This article defines vertebra-related causes of vertebrobasilar insufficiency in patients with the signs of tortuosity of segment VI of the VA. The aim of this study is to present the results of diagnostics of discirculatory phenomena in the vertebrobasilar system and to show their importance for differentiated surgical treatment of stenotic lesions of segment V1 of VA in pathological disorders of cerebral circulation in the VBS caused by osteochondrosis of the cervical spine. The following traditional methods are used in diagnostics: Doppler ultrasonography, multispiral computed tomography with contrast enhancement. Also using developed by the author method for determining VA reactivity and circulatory insufficiency in the vertebrobasilar system (VBS). Based on our methodology and criteria, patients were selected for different types of surgical treatment with clinical outcome prediction following interventions on the arteries of the VBS. To determine the pathologies of the intracranial segments of the vertebral and basilar arteries, taking into account the pathways of collateral compensation in the VBS, cerebral angiography is recommended before surgery on the arteries of the VBS. Reconstructive techniques used on segment VI of the VA will predictably show the best long-term clinical results. The excision of a tortuous segment VI of the VA may be effective in obtaining reliable results of successful interventions in the early postoperative period. The conservative treatment of the patients with multiple VBD lesions is possible. early outcomes of their use are satisfactory.
This article provides an up-to-date literature review on the role of pathological changes in the extracranial, trunk segments of the vertebral arteries (VA) in the development of chronic and progressive vertebrobasilar insufficiency (VBI). Improving methodology of differentiated reconstructive interventions for VA stenosis based on specifically determined vascular territory with application of microsurgery instruments and minimally invasive technologies has made it possible to determine that all other conditions that could lead to the formation of VBI should be excluded in patients with this clinical picture during the planning of arterial reconstruction, and possible outflow pathways and reactivity of the arteries of the vertebrobasilar territory should be determined.
Of the total number of circulatory disorders in the vertebrobasilar basin (VBB), which reaches 30 % of all diagnosed disorders of cerebral circulation, transient forms acquire the character of stable in 25–30 % and progress to the stage of complete stroke in 25–50 out of 100 patients within 2–5 years of the disease. The level of disability at the same time reaches 80 %. To date, there are no recommendations and developments for the management of patients with combined lesions of the extracranial arteries occurring against the background of the syndrome. The known methods of diagnosis of VSN are based on the assessment of clinical and hemodynamic, structural and morphological features and the results of dynamic observation. These methods allow using expensive equipment and repeated long-term examinations to objectify the condition of HA, and with the help of rotational samples to determine the probable genesis of VSN. However, the disadvantage is the low level of availability to attract expensive equipment and a dichotomically qualitative approach to the diagnostic process. Therefore, a diagnostic algorithm was developed, on the basis of which it is possible not only to determine the indications for reconstructive operations on V1 PA arteries with the VDN clinic, but also to predict the clinical effectiveness of the operation, but also to predict the effectiveness of surgical treatment.
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