[Efficacy and safety of surgical treatment of patients with pathological tortuosity of the internal carotid artery]. / Effektivnost' i bezopasnost' khirurgicheskogo lecheniya bol'nykh s patologicheskoi izvitost'yu vnutrennei sonnoi arterii.

No multicenter randomized clinical trial has been conducted worldwide to date on indications, types of surgery and their comparison with conservative treatment in patients with PI BSA. OBJECTIVE: Of the study is to improve the results of surgical treatment in patients with pathological tortuosity of the internal carotid artery. MATERIAL AND METHODS: The study included 119 patients (41 (34%) men and 78 (66%) women) with PI ICA aged 34 to 71 years (average age 53.2±7.5 years) divided into 2 groups. 64 patients (54%) of group I underwent BSA resection with lower mouth and 55 patients (46%) of group II underwent BSA prosthetics. Depending on the degree of neurological disorders, patients were distributed according to the classification of A.V. Pokrovsky. RESULTS: In the early postoperative period, TIA was noted in one patient, and transient lesions of the cranial nerves were observed in 5 patients. During 5 years of follow-up, none of the patients developed TIA, IS or other vascular events. In the early surgical period, there were no significant differences in effectiveness between the groups of patients. In the long-term period (5 years after surgery), a higher frequency of asymptomatic patients was noted in group I. CONCLUSION: Resection and replacement of a pathologically tortuous internal carotid artery (ICA) is a safe and effective surgical treatment. A multicenter randomized trial should be conducted to compare the effectiveness of surgical treatment of PI ICA with a conservative approach to effectively treat patients.

[Surgical prevention of progressive cerebral ischemia after ischemic stroke]. / Khirurgicheskaya profilaktika progressirovaniya ishemii golovnogo mozga u patsientov posle insul'ta.

OBJECTIVE: To evaluate the effectiveness of carotid endarterectomy after ischemic stroke and to analyze postoperative neurological status. MATERIAL AND METHODS: There were 120 patients with carotid artery stenosis complicated by chronic cerebrovascular insufficiency (CVI). Patients with CVI grade I-III were included in the first group (n=70), 50 patients had previous ischemic stroke (the second group). Age of patients was 61-89 years. All patients underwent unilateral carotid endarterectomy. RESULTS: Over 36-month follow-up period, postoperative stroke occurred in 5 (7.2%) and 9 (18.3%) patients in both groups, respectively. The combined end-point (stroke + mortality) was significantly less common in group I compared to group II (10 (14.5%) and 15 (30%) cases, p>0.05). Positive changes in neurological status were found in the 2nd group (relief of focal neurological deficit, symptoms of cerebrovascular insufficiency, no progression of vascular dementia). Barthel score increased from 74.3 to 92.8 after carotid endarterectomy in the 2nd group. Baseline FAB score <11 was observed in 9% of patients in the 1st group and 22% in the 2nd group. No progression of dementia was observed in long-term period. CONCLUSION: Carotid endarterectomy is effective in prevention of primary and recurrent stroke. Moreover, this procedure slows down progression of chronic cerebral ischemia and cognitive impairment.

[Minimally invasive carotid artery surgery]. / Maloinvazivnaya khirurgiya sonnykh arterii.

OBJECTIVE: To determine the criteria for choosing a surgical approach and compare an effectiveness of carotid endarterectomy (CEAE) via 3 approaches. MATERIAL AND METHODS: The study included 120 patients who underwent CEAE via 3 different approaches. Intraoperative skin marking included lower jaw angle, skin fold closest to common carotid artery bifurcation. Carotid artery bifurcation and borders of atherosclerotic plaque were visualized using ultrasound. An effectiveness of each access was evaluated in accordance with the following criteria: neurological complications, cosmetic effect and quality of life after 1 and 12 months. The patients were divided into 2 groups. Group I - 80 patients with CEAE with access through the natural skin fold (NSF); group II - 40 patients with CEAE using the classical longitudinal access. The 1st group was divided into 2 subgroups. Subgroup I A - 39 patients with CEAE using mini-access via NSF; subgroup I B - 41 patients with CEAE using extended access via NSF. RESULTS: There were no strokes and transient ischemic attacks in a month after surgery in both groups. After 12 months, stroke occurred in 2 (%) patients of group II, cranial neuropathy - 8 (21%) patients in the same group. The best cosmic effect was achieved in subgroup I A after 1 and 12 months (37.1±6.7 scores). Mean score of physical health was 51.59±5.9 scores in subgroup I A, 46.03±7.53 scores - in subgroup I B, 38.84±5.28 scores - in group II. Index of mental health was 49.63±6.69, 45.68±5.6, and 48.59±7.29 scores, respectively. CONCLUSION: Considering these data, we developed a personalized computer program ensuring fast choice of optimal surgical approach.

