.Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. J Vasc Surg. 2010 Dec; 52(6):1486-1496.e1-5. 3. Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease ACCF/AHA Pocket Guideline Based on the 2011ASA/ACCF/AHA/AANN/AANS/ACR/CNS/SAIP/SCAI/ SIR/SNIS/SVM/SVS. P 22-23. 4. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis.Circulation. 2002 Mar 5; 105(9):1135-43. 5. Redgrave JN, Lovett JK, Rothwell PM. Histological features of symptomatic carotid plaques in relation to age and smoking: the oxford plaque study. Stroke. 2010; 41:2288-94. 6. Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg. 1988;29:676-681. 7. Kwon HM, Sangiorgi GU, Ritman EL, et al.Enhanced coronary vasa vasorum neovascularization in experimental hypercholesterolemia. J Clin Invest 1998; 101: 15511556. 8. Cosgrove D. Angiogenesis imaging-ultrasound. Br J Radiol 2003; 76:S43-9. 9. Kumamoto M, Nakashima Y, Sueishi K. Intimal neovascularization in human coronary atherosclerosis: its origin and pathophysiological significance. Hum Pathol 1995; 26:450-6. 10. Balahonova T.V., Pogorelova O.A., Tripoten' M.I., Gerasimova V.V., Safiulina A.A., Rogoza A.N. Contrast enhancement during ultrasound examination of blood vessels: atherosclerosis, nonspecific aortoarteritis. Ul'trazvukovaya i funkcional'naya diagnostika 2015; 4: 33-45. [In Russ]. 11. Coli S, Magnoni M, Sangiorgi G, Marrocco-Trischitta M. et al.Contrast-Enhanced Ultrasound imaging of intraplaque neovascularisatopn in carotid arteries. J of the American College of Cardioilogy 2008; 52(3): 345-2. 12. Vicenzini E. Giannoni MF, Puccinelli F. et al. Detection of carotid adventitial vasa vasorum and plaque vascularisation with ultrasound cadence contrast pulsr sequencing technique and echo-contrast agents. Stroke 2007; 38:2841-3. 13. Shah F, Balah P, Weinber M, et al. Contrast-enhanced ultrasound imaging of atherosclerotic plaque neovascularization: a new surrogate marker of atherosclerosis? Vasc Med 2007; 12:291-7. 14. CHechetkin AO, Druina L.D., Possibilities of contrast ultrasound in angioneurology. Annaly klinicheskoj I eksperimental'noj nevrologii 2015; 9(2): 33-40. [In Russ]. 15. Silvestre-Roig C, de Winther MP Atherosclerotic plaque destabilization: mechanisms, models, and therapeutic strategies. Weber C, Daemen MJ, Lutgens E, Soehnlein O. Circ Res. 2014 Jan 3; 114(1):214-26. 16. Ross R. Atherosclerosis is an inflammatory disease. Am Heart J. 1999; 138:S419-20. doi: 10.1016/S0002-8703(99)70266-8. 17. Casadei M, Floreani R, Catalini C, Serra AP, Assanti and P Concif Sonographic characteristics of carotid artery plaques: Implications for follow-up planning? J Ultrasound. 2012 Sep; 15(3): 151-157. 18. Carmeliet P Angiogenesis in health and disease. Nat Med 2003;9;653-52. 19. Moulton K.,Vakili K., Zurakovski D., et al. Inhibition of plaque neovascularizatopn reduces macrophage accumulation and progression of anvanced atherosclerosis. Proc Natl Acad Sci U S A 2003; 100: 4736-41. 20. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation. 2003;108:1772-8. doi: 10.1161/01.CIR.0000087481.55887.C9. 21. Gutstein DE, Fuster V. Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res. 1999; 41:323-33. doi: 10.1016/S0008-6363(98) 00322-8. 22. Petrikov SS, Hamidova LT. About the conference «Emergency care for patients with acute cerebrovascular accident» ZHurnal im. N.V. Sklifosovskogo «Neotlozhnaya medicinskaya pomoshch'». 2015; 1:11-18. [In Russ]. 23. Krylov VV., Dash'yan VG., Lemenyov VL., Dalibaldyan VA., i dr. Surgical treatment of patients with bilateral occlusion-stenotic lesions of brachiocephalic arteries. Nejrohirurgiya.2014; 16-25. [In Russ]. 24. Novikov N.E. Contrast-enhanced ultrasound examinations. History of development and modern possibilities. Russian Electr. J. Radiol. (REJR). 2012; 2 (1): 20-28. [In Russ].
