Objective. To assess the effect of external carotid artery (ECA) endarterectomy on regional cerebral blood flow, cognitive function, and quality of life in patients with ICA occlusion.Materials and Methods. From 2019 to 2020 year, 14 operations were performed on patients with ICA occlusion and hemodynamically significant ECA lesion. 14 patients, 12 men (85.7 %) and 2 women (14.3 %) underwent resection of the ICA, endarterectomy of the common carotid artery (CCA), and ECA. All patients had a history of stroke of 7±5.7 months. Neurological deficit according to the Rankin scale was 2 points in 11 patients (78.6 %) and 3 points in 3 patients (21.4 %). The mean age was 62.8±11.6 years. The preoperative period included ultrasound duplex scanning and computed tomography with the contrast of the brachiocephalic arteries. Single-photon emission computed tomography was used to assess cerebral blood flow before and after surgery. Cognitive status and quality of life were assessed by questionnaire survey.Results. In the early postoperative period, there were no registered strokes. A decrease in hypoperfusion foci and an increase of cerebral blood flow by an average of 10,33 ± 6,70 ml/min/100 g were observed in 13 patients (92,8 %). The Montreal Cognitive Deficit Scale score was 3,92±3,6. Improvement of quality of life according to the Short Form-36 questionnaire was 9.27±14.75.Conclusion. Endarterectomy of the external carotid artery at the internal carotid artery occlusion leads to a significant increase of regional cerebral blood flow in symptomatic patients, which in turn correlates with the regression of neurological deficit and improvement of quality of life. Continued work in this area will be a detailed analysis of the results of the treatment of patients with occlusion of the internal carotid artery for the period from 2018 to 2022 year.
Objective. To evaluate the outcomes of internal carotid artery (ICA) redressment with transposition into the «new orifice» with a severe pathological elongation of the internal carotid artery. Materials and methods. In 2021, 42 operations were performed in 38 patients having severe deformations of the ICA required the transposition of ICA orifice by 2 or more diameters from the old orifice are presented. Four patients underwent reconstructions on both sides. All patients were symptomatic, with chronic cerebrovascular insufficiency grade 2–4 (according to the classification of A. V. Pokrovsky, 1978). 29 women (76.3 %), 9 men (23.7 %) were enrolled in the study. The average age was 69.1±7.7 years. 18 patients (47.4 %) were found to have a combination of hemodynamically significant pathological deformities with atherosclerotic lesions of the carotid arteries. All patients underwent ultrasound duplex scanning and computed tomography with contrasting brachiocephalic arteries in the preoperative period. Results. Most deformations are represented by S- and Z-shaped (73,8 %) оr ICA loops (21,4 %). The maximum level of transposition was required for loop deformations (25.6 mm±6.17) and was comparable for S- and Z-shaped deformations (17.8 mm±6.3; 17.5 mm±8.0). In the postoperative period, there were no signs of cerebral circulation disorders in this group of patients. In 84 % of cases, 32 patients showed clinical improvement with partial or complete regression of cerebral neurological symptoms. In 1 case (2.4 %), there was a hematoma of a postoperative wound that did not require specific surgical or medical treatment. During postoperative duplex control in the postoperative period, turbulent flows, stenosis and deformity in the area of the new orifice were not observed. Conclusion. The results confirm the data reported by other authors about the safety of the surgical method. ICA reconstruction with orifice transposition may be an alternative method of surgical treatment with minimal risk of complications. To achieve the best result, during the creation of a new orifice of the ICA, it is necessary to preserve as much as possible the original anatomy of the bulb of the ICA and the bifurcation of the common carotid artery. For a more detailed assessment of the results, further study is planned on a large clinical material.
Strokes account for 15–25 % of confirmed cases internal carotid artery (ICA) occlusion. The frequency of ICA occlusion in asymptomatic patients is unknown. The strategy of treatment patients with symptomatic ICA occlusion has not been determined. A clinical observation is presented with the stage of surgical treatment of a 67‑year-old patient with a developed stroke in the basin of the left middle cerebral artery. The examination according to MSCT angiography revealed occlusion of the left ICA. To assess the brain perfusion, a single-photon emission computed tomography (SPECT) with 99mTc was performed. Throb endarterectomy of the left internal carotid artery was performed, with a control ultrasound examination on the 6th day after the operation and after 6 months the blood flow through the internal carotid artery was preserved. Control SPECT with 99mTc was performed, in comparison with the previous study, a significant improvement perfusion on both hemispheres is determined. Improvements in the neurological status were noted in the form of a complete regression of neurological symptoms. On the sixth day after surgical treatment, the patient was discharged in a satisfactory condition. During the hospital stay, the patient was “examined” using a questionnaire for assessing the quality of life – The Short Form‑36 (SF‑36) and MoCA (Montreal Cognitive Impairment Assessment Scale). The survey was conducted on the 15th day of inpatient treatment, before surgery, and on the 6th day after surgery. After 6 months, the patient was re-interviewed. The results obtained indicate a correlation between the improvement of brain perfusion and cognitive impairment, as well as a positive effect of revascularization of the internal carotid artery on the patient’s quality of life. The presented results indicate not only the possibility, but also the high efficiency of surgical treatment of occlusive lesions of the internal carotid artery. Surgical treatment in the early stages after occlusion against the background of the collapse of atherosclerotic plaque and thrombosis of the lumen is a determining factor in the successful restoration of blood flow, improvement of brain perfusion.
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