Endovascular treatment of supra-aortic extracranial stenoses in patients with vertebrobasilar insufficiency symptoms.

PURPOSE: Stenoses and thromboses of vessels feeding the vertebrobasilar territory can evoke serious disturbances including ischemic stroke. We present our experience of endovascular interventions for patients with signs of vertebrobasilar insufficiency (VBI) resulted from subclavian, vertebral and brachiocephalic arterial stenoses. METHODS: Twenty-one patients (10 men) aged from 35 to 84 years (mean 64.3 years) with symptoms compatible with VBI underwent balloon angioplasty and stenting of subclavian (SA), innominate (IA) and vertebral (VA) arteries. Procedures were done by radiologists experienced in systematic stenting of the lesions. VBI was manifested by persistent signs in 15 patients, and by transitory ischemic attacks in the posterior circulatory territory in 4 (19%). Two patients (10%) experienced ischemic strokes (in the vertebrobasilar circulation in both cases). In 3 patients (14%) VBI was accompanied by upper limb vascular insufficiency symptoms. All cases were resistant to medical treatment. A neurologist assessed complaints, initial VBI signs and their alteration after intervention in all patients. Outcomes were measured with the 5-point scale suggested by Malek et al.: (1) excellent result (asymptomatic, no neurologic deficits and no symptoms of vertebrobasilar ischemia); (2) good (no neurologic deficits, at most one transient episode of vertebrobasilar ischemia over a period of 3 months after treatment); (3) fair (minimal neurologic deficit and at most one transient episode per month of vertebrobasilar ischemia); (4) poor (no improvement compared with neurologic status before treatment and/or persistent symptoms of vertebrobasilar ischemia); (5) death (regardless of cause). Endovascular treatment was performed for SA stenosis in 15 patients, for SA occlusion in 2, for IA stenosis in 2, and for VA stenosis in 2. There were 15 cases of atherosclerosis, 2 of aortoarteritis, 4 of proximal SA kinking. SA and IA stenoses ranged from 60% to 100% (mean 74.5%), VA stenoses were 90% in both cases. RESULTS: Initial technical success was achieved in 96% of cases. There were no postprocedural complications or deaths. During 6-36 months (mean 21.3 months) of follow-up all patients showed improvement in VBI symptoms or upper limb ischemia. Within 36 months after the procedure outcomes were estimated as excellent and good in 13 patients (76%) and poor in 2 (12%), the last being attributed to atherosclerosis progression in other vascular areas. Restenosis in the stented area has developed in 1 patient (6%). CONCLUSIONS: Balloon angioplasty and stenting of extracranial vertebrobasilar arterial stenoses appeared to be effective in endovascular treatment of medically resistant VBI. Further investigations are required to clarify the role of subclavian artery kinking in VBI development and indications for various methods of its correction.

[Stenting of left common carotid artery kinking in the region of carotid subclavian anastomosis in a patient operated for occlusion of left subclavian artery]. / Stentirovanie peregiba levoi obshchei sonnoi arterii v oblasti karotidno-podkliuchichnogo anastomoza u bol'noi, operirovannoi po povodu okkliuzii levoi podkliuchichnoi arterii.

The paper presents a case report of left common carotid artery kinking treated by stenting in a patient with aortoarteritis. The kink had developed 10 months after performance of carotid-subclavian anastomosis for occlusion of left subclavian artery and steal syndrome. The stenting procedure of left common carotid artery is described. Follow-up for 42 months and control angiography 6 months after stent implantation demonstrated good outcome and regression of neurological symptoms. Special features of stenting procedure in coiled artery with unaltered walls are analysed. The authors mention that carotid stenting in this patient was the most appropriate method of surgical treatment. It is the first description of stent use for carotid artery kinking correction.

[Risk factors of vascular brain disorders in patients with diabetes mellitus]. / Faktory riska sosudistykh porazhenii mozga u bol'nykh sakharnym diabetom.

Several studies of patients with diabetes mellitus were analyzed in review. The aim of these studies was to determine the most significant risk factors of vascular brain disorders. The pattern and peculiarities of microvascular disorders which progress simultaneously with changes in brain vessels are discussed. The interaction between several risk factors of major arteries atherosclerosis is analyzed what is of reasonable practical importance.

