[Graft-renal bypass surgery during intraoperative dissection of renal artery in a patient with high occlusion of the aorta]. / Protezno-pochechnoe shuntirovanie pri intraoperatsionnoi dissektsii pochechnoi arterii u patsienta s vysokoi okkliuziei aorty.

Despite advances in the development of endovascular techniques of revascularization of renal arteries, in certain clinical cases still remains the need to perform extra-anatomic renal bypass grafting. To such instances belong complicated atherosclerotic aortic lesions, technical difficulties occurring during open revascularization of the aorta and its branches, as well as aneurysms of the juxtarenal portion of the abdominal aorta. Presented herein is a clinical case concerning a patient subjected to non-standard restoration of blood flow in the right renal artery after thromboendarterectomy from the juxtarenal aorta, performed from the left-sided extraperitoneal phrenolumbotomic approach and complicated by secondary dissection of the intima in the right renal artery.

[Robotic-assisted operations for pathology of the aortoiliac segment: own experience]. / Robot-assistirovannye operatsii pri patologii aorto-podvzdoshnogo segmenta: nash opyt.

AIM: The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system. PATIENTS AND METHODS: Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta. RESULTS: Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed. CONCLUSION: From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.

[Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions]. / Autoarterial'noe remodelirovanie bifurkatsii obshchei sonnoi arterii v lechenii stenoticheskikh porazhenii.

Carotid endarterectomy is the main operation carried out for prevention of ischaemic stroke in haemodynamically significant stenoses of the bifurcation of the common carotid artery. Despite the literature data demonstrating some advantages of eversion carotid endarterectomy over the classical technique there arises a series of complicated, as yet unsolved problems. This concerns the control of the distal portion of an atherosclerotic plaque in prolonged lesions of the internal carotid artery, the absence of a temporary bypass graft, necessity of prosthetic repair of the internal carotid artery in detachment of the distal border of the plaque. We suggested a new technique of carotid endarterectomy making it possible to widen visual removal of atheromatous masses from the internal carotid artery, to improve the control of the distal portion of the plaque in a prolonged lesion of the internal carotid artery. We carried out a comparative assessment of efficacy and safety of the new method of carotid endarterectomy versus the classical variant in a randomized study. The proposed technique of carotid endarterectomy turned out to be compatible by safety and demonstrated similar results with the classical carotid endarterectomy by the number of ischaemic strokes, transitory ischaemic attacks, and myocardial infarctions in the early and remote postoperative periods. When comparing the groups by efficiency, the primary efficacy endpoint, including cases of restenosis >50% according to the findings of ultrasonographic examination of the brachiocephalic arteries, all cases of ischaemic events (acute impairments of cerebral circulation, transitory ischaemic attacks), as well as the presence of the clinical picture of cranial nerve paresis demonstrated a significant advantage of the new technique versus the comparison group at the expense of a lower incidence of restenoses in the area of the operation during the whole period of follow up. In the group of autoarterial remodelling, the composite endpoint of outcomes occurred in 6 patients (6.1%) and in the group with the classic carotid endarterectomy - in 19 (19.6%) patients, p=0.005.

Stenting of the carotid artery with CGuard and Acculink stents: interim results of a randomized trial. / Stentirovanie sonnoi arterii stentami CGuard i Acculink: promezhutochnye rezul'taty randomizirovannogo issledovaniia.

AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.

[Endovascular interventions for stenoses and occlusions of the brachiocephalic trunk]. / Éndovaskuliarnye vmeshatel'stva pri stenozakh i okkliuziiakh brakhiotsefal'nogo stvola.

The study was undertaken to evaluate the efficacy and safety of endovascular interventions in the treatment of stenoses and occlusions of the brachiocephalic trunk (BCT). Described in the article are the results of retrospectively analysing the efficacy of endovascular interventions performed in a total of forty-five patients presenting with lesions of the BCT. Depending on the type of the BCT lesion, the patients were divided into 2 groups: Group One consisted of 28 patients diagnosed with stenoses of the BCT and Group Two included 17 patients found to have occlusions of the BCT. The outcomes of the interventions were assessed with due regard for the findings obtained by angiography, ultrasonographic duplex scanning of the brachiocephalic vessels, as well as by the examination of the patient's neurological status. The remote results were evaluated at follow-up terms ranging from 6 months to 4 years. No ischaemic strokes, myocardial infarctions, nor lethal outcomes were observed during 30 days after the intervention. In the early postoperative period, there occurred 1 (3.6%) case of transitory ischaemic attack in Group One, with also 1 (5.9%) case thereof encountered in Group Two. Within the time frame of the follow-up period (48 months), recurrent occlusion of the stented segment of the BCT was registered in 2 (7.1%) patients from Group One and in 1 (5.8%) patient from Group Two (p=0.87). The primary patency rate at 4 years in Group One and Group Two patients amounted to 86.8 and 88.3%, respectively (p=0.84). A conclusion thus drawn was as follows: endovascular intervention for stenoses and occlusions of the BCT is an effective and safe method of preventing acute cerebral circulation impairments in the vertebrobasilar basin.