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Abstract: Aim: was to identify risk factors of early adverse cerebral events after carotid artery stenting anc endarterectomy Materials and methods: 908 patients who underwent isolated carotid stenting (N = 522) and carotid endarterectomy (N = 386) were included in this retrospective analysis. Patients with simultaneous cardiac surgery and patients with symptomic stenosis of CA were excluded from research. The primary end point was ipsilateral perioperative ischemic stroke, proved by neurologist and CT/MRI data. To identify predictors, multivariate regression was used, with factors that could influence endovascular and surgical methods of treatment. Results: patients from two groups were similar in main clinical and demographic characteristics. There were no deaths and cerebral hemorrhagic complications. The stroke rate in the endovascular and surgical groups was 1.7% and 1.04% respectively (p = 0.5). The total rate of strokes and transitory ischemic attack (TIA) using two methods was 1.4%. The TIA rate was higher in the endovascular group without statistically difference (1.3% vs. 0.3%, p = 0.1). The regression analysis showed that predictor of the adverse cerebral events was the degree of carotid artery stenosis in endovascular group (OR 1.318, 95% CI: 1.131-1.535, p <0.001). There were no any predictive factors of TIA or stroke in the surgical group. Conclusions: the independent predictor of early TIA and stroke in endovascular group, unlike endarterectomy, was the degree of carotid stenosis. References 1. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. 2011 ASA/ACCF/AHA/AANN/ AANS/ACR/ ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease:executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force of Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventionalSurgery, Society for Vascular Medicine, and Society for VascularSurgery. Developed in collaboration with the American Academyof Neurology and Society of Cardiovascular Computed Tomography Catheter Cardiovasc Interv 2013; 81:76-123. 2. Sakai N, Yamagami H, Matsubara Y et al. Prospective registry of carotid artery stenting in Japan: investigation on device and antiplatelet for carotid artery stenting. J Stroke Cerebrovasc Dis.2014; 23: 1374-1384. 3. Jhang K, Huang J, NforIs O et al. Is Extended Duration of Dual Antiplatelet Therapy After Carotid Stenting Beneficial? Medicine 2015; 94:40. 4. Mo D, Wang B, Ma N, et al. Comparative outcomes of carotid artery stenting for asymptomatic and symptomatic carotid artery stenosis: a single-center prospective study. J Neurointerv Surg. 2016; 8(2): 126-129. 5. Bonati LH, Dobson J, Featherstone RL, et al. Longterm outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the Internation al Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015; 385: 529-538. 6. Stingele R, Berger J, Alfke K, et al. Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol 2008; 7: 216-222. 7. Howard VJ, Lutsep HL, Mackey A, et al. Influence of sex on outcomes of stenting versus endarterectomy: a subgroup analysis of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Lancet Neurol 2011; 10: 530-537. 8. Setacci C, Chisci E, Setacci F, et al. Siena carotid artery stenting score: a risk modeling study for individual patients. Stroke 2010; 41: 1259-1265. 9. AbuRahma AF, Alhalbouni S, Abu-Halimah S, et al. Impact of chronic renal insufficiency on the early and late clinical outcomes of carotid artery stenting using serum creatinine vs glomerular filtration rate. J Am Coll Surg 2014; 218: 797- 805. 10. Kofoed SC, Wittrup HH, Sillesen H, Nordestgaard BG. Fibrinogen predicts ischaemic stroke and advanced atherosclerosis but not echolucent, rupture-prone carotid plaques: the Copenhagen City Heart Study. Eur Heart J 2003;24:567-576. 11. Dosa E, Rugonfalvi-Kiss S, Prohaszka Z, Szabo A, Karadi I, Selmeci L, et al. Marked decrease in the levels of two inflammatory markers, hs-C-reactive protein and fibrinogen in patients with severe carotid atherosclerosis after eversion carotid endarterectomy. Inflamm Res 2004; 53:631-635. 12. Maresca G, Di Blasio A, Marchioli R, Di Minno G. Measuring plasma fibrinogen to predict stroke and myocardial infarction: an update. Arterioscler Thromb Vasc Biol 1999; 19:1368-1377. 13. Gray WA,Yadav JS, Verta P, et al. The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv 2007; 70: 1025-1033. 14. Theiss W, Hermanek P, Mathias K, et al. Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data. Stroke 2008; 39: 2325-2330. 15. Chaturvedi S, Matsumura JS, Gray W, et al. Carotid artery stenting in octogenarians: periprocedural stroke risk predictor analysis from the multicenter Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) clinical trial. Stroke 2010; 41: 757-64. 16. Mathur A, Roubin GS, Iyer SS, et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998; 97: 1239-1245. 17. Nicolaides AN, Kakkos SK, Kyriacou E, Griffi n M, Sabetai M, Thomas DJ, et al. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J Vasc Surg 2010;52:1486-1496. 18. Obeid T, Arnaoutakis DJ, Arhuidese I, et al. Poststent ballooning is associated with increased periprocedural stroke and death rate in carotid artery stenting. J Vasc Surg 2015; 62: 616-623. 19. Aronow HD, Gray WA, Ramee SR, et al. Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients. Circ Cardiovasc Interv 2010; 3: 577-584.
Abstract: The report is about giant false aneurysm of an extracranial part of the left internal carotid artery (ICA) in a patient aged one year and nine months. The reason of the complexity of diagnostics in this case was that the dissection of the ICA with formation of false aneurysm imitated the peritonsillar abscess' clinic. We have not found any descriptions of a similar cases of patients at such an early age in modern literature. References 1. Nikitina T.G., Kochurkova E.G., Petrosyan K.V., Alekyan B.G. Application of a stent-graft to correct a false aneurysm of the internal carotid artery. Creative. cardiol. 2015; 1: 66 [In Russ]. 2. Kalashnikova L.A. Dissection of arteries, blood supplying the brain, and disorders of cerebral circulation. Ann. clin. and exper. neurology. 2007; 1 (1): 41-49 [In Russ]. 3. Schievink W.I. Spontaneous dissection of the carotid and vertebral arteries. N. Engl. J. Med. 2001; 344: 898— 906. doi.org/10.1056/NEJM200103223441206. 4. 5. Kalashnikova L.A., Dobrynina L.A., Chechetkin A.O., Dreval M.V., Krotenkova M.V., Zakharkina M.V. Disorders of cerebral circulation in the dissection of the internal carotid and vertebral arteries. Algorithm of diagnostics. Nerve. disease. 2016; 2: 10-15 [In Russ]. 6. Kieslich M., Fiedler A., Heller C. et al. Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases. J. Neurol. Neurosurg. Psychiatry 2002; 73: 13-6. 7. Seerig M.M., Chueiri L., Jacques J. et alt. Bilateral Peritonsillar Abscess in an Infant: An Unusual Presentation of Sore Throat. Case Rep Otolaryngol. 2017; 2017: 467015. doi.org/10.1155/2017/4670152. 8. Mazur E, Czerwinska E, Korona-Gtowniak I, Grochowalska A, Koziot-Montewka M. Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. 2015 Mar; 34(3):549-54. doi.org/10.1007/s10096-014-2260-2.
