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Management of intracranial aneurysms with extracranial carotid pathologyстатья
- Авторы: Usachev Dmitry, Lukshin Vasily, Shulgina Anna, Yakovlev Sergey, Belousova Olga, Kondakov Mark
- Сборник: Understanding and Managing Cerebral Aneurysms
- Год издания: 2024
- Издательство: Nova Science Publishers, Inc.
- Местоположение издательства: United States
- Первая страница: 301
- Последняя страница: 320
- Номер статьи: Chapter 19
- DOI: 10.52305/MFLO0750
- Аннотация: Reconstructive interventions on the carotid arteries in patients with intracranial aneurysms requires an individual patient-selected approach, in contrast to certain standards based only on the principles of evidence-based medicine. It should be noted that such situations are not uncommon in neurosurgical practice - the incidence of cerebral aneurysms in the population, according to epidemiological studies, varies from 3 to 5%, and in the group of patients with hemodynamically significant stenosis of the carotid arteries, it is 3.2% [1]. In N. N. Burdenko National Medical Research Center for Neurosurgery experience, cerebral aneurysms were diagnosed in 4.1% of all patients who had indications for carotid endarterectomy. At the same time, due to the wider use of CT angiography as a method of primary diagnosis of steno-occlusive pathology, the number of such clinical cases is increasing every year.Present clinical guidelines classify such patients in a group of increased risk of carotid endarterectomy, pointing out the disagreement in approaches to the treatment of cerebral aneurysms in combination with internal carotid artery (ICA) stenosis and assigning the first role in making a decision the individual characteristics of each individual patient and the capabilities of the surgical hospital. The complexity of determining the tactics of treating such patients is due to the competition of mutually opposite pathogenetic mechanisms that determine the likelihood of ischemic stroke on the one hand and the risk of aneurysm rupture on the other. This, in turn, leads to antagonism of the methods of potential medical and surgical treatment.Taking into account the increased risks of perioperative complications of reconstructive surgery, such patients are often redirected from the departments of vascular surgery to neurosurgical hospitals for the primary treatment of cerebral aneurysms, followed by a decision on the issue of carotid endarterectomy. At the same time, this treatment tactic is not always justified, since it does not take into account the individual risks of aneurysm rupture and possible ischemic cerebrovascular accident.The aim of this chapter is to determine the algorithm for the treatment of patients with a combination of cerebral aneurysms with carotid stenosis.
- Добавил в систему: Шульгина Анна Алексеевна