Treatment of Patients with Ischemic Stroke: Neurosurgical Aspects

D.Yu. Usachev, V.A. Lemenev, G.E. Mitroshin, V.A. Lazarev, V.M. Churilov, V.A. Shakhnovich,
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)

Since 1999 specialists from the Burdenko Research Institute of Neurosurgery have performed 147 reconstructive operations in 121 cases with different stenosing and occluding lesions of brachiocephalic arteries.

The age of patients varied from 7 up to 77, being equal to 56 on the average. There were 72% of male and 28% of female cases.

A certain algorithm of complex examination was used. We performed 110 reconstructive operations on the carotid region and 21 interventions on vertebral arteries; 18 patients demanded extra-intracranial microanastomosis. Different versions of endarterectomy, resection and redressment of arteries, plasty of openings of the external carotid and vertebral arteries were used.

Cases with multiple lesions of major cerebral arteries underwent stage-by-stage surgical treatment. Operations on the carotid region were performed under general anesthesia with application of intraoperative multimodality neuromonitoring of blood supply, metabolism and cerebral functions (transcranial Doppler, EEG, cerebral oximetry).

All cases were subject to control complex examination. The majority of them had regression of signs of cerebral ischemia. Data of duplex scanning, MRI in a vascular mode, CT spiral angiography, cerebral X-ray angiography were compared with intraoperative findings. Duplex scanning, CT spiral and X-ray angiography turned out to be the most reliable means of examination. The rate of postoperative complications and mortality made 4.7% and 1.3% respectively.