Abstract: Aim: was to analyze long-term results of carotid endarterectomy (CEA) in patients with unilateral lesion of the internal carotid artery ( Materials and methods: for the period January 2009-December 2010, 262 CEA performed in 262 patients. Evaluated results of survival rate, stroke and myocardial infarction, condition of carotid arteries, effect of various factors on features of atherosclerotic lesions and effect of statin therapy on these processes. Results: in late follow-up period - 245(93,5%) survivors. Patients were divided into groups: simvastatin - 60(24,5%) patients, atorvastatin - 134(54,7%) observations, rosuvastatin - 51(20,8%) cases. 14 patients died, data were obtained on the 13, average loss of 6.06%. The frequency of cardiovascular events leading to death is seven cases. Non-fatal stroke of any location - 5(1,9%) observations. The influence of hypertension (p=0,019), smoking (p=0,004), type 2 diabetes (p=0,03), dyslipidemia: hypercholesterolemia (p=0,05), hypertriglyceridemia (p=0,02), low-density lipoprotein (LDL) level is higher than normal (p=0,015), high-density lipoprotein (HDL) is below normal (p = 0,03) and other factors. Lowering cholesterol by 5,9% is marked in the atorvastatin group, maintaining at recommended values throughout the period from the initial selection in the rosuvastatin group (p = 0,0001). LDL cholesterol decreased by 19,1% in the mean value in the atorvastatin group (p = 0,0001), the increase of HDL level of 3,4% in the rosuvastatin group (p=0,02). Achievement of recommended levels of cholesterol was more often observed in the rosuvastatin group at 64,7% compared with simvastatin (p = 0,03). Risk factors influenced the incidence of restenosis ipsilateral side in 3 patients (1,2%). The greatest influence of risk factors was determined in the atorvastatin group (4,1%, p=0,001). Atorvastatin therapy stabilized the wall of the ICA 17,6% more often (p=0,05) and contralateral common carotid artery, leaving it intact at 84,6% (p=0,002) compared with other groups of statins. Conclusion: the purpose of statin therapy depends on the severity of the atherosclerotic process the characteristics of the lipid profile and the need correction of risk factors. The most effect is provided by the group of synthetic statin above semisynthetic. Atorvastatin therapy is effective with moderate hypercholesterolemia; rosuvastatin prescribed with severe dyslipidemia. References 1. Rothwell P.M., Eliasziw M., Gutnikov 2. AbuRahma A.F., Srivastava M., Stone P.A. Effects of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis. J Am Coll Surg. 2015;220:481-488. 3. Sillesen H., Amarenco P., Hennerici M.G., Callahan A., Goldstein L.B., Zivin J. et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008; 39: 3297-3302. 4. O'Regan C., Wu P., Arora P., Perri D., and Mills E.J. Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am J Med. 2008; 21: 24-33. 5. Perler B.A. The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007; 20: 252-258. 6. McGirt M.J., Perler B.A., Brooke B.S., Woodworth G.F., Coon A., Jain S. et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J. Vasc Surg. 2005; 42: 829-836. 7. Paraskevas K.I., Athyros V.G., Briana D.D., Kakafika A.I., Karagiannis A., and Mikhailidis, D.P. Statins exert multiple beneficial effects on patients undergoing percutaneous revascularization procedures. Curr Drug Targets. 2007; 8: 942-951. 8. Koh K.K. Effects of statins on vascular wall (vasomotor function, inflammation, and plaque stability). Cardiovasc Res. 2000; 47: 648-657. 9. Amarenco P., Labreuche J., Lavallee P., and Touboul, P.J. Statins in stroke prevention and carotid atherosclerosis (systematic review and up-to-date meta-analysis). Stroke. 2004; 35: 2902-2909. 10. Amarenco P. and Labreuche J. Lipid management in the prevention of stroke: review and updated metaanalysis of statins for stroke prevention. Lancet Neurol. 2009; 8: 453-463. 11. Pokrovsky A.V., Beloyartsev D. F., Talibli O. L. Analysis of long-term results of eversion carotid endarterectomy. Angiology and vascular surgery. 2014; 20 (4): 100-108 [In Russ]. 12. Efthymios D. Avgerinos Rabih A., Abdallah Naddaf, Omar M. El-Shazly, Luke Marone, Michel S. Makaroun. Primary closure after carotid endarterectomy is not inferior to other closure techniques. Presented at the Vascular and Endovascular Surgery Society 2015 Summer Meeting, 13. Taylor A.J., Kent S.M., Flaherty P.J., Coyle L.C., Markwood T.T., and Vernalis, M.N. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002; 106: 2055-2060. 14. Taylor A.J., Sullenberger L.E., and Lee H.Y ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation. 2005; 112: II-179. 15. Jones P., Davidson M., Stein E. et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am. J. Cardiol. 2003; 92(2): 152-160. 16. Crouse J.R. III, Raichlen J.S., Riley W.A. et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007;297:1344-1353. 17. Radak D., Tanaskovic S., Matic P., et al. Eversion Carotid Endarterectomy - Our Experience After 20 Years of Carotid Surgery and 9897 Carotid Endarterectomy Procedures. Ann. Vasc. Surg. 2012; 26(7): 924-928. 18. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273: 1421-1428. 19. Sever P.S., Poulter N.R., Dahlof B. et al. Different Time Course for Prevention of Coronary and Stroke Events by Atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Am J Cardiol. 2005; 96: 39-44. 20. Paraskevas K.I., Hamilton G., Mikhailidis D.P. Statins: an essential component in the management of carotid artery disease. J Vasc Surg. 2007; 46: 373-386.
