Algorithm of Diagnosis and Monitoring of Cerebral Functions in Patients with Ischemic Stroke

V.A. Shakhnovich, V.A, Lazarev, D.Yu. Usachev, M.V. Churilov, V.A. Lukshin, A.Yu. Lubnin,
A.V. Shmigelsky, O.B. Sazonova, A.A. Ogurtsova

(Burdenko Research Institute of Neurosurgery of the Russian Academy of Medical Science, Chair of Neurosurgery, Russian Medical Academy of Postgraduate Education, Moscow)

A complex clinical and pathophysiological study was carried out in 86 cases (52 male patients, aged 42-76), operated for stenosis of internal carotid arteries, varying from 55% up to critical values. Different versions of carotid endarterectomy were used. The study included neurologic examination, estimation of lipid and clotting factors of blood, duplex scanning of brachiocephalic arteries together with transcranial Doppler examination and assessment of volumetric blood flow velocities, MR-angiography, CT of the brain with application of computer tomoangiograpgy of brachiocephalic arteries and their selective angiography. Intraoperative monitoring was based on transcranial ultrasonic dopplerography, EEG and cerebral oximetry. Obtained data were used for estimating a degree of atherosclerosis severity, an atheromatous plaque structure, its embologeneity and hemodynamic importance, states of collateral cerebral circulation, causing changes of cerebral hemodynamics during surgical interventions on carotid arteries.