[Advantages of profundoplasty in patients with lower limb critical ischaemia in redo operations]. / Preimushchestva profundoplastiki u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei pri povtornykh operatsiiakh.

Our study was aimed at determining advantages of profundoplasty in patients with critical ischaemia of lower limbs in repeat arterial reconstructions. It included a total of 56 patients subjected to redo operations for thrombosis of a femoropopliteal bypass graft. Of these, 29 underwent profundoplasty (group I) and 27 repeat femoropopliteal bypass grafting (group II). Critical ischaemia was relieved in the early postoperative period in 28 (97%) and 24 (89%) patients of group I and II, respectively. The 3-year patency rate after profundoplasty amounted to 100% and after femoropopliteal bypass grafting to 47% (p<0.05). The lower-limb amputation rates over the 3-year period of follow up amounted to 3 (10%) and 11 (41%), p<0.05, respectively. Over the 3-year period of follow up, there was no statistically significant difference in the values of the ankle-brachial index (p>0.05).

[Significance of the deep femoral ertery in repeat reconstructions]. / Znachenie glubokoi arterii bedra pri povtornykh rekonstruktsiiakh.

Atherosclerosis obliterans is managed by various reconstructions of lower-limb arteries, but despite this, in the immediate and remote postoperative period there appears the necessity to carry out repeat reconstructions, which might be caused by shunt thrombosis, progression of atherosclerosis, etc. One of the methods of solving this problem is revascularization of lower-limb arteries through the deep femoral vein with plasty thereof. In occlusive lesions of the superficial femoral artery, the deep femoral artery plays the key role in blood supply of the entire extremity. The article deals with the principles of repeat surgical treatment of lower-limb arteries with the use of the deep femoral artery, also discussing the problems concerning the frequency of occurrence of thromboses in various positions, and the role of the deep femoral artery in blood supply of the lower extremity. The problem of efficacy of redo operations on lower-limb arteries using the deep femoral artery is still important. Despite the possibility of revascularization of lower extremities through the deep femoral vein, a high percentage of amputations remains. The terms of patency of the reconstructed deep femoral artery has proved to be several times longer than those of femoropopliteal and femorotibial shunts in the remote postoperative period. Besides, there are no clear-cut criteria for prognosis of efficacy of reconstructive interventions on the deep femoral artery in patients with multi-segment lesions of arteries of lower extremities after primary interventions, therefore, no common surgical policy exists. The use of the deep femoral artery in patients with ischaemia of lower extremities is explained by the minimally traumatic nature and confirmed efficacy after a series of previously performed multilevel operations, severe lesions of the distal bed, as well as in patients with severe concomitant diseases.

[Surgical treatment of internal carotid artery kinking following fibromuscular dysplasia]. / Rezul'taty khirurgicheskogo lecheniya patologicheskoi izvitosti vnutrennei sonnoi arterii na fone fibrozno-myshechnoi displazii.

OBJECTIVE: To evaluate the results of surgical treatment of internal carotid artery kinking following fibromuscular dysplasia. MATERIAL AND METHODS: There were 32 patients who underwent surgical treatment of internal carotid artery kinking following fibromuscular dysplasia. Structural changes of carotid artery wall were analyzed using immunohistochemical survey. Considering destructive changes revealed, we divided all patients into 2 groups in order to assess long-term postoperative outcomes: 1 - ICA resection followed by anastomosis in end-to-end fashion; 2 - ICA replacement. Postoperative analysis included incidence of stroke, thrombosis and deformities of anastomosis zone, regression of cerebrovascular insufficiency. RESULTS: The main «phenotype¼ of arterial wall in patients with ICA kinking following fibromuscular dysplasia is a large number of smooth muscle cells releasing matrix matelloproteinases-2 and -9 and low level of their tissue inhibitor type 1. Postoperative deformities are more common within a year after surgery. Maximum incidence is observed after 12 months. Both ICA resection and replacement are followed by similar incidence of deformity later. No severe deformities were diagnosed. Resection of ICA kinking on the background of fibromuscular dysplasia is followed by comparable results with ICA replacement regarding the incidence stroke, thrombosis and regression of cerebrovascular insufficiency. CONCLUSION: Despite degradation of extracellular matrix, destruction of elastic fibers and their fragmentation, no significant deformities are observed in long-term postoperative period in patients with ICA kinking and fibromuscular dysplasia.