Abstract: 19 males with unilateral symptomatic internal carotid artery stenosis were stented in 2007 using Mo.Ma cerebral protection device (Invatec, Italy). Angiographic success rate was 100%, average procedure time 53,7±9,9 min, ICA occlusion time 53,7±19,9 min. 2 patients presented transitory ischemic attack. Clinical improvement achieved in all cases. Our experience demonstrates that the Mo.Ma device effectively prevents intraprocedural cerebral embolism in carotid stenting, and the idea of proximal protection seems to be safe, user-friendly and very promising.
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Abstract: Internal carotid artery (ICA) pathological kinking considered to be one of the main causes of stroke. Aim of our study was to assess endovascular possibilities to manage this condition. Carotid stenting performed in 15 non-fixed human corpses with ICA kinking (6 - L-shaped, 5 - S-shaped, 4 - looping) under hydrodynamic monitoring. It is shown that endovascular correction (stenting) of kinked ICA straightens the artery, considerably reduces pressure gradient, and increases volume of flow. At the same time carotid stenting, performed for ICA kinking, does not distress the vessel wall, in particular, it causes no significant intimal trauma. Reference 1. Riser M.M., Gerause J., Ducoudray J., Ribaunt L. Dolicho-carotide interne avec syndrome vertigneux. Neurology. 1951; 85: 145-147.
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Abstract: Aim: was to assess computed tomography angiography (CTA) abilities in analysis of internal carotid artery (ICA) critical atherosclerotic lesions. Material and method: for the period 2014-2016 - 321 patients underwent examination (ultrasound and CTA of brachiocephalic arteries) prior to surgical treatment of ICA occlusive disease. CTA was made on Philips iCT 256-slice (noncontrast examination, arterial and venous phases), 50 ml on nonionic contrast agent was injected (4-4,5 ml/sec). We distinguished several types of ICA changes: stenosis more than 60% and 70%, critical stenosis, subocclusion (also with distal collapse), local occlusion. Results: CTitical ICA stenosis was detected in 82 patients (26% of all observed cases); ICA changes with diffuse decrease of upper segments - in 20 cases (6,2% of cases). Among group of decreased diameter we saw subocclusion (18 patients) and local occlusion (2 patients). In the setting of local occlusion ICA contrast-enchanced through atypical ascending pharyngeal artery In patients with diffuse decrease of upper ICA segments all elements of circle of Wills were detected in 70% of cases. During surgery CTA results were confirmed, but atherosclerotic plaque extension was higher than observed at CT approximately at 10 mm. Conclusion: we can refer critical stenosis, subocclusion and local occlusion to critical atherosclerotic ICA changes. The one should consider CTA limitations in differentiation of upper part of atherosclerotic plaque. In majority of cases decrease in ICA diameter was associated with severe atherosclerotic involvement and not with congenital changes CTA is necessary for preoperative assessment of carotid occlusive disease, especially in critical ICA changes. References 1. John J. Ricotta, Ali AbuRahma, Enrico Ascher, Mark Eskandari, Peter Faries and Brajesh K. Lal. Washington, DC; Charleston, WV; Brooklyn, NY; Chicago, Ill; New York, NY; and Baltimore, Md Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011: Sep; 54(3):1-31. 2. Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami brahiocefal'nyh arterij [National recommendations on treatment of brachicephalic arteries disease]. Rossijskij soglasitel'nyj dokument. 2013; 72S [ In Russ]. а) Nacional'nye rekomendacii po vedeniyu pacientov s zabolevaniyami brahiocefal'nyh arterij [National recommendations on treatment of brachicephalic arteries disease] [Elektronnyj resurs]: ros. soglasit. dok. /Ros. o-vo angiologov i sosudistyh hirurgov, Assoc. serdech.-sosudistyh hirurgov Rossii, Ros. nauch. o-vo rentgenehndovaskulyar. hirurgov i intervencion. radiologov, Vseros. nauch. o-vo kardiologov, Assoc. flebologov Rossii ; L. A. Bokeriya, A. V. Pokrovskij, G. YU. Sokurenko [i dr.]. - M., 2013. - 72 s. - Rezhim dostupa: www. url: http://www.angiolsurgery.org /recommendations2013/recommendations_brachio- cephalic.pdf . 03.04.2015 [In Russ]. b) Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal'nyh arteriT [National recommendations on treatment of brachicephalic arteries disease]. M.2013 [In Russ]. 3. Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 2-Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement. American Journal of Neuroradiology 2016; 37(2):200-204. 4. Johansson E. and A.J. Fox., Carotid Near-Occlusion: A Comprehensive Review, Part 1- Definition, Terminology, and Diagnosis. American Journal of Neuroradiology Jan 2016; 37(1):2-10. 5. Vishnyakova M.V., Pronin I.N., Lar'kov R.N., Zagarov S.S. Komp'yuterno-tomograficheskaya angiografiya v planirovanii rekonstruktivnyh operacij na vnutrennih sonnyh arteriyah [CT-angiography in planning of reconstructive operations on internal carotid arteries]. Diagnosticheskaya i intervencionnaya radiologiya. 