[Endoprosthetic repair of the aorta for an infrarenal aneurysm combined with occlusion of one of the iliac arteries]. / Éndoprotezirovanie aorty pri anevrizme infrarenal'nogo otdela v sochetanii s okkliuziei odnoi iz podvzdoshnykh arterii.

Described herein is a clinical case report regarding successful endovascular treatment of a patient presenting with an abdominal aortic aneurysm combined with occlusion of one of the iliac arteries. Cases concerning elimination of such pathology appear to be reported only sporadically in the available literature. The patient underwent reconstructive repair in two stages. The first stage comprised recanalization with stenting of the occluded iliac artery on the right and implantation of the Zenith stent graft. The findings of intraoperative check angiography showed no evidence of endoleak, with the preserved patency of both the stent graft and iliac arteries on the right. The second stage consisted of balloon angioplasty of stenosis of the external iliac artery on the left. The results of the follow-up examination at 3 years showed that the iliac arteries on both sides and the aortic endograft were free from significant stenoses, with no evidence of endoleaks.

[Efficacy and safety of temporary bypass grafting in carotid endarterectomy]. / Éffektivnost' i bezopasnost' vremennogo shuntirovaniia pri karotidnoi éndarteréktomii.

The authors analysed interrelationship between the use of temporary bypass grafting during operations of carotid endarterectomy and the frequency of the development of ischaemic complications (stroke and transitory ischaemic attacks in the early postoperative period). It was shown that in the group wherein a temporary bypass graft was established only by the criterion of decreasing retrograde pressure ischaemic complications were encountered in ten (4.4%) patients and in the group wherein temporary shunts were established by the criterion of a simultaneous decrease in cerebral oxygenation and retrograde pressure - in two (0.9%) patients (OR 5.28; 95% CI 1.22-24.38; p=0.03). It was demonstrated that using temporary bypass grafting in cases of isolated assessment of the parameters of cerebral oxygenation and retrograde pressure increased the frequency of the development of shunt-related ischaemic complications as compared with the patients in whom shunts were not used due to lack of a synchronous decrease in these parameters (13.5 vs 1.5%, respectively; OR 10.0; 95% CI 1.1-82.2; p=0.039). The findings of the carried out retrospective analysis suggested that the main predictor of the development of the outcome 'stroke + transitory ischaemic attack' was the use of a temporary internal shunt during the main stage of the operation (p<0.00001).

[Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment].

Presented herein are the results of endovascular interventions performed in a total of 220 patients with chronic ischaemia of lower limbs and occlusive and stenotic lesions of the aortoiliac arterial segment. Group One patients (n=155) underwent angioplasty with stenting (a total of 186 interventions performed) and Group Two patients (n=65) were subjected to recanalization of the occlusion zone with stenting (65 interventions). The remote results were assessed in all patients within the terms of up to 4 years. In Group One patients, restenosis of the stented segments within the mentioned terms of follow up was revealed in 11 (7.1%) cases, thrombosis - in 5 (3.2%) cases. In Group Two patients restenosis was detected in 3 (4.6%) cases and thrombosis of the stented segment in 6 (9.2%) cases. In the both groups, restenosis >50% or thrombosis of the stented segment developed significantly more often with the length of the stented segment exceeding 100 mm (p=0.01 in Group One and p=0.0077 in Group Two). Primary patency of the stented segments at 12 and 24 months after the intervention in Group One amounted to 97.5±1.5 and 92.3±3.3% and in Group Two 92.7±3.6 and 81.9±6.6%, respectively. A conclusion was made that endovascular interventions may be a method of choice in occlusive and stenotic lesions of the aortoiliac-segment arteries. Extended length of the lesion of iliac-segment arteries (more than 100 mm) deteriorates the rates of primary patency after stenting.

