[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.

[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.

[Secondary reconstructions after endovascular treatment of a woman with critical lower limb ischaemia]. / Povtornye rekonstruktsii posle éndovaskuliarnogo vmeshatel'stva u bol'noi s kriticheskoi ishemiei nizhnikh konechnostei.

Primary endovascular interventions carried out according to the indications determined by the TASC II guidelines have proved successful in treatment of patients presenting with critical lower limb ischaemia. However, performing secondary and complicated reconstructions requires an individual approach with the assessment of all possible risks involved. Presented herein is a clinical case report regarding repeat reconstruction in a woman with critical lower limb ischaemia after a previously performed endovascular intervention.

[Treatment of patients with critical lower limb ischaemia: endovascular methods or reconstructive operations]. / Lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei: éndovaskuliarnye metody ili rekonstruktivnye operatsii.

Presented herein is a review of the literature related to endovascular methods of treatment of patients with critical lower limb ischaemia. This is followed by comparative assessment of the outcomes of endovascular and open surgical interventions. Also covered are problems concerning appropriate therapeutic decision making, taking into consideration peculiarities of lower limb ischaemia and the state at the expense of insufficiency of inflow/outflow.

A Method for Microencapsulation of Cells and a Device for Its Realization.

The device for cell encapsulation makes it possible to fabricate microcapsules of a preset size with even smooth surface, without defects or adhesion to each other, with viable cells inside the capsule. The cells were derived from newborn piglet pancreases.

[Outcomes of carotid endarterectomy and stenting in patients with carotid artery stenosis].

Analysed in the article are the outcomes of treating a total of 156 patients diagnosed with carotid artery stenosis. Of these, carotid endarterectomy was performed in 82 patients and stenting of carotid arteries was carried out in the remaining 74 patients. The incidence rate of perioperative stroke in the carotid endarterectomy group amounted to 3.6%, being in the stenting group 4.8%, P = 0.57. Multifactorial analysis was used to reveal risk factors for each method. Thus, in the carotid endarterectomy group, the risk factors for cerebrovascular complications appeared to be contralateral occlusion in patients with a history of stroke endured within less than six previous months (P<0.05), as well as the age over 75 years amongst the patients requiring placement of a temporary intraluminal bypass graft (P<0.05). For carotid stenting, risk factors of cerebrovascular complications included a hypoechogenic heterogeneous type of an atherosclerotic plaque (P<0.05) and ulceration of its surface (P<0.05). The presence of the patient's baseline functional class III angina of effort appeared to be a risk factor for the development of cardiovascular complications for carotid endarterectomy (P<0.05). No cardiovascular risk factors for carotid stenting were revealed. Based on the assessment of the risk factors thus detected, the authors worked out an algorithm of choosing an optimal treatment policy for patients presenting with carotid artery stenosis.

[Neurological status and quality of life in patients with degree IV chronic cerebral ischaemia after endured carotid endarterectomy].

UNLABELLED: The study was aimed at evaluating the dynamics of the neurological status and quality of life (QOL) in patients after endured carotid endarterectomy (CEA) with previously sustained ischaemic stroke (IS). MATERIALS AND METHODS: At the Department of Vascular Surgery of the B. V. Petrovsky Russian Research Centre of Surgery under the Russian Academy of Medical Sciences, from 2001 to 2009 we treated a total of ninety-six patients after endured IS. CEA was performed in fifty-one patients (Group I), and the control group patients underwent conservative treatment (Group II). QOL was assessed by means of the Medical Outcomes Study Short Form - 36 (SF-36) questionnaire and the Bartel scale (predominantly in order to determine life activity). Initially, patients from the both groups had had equally low baseline QOL scores. After one year we carried out a repeat survey using the same SF-36, Bartel scale, and examination by the neurologist. Relapses of cerebral circulatory impairments were registered in two (3.9%) Group I patients and in three (6.6%) Group II subjects (p>0.05). Total mortality rate in Group I amounted to 1 (1.9%) case and in Group II - 2 (4.4%) lethal cases (p>0.05). According to the findings of the SF-36 questionnaire, restoration of the lostfunctions was observed in eleven (22%) Group I patients and in five (11.6%) Group II patients. Partial restoration was seen in seventeen (34%) Group I patients and in twelve (27.9%) Group H subjects. The neurological status was noted to have preserved in twenty- three (46%) Group I patients and in twenty-six (60.5%) Group II patients (p>0.05). Both in Group I and Group II patients, positive dynamics of the neurological status was observed among those being in the early restoration period (p<0.05). CONCLUSION: CEA performed in the early restoration period in patients with endured IS appeared to promote improved neurological status, extending physical activity, improving QOL, and is thus an efficient means of preventing relapses of cerebrovascular circulatory impairments.

[Preventive maintenance of repeated ischemic insults].

In the review we offer analysis of the effectiveness of carotid endarterectomy in treatment of post-functional apoplexy or stroke patients. Published results of the researches specify possible efficiency of carotid endarterectomy in preventive maintenance against repeated apoplectic attack or strokes. Yet the criteria of usage and execution of the carotid endarterectomy are still to be discussed.

[Surgical treatment of an aneurysm of the superficial femoral artery 40 years after an injury: a case report].

Presented herein is a case report of a male patient with a posttraumatic aneurysm revealed 40 years after an injury. The presence of a foreign body in the lumen of the artery for such a long time had had no manifestations and was detected by ultrasonographic duplex scanning. The patient was subjected to resection of the aneurysm of the superficial femoral artery on the right lower limb with prosthetic repair performed by a reversed autovein.