In the original publication [...].

GOAL:Presentation of the first Russian computer program (www.carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CEE).MATERIAL AND METHODS:The present study is based on the analysis of a multicenter Russian database that includes 25,812 patients after CEE operated on from 01/01/2010 to 04/01/2022. The following types of CEE were implemented: 6814 classical CEE with plastic reconstruction of the reconstruction zone with a patch; 18,998 eversion CEE.RESULTS:In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14%-myocardial infarction, 0.35%-stroke. The combined endpoint was 0.68%. For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. Based on this formula, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. On the basis of the obtained calculations, a computer program CarotidSCORE was created. Its graphical interface is based on the QT framework (https://www.qt.io), which has established itself as one of the best solutions for desktop applications. It is possible not only to calculate the probability of developing a complication, but also to save all data about the patient in JSON format (for the patient's personal card and his anamnesis). The CarotidSCORE program contains 47 patient parameters, including clinical-demographic, anamnestic and angiographic characteristics. It allows you to choose one of the four types of CEE, which will provide an accurate stratification of the risk of complications for each of them in person.CONCLUSION:CarotidSCORE (www.carotidscore.ru) is able to determine the likelihood of postoperative complications in patients undergoing CEE.

ЦЕЛЬ ИССЛЕДОВАНИЯ Улучшение диагностики и результатов лечения пациентов с острой мезентериальной ишемией в условиях многопрофильного стационара. МАТЕРИАЛ И МЕТОДЫ Проанализированы результаты лечения 42 пациентов с острой мезентериальной ишемией за период с 2017 по 2019 г. Оценивали пол, возраст, коморбидный фон, артериальный бассейн мезентериальной ишемии, методы ее диагностики, время от начала симптоматики до хирургического вмешательства, исход лечения в зависимости от реваскуляризации висцеральных артерий. Средний возраст пациентов составил 75±11 лет, из них было 71% женщин и 29% мужчин. Чаще (76%) встречалось поражение верхней брыжеечной артерии. РЕЗУЛЬТАТЫ Ангиография мезентериальных сосудов выполнена в 24 (57%) случаях, диагностическая лапаротомия — в 20 (48%). По результатам выявленных патологических изменений гемиколэктомия выполнена в 8 (19%) случаях, резекция желудка и желчного пузыря — в 1 (2,4%), резекция сигмовидной кишки — в 1 (2,4%), резекция тонкой кишки — в 8 (19%), резекция тонкой кишки в сочетании с правосторонней гемиколэктомией — в 4 (10%). Эндоваскулярное восстановление кровотока в бассейне верхней брыжеечной артерии выполнено у 5 (12%) пациентов, чревного ствола — у 4 (10%), открытая пластика обеих артерий — у 3 (7%). Таким образом, восстановление кровотока по целевой артерии зарегистрировано в 12 (29%) случаях. Среди погибших у 26 (62%) больных никакой сосудистой реваскуляризации не проводили. Выявлена корреляция между исходом и бассейном поражения: максимальная летальность зарегистрирована при поражении верхней брыжеечной артерии (n=22, 52%) (p<0,02) и в случаях тотального поражения (n=6, 14%). Общая летальность составила 71,4%. Количество благоприятных исходов было выше при реваскуляризации висцерального бассейна. ВЫВОД Оптимальные результаты получены в случаях ранней диагностики с контрастированием висцеральных ветвей и реваскуляризирующих вмешательств. Мультидисциплинарный подход предполагает участие общего, сердечно-сосудистого и эндоваскулярного хирургов в принятии тактических решений. Оптимальное время от развития симптомов острой мезентериальной ишемии до активного хирургического лечения не должно превышать 8 ч.

Цель. Определить вероятность возникновения абдоминальных осложнений после операций с искусственным кровообращением (ИК) при развитии системной гипоперфузии в раннем послеоперационном периоде и определить возможности повышения безопасности проведения кардиохирургических операций.