[Ways to improve immediate and remote results of carotid endarterectomy].

The authors analysed the results of carotid endarterectomy in a total of 469 patients with the use of simultaneous assessment of the oxygen status and collateral blood flow of the brain in order to determine feasibility of placing a temporary bypass, carried out at the Centre of Vascular and Hybrid Surgery of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin in 2008-2012. It was shown that it is more appropriate to use a temporary bypass based on simultaneous assessment of the oxygen status and collateral blood flow of the brain: in synchronous decrease of the degree of cerebral oxygenation during tentative occlusion by more than 20% of the baseline level, or in absolute values of cerebral oxygenation below 40% and simultaneous decrease of retrograde pressure below 40 mm Hg. It was determined that simultaneous assessment of tolerance of the brain to ischaemia significantly decreased the incidence of using a temporary bypass from 16 to 3% (χ2=22.51; p<0.00001), accompanied by a tendency towards a decrease in the incidence of perioperative stroke from 2.6 to 0.8% (odds ratio 0.30; 95% CI 0.06-1.55; p=0.15). Long-term results of carotid endarterectomy after 4 years showed that a decrease in the number of temporary shunts did not influence cumulative survival (log-rank test; p=0.73), the incidence of stroke (log-rank test; p=0.68) and patency of the reconstructed carotid arteries in the remote period (log-rank test; p=0.70). It was determined that in the remote period of carotid endarterectomy restenoses of reconstructed carotid arteries were encountered statistically significantly less often in the group of eversion carotid endarterectomy as compared with classic carotid endarterectomy (OR 0.23; 95% CI 0.07-070; p=0.009) and with prosthetic repair of the internal carotid artery (OR 0.13; 95% CI 0.02-0.83; p=0.03).

[Experience with cryopreserved homografts used in aortofemoral position in infection of vascular prostheses].

The authors share herein their experience in reconstructive interventions on the aortofemoral segment in infection of the implant in three 59-to-69-year-old male patients. Infection of the prosthesis was diagnosed by the clinical data, findings of MSCT angiography and duplex scanning of the infrarenal portion of the aorta and arteries of lower limbs. Pseudoaneurysms of distal anastomoses were revealed in two cases. All secondary reconstructions were performed with the use of a cryopreserved aortic bifurcation homograft in the in situ position with simultaneous removal of the infected implant. The results of inoculation from the removed implants yielded Staphylococcus aureus in two cases and Staphylococcus epidermidis in one case. One patient died 6 months later due to causes not related to the operative intervention, in the remaining two cases during one year no findings suggesting reinfection or steno-occlusive lesion of the aortofemoral segment have been revealed.

[Short- and long-term results of various methods of reconstruction of carotid artery bifurcation].

AIM: comparative assessment of immediate and remote outcomes of various methods of reconstruction of the zone of bifurcation of the common carotid artery in stenotic lesions. MATERIAL AND METHODS: the authors carried out retrospective and prospective analysis of a total of 457 reconstructive operations on the bifurcation of the common carotid artery in 432 patients presenting with haemodynamically significant stenoses. Depending on the type of reconstruction of the carotid artery bifurcation, the patients were subdivided into four groups: group I - eversion carotid endarterectomy (CEA) - 157 (34.4%) operations, group II - CEA with xenopericardial patch plasty - 211 (46.2%) operations, group III- CEA with polytetrafluoroethylene (PTFE) patch plasty - 61 (13.3%) operations, group IV - CEA with original autoarterial remodelling of the bifurcation of the common carotid artery - 28 (6.1%) operations. We evaluated both immediate and remote (from 6 month to 4 years) results of surgical treatment. RESULTS: clinical efficacy of carotid endarterectomy in prevention of ischaemic stroke in the remote period after surgery amounted to 97.8%. Strokes developed in 2.2% of cases. It was shown that after using a xenopericardium patch the incidence rate of the development of restenosis proved statistically significantly lower than after using a PTFE patch. It was confirmed that CAE with autoarterial remodelling of the common carotid artery bifurcation or eversion CEA are accompanied by a significantly lower incidence rate of restenosis development in remote terms of follow up as compared to the methods of CAE with xenopericardial or PTFE patches (p<0.01). It was determined that coronary revascularization carried out by indications as the first stage statistically significantly decreases the incidence rate of acute myocardial infarction both in the immediate and remote terms of follow up after CEA.

