Вибір методу профілактики гострого порушення мозкового кровообігу при атеросклеротичному ураженні сонних артерій

Abstract

Introduction. Atherosclerotic lesions of the internal carotid artery (ICA) cause the development of acute cerebrovascular disease (ACVD) in almost 75% of patients.The aim of the study. Evaluation the criteria for selecting patients for carotid endarterectomy (CEA) and carotid artery stenting, and to analyze the results of treatment.Materials and methods. The results of treatment of 120 patients with ICA stenosis over the period from 2012 to 2017 were analyzed. There were 75 (62.5%) patients with symptomatic ICA stenosis and 45 patients with asymptomatic ICA stenosis. All the patients were divided into 2 groups according to the treatment method: Group I included 82 (68.3%) patients who underwent carotid endarterectomy; Group II comprised 38 (31.7%) patients who underwent carotid artery stenting. When selecting the method of treatment, carotid endarterectomy was the preferred one. In 49 (57%) patients, eversion CEA was performed; 25 (30.5%) patients underwent traditional CEA with surgical plasty of the ICA; in 8 (9.8%) patients, intraoperative shunting was used. Endovascular stenting was performed in 19 symptomatic patients at high surgical risk, 7 patients with contralateral ICA occlusion and 12 patients with a combination of significant lesions of several supraaortic vessels.Results and discussion. In Group I, 2 (2.4%) patients developed acute cerebrovascular disease; 1 (1.2%) patient died. In 3 (3.7%) patients, postoperative bleeding was observed. In Group II, 1 (2.6%) patient developed ACVD in the early postoperative period. The comparison of the postoperative results of carotid endarterectomy and ICA stenting in our study did not reveal any statistically significant difference.Conclusions. Surgical and endovascular prevention of ACVD in patients with ICA stenosis allows achieving good postoperative results. The selection of the treatment method (carotid endarterectomy – stenting) should be based on the consensus achieved by vascular surgeon, interventional radiologist and neurologist.