2016; 10(3):11-19 [In Russ]. 6. Suzie M. El-Saden, Edward G. Grant, Gasser M. Hathout, Peter T. Zimmerman, Stanley N. Cohen, and J. Dennis Baker. Imaging of the internal carotid artery: the dilemma of total versus near total occlusion. Radiology 2001; 221(2):301-308. 7. Mamedov F.R., Arutyunov N.V., Usachev D. YU, Lukshin V.A., Mel'nikova-Pickhelauri T.V., Fadeeva L.M., Pronin I.N., Kornienko V.N. Sovremennye metody nejrovizualizacii pri stenoziruyushchej i okklyuziruyushchej patologii sonnyh arterij [Modern methods of neurovisualization in stenotic and occlusive pathology of carotid arteries.]. Luchevaya diag nostika i terapiya. 2012; 3(3):109-116 [In Russ]. 8. Vishnyakova M.V. (ml), Pronin I.N., Lar'kov R.N., Vishnyakova M.V.. Detalizaciya okklyuziruyushchego porazheniya vnutrennej sonnoj arterii pri komp'yuternoj tomograficheskoj angiografii dlya planirovaniya rekonstruktivnyh operacij [Detalization of occlusive lesion of internal carotid artery in CT angiography for planning of reconstrutive operations]. Vestnik rentgenologii i radiologii. 2017; 98(2):69-77 [In Russ]. 9. Lippman H.H., Sundt T.M. Jr., Holman C.B.. The poststenotic carotid slim sign: spurious internal carotid hypolasia. Mayo Clin Proc. 1970; 45:762-767. 10. Fox Allan J., Michael Eliasziw, Peter M. Rothwell, Matthias H. Schmidt, Charles P. Warlow, Henry J.M. Barnett. Identification, Prognosis, and Management of Patients with Carotid Artery Near Occlusion. American Journal of Neuroradiology. Sep 2005; 26(8):2086-2094 11. Johansson E., Chman K., Wester P.. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277:615-623.
Abstract: In clinical practice, ischemic stroke still remains a difficult problem, being in most leading causes of death. Development of new treatments, founding of new therapeutic algorythmes and untiringly technical progress in sphere of instrumental support of operation-room allow to proceed endovascular intervention in group of patients with cardioembolic stroke. Case report presents successful endovascular treatment of patient from cardio-surgical department of Belgorod Region Clinical Hospital named after St. loasaf, with cardioembolic stroke, onset in preoperative period (before aorto-coronary bypass). Materials and methods: patient A., 59 years, diagnosis: «Ischemic heart disease. Exertional angina FC II. Post-infarction cardiosclerosis. (AMI in September 2014). Stenosis of coronary arteries according to coronary angiography (CAG), hemodynamically significant. Hypertensive heart disease III st., 2 degree, with the defeat of the heart and blood vessels of the brain, with the achievement of target blood pressure (BP). Diabetes mellitus type 2, the second insulin-depended, stage subcompensation. Risk factor 4. congestive heart failure 2a class, functional class III. Chronic gallstone disease. Chronic calculous cholecystitis without exacerbation». 05.02.15 - onset of ischemic stroke in left hemisphere of brain. Patient urgently underwent: multislice computed tomography (MSCT), MSCT-angiography of main brain arteries, direct angiography of main brain arteries. Survey showed: occlusion of proximal third of left common carotid artery (CCA) with TICI-0 blood flow; left middle cerebral artery (MCA) and anterior cerebral artery (ACA) were filled threw anterior communicating artery (ACoA) from right internal carotid artery (ICA). Patient underwent: recanalization of occlusion, thrombectomy from left CCA, stenting of CCA-ICA segment, selective thrombolythic therapy into left MCA. Results: «Time-To-Treatment» was 4 hours 15 minutes. Made endovascular treatment leaded to regression of neurological deficit. Conclusions: the use of endovascular methods in patients with cardioembolic stroke car decrease neurological deficit and increase quality of life of patients in this group. References
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Abstract: Aim: was to estimate the efficiency and safety of stenting of subtotal stenosis of internal carotid artery Materials and methods: we analyzed data of 31 patients who underwent stenting of subtotal stenosis of internal carotid artery. Middle age was 68,2±6,9 yrs. Research included 23 males (74,2%). 