Surgical treatment of atherothrombotic and hemodynamical forms of ischemic insult
Objective. To analyze the surgical treatment results in patients, suffering the carotid arteries affection, in acute and early restorational period of ischemic insult.
Маterials and methods. Results of surgical treatment were analyzed in 47 patients, suffering hemodynamically significant stenosis of carotid arteries (СА) and/or presence of embologenic pluck in an acute and early restorational period of ischemic insult in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2014 - 2017 yrs. There were 41 (87.2%) men-patients and 6 (12.8%) women-patients. Average age of the patients operated was (60 ± 15) yrs. To all the patients, undergoing examination for possible ischemic insult, a computer tomography (CT) is performed initially as a more rapid investigation, permitting to exclude a cerebral hemorrhage. Indications for carotid endarterectomy were stenosis of CA more than 60%, оcclusion of СА or presence of embologenic pluck. To all the patients an operative intervention under the block anesthesia was performed, permitting to control a consciousness in the CA clamping period. The presence of neurological deficiency was an indication for performance in 17% observations of endarterectomy from internal carotid artery (IСА), using temporal shunting and the synthetic patch sewing in. The eversion endarterectomy was performed in 39 patients.
Results. Immediate results of the operation were estimated in a complex way, basing on degree of degradation of clinical status and presence of postoperative complications. In 32 patients in postoperative period morbidity was absent. The neurological deficiency regress was noted, beginning from the 7-th day postoperatively, depending on degree of its manifestation, till 3 - 4 mo. On the 14th day a control of the СА passability and the ischemic zone state was conducted. The absence of the CA stenosis and reduction of the ischemic focus in two times was registered. A special apprehension was caused by postoperative reperfusion syndrome, which have had manifested in 35% of patients by a headache and dizziness. This syndrome have begun from the 3-d day, and it demanded the arterial pressure control and correction doing, but it have had eliminated spontaneously on the 7 – 10-th day.
Conclusion. To determine the treatment tactics in patients, suffering the CA affection in acute and restorational period of ischemic insult a magnet-resonance tomography (МRТ) and the contrast-enhanced CТ must be performed in the first 6 h. In hemodynamically significant stenosis and instability of pluck in patients, suffering ischemic insult, it is mandatory to perform a carotid endarterectomy in the first 14 days.
Carotid endarterectomy reduces the risk of the ischemic insult and the cerebral ischemia zone in 98% of observations.
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