[Subclavian artery aneurysms: pathogenesis, diagnosis, and therapeutic decision-making]. / Anevrizmy podkliuchichnoi arterii: patogenez, diagnostika, vybor taktiki i metoda lecheniia.

The article deals with the relevant literature data concerning diagnosis and treatment of subclavian artery aneurysms. This nosological entity is relatively uncommon, however its importance for modern medicine should not be underestimated. Despite a low incidence of the pathology, it should be understood that the disease's course for the patient is associated with the development of severe complications which may lead to disability or even death. The development of complications is extremely difficult to predict and stratification of risks for such patients is too complicated. It is also known that the diagnosis of a subclavian artery aneurysm is frequently an accidental finding, since the pathology may for a long time proceed symptom-free. At the same time, the subclavian artery occupies the first place by the frequency of localization of upper-limb aneurysms, thus making this problem currently important. Besides, separate attention should be paid to modern methods of correction of this disease, since implementation of high-tech interventions into vascular surgery have significantly expanded the arsenal of the operating surgeon.

[Robot-assisted operations in vascular surgery]. / Robot-assistirovannye operatsii v sosudistoi khirurgii.

The article contains a systematic review of the literature dedicated to vascular robot-assisted operations, also discussing the use of robotic technologies in vascular surgery, their advantages and disadvantages. In so doing, we studied the experience of Russian and leading international surgical centres, comparing the reported outcomes by such parameters as the average duration of the operation, mean time of aortic cross-clamping, time spent for anastomosis formation, frequency of postoperative complications, etc. Benefits of robot-assisted operations allowed the latter to occupy the leading positions in various fields of surgery, although the use of robots in vascular surgery has only begun to gain popularity. A robotically assisted system eliminates the main shortcomings of laparoscopy and opens opportunities for expanding robot-assisted surgery in this field.

[Advantages of minimally invasive approach for carotid endarterectomy]. / Preimushchestva mini-dostupa pri karotidnoi éndarteréktomii.

OBJECTIVE: To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). MATERIAL AND METHODS: There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). RESULTS: Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). CONCLUSION: Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.

[Meta-analysis of the results of eversion carotid endarterectomy and endarterectomy with patch plasty]. / Metaanaliz rezul'tatov éversionnoi karotidnoi éndarteréktomii i éndarteréktomii s plastikoi zaplatoi.

AIM: The study was aimed at comparing the results of eversion carotid endarterectomy and carotid endarterectomy with patch plasty in the immediate and remote postoperative periods. MATERIALS AND METHODS: The literature was retrieved by means of electronic databases, with the dates of publications ranging from 1970 to 2019. According to the inclusion and exclusion criteria we selected the literature making it possible to carry out a meta-analysis in the immediate and remote postoperative periods. The results were obtained with the help of the Stata 14 software package. Eventually, we retrieved and analysed a total of 2139 articles. Of these, ten were included into the study and contained 3568 patients subjected to 3672 operations (eversion carotid endarterectomy - 1718 and carotid endarterectomy with a patch - 1954). The results of the meta-analysis were as follows: the mean time of carotid artery cross-clamping for eversion carotid endarterectomy was shorter than that for carotid endarterectomy with a patch (4.1±2.9 min); the frequency of using intraoperative temporary bypass in eversion carotid endarterectomy turned out to be significantly less compared with carotid endarterectomy with patch plasty - 13.5% (91/672) and 62.0% (492/793), OR=0.183, 95% CI: 0.136-0.254, p<0.001; the incidence rate of ischaemic stroke in the immediate and remote postoperative periods was significantly lower after eversion carotid endarterectomy than that after carotid endarterectomy with patch plasty - OR=0.452, 95% CI: 0258-0.792, p=0.005 and OR=0.300, 95% CI; 0.155-0.579, p=0.000. The development of restenosis in the immediate and remote postoperative periods was observed less often for eversion carotid endarterectomy compared with carotid endarterectomy with patch plasty - OR=0.604, 95% CI: 0.422-0.864, p=0.006. CONCLUSION: Eversion carotid endarterectomy was associated with shorter time of carotid artery cross-clamping, lower frequency of intraoperative temporary bypass, lower number of cases of ischaemic stroke in the immediate and remote postoperative periods, as well as those of restenosis in the long-term postoperative period.