28 patients (90,3%) had ischemic stroke or transient ischemic attack in anamnesis. Asymptomatic patients (9,7%) in the pre-operative stage underwent single-photon emission computed tomography of the brain, which revealed the presence of subtotal stenosis of internal carotid artery complicated with ishemia. Stenting of internal carotid arteries were made with the help of embolic protection devices in all cases (100%), in 90,3% - with additional proximal protection. In 100% - predilatation of critical stenosis zones were performed. Two patients (6,4%) underwent simultaneous stenting of internal carotid artery and vertebral artery in 1 patient (3,2%) - stenting of internal carotid artery and subclavian artery The operative time was equal to the average 32,6±8,7 minutes. The results of endovascular interventions were assessed by the presence / absence of neurological symptoms during hospitalization and in the late postoperative period. Stent patency and the presence / absence of restenosis were determined by ultrasound, selective angiography of the brachiocephalic arteries. Before discharge in asymptomatic patients evaluated cerebral perfusion using single photon emission computed tomography Results: successful stenting of subtotal stenosis of the internal carotid artery with blood flow restoration (TICI-3) achieved in 100% of cases. According to the single-photon emission computed tomography of the brain, performed before discharge in asymptomatic patients (9.7%) noted improvement in cerebral blood flow. During the observation period, which amounted to 11,6 ± 3,1 months, the new transient ischemic attacks or ischemic strokes were not observed, no deaths. According to the ultrasonic examination - stents in the internal carotid arteries are passable, with no signs of restenosis. Conclusion: stenting of critical subtotal stenosis of the internal carotid artery is effective and safe. Application of the proximal cerebral protection can reduce the potential risk of embolism during stenting of subtotal stenosis of the internal carotid artery as it provides protection at all stages of the procedure. It is necessary to conduct large randomized studies to confirm the clinical efficacy and determine the indications for this kind of intervention in these group of patients. References 1. Berman S.S., Devine J.J., Erodes L.S. et al. Distinguishing carotid artery pseudo-occlusion with color flow Doppler. Stroke. 1995; 26:434-438. 2. Dix J.E., McNulty B.J., Kalimes D.F. Frequency and significance of a small distal ICA in carotid stenosis. AJNR Am. J. Neuroradiol. 1998;19:1215-1218. 3. Fox AJ. How to measure carotid stenosis. Radiology. 1993;186:316-318. 4. Gabrielsen T.O., Seeger J.F., Knake J.E. et al.The nearly occluded internal carotid artery: a diagnostic trap. Radiobgy. 1981;138:611-618. 5. Henderson R., Eliasziw M., Fox AJ. et al. The importance of angiographically defined collateral circulation in patients with severe carotid stenosis. Stroke. 2000; 31:128-132. 6. Lee D.H., Gao F., Rankin R.N. et al. Duplex and color Doppler flow sonography of occlusion and near occlusion of the carotid artery. AJNR AmJ. Neuroradiol. 1996;17:1267-1274. 7. Gonzalez A., Gil-Peralta A., Mayol А. et al. Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome. AJNR Am.J. Neuroradiol. 2011;32:252-258. 8. Fox A.J., Eliasziw M., Rothwell P.M. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am.J.Neuroradiol. 2005;26:2086-2094. 9. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N.Engl.J.Med. 1991; 325:445-453. 10. Rothwell P.M., Gutnikov S.A., Warlow C.P., The European Carotid Surgery Trialists’ Collaboration. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 2003;34:514-523. 11. Berman S.S., Bernhard V.M., Erly W.K. et al. Critical carotid artery stenosis: diagnosis, timing of surgery, and outcome. J.Vasc.Surg. 1994;20:499-510. Samson R.H., Showalter D.P., Yunis J.P. et al. Color 12. flow scan diagnosis of the carotid string sign may prevent unnecessary surgery. Cardiovasc.Surg. 1999; 7:236-241. 13. Archie Jr J.P. Carotid endarterectomy when the distal internal carotid artery is small or poorly visualized. J.Va,sc.Surg. 1994;19:23-30. 14. Barnett H.J., Meldrum H.E., Eliasziw M., North American Symptomatic Carotid Endarterectomy Trial (NASCET) collaborators. The appropriate use of carotid endarterectomy. CMAJ. 2002;166: 1169-1179. 15. Pappas J.N. The angiographic string sign. Radiology. 2002; 222: 237-238. 16. Giannoukas A.D., Labropoulos N., Smith F.C.T. et al. Management of the near total internal carotid artery occlusion. Eur.J.Vasc.Endovasc. Surg. 2005; 29: 250-255. 17. O’Leary D.H., Mattle H., Potter J.E. Atheromatous pseudo-occlusion of the internal carotid artery. Stroke. 1989; 20:1168 1173. 18. Houser O.W., Sundt T.M., Holman C.B. et al. Atheromatous disease of the carotid artery. Neurosurg. 1974;41:321-331. 19. Heros R.C., Sekhar L.N. Diagnostic and therapeutic alternatives in patients with symptomatic «carotid occlusion» referred for extracranial-intracranial bypass surgery. J.Neurosurg. 1981; 54:790-796. 20. Sekhar L.N., Heros R.C., Lotz P.R. et al. A
Abstract: The article presents the experience of stenting the internal carotid arteries (ICA) in 45 patients. The patients' age ranged from 49 to 78 years, on average 64.8 years. The degree of ICA stenosis ranged from 60% to 95%, on average 72.7 ± 7.2%. 28 (62.2%) patients had a history of acute cerebrovascular accident, 17 (37.7%) patients had cerebral symptoms of circulatory disorders. After 48 endovascular procedures, neurological complications developed in 3 (6.2%) cases: transient ischemic attack - in 2 (4.1%) patients, minor stroke - in one (2%) patient. Hospital mortality was 2.2%. In the remote period, 13 (28.8%) patients were examined. There were no myocardial infarctions and strokes.
