VASCULAR RECONSTRUCTION IN CHRONIC OCCLUSION OF THE INTERNAL CAROTID ARTERY

Abstract

Background. Ischaemic stroke (IS) occurs in 40–69% of patients with VCA occlusion, with mortality rates as high as 16–55%. About 15% of acute cerebral circulatory disorders are attributable to occlusion of the internal carotid artery (ICA), with atherosclerosis being the main cause. Material and methods. A clinical observation of a patient with chronic occlusion of the internal carotid artery is presented. Patient K., 63 years old, was admitted to the neurological department on 29.01.2022 after a night’s sleep, when severe dizziness and shakiness when walking appeared. According to ultrasound examination, occlusion of the right VCA was detected in 2021. An attempt of endovascular recanalisation of the right VCA was made. Taking into account the findings, it was decided to perform carotid reconstruction on the right side. On 09.03.2022 — right VCA disobliteration, endarterectomy from common and external carotid artery, right VCA redressing were performed. On the 7th day after the operation the patient was discharged in satisfactory condition. At the outpatient stage double antiaggregant therapy was prescribed. Experience shows that it is possible to restore adequate cerebral perfusion by performing carotid endarterectomy. Carotid endarterectomy and hybrid surgeries are more often preferred in patients with chronic occlusion of the VCA instead of conservative treatment or extra-intracranial microvascular anastomosis. Conclusion. It is necessary to take into account and compare the data of the main research methods (ultrasound Dopplerography and computed tomography with carotid artery contrasting) for differentiated approach to the choice of surgical tactics depending on the occlusion time, which will reduce the incidence and probability of TIA and stroke readmission.