Diagnostic peculiarities, surgical policy, and efficacy of reconstructive operations in pathological tortuosity of internal carotid arteries

Kazakov Yu.I.^1,2, Ivanova O.V.^1,2, Pospelova A.M.², Vardak A.¹

1) Chair of Cardiovascular Surgery, Tver State Medical Academy of the Ministry of Public Health of the Russian Federation,
2) Department of Vascular Surgery, Regional Clinical Hospital, Tver, Russia

We examined a total of 88 patients presenting with unilateral pathological tortuosity of internal carotid arteries (PT ICA), who were subjected to reconstructive interventions. The patients underwent ultrasound duplex scanning of brachiocephalic arteries, CT angiography of the brain, and assessment of cognitive functions according to the Montreal scale (MoCA test). It was proved that absolute indications for operative intervention in patients with pathological tortuosity of ICA comprise coiling, and in kinking – an increase in the linear blood velocity greater than 180 cm/s. Perfusion CT makes it possible to objectively assess the state of blood supply to the cerebral hemispheres. CT angiography of ICAs with 3D reconstruction makes it possible to reveal microaneurysms of the vascular wall in the area of pathological tortuosity. PT leads to deficit of cognitive functions, and performing reconstructive operations improves cognitive functions after 6 months in stage III chronic cerebrovascular insufficiency in 91% of cases, and in stage IV – in 55%.

KEY WORDS: pathological tortuosity of ICA, indications for operative treatment, cognitive functions, perfusion CT of the brain.

P. 157

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