Abstract: Acute cerebrovascular accident (CVA) is one of leading causes of death and disability in the population, both in Russia and around the world. Aim: was to improve the effectiveness of the prevention of ischemic stroke (IS) in patients with asymptomatic stenosis of internal carotid arteries (ICA). Materials and methods: this article is an analysis of the world literature on the subject of stroke in patients without focal or ocular symptoms (asymptomatic stenosis), medical and surgical (carotid stenting / carotid endarterectomy) correction of such stenotic lesions, postoperative complications, and the risk of stroke in the immediate and late postoperative period. We presented data on development of stroke, depending on the type of plaques, brain CT data, comorbidities in these patients, the method of surgical correction of stenosis. On the basis of international multicenter studies and experience of individual domestic and foreign clinics we performed evaluation of IS conservative anc surgical prophylaxis in this group of patients. Results: performed analysis allowed to formulate recommendations on the tactics of treatment and examination of patients with asymptomatic internal carotid artery stenosis. References 1. Bokerija L.A., Gudkova R. G. Serdechno-sosudistaja hirurgija. 2010; Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija. [Cardio-vascular surgery. 2010. Diseases and congenital abnormalities of blood circulation]. M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 192 [In Russ]. 2. Pokrovskij A.V. Klinicheskaja angiologija. A.V. Pokrovskij. [Clinical Angiology]. Moscow; 2004;1; 808. [In Russ]. 3. Chernjavskij A.M. Programma bor'by s insul'tom, prehodjashhimi narushenijami mozgovogo krovoobrashhenija i discirkuljatornymi jencefalopatijami: metod. rekomendacii A.M.Chernjavskij, T.E.Vinogradova. 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Abstract: Ischemic strokes are still the worldwide problem with high mortality and morbidity. Carotid endarterectomy that is used for revascularization of changed artery required precise visualization of carotid arteries at extra- and intracranial level, assessment of intracranial circulation. References 1. Insul't: Rukovodstvo dlja vrachei. Pod red. L.V. Stahovskoi, S.V. Kotova. [Stroke: guide for physicians. Under edition of L.V.Stakhovsky, V.Kotov] M.: OOO «Medicinskoe informacionnoe agentstvo», 2013;400S [In Russ]. 2. 3. Vereshhagin N.V. Rol' porazhenij jekstrakranial'nyh otdelov magistral'nyh otdelov golovy v patogeneze narushenij mozgovogo krovoobrashhenija. Sosudistye zabolevanija nervnoj sistemy. [Role of extracranial arteries’ lesion in pathogenesis of disorders of cerebral circulation] 4. Gusev E.I., Skvorcova V.I. Ishemija golovnogo mozga. [Ischemia of brain]. Zhurn.nevropat. i psihiatr. 2003;9:66- 70 [In Russ]. 5. Harbaugh R.E., Schlusselberg D.S., Jeffery R., Hayden S., Cromwell L.D., Pluta D. Threedimensional computerized tomography angiography in the diagnosis of сerebrovascular disease. J. Neurosurg 1992; 76: 408-414. 6. Heiserman J.E., Dean B.L., Hodak J.A. et al. Neurologic complications of cerebral angiography. AJNR Am Neuroradiol. 1994; 15: 1401-1407. 7. Dzhibladze D.N. Patologija sonnyh arterii i problema ishemicheskogo insul'ta (klinicheskie, ul'trazvukovye i gemodinamicheskie aspekty). [ Pathology of carotid arteries and problem of ischemic stroke (clinical, ultrasonic and hemodynamic aspects)] Moskva. 2002; 208S [In Russ]. 8. John J. Ricotta, MD,a Ali AbuRahma, MD, FACS,b Enrico Ascher, MD,c Mark Eskandari, MD,d Peter Faries, MD,e and Brajesh K. Lal MD,f Washington, DC; Charleston, WV; Brooklyn, NY; Chicago, Ill; New York, NY; and Baltimore, Md Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011 Sep; 54(3): 1-31. 9. Buskens E., Nederkoorn P.J., Buijs-Van Der Woude T., Mali W.P., Kappelle L.J., Eikelboom B.C., Van Der Graaf Y, Hunink M.G. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology. 2004;233:101-112. 10. Edward C. Jauch et al., Guidelines for the Early Management of Patient With Acute Ischemic Stroke. Stroke. 2013;44: 870-947. 11. Gladstone D.J., Kapral M.K., Fang J., Laupacis A., Tu J.V. Management and outcomes of transient ischemic attacks in Ontario. CMAJ. 2004;170:1099-1104. 12. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med. 1991;325:445-453. 13. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998 May 9; 351 (9113): 1379-87. 14. Osborn A.G.; Diagnostic Cerebral Angiography. 2nd edition Philadelphia, PA: Williams and Wilkins; 1999. 15. Choi YJ., 16. Extracranial vascular-interventional: E. Johansson and A.J. Fox Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis. AJNR Am. J Neuroradiol 2016 37: 2-10. 17. The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: risk of rupture and risks of surgical intervention. N Engl J Med. 1998; 339: 1725-1733 18. Krylov V.V. Jepidemiologija i jetiopatogenez anevrizm i subarahnoidal'nyh krovoizlijanii. [Epidemiology and ethiopathogenesis of aneurysms and subarachnoid hemorrhage] Krylov V.V., Godkov I.M. Hirurgija anevrizm golovnogo mozga: v 3-h t. Pod red. V.V. Krylova. Tom
