The clinical observation presents a rare case of a patient with arterial tortuosity syndrome, with a 9-year follow-up of the clinical picture dynamics.

A case of ICA aneurysm is presented, all possible pathogenesis mechanisms that led to the formation of an aneurysm are analyzed. In the analysis of the clinical case, mathematical modeling confirmed the assumption of the relationship between biomechanical conditions in the aneurysm area, regardless of etiology.

BACKGROUND:Carotid endarterectomy belongs to the most common vascular operations performed in atherosclerotic lesions of brachiocephalic arteries for prevention of ischemic stroke. One of intraoperative complications of this intervention is ischemic stroke, therefore, currently important remains the task of choosing an optimal technique of intraoperative monitoring and improving methods of preventing the development of ischemic stroke. OBJECTIVE:The purpose of this study was to determine an optimal combination of methods of comprehensive intraoperative neuromonitoring during carotid endarterectomy. PATIENTS AND METHODS:We analyzed the results of treating a total of 206 patients subjected to carotid endarterectomy. The mean age of the patients was 63.9±8.7 years. Depending on the method of intraoperative control over the development of cerebral ischemia, the patients were divided into 2 groups. Group One comprised 97 patients in whom the method of control was the measurement of the retrograde arterial pressure in the internal carotid artery with the calculation of the retrograde arterial pressure index. Group Two was composed of 109 patients in whom the control method consisted in measuring the retrograde arterial pressure and comprehensive intraoperative monitoring. RESULTS:By the main parameters, the patient groups were comparable (p>0.05). The frequency of developing ischemic stroke amounted to 4.1 and 0.9% in Group One and Group Two, respectively (p=0.048). An intraluminal shunt was used significantly more often in Group Two (with intraoperative monitoring), i. e., in 26.5% (28 patients) vs 12.4% (12 patients) in Group One (without intraoperative monitoring) (p=0.025). The predictive model of reposition of an intraluminal shunt based on the data of intraoperative monitoring: somatosensory evoked potentials + transcranial dopplerography + electroencephalography and intraoperative monitoring: somatosensory evoked potentials + transcranial dopplerography was assessed by means of the ROC analysis and demonstrated comparable parameters of sensitivity and specificity (83%). Therefore, the protocol of intraoperative monitoring with the use of an intraluminal shunt was reduced to assessing alterations in 2 diagnostic parameters (somatosensory evoked potentials + transcranial dopplerography). CONCLUSION:Combined neuromonitoring during carotid endarterectomy under conditions of general anesthesia makes it possible to verify critically decreased cerebral perfusion and to determine intraoperative indications for placing an intraluminal shunt and assess its condition during the main stage of surgery, thus resulting in a decrease in the frequency of neurological complications.

. This study is based on the results of a retrospective analysis of simulta- neous and staged surgical treatment of patients with combined atherosclerotic lesions of the coronary arteries and pathological convolutions of the internal carotid arteries. When comparing the two groups of patients, depending on postoperative complications, it was revealed that the probability of developing delirium, bleeding and cerebral ischemia in the group of staged operations was lower compared to the group of simultaneous operations (by 39.4% (p<0.05); by 33.5% (p>0.05) and by 19.9% (p>0.05), respectively). The probability of myocardial infarction in the group of staged operations was 17.2% higher compared to the group of simultaneous surgery (p>0.05). According to the results of the study, it was concluded that patients with combined hemodynamically significant atherosclerotic lesions of the coronary arteries and pathological hemodynamically significant tortuosity of the internal carotid arteries, the method of choice is to perform staged revascularization. The first stage is recommended to perform aorto-coronary by- pass surgery followed by resection of the pathological tortuosity of the internal carotid artery.

. This article analyzes the laboratory marker of cerebral ischemia at vari- ous stages of treatment with the assessment of the neurocognitive status of patients by a specialized questionnaire at the pre- and postoperative stages, depending on the degree of cerebrovascular insufficiency. As a result, it was revealed that the level of the NSE marker is statistically significantly lower with the use of a temporary shunt (17.5±3.4 mcg/l) than with operations without a shunt (20.1±2.7 mcg/l) (p<0.05). Temporary shutdown of blood flow through the carotid arteries during the operation of resection of the tortuosity of the ICA is accompanied by a mandatory significant increase in the concentration of the marker of brain damage, followed by the restoration of markers on the 3rd day after surgery (the level of NSE before surgery — 16.35 mcg/ l, after surgery — 12.40 mcg/l (p<0.05)). When assessing among all types of tortuosity, the highest value of NSE was found in patients with kinking (before surgery — 19.6 mcg/l, intraoperatively — 23.45±2.33 mcg/l, in the postoperative period — 14.70 mcg/l (p<0.05)). When assessing the neurocognitive status of the questionnaire after resection of the pathological tortuosity of the ICA, an increase in the number of points was noted for all degrees of cerebrovascular insufficiency (I. before surgery-26 points, after surgery- 28; II. before surgery- 25 points, after surgery- 27 points; III. before surgery- 25 points, after surgery- 26 points; IV art. before surgery — 23 points, after surgery — 25 points (p <0.05)). As a result, it is concluded that a comprehensive assessment of cerebral ischemia at the intraoperative stage during resection of pathological tortuosity can be carried out using a laboratory marker of ischemia in routine practice in order to reliably assess ischemia at the level of brain neurons, and the performed operation for resection of pathological tortuosity of the ICA is accompanied by an improvement in cognitive functions up to 6 months after the operation according to the questionnaire.

. The article presents the immediate and long-term results of conservative and surgical treatment of asymptomatic patients with pathological tortuosity of the internal carotid arteries, assesses the effectiveness of the operation in relation to the development of ischemic events and the presence of cerebral symptoms in patients after the intervention. The values of the linear velocity of blood flow are determined, at which the development of ischemic events is predicted, which is important in choosing indications for surgical correction in this category of patients.