[Hybrid operative interventions in patients with multi-level atherosclerotic lesions of lower-limb arteries].

The authors share their experience gained in hybrid surgical interventions for multi-level steno-occlusive lesions of the aortoiliac and infrainguinal segments in a total of 96 patients presenting with chronic ischaemia of the lower limbs. The postoperative-period complications included haematomas observed in 9 (9.4%) cases and 6 (6.3%) instances of lymphorrhea occurring in the area of the postoperative wound. There were no lethal outcomes in the immediate postoperative period. The remote results were assessed at follow-up terms varying from 6 to 53 months in 75 (79.7%) patients. Thrombosis of the bypass graft was registered in 6 cases and thrombosis of the stented iliac segment was encountered in 3 cases, which required amputation of the lower limb in 5 (6.7%) patients.

[Use of laser technologies in treatment of chronic venous insufficiency in patients with a wide ostial segment of the main trunks of subcutaneous veins].

Presented herein is the authors' experience in endovascular laser obliteration of the major trunks of the grate saphenous vein (GSV) with a wide ostial segment (measuring from 15 to 34 mm) in patients presenting with chronic venous insufficiency. Group One patients (n=32) underwent crossectomy followed by endovasal laser obliteration (EVLO) of the GSV's trunk on the femur. Group Two patients (n=46) were not subjected to crossectomy, whereas obliteration of the GSV's trunk was carried out immediately from the ostium. In Group One we managed to achieve obliteration of the GSV's trunk in 32 patients (100%) with no additional interventions, and in Group Two this was achieved in 42 (91.3%) patients. Four patients (8.7%) required performing a secondary procedure of EVLO after which obliteration of the trunk was achieved in all patients of Group Two. There was no evidence of deep-vein thrombosis.

[Results of endoprosthetic reconstruction in patients with aneurysm of the infrarenal portion of the aorta].

The authors herein share their experience with implantation of endografts in a total of 41 patients for an aneurysm of the infrarenal portion of the aorta. Of these, there were 34 (83%) men and 7 (17%) women, with the average age amounting to 71±7 years. All patients were found to have a history of coronary artery diseases (CAD) and arterial hypertension. The first stage in 15 (36.6%) cases consisted of stenting of coronary arteries and in 8 (19.5%) cases of coronary aortic bypass grafting. Seven patients were within 6 months diagnosed as having developed thrombosis of the stent-graft s branch, treated by recanalization with stenting in 5 cases, and by femoro-femoral cross-over bypass in 2 cases. One patient was found to have stenosis due to bending of the left branch of the stent-graft corrected by stenting; two patients showed endoleak (in one case that of type 2 due to retrograde blood flow from lumbar arteries and in the second case that of type 3 due to impairment of the stent-graft covering integrity). Thromboembolism into the distal bed during implantation of stent-grafts was verified in 3 cases, with two of them requiring thrombectomy. One more patient was diagnosed as having dissection of the intima of the iliac artery, treated by stenting of the arterial segment involved. There were no other complications, nor lethal outcomes.

[Surgical correction of visceral-organ and lower-limb malperfusion syndrome in patients with aortic dissection].

The article deals with the experience gained in treatment of 28 patients presenting with type I and III aortic dissection (according to DeBakey) complicated by visceral-organ and lower-limb malperfusion syndrome. Those presenting with type I aortic dissection were subjected to reconstructive operations on the aortic arch as the first stage. The events of renal insufficiency and abdominal ischaemia were coped with and relieved using by-passing operations on the visceral branches - iliac-renal, ilac-renal-mesenteric by-pass grafting. In two cases in acute ischaemia of the lower limbs we performed aorto-bi-iliac prosthetic repair. In one case we revealed thrombosis of the iliac-renal by-pass, also performing iliac-renal re-do shunting. No other complications during surgical interventions were observed, neither were any lethal outcomes encountered. Bypassing operations on the visceral and renal arteries in patients with aortic dissection make it possible to eliminate both abdominal and renal ischaemia as well as malperfusion of lower extremities.

[Oxygen provision of the brain during carotid endarterectomy in the settings of general and local anaesthesia].