[Profundoplasty in treatment of patients with chronic lower limb ischaemia]. / Profundoplastika v lechenii bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei.

Occlusion of the superficial femoral artery is a frequently encountered pathology in peripheral vascular disease. In patients with chronic lower limb ischaemia in a lesion of crural arteries the results of femoropopliteal bypass grafting are unsatisfactory, therefore, the deep femoral artery becomes the decisive collateral pathway for perfusion of the lower extremity. PATIENTS AND METHODS: The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV. RESULTS: Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years. CONCLUSION: Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.

[Immediate results of conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes]. / Blizhaishie rezul'taty konservativnogo lecheniia 'nerekonstruktabel'nykh' bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei s troficheskimi izmeneniiami.

The purpose of the study was to comparatively assess efficacy of using agents belonging to the group of prostaglandin E1 in comprehensive conservative treatment of patients with unreconstructable critical limb ischaemia and trophic changes by the frequency of major amputation, amputation-free survival, and total mortality by combinations of the WIfI classification during a 6-month follow up period. Our retrospective multicentre study enrolled a total of 109 patients, including 60 men and 49 women, with a mean age of 70±7.3 years. The patients were subdivided into 2 groups. Group 1 patients (n=58) received standard conservative therapy without prostaglandin E1 and group 2 patients (n=51) received similar treatment with the use of prostaglandin E1. The statistical analysis (chi-squared test, Fisher criterion, log-rank test) was carried out with regard to stratification of the patients in the groups by the WIfI component combinations. No statistically significant differences between the groups in the frequency of amputation and total mortality were revealed (p=0.094 and p=0.925, respectively). The use of the WIfI classification system made it possible to single out a cohort of patients (with a WIfI combination of 130) for whom the results of administering prostaglandin E1 statistically significantly differed by the frequency of amputation (p=0.042) and by amputation-free survival (p=0.017). No significant differences by these outcomes were obtained for other combinations analysed. A conclusion was drawn that using prostaglandin E1 in comprehensive conservative treatment decreased the frequency of amputation and increased amputation-free survival in patients presenting with unreconstructable critical limb ischaemia and referred to the category with a combination of 130 according to the WIfI classification.

[Early carotid endarterectomy in patients after endured acute cerebral circulation impairment]. / Ranniaia karotidnaia éndarteréktomiia u patsientov, perenesshikh ostroe narushenie mozgovogo krovoobrashcheniia.

Recent years have witnessed a series of studies dedicated to assessment of optimal terms of performing carotid endarterectomy (CEA) after sustained acute cerebral circulatory impairment (ACCI). However, there is no commonly accepted opinion concerning feasibility and safety of early CEA in 'symptomatic' patients. The 2015 Guidelines of the American Heart Association suggest that surgical intervention should be performed within the shortest terms or during 2 weeks after a neurological event (class IIb, level B evidence). In the presented herein review of literature most authors demonstrated safety and efficacy of performing early CEA after endured ACCI. However, further prospective, randomized studies are needed in order to work out new standards of examination and to determine optimal surgical policy.

[Differentiated approach to treatment of decompensated lower limb ischaemia with the use of the WIFI classification system]. / Differentsirovannyi podkhod k lecheniiu dekompensirovannoi ishemii nizhnikh konechnostei s ispol'zovaniem sistemnoi klassifikatsii WIfI.

