As known, 95% of ischemic insult and transient ischemic attacks are connected with atherosclerosis paths, which in the most cases (76,6%) are located in the main vessels of the neck. The cause of ischemic insult in 80% cases is multifocal damage of vessels. Carotid-vertebrobasilar stenosis form in the common structure vessels damages 27,8%.
The results of surgical treatment of 82 patients with hemodynamic significant atherosclerosis damage of more then one extra cranial artery nourishing brain were analyzed. From 2002 to 2009 93 reconstructive operations were made. On the background of universal neurological symptom all patients had the signs of hypo perfusion in vertebral basilar bath (VBB). More often (63,4%) patients had chronic discirculation, 25 (30,5%) of patients had transient ischemic attacks, in other cases ischemic insult is verified.
All patients were examined by angiosurgent, neurologist, cardiologist, otoneurologist, neuroophtalmologist.
Instrumental diagnosis included triplex scanning of vessels of the neck, transcranial Doppler investigation (TDI) with the samples of squeezing of carotid artery and head turning in different directions. Computed tomography of brain, radioopaque or MR-angiography, the widen laboratory research of blood were also made.
During the research 65 patients had bilateral hemodynamic significant stenosis of internal carotid arteries (ICA), and the «carotid steal-syndrome» took place.In 14 cases was definied stenosis of ICA and occlusions of vertebral artery in the first segment. Three patients had bilateral stenosis of carotid and occlusions of one of vertebral artery and it lead to infarct of cerebellum.
In all cases to the patients was made carotid endarterectomy from the general and internal carotid arteries with the plasty of arteriotomy stoma by synthetic patch. In 11 cases endarterectomy was made on contra lateral side. Preferable method of interoperation patronage of brain was the usage of intralumenal temporary bypass. In all cases the constant interoperation monitoring of cerebral blood flow with the help of TDI, control of arterial tension, electrocardiogram and blood saturation was made. After closing the arteriotomy stoma the volumetric blood flow in ICA was measured by method of laser Doppler ultrasounds.
The operation was made on the side of hemodynamic more significant stenosis of ICA with homogeneous atherosclerosis paths or on the vessels, damaged by heterogeneous path. In the case of combination of bilateral stenosis and the damage of vertebral artery the reconstructions was made on the side of occlusion of the latter.
Post operation complications were connected with the light paresis of motor nerves in the field of neck, were reduction to the moment of discharge. The improvement of well-being, psycho neurologic status, full reduction or reducing the symptoms of discirculation in vertebral basilar bath after operation had 56 (68,3%) patients. 10 patients had reducing the frequency and expression of headache, sleep reappeared, but moderate vertigo and swaying while walking were kept. In 5 cases (patients with infarct in vertebral basilar bath) were kept the signs of vestibulocochlear and/or cerebellar syndromes. Repeated or primary insults in the time of supervision from 2 month to 7 years were not registered.
The work is submitted to Scientific Conference "The Problems of International Integration of Educational Standards", England (London) - France (Paris), April 20-28, 2009. Came to the Editor´s Office on 15.04.2009.