[Diagnosis and treatment of acute paraproctitis]. / Diagnostika i lechenie ostrogo paraproktita.

The results of treatment of 399 patients with various forms of acute paraproctitis are discussed. Comparative evaluation of therapeutic methods applied in the clinic is made. The authors suggest a complex method of treatment in which they use thermography with fluid crystals in topical diagnosis of abscesses of the pararectal fatty tissue and apply papain in combination with medium-frequency ultrasound for the treatment of perineal wounds. This method led to recovery of 97.4% of patients.

[The prevention of hemorrhagic and suppurative complications in the abdominoperineal extirpation of the rectum]. / Profilaktika gemorragicheskikh i gnoinykh oslozhnenii pri briushno-promezhnostnoi ékstirpatsii priamoi kishki.

A special two-walled latex balloon on a draining tube was introduced into the perineal wound in the abdomino-perineal extirpation for locally spread tumor in 36 of 68 patients. This tamponing device allowed to make simultaneous hemostasis, irrigation of the wound with antiseptics and its valuable drainage. As a result, postoperative blood loss was greatly reduced (up to 80-100 ml) as well as the amount of suppurations (from 56.3 to 5.6%). The average postoperative stay at the hospital became shortened from 38 to 22 days.

[Physical activity and physical work capacity of patients with initial manifestations of cerebrovascular disorders in arterial hypertension]. / Fizicheskaia aktivnost' i fizicheskaia rabotosposobnost' bol'nykh s nachal'nymi proiavleniiami nedostatochnosti krovoobrashheniia mozga pri arterial'noi gipertonii.

The routine protocol of general and neurological examinations and some special questionnaires were used to examine physical activity (FA) and physical working capacity (FWC) in a random population from one of the Moscow districts which included 1200 persons (males and females aged 30-64 years). The majority of the examinees were those who had slight and moderate exercises, mainly sitting work, did few or no physical exercises. The proportion of persons with low physical activity increased with age both among males and females. The ratios generally remained despite the presence of early signs of abnormal blood supply. Bicycle ergometer testings showed a significant reduction in the physical working capacity of the patients with abnormal brain blood supply, in a greater extent, in arterial hypertension. Decreased functional activity and functional working capacity may regarded as one of the risk factors for cerebrovascular disorders, in arterial hypertension in particular, and should be borne in mind in implementing preventive measures.

[Detection of the pathology of the major cerebral arteries in transient disorders of cerebrovascular circulation using Doppler ultrasonography]. / Vyiavlenie patologii magistral'nykh arterii golovy pri prekhodiashchikh narusheniiakh mozgovogo krovoobrashcheniia metodom ul'trazvukovoi dopplerografii.

One hundred and six males aged 40-59 were examined generally, neurologically and using ultrasonic dopplerography within one month following an emergency call for transitory ischemic attacks, hypertensive cerebral crises. Ultrasound signs of arterial lesions were recorded in 79.2% of the examinees. Hemodynamic disturbances occurred most frequently (50.9%). Arterial stenosis was diagnosed in 27.4% of cases. With growing number of risk factors, the incidence of major arteries lesions was on the increase.

[Evaluation of late results of stroke based on 12-year prospective study]. / Otdalennye iskhody mozgovogo insul'ta po materialam 12-letnego prospektivnogo issledovaniia.

A study was made of the results of the 12-year prospective follow-up of 140 patients (69 men and 71 women) who suffered brain stroke. The initial group of patients included 1538 persons. The survived patients (9.1%) pertained mainly to the number of those who developed brain stroke at an age under 70 years and was not accompanied by grave clinical disorders in the majority of cases. On the whole these were patients with brain infarction of hemispherical localization. In the final stage of the work, almost half of the patients did not show any motor disorders and 70.7% of the patients retained the everyday life activity.

[Possibilities of liquid crystal thermography in the diagnosis of acute paraproctitis]. / Vozmozhnosti zhidkokristallicheskoi termografii v diagnostike ostrogo paraproktita.

Results of using coloured thermography with cholesterol liquid crystals in complex diagnostics in 123 patients with different forms of acute paraproctitis are presented. The diagnostic value of the method was established to increase along with deepening and spreading the inflammation focus and development of the scar process in the pararectal fat. In 46 patients (37.4%) with deep forms of the disease the liquid crystal thermography has acquired the leading diagnostic value.