In the present article, the authors substantiate the necessity of subdividing a heterogeneous cohort of patients presenting with Fontaine-Pokrovsky grade IV critical limb ischaemia into subgroups with the aim of making an appropriate therapeutic decision and predicting the outcome. We also translated into the Russian language the WIfI classification system developed by the Society for Vascular Surgery (2014) in order to predict limb loss and feasibility of performing revascularization. This is followed by comments on the classification, accompanied by examples of own clinical case studies. In order to check-up the ability of the SVS WIfI classification system to predict the one-year risk of major amputation in patients with decompensated ischaemia, we carried out a retrospective multicenter study, enrolling a total of 109 patients with unreconstructable stage IV chronic ischaemia. Our primary endpoint was the frequency of major amputation during the first year of follow up. The patients were divided into 4 subgroups based on a combination of the three WIfI domains, i. e., wound, ischaemia, and foot infection, respectively, as follows: 130 - 27% (n=29), 131 - 23% (n=25), 230 - 20% (n=22), and 231 - 30% (n=33). The frequency of amputation during the first year of follow-up with the natural course of the disease on the background of conventional therapy averagely amounted to 36%. By the WIfI component combinations, we revealed statistically significant differences between the subgroups (p=0.035): 130 - 21% (n=6), 131 - 28% (n=7), 230 - 36% (n=8), 231 - 55% (n=18). The WIfI classification makes it possible to predict the risk of major amputation in patients with limb-threatening ischaemia. The frequency of amputation during the first year of follow up in the natural course of the disease is associated not only with the WIfI clinical stage but also with the WIfI component combinations.

[Prospects and peculiarities of the procedure of ultrasound ablation of subcutaneous veins of the lower limbs]. / Perspektivy i osobennosti tekhnologii ul'trazvukovoi obliteratsii podkozhnykh ven nizhnikh konechnostei.

The last decade has seen active development of minimally invasive (endovenous) methods of surgical removal of lower limb varicose veins (LLVV); however, the problem of increasing efficacy of these methods and improving long-term results still remains of current importance. The authors of this work propose a method of ultrasound ablation of subcutaneous veins of lower extremities. Our experimental study was aimed at determining the pattern of venous wall damage after ultrasound exposure. Samples of segments of the trunk of the great saphenous vein (GSV) were divided into 5 groups: group 1 - the control group, group 2 - treatment with a sclerosant in the amount of 0.3 ml for 30 s, group 3 - treatment with ultrasound at a frequency of 26 kHz and amplitude 40 µm and 0.3-ml sclerosant for 30 s, group 4 - exposure to ultrasound at a frequency of 26 kHz and amplitude 40 µm and 0.3-ml sclerosant for 60 s, group 5 samples were exposed to ultrasound at 26 kHz and amplitude of 40 µm for 60 s. The results of analysing the histological sections of the samples of the 2nd and 3rd groups demonstrated that the degree of alteration in the GSV wall on combined exposure to ultrasound and a sclerosant was 4.5-fold higher as compared with treatment with a sclerosant solution alone. During ultrasound exposure, the maximum temperature of the venous wall of group 5 samples was by 20 °C higher than in samples of group 4. Analysing the histological sections demonstrated a similar pattern of structural alterations of the samples of group 4 and 5, thus suggesting a possibility of controlling the temperature of the venous wall during ultrasound ablation without changing quality of structural lesions. The obtained findings showed a possibility of initiating irreversible dystrophic alterations in the venous wall on exposure to ultrasound by means of combining the mechanisms of chemical, mechanical, and thermal ablation.

[Comprehensive treatment of a patient with Buerger's disease using genetically engineered complexes VEGF-165]. / Kompleksnoe lechenie patsienta s bolezn'iu Biurgera s primeneniem genno-inzhenernykh konstruktsii VEGF-165.

Buerger's disease, also known as thromboangiitis obliterans, is a severe invalidating systemic vascular disease. To one of the modern methods, which is distinguished by its radically new principles of action, as well as holding much promise for further study and application in treatment of patients with lower limb chronic ischaemia induced by thromboangiitis obliterans belongs the use of genetically engineered complexes based on vascular endothelial growth factor VEGF-165 ('Neovasculgen'). 'Neovasculgen' is a genetically engineered complex being a circular DNA (native plasmid on the CELO vector and Ad5), carrying the human VEGF-165 gene, encoding VEGF synthesis. Injection of this drug to the ischaemised tissues of lower extremities ensures long-term synthesis of vascular endothelial growth factor 165 leading to the development of an additional collateral vascular network and consequently to increased perfusion of tissues with oxygen and decreased degree of ischaemia. Presented herein is a clinical case report of a successful therapeutic outcome achieved in a patient suffering for a long time from thromboangiitis obliterans (Buerger's disease) and treated with genetically engineered complexes based on vascular endothelial growth factor ('Neovasculgen') used as a component of comprehensive conservative therapy.

