THE POLICY AND INDICATIONS FOR SURGICAL-TREATMENT OF THE CAROTID ARTERIES

The authors present the results of surgical treatment of patients with concomitant extra-intracranial and bilateral lesions of the carotid arteries. The patients underwent 163 operations for establishment of extra-intracranial microanastomosis (EICMA) including reconstruction of the extracranial segments with EICMA establishment (75 cases). In 66 cases, EICMA was performed for contralateral stenosis of the internal carotid artery (ICA). Of these, 22 patients later underwent carotid endarterectomy. In 14 patients, EICMA was established as the first stage before reconstruction of the iliofemoral segment. The operation was also performed in 8 patients with occlusion of the median cerebral artery or with the crimp of the carotid arteries. Examinations that included ultrasound dopplerography, transcranial dopplerography, studies of the cerebral blood flow according to 133Xe clearance and angiography were carried out. A study was made of the long-term results of the surgical treatment (from 0.5 to 5 years). It has been discovered that to estimate indications for surgical treatment, it is necessary that the data on the regional blood flow (RBF) be taken into account. In patients with stable cerebral hemodynamics according to the RBF that characterizes an uneventful course of ICA occlusion and in the decompensated type most typical of patients with pronounced postinsult neurological dificit, the establishment of EICMA is not indicated. Surgical treatment is most desirable in ICA occlusion (with preliminary reconstruction of the extracranial segments provided they are impaired) and in patients with unstable cerebral hemodynamics most typical of patients with transitory ischemic attacks, dyscirculatory encephalopathy, and minor brain stroke with chiefly mild residual phenomena of ischemic brain stroke.