THE DIAGNOSIS AND TREATMENT OF PATHOLOGIC DEFORMATIONS OF THE CAROTID ARTERIES

P.O. Kazanchyan, V.A. Popov, Ye.N. Gaponova, T.V. Rudakova
Department of Vascular Surgery,
M.F. Vladimirsky Moscow Regional Research Institute,
Moscow, Russia

The problem of the treatment policy for patients with pathologic deformations of the carotid arteries has not been solved until recently. Meanwhile this pathology is far from being encountered rarely in clinical practice. It is the cause of cerebrovascular insufficiency of varying severity including ischemic strokes. The aim of the present study was to work out the policy and methods for surgical treatment of pathologic deformations of the carotid arteries. A total of 118 patients with different types of pathologic deformations of the carotid arteries were entered in the study. 71 patients underwent 76 operations. When making decision on the treatment policy we proceed from the hemodynamic significance of lesion. In patients presenting with concomitant atherosclerotic lesion of the artery, we take into account the grade of stenosis and the morphology of an atherosclerotic plaque. We hold that the indication for operation is the presence of the hemodynamically significant tortuosity irrespective of the neurologie manifestation of the process. In concomitant atherosclerotic stenosis of the internal carotid artery, the indication for operation, in our opinion, is the presence of embologenic atherosclerotic plaques. When selecting a method for correction we proceed from the extent and degree of fibrous transformation of the arterial wall. Preference is given to the resection with reimplantation or to the resection of the involved arterial segment with restoration of vessel integrity by an end-to-end anastomosis. Adequate correction of the blood flow was achieved in 97.4% of cases, while the postoperative lethality was equal to zero. The clinical effect with disappearance (regression) of the neurologic symptomatology was observed in 95.8% of patients.

KEY WORDS: carotid artery, pathologic deformation.

P. 93-103

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