Journal «Angiology and Vascular Surgery» • 

2015 • VOLUME 21 • №3

Outcomes of reconstructive operations on carotid arteries in acute period of ischaemic stroke

Mikhailov M.S., Kirillov V.I., Ridel V.Yu., Alekseev A.Yu., Novozhilov A.V., Eidlin E.G., Zelenkina N.Yu., Solovov D.V.

Department of Cardiovascular Surgery, Samara Municipal Clinical Hospital No1 named after N.I. Pirogov, Samara, Russia

Analysed herein are the results of surgical treatment of 55 patients who from June 2013 to August 2014 underwent a total of 56 reconstructive operations on carotid arteries during an acute period of ischaemic stroke. The operations were performed within the terms varying from 24 hours to 18 days after the onset of first symptoms of ischaemic stroke.

The neurological status was assesses by the neurologist according to the NIH Stroke Severity Scale (USA) and the Modified Rankin Scale. Prior to operation neurological deficit in 18 patients corresponded to 4 points by the Rankin Scale.

Carotid endarterectomy was performed in 55 patients, of these in 24 according to the eversion technique. In 10 patients eversion carotid endarterectomy was performed in combination with ICA resection. One patient was simultaneously subjected to eversion carotid endarterectomy and carotid-subclavian shunting bypass grafting. Carotid endarterectomy with autovenous-patch plasty was performed in 11 patients. Resection of the occluded internal carotid artery with plasty of the external carotid artery was carried out in 7 patients and resection of the internal carotid artery for pathological tortuosity was carried out in 2 patients.

At discharge from hospital, regression of neurological symptomatology was noted in 46 (83%) patients. Nine (20%) patients showed complete restoration of neurological deficit, two (4%) patients were found to have increased manifestations of neurological deficit.

In the postoperative period two patients died: one on postoperative day 24 from augmenting respiratory and cardiac failure, the other one on day 29 from augmenting renal insufficiency followed by cardiac failure. In both cases, autopsy revealed no signs of secondary impairment of cerebral circulation.

Surgical interventions on carotid arteries performed at a multimodality vascular centre during the first 18 days after the development of ischaemic stroke in the majority of cases are accompanied and followed by regression of neurological deficit, being safe concerning the development of haemorrhagic transformation.

KEY WORDS: ischaemic stroke, acute period, carotid endarterectomy, neurological status, neurological deficit, haemorrhagic transformation, cerebral reperfusion.

P. 123

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