Our experience on surgical treatment of patients with multiple atherosclerotic lesions of carotid arteries

Аннотация

The objective of study was improvement of results of surgical treatment of patients with bilateral atherosclerotic defeats of carotid arteries. Studied results of treatment of 180 patients with bilateral atherosclerotic defeats of the carotid arteries in 2014-2019 y. Patients were divided into the first (60 patients) and the second (120 patients) groups depending on tactic of surgical treatment. In the 1st group of patients: first stage of CEA performed on the side with greater degree of stenosis and on the side where stroke happened. Terms of СEA on the opposite side varied from 2 weeks till 2 years. Complications in the 1st group were (5.0 %). At patients of the second group was applied to revealing of carotid pool of primary importance. To 120 patients performed 200 carotid reconstructions. Performance terms of CEA on the opposite side varied from 45 days till 3 months. Total percentage of complications in the 2nd group was 1.7 %. It is important to do CEA stage by stage. According to our data it is ideal to perform CEA on the opposite side in period from 2 to 3 months. 161 Scientific research results in pandemic conditions (COVID-19) Choosing the side of primary importance for bilateral atherosclerotic lesions determines the results of treatment. Keywords: bilateral lesions, carotid arteries, side of primary importance, stage of operations, time-frame of operations. Atherosclerotic defeats of brachiocephalic arteries are one of the main reasons of acute and transient brain circulation disorders [1-4]. Bilateral atherosclerotic defeats are more usual then isolated [5, 6]. The most saved and effective method of preventing the stroke which is caused by atherosclerosis of carotid arteries is carotid endarterectomy [13, 15]. It is steel important, to research hemodynamic in brain vessels before planning intervention [11-14]. According to some authors it is necessary to orientate not only on the degree of stenosis but mainly on properties of atherosclerotic plaque (ASP) [8-9]. Although, some questions are not solved yet: on which criteria we should relay for determining surgical tactic, staging, sequence of the operations and intervals between them [7, 12]. It is very important to protect the brain from ischemia during operation in the patients with bilateral atherosclerotic lesions of carotid arteries. Besides this lop-sided approach, that considers only hemodynamic importance of lesion or carotid pool with prevalent carotid symptoms, is hopeless and fraught with serious consequences [10]. In connection with this it is necessary to have particular tactic of choosing side of primary importance for performing carotid reconstruction. Taking into account everything mentioned above, the aim was optimization of the results of the treatment of patients with bilateral lesions of carotid arteries, by means of revealing time-frame and staging of performing carotid reconstruction and protecting brain from ischemia. MATERIAL AND METHODS Analyzed results of 2140 patients, treated in our hospital, 180 of them were with bilateral atherosclerotic defeats of carotid arteries in period 2014-2019. Patients were divided into the first and the second groups, depending on tactic of surgical treatment. 1st group included 60 (33,3%) patients who undergone carotid reconstruction step-by-step on both sides. 2nd group included 120 (66,7%) patients with bilateral atherosclerotic defeats of carotid arteries, to whom at the first stage performed carotid reconstruction on the side of primary importance. Patients of both groups did not mainly differ by their age and sex. Age of the patients varied form 42 to 82. Average age was 59±5.6 years, (р<0,005). To all patients performed duplex imagining. For duplex scanning used ultrasound machine «Medison X6» (Korea 2008). Measured the diameter of CCA, ICA, ECA, vertebral arteries, thickness of complex media-intima, linear 162 Scientific research results in pandemic conditions (COVID-19) and volumetric velocity of blood, pulsation index and index of resistance in the vessels. Degree of stenosis calculated by diameter of the vessel by ЕCSET methodic [3, 4]. Also were paid attention for the structure of plaques, speed and direction of the blood flow. All patients underwent duplex imagining investigation with identification of stenosis percentage, speed of the blood flow and the structure of plaques. For description of ASP was used supplemented classification of Gray-Weale [1]. Volumetric bloodstream in brachiocephalic arteries was measured at extracranial and intracranial levels. By adding data was calculated average volumetric blood speed at the right and left side in every patient. Studying hemodynamic in the intracranial arteries used analogical methodic with calculating average volumetric blood speed. Performing transcranial duplex imagining we paid attention for direction and speed of the blood flow in the MCA, and carried out compression tests for estimating communicant arteries. For estimatin