Reconstructive surgery of the extra- and intracranial brain arteries: Burdenko Center for Neurosurgery experience of 3500 vascular reconstructionsтезисы доклада
Дата последнего поиска статьи во внешних источниках: 24 июля 2024 г.
Аннотация:Objectives: To highlight the algorithms for choosing the tactics of treating patients with cerebral ischemia caused bystenosing and occlusive pathology of the brachycephalic arteries, the features of surgical interventions and the resultsof this treatment.Background: Treatment of acute and chronic cerebral ischemia remains an urgent problem of world heathcare. Aunique opportunity of neurosurgery is the ability to perform surgical interventions at all levels of the vascular systemof the brain - from the branches of the aortic arch to cortical and pial arteries for the treatment and prevention ofcerebral ischemia.Methods: During the last 20-years over 2500 patients with stenotic and occlusive pathology of brachiocephalicarteries were treated, who underwent over 3500 surgical interventions in Burdenko Neurosurgical Center. The surgicalinterventions included open reconstructive operations on the carotid and vertebral arteries, cerebral revascularizationfor acute and chronic ischemia, excision of neurovascular bundle tumors, compressing the carotid arteries,endovascular interventions and various variations of staged and simultaneous surgical interventions using hybrid andpseudohybrid approaches for patients with complex combined pathology.Results: The use of a comprehensive individual approach to the examination and treatment of patients with stenoocclusive and combined pathology of the brachiocephalic arteries, taking into account clinical, angiographic andperfusion factors, made it possible to achieve good results of reconstructions in 88% of cases. Complications ofsurgical treatment were seen in 4.6% of cases, while persistent neurological defects developed in 2.6% of cases, andlethal outcomes - in 0.5% of cases.Conclusions: Surgical treatment of steno-occlusive pathology of brachiocephalic arteries is a multifacetedinterdisciplinary problem that goes beyond the standards. The conditions of the neurosurgical clinic allow the use of acomprehensive individual approach to determine surgical tactics, including a reasonable combination of bothendovascular and direct methods of reconstruction and revascularization of both extracranial and intracranial arteries