Based on the indices of cerebral oximetry, analysed herein is efficiency of oxygen support of the brain in various types of anaesthesiological provision (total and general anaesthesia) in patients presenting with atherosclerosis of the brachiocephalic arteries during carotid endarterectomy. It was shown that at the expense of preserving the mechanism of autoregulation, the use of local anaesthesia provides higher efficiency of cerebral perfusion than general anaesthesia which is evidenced by the values of cerebral oximetry exceeding 60% at all stages of the operation. Dynamics of cerebral oxygenation during occlusion of the carotid arteries in the setting of local anaesthesia suggests high reactivity of the cerebral vessels in this cohort of patients and hence preservation of the cerebrovascular reserve in them.

[Experience in surgical management of posttraumatic arteriovenous aneurysms of the aortorenal zone].

Presented herein are two clinical case reports concerning surgical management of posttraumatic arteriovenous aneurysms of the juxtarenal portion of the aorta and left renal vein, demonstrating the informative value of multispiral computed angiography in diagnosis of the pathology involved. Two patients presenting with a stab-and-lacerated wound of the abdominal cavity and subjected to comprehensive examination were found to have an arteriovenous anastomosis between the aorta and left renal vein with the formation of an up to 35-mm aneurysm in one case, and an arteriovenous anastomosis between the left renal artery and left renal vein with the formation of a pseudoaneurysm sized up to 30 mm in the other. Both patients had a clinical picture of cardiopulmonary insufficiency induced by overloading of the right portions of the heart. Both pathologies were treated surgically in the scope of removing the arteriovenous anastomosis and aneurysm of the juxtarenal portion of the abdominal aorta and left renal artery. The postoperative period showed nothing to report and turned out uneventful, with the patients being discharged from the clinic in a satisfactory condition with good laboratory and haemodynamic parameters.

[Hybrid operative intervention for DeBakey type III aortic dissection with the relay stent graft].

Determining the exact incidence of aortic dissection is highly conjectural because many cases of the disease remain undiagnosed. According to the autopsy findings, the incidence rate of the pathology concerned varies within the range from 0.2 to 0.8%. In clinical practice, aortic dissection is the cause of sudden death in 1.1% of the patients involved. However, aortic dissection should by no means be considered a rare disease. According to Borst et ah, ruptures in thoracic-portion aortic dissections are encountered 2-3 times more often than tears occurring in abdominal aortic aneurysms. The prognosis for patients presenting with a chronic aortic dissection is unfavourable. The commonest complications of the natural course of the disease include the development of a secondary dissection, formation of an aneurysm, progression of aortic regurgitation and circulatory insufficiency, occlusion of the aortic branches, and a late aortic rupture being the immediate cause of death in 30% of patients suffering from chronic dissection. With the recent advent of stent grafts, there appeared a possibility in the majority of cases involving a chronic type B dissection by the Stanford classification to substantially avoid an otherwise inevitably traumatic and typically prolonged reconstructive operation. Unfortunately, in some patients, owing to anatomical peculiarities, it is not always possible to deploy an endograft, thus requiring a major surgical intervention to perform instead. The authors describe herein a case of endovascular prosthetic reconstruction of the aortic arch and the descending portion in a patient who was found to have a type III aortic dissection according to the DeBakey classification and treated with the Relay stent graft.

[Hybrid operative interventions in multilevel lesions of the brachiocephalic arteries in patients with cerebrovascular insufficiency].

The authors share herein their experience with hybrid surgical interventions for multilevel lesions of the brachiocephalic arteries (stenting and an open operation) in a total of eleven patients presenting with cerebrovascular insufficiency. Our first experience gained in performing hybrid operations confirmed a possibility of correcting tandem stenoses of the brachiocephalic arteries from the standard approach to the common carotid artery bifurcation. No intraoperative complications were encountered. Hybrid interventions made it possible to reliably correct multiple arterial stenoses, necessitating neither additional bypass grafting nor prosthetic repair.

[Assessment of brain protection by means of cerebral oximetry incarotid endarterectomy].

Presented herein are the results of cerebral oximetry in the assessment of the indication for brain protection during operations of carotid endarterectomy in a total of forty-eight patients presenting with carotid artery stenoses. It was determined that cerebral oximetry gives an insight into the degree of efficacy of the collateral blood flow along both hemispheres, and by virtue of its integral approach to the assessment of cerebral blood flow is an important criterion in determining the indications for brain protection during carotid endarterectomy.