SURGICAL METHODS OF TREATMENT OF CAROTID ARTERY PATHOLOGY IN THE ACUTE PERIOD OF ISCHAEMIC STROKE: INDICATIONS AND VARIANTS OF SURGICAL TREATMENT

Abstract

Background. The treatment of acute cerebral circulatory disorders (ACBD) has undergone significant changes over the last decade. The issues of reconstructive interventions on vessels in the acute period of ischaemic stroke are the subject of discussions of vascular surgeons, neurosurgeons and other specialists. Prolonged waiting time of more than 6 weeks is accompanied by the development of recurrent ACBD in up to 40% of cases. A recurrent stroke in the same basin is registered in 25% of patients. This contributed to the revision of the significance of critical stenosis repair for urgent and delayed indications. Material and methods. The results of early surgical correction of carotid artery (CA) and vertebral artery (VA) pathology, the aim of which was not only to restore the initial blood flow during acute ischaemia, but also to improve blood supply to the brain tissue and to prevent recurrent STEMI, were presented on the experience of more than 2500 operations in the acute period of ischaemic stroke for the period from 01.01.2011 to the present day. The aim of the study: to familiarise neurologists with the types of applied surgical techniques, criteria for determining indications and choosing the optimal time for surgical intervention, basic requirements for their performance. Results. Surgical methods of aortic arch branch reconstruction in acute ischaemic stroke and with the purpose of secondary prevention of ischaemic stroke are indicated in patients with acute ischaemic stroke (IS) or transient ischaemic attack (TIA) caused by 70–99% stenosis of the VCA, it is recommended to perform CEAE with the purpose of prevention of recurrent stroke. It is also recommended to perform CEAE in patients with MI in the acute period or TIA and stenosis of the VCA lumen 50-69% in order to remove the unstable plaque and prevent recurrent stroke within 14 days.