Abstract: Revascularization strategy definition in acute coronary syndrome in patients with multivessel coronary artery disease is a significant problem of modern interventional cardiology. Aim: was to evaluate effectiveness of special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» designed to the revascularization strategy definition ir acute coronary syndrome patients. Materials and methods: revascularization strategy of 50 acute coronary syndrome patients was analyzed. In all cases the revascularization strategy was defined by the group of intervention cardiologists with the help of independent experts and special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance». Experts-, physicians-, and soft- based revascularization strategies were compared among themselves Results: complete coincidence between expert-based and soft-based revascularization strategies was registered in 66% patients and the incomplete coincidence - in 32% patients. Complete mismatch between expert-based and soft-based revascularization strategies was registered in 2% patients. The complete coincidence between physicians-based and soft-based revascularization strategies was registered in 42% patients and the incomplete coincidence - ir 52% patients. Complete mismatch between physicians-based and soft-based revascularization strategies was registered in 6% patients. Conclusion: as well as experts, special PC programs «Sapphire 2015 - Right dominance» and «Sapphire 2015 - Left dominance» provide success in the revascularization strategy definition 1г acute coronary syndrome patients with multivessel coronary artery disease. References 1. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/ SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Circulation. 2011; 124:54-130. 2. Cohen D, Stolker J, Wang К, et al. Health-Related Quality of Life After Carotid Stenting Versus Carotid Endarterectomy. Results From CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). JACC Vol. 2011;15:58. 3. Amirdjanova V.N., Goryachev D.V., Korshunov N.I., Rebrov A.P., Sorotskaya V.N. Populyatsionnie pokazateli kachestva zhizni po oprosniku SF-36 (rezultati mnogotsentrovogo issledovaniya kachestva zhizni) Mirazh. [Population' indicators of quality of life questionnaire SF-36 (results of a multicenter study of quality of life «MIRAGE»).]. Rheumatology Science and Practice. 2008;46(1):36-48. [In Russ]. 4. Stolker JM, Mahoney EM, Safley DM, et al. Health-related quality of life following carotid stenting versus endarterectomy: results from the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) trial. J Am Coll Cardiol Intv. 2010;3: 515-23. 5. PQcTte E, Slisers M, Miglane E et al. Health-Related Quality of Life Among Patients with Severe Carotid Artery Stenosis. The Journal of Latvian Academy of Sciences. 2015; 5:237-242. 6. Kazmierski P, Kasielska A, Bogusiak K, Lysakowski M, Stela О gowski M. Influence of internal carotid endarterectomy on patients’ life quality. Pol Przegl Chir. 2012;84:17-22. 7. Shan L. Saxena A .Quality of Life and Functional Status After Carotid Revascularisation: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2015;49: 634-645. 8. Stolker JM, Mahoney EM, Safley DM, et al. Health-related quality of life following carotid stenting versus endarterectomy: results from the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) trial. J Am Coll Cardiol Intv. 2010;3: 515-523. 9. CaRESS Steering Committee. Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I clinical trial: 1-year results. J Vasc Surg. 2005;42:213-219.
Abstract: Aim: was to estimate efficacy and safety of carotid stenting and carotid endarterectomy Г patients, admitted to center of cardiovascular surgery. Material and methods: we investigated possibilities of treatment with randomization one-by-one, according to admittance to hospital and use of carotid endarterectomy or stenting. Final decision in each case was made by consilium. For the period 2011-2013, 269 patients were treated including 132 patients who underwent carotid endarterectomy and 137 patients who underwent carotid stenting. The majority of patients had an anamnesis of coronary heart disease or needed coronary revascularization. Symptomatic stenosis was an indication for 19,0 % revascularization in both groups (p = 0.994). Results: there were no in-hospital deaths registered. Incidence of stroke after carotid endarterectomy was 6(4,5%) and 2(1,5%) after stenting. Transient ischemic attack occurred in 3(2,2 %) patients in the stenting and 1 patient (0,76 %) in endarterectomy groups. Major bleeding was observed in both groups with equal frequency (p = 0,584). Defeat of cranial nerves (7,6 %; p = 0,001) was only observed in the endarterectomy group. Finally both methods of carotid revascularization showed the same level of complications (p = 0,569) besides cranial nerve defeat. Conclusion: carotid stenting and endarterectomy show similar results in the treatment of patients with atherosclerotic lesions of carotid arteries. Both methods can equally be used in clinics with adequate experience in surgical interventions on the heart and peripheral vessels. The complex assessment of the patient and the lesion by the vascular team is necessary. References 1. Casserly I.P, Sachar R., Yadav J.S. Practical peripheral vascular interventions. Second edition. Wolters Kluwer Health/Lippincott Williams & Wilkins. Philadelphia. 2011; 466 p. 2. Cutlip D. 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Fokkema M., de Borst G. J., Nolan B. W., Indes J., Buck D. B., Lo R. C., Moll F. L., Schermerhorn M. L. Clinical relevance of cranial nerve injury following carotid endarterectomy. Eur. J. Vasc. and Endovasc. Surg. 2014; 47(1): 2-7. 15. Thirumala P., Kumar H., Bertolet M., Habeych M., Crammond D., Balzer J. Risk factors for cranial nerve deficits during carotid endarterectomy: A retrospective study. Clinical Neurol. and Neurosurg. 2015; 130:150-154.
