[Stagewise treatment of tandem lesions of the internal carotid artery in patients with ischaemic stroke]. / Étapnoe lechenie tandemnogo porazheniia vnutrennei sonnoi arterii u patsientov s ishemicheskim insul'tom.

AIM: The study was aimed at assessing the results of a stagewise approach to surgical treatment of patients with ischaemic stroke and tandem lesions of coronary arteries. PATIENTS AND METHODS: We analysed the results of treating a total of 19 patients with ischaemic stroke having endured in 2017-2018 surgical interventions for tandem lesions of the internal carotid artery. All 19 patients with tandem lesions underwent as the first stage of surgical treatment recanalization of the intracranial portion of the internal carotid artery. Nine patients were subjected to thromboextraction followed by carotid stenting (Group One), ten underwent thromboextraction and carotid endarterectomy (Group Two). One patient was subjected to simultaneous endovascular intervention at the intra- and extracranial level, in 18 patients reconstruction of the internal carotid artery at the extracranial level (second stage) was performed within a postponed period (3-5 days). In the postoperative period we assessed neurological deficit and the results of 90-day survival. RESULTS: No deterioration of neurological deficit was observed after the first stage of surgical treatment. There were statistically significant differences in the degree of regression of a stagewise treatment at discharge, with predominance in the second group. The 90-day survival rate had no prevalence in either group, despite 1 lethal outcome in a patient with simultaneous thromboextraction and stenting of the extracranial portion of the internal carotid artery. CONCLUSION: Adequate prevention of haemorrhagic transformation of the damaged zone of cerebral tissue in patients with ischaemic stroke caused by tandem lesions of carotid arteries may be ensured by means of selecting stagewise treatment, i. e., postponed elimination of extracranial stenosis of the internal carotid artery. Given a small sample size, the study requires further examination and assessment of the obtained results.

[PSEUDOANEURISM OF CAROTID ARTERIES AFTER CAROTID ENDARECTOMY IN PATIENTS WITH ATHEROSCLEROSIS].

This research evaluated a long-term passability and geometric stability in the area of plasty at the first-second days and after 6, 12,48 months after surgical reconstruction in 35 patients, who underwent endarectomy. The plasty of arteriotomic opening was performed using autovenous patch (segment of saphenous vein) in 19 patients. An application of synthetical patch (Carotid patch 6 mm) was carried out in 16 cases. According to obtained data, an increase of diameter in bifurcation area of arteria carotis was revealed in group of patients with autovenous plasty 15 (78,95%) at the first 12 months after operation. There weren't observed any enlargement of the plasty area in following period. The diameter of bifurcation area has reached 2,0 cm in mean diameter OSA 0,74 cm in 5 patients out of 19 (26%). A dilatation of anastomosis area was detected in 5 patients out of 16 (31,25%) in group with plasty of arteriotomic opening by synthetical patch. All patients with dilatation anastomosis had arterial hypertension, which was one of the main factors of dilatation development of plasty area.

[Long-term results of surgical treatment of the extracranial arteries aneurysm].

Aneurysms of extracranial arteries are sufficiently rare pathology in the extracranial arteries surgery. The authors aimed to research the frequency of occurrence of the extracranial arteries aneurysm, reasons of the onset, the localization, clinical manifestations and surgical treatment strategy. A retrospective study presents 10 cases of the extracranial arteries aneurysm for the last 5 years. A presence of aneurysmatic dilatation of extra-cranial arteries was detected according to the data of ultrasonic duplex scanning (UDS) and patients were directed to the hospital. The UDS was carried out as a routine procedure because of the presence of earlier acute stroke or the transitory ischemic attack. All the patients were carefully examined. A computed tomography and the recurring UDS were performed and the neurologic status of patients was estimated. An indication to surgical treatment was an increase of the internal carotid artery diameter and the common carotid artery more than 50% or equal to it. The presence of the local saccular aneurysm was one of the reasons. Surgical treatment strategy was determined by the anatomic position and possibilities for the reconstruction. The results of given operations showed, that the surgical treatment strategy should be recommended and could be fully justified in this pathology.

[Results of combined reconstructions of the renal arteries, abdominal aorta and its other branches in patients with atherosclerosis].

A comparative analysis was made of clinical indices and long-term survival in 20 patients (13 men and 7 women of mean age 62 +/- 2 years), having multifocal atherosclerosis of the renal arteries (RA), abdominal aorta and arteries of lower extremities (LE) (11 aneurysms, 7 occlusive lesions of the aorta and 3 of its unpaired branches) who underwent combined reconstructions, with patients having similar lesions, but not operated (12) or operated only on RA or on the arteries of LE (45). The groups of patients had no great differences except more pronounced renal dysfunction (RD) in the first of them. In spite of high postoperative lethality (20%) mainly due to acute renal failure (3), long-term survival proved to be significantly higher (14 from 16), than in not operated (3 from 12) (p = 0.00001) and had better tendency than in those operated on the same basin (35 from 45). In addition, the patients after combined operations had substantially decreased systolic and diastolic arterial pressure (159 +/- 13 vs. 132 +/- 9, p = 0.00001; 91 +/- 5 vs. 83 +/- 7, p = 0.010) and also stabilized renal function.

[Results of treatment of chronic generalized periodontitis with a dispersed biomaterial Alloplant]. / Rezul'taty lecheniia khronicheskogo generalizovannogo parodontita s ispol'zovaniem dispergirovannogo biomateriala Alloplant.

There is a method of treatment of generalized chronic periodontitis with using dispersing biomaterial Alloplant and immunological, histomorphological criteria of this estimation.