PRONOUNCED PATHOLOGICAL DEFORMITY OF INTERNAL CAROTID ARTERIES. SURGICAL TREATMENT
Abstract
Background. Arteriographic diagnostic methods show that the incidence of pathological deformities ranges from 10 to 43%. Pathological tortuosity (PI) of the internal carotid artery ranks second after atherosclerosis among the causes leading to the development of acute and chronic cerebrovascular insufficiency (CVI). Material and methods. The study included 38 patients who underwent internal carotid artery redressing with transposition to a new orifice. Of them 4 patients underwent these reconstructions on both sides. Algorithm of patient examination: anamnesis and physical examination, laboratory clinical tests, ECG, EGDS, ultrasound duplex scanning (USDS) of brachiocephalic arteries (Vivid e95 General Electric, USA), multispiral computed tomography (MSCT) of BCA in extra- and intracranial sections, consultations of neurologist and cardiologist. Results of the study. 42 operations of internal carotid artery redressing with transposition to a new orifice were performed in 38 patients. In 20 cases (47.6%) pathological deformations were combined with atherosclerotic lesion of the homolateral VCA, which required additional endarterectomy from the VCA bulb and bifurcation of the common carotid artery (CCA). Embolus-prone atherosclerotic plaques (APP) were detected in 75%. The follow-up time was 549 (389 to 640) days. During the postoperative period, thrombosis of the reconstructed VCA (2.4%) was observed in 1 case, detected 2 months later at the control ultrasound examination of the BCA. The thrombosis was asymptomatic, and the patient underwent VCA redressing with carotid endarterectomy. During the follow-up period, the survival rate was 100%, and there were no complications. Conclusions. Reconstruction of the VCA with transposition of the orifice can be an alternative method of surgical treatment with minimal risks of complications. In order to achieve the best result during the creation of a new VCA orifice it is necessary to preserve the original anatomy of the VCA bulb and common carotid artery bifurcation as much as possible.
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