[Hybrid reconstructions in patients with lower limb chronic ischaemia and multilevel arterial lesions]. / Gibridnye rekonstruktsii u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei i mnogourovnevym porazheniem arterii.

Presented herein is a review of the literature related to performing hybrid operations for multilevel lesions of the arteries of the lower limbs. This is accompanied and followed by analysing the data on variants of stagewise use of different methods of revascularization in hybrid interventions ("open" and endovascular) on the lower extremities, as well as complications, lethality rates, and remote results as compared with the parallel parameters obtained while performing non-hybrid operations.

[Carotid endarterectomy and stenting in patients with internal carotid artery stenosis and contralateral occlusion]. / Karotidnaia éndarteréktomiia i stentirovanie u bol'nykh s gemodinamicheski znachimym stenozom vnutrennei sonnoi arterii i kontralateral'noi okkliuziei.

AIM: To determine surgical risk factors and to compare early outcomes after carotid endarterectomy and carotid stenting in patients with internal carotid artery stenosis and contralateral occlusion. MATERIAL AND METHODS: 132 patients were enrolled. 62 and 70 patients underwent carotid endarterectomy and carotid stenting respectively. Early postoperative results were compared depending on type of surgical intervention and presence of risk factors. RESULTS: Significant difference between groups was only found for incidence of neuropathy of the cranial nerves. It was established that cardiac comorbidities are risk factors for adverse events after carotid endarterectomy. Stable (homogeneous) atherosclerotic plaque with clear contour and no ulceration is optimal for carotid stenting.

[An efficacy of carotid arteries repair for tortuosity combined with stenosis]. / Éffektivnost' rekonstruktivnykh operatsii na sonnykh arteriiakh pri sochetanii izvitosti i stenoza.

AIM: To assess an efficacy of carotid arteries reconstruction in patients with internal carotid artery stenosis combined with tortuosity. MATERIAL AND METHODS: 86 patients with ICA tortuosity and stenosis were enrolled. All patients were divided into groups depending on type of surgery: group I - open carotid endarterectomy (CEA) followed by obligatory repair with synthetic patch (31 (36%) patients); group II - eversion CEA with ICA resection, redressation and reimplantation into own ostium (35 (40.7%) patients); group III - ICA replacement (20 (23.3%) patients). Synthetic prosthesis and autovein were used in 13 (65%) and 7 (35%) patients respectively. The study included patients with ICA stenosis ≥60% (any type of plaque) and any degree of cerebrovascular insufficiency or ICA stenosis <60% (plaque type I-III) with CVI grade II-IV combined with S- or C-tortuosity, bend or loop with blood flow velocity over 110 cm/s and its turbulence. Only 6 (7.0%) out of 86 patients had no clinical signs of CVI/previous stroke. Asymptomatic/symptomatic patients ratio was following in all groups: group I - 12 (38.7%)/19 (61.3%); group II - 29 (82.9%)/6 (17.1%); group III - 10 (50%)/10 (50%). RESULTS: Within 6-month follow-up 22 (70.9%) out of 31 patients were asymptomatic in group I, 30 (85.7%) (p=0.9475) out of 35 - in group II, 9 (45%) (p=0.9511) out of 20 patients - in group III and 1 (5%) patient developed thrombosis of the reconstruction zone followed by ischemic stroke. After 12 months following patients were asymptomatic: 22 (70.9%) in group I, 30 (85.7%) (p=0.9475) in group II and 9 (45%) patients (p=0.9511) in group III. After 1 year 4 (33.3%) out of 12 patients with CVI grade IV had partial regression of focal neurological symptoms. CONCLUSION: Surgery for ICA tortuosity combined with stenosis confirmed its efficacy and safety for both asymptomatic and symptomatic patients. Significantly better results were observed in eversion CEA compared with conventional procedure and ICA replacement.