ЦЕЛЬ ИССЛЕДОВАНИЯ Анализ непосредственных результатов каротидной эндартерэктомии (КЭЭ) с селективным применением временного шунта (ВШ) и отказом от него. МАТЕРИАЛ И МЕТОДЫ В данное многоцентровое ретроспективное исследование за период с января 2005 г. по октябрь 2020 г. вошли 4967 пациентов с гемодинамически значимыми стенозами внутренней сонной артерии (ВСА), которым выполнена классическая КЭЭ с пластикой зоны реконструкции заплатой. В зависимости от применения ВШ все пациенты были распределены на три группы: 1-я (n=1328, 26,7%) — ВШ был установлен ввиду низкого ретроградного давления в ВСА (<60% от системного); 2-я (n=1853, 37,3%) — ВШ не был установлен ввиду удовлетворительного ретроградного давления (≥60% от системного); 3-я (n=1786, 35,9%) — ВШ не был установлен умышленно (ретроградное давление в ВСА не измеряли). Среднее время установки шунта в 1-й группе составило 46,2±17,6 с. В работе описана подробная инструкция по установке ВШ с наглядными иллюстрациями, указаны основные нюансы процедуры. Предложенные этапы установки ВШ могут лечь в основу обучения ординаторов и молодых сосудистых хирургов, а также должны быть внесены в новую версию национальных рекомендаций. РЕЗУЛЬТАТЫ В госпитальном периоде группы были сопоставимы по частоте летальных исходов (p=0,62), фатальных (p=0,96) и нефатальных инфарктов миокарда (ИМ) (p=0,73), фатальных острых нарушений мозгового кровообращения (ОНМК) (p=0,54) и нефатальных ОНМК/транзиторных ишемических атак (ТИА) (p=0,12). Однако наибольшее количество «немых» ОНМК было зафиксировано в группе больных, в которой ВШ был установлен (1-я группа: 2,56%, n=34; 2-я группа: 0,5%, n=9; 3-я группа: 0,55%, n=10; p<0,0001). Это состояние повлияло на максимальные значения комбинированной конечной точки (с учетом «немых» ОНМК), которую чаще определяли в 1-й группе (1-я группа: 3,3%, n=44; 2-я группа: 1,02%, n=19; 3-я группа: 1,56%, n=28; p<0,0001). Наибольшее количество фатальных ишемических ОНМК зафиксировано при стенозе ВСА 60—80% в 1-й группе (p=0,02; селективная установка ВШ), 91—99% во 2-й группе (p=0,003; отказ от ВШ ввиду удовлетворительного ретроградного давления) и 3-й группе (p<0,0001; умышленный отказ от ВШ). Подавляющее количество нефатальных ОНМК (1,8%; n=5) выявлено в группе 3 (умышленный отказ от ВШ) при выраженности контралатерального стеноза ВСА 91—99% (p=0,0008). Наибольшее количество «немых» ОНМК (4,4%; n=11) было зафиксировано в 1-й группе (селективная установка ВШ) при выраженности контралатерального стеноза ВСА 91—99% (p=0,02). Таким образом, комбинированная конечная точка показала, что ОНМК чаще развивается при выраженности контралатерального стеноза ВСА 91—99% (1-я группа: 0,4%, n=6; 2-я группа: 0,2%, n=6; 3-я группа: 1,85%, n=15; p<0,0001). ВЫВОД В госпитальном послеоперационном периоде при применении ВШ было выявлено наибольшее количество «немых» ОНМК, в результате чего комбинированная конечная точка в данной группе имела наибольшие показатели. По частоте нефатальных/фатальных ОНМК, ТИА, ИМ, летальных исходов значимых различий не выявлено. Измерение ретроградного давления не всегда соответствовало действительным компенсаторным возможностям коллатерального кровообращения. В результате при нормальных показателях (≥60% от системного) было выявлено значимое возрастание частоты ОНМК в условиях контралатерального стеноза ВСА 60—80%. При умышленном отказе от установки ВШ установлена значимая динамика в увеличении количества случаев фатальных и нефатальных ОНМК в условиях контралатерального стеноза ВСА 91—99%.

This article provides data from the current Russian (National guidelines for the management of patients with diseases of the brachiocephalic arteries of 2013; Recommendations “Blockage and stenosis of the carotid artery” of the Ministry of Health of the Russian Federation, 2016) and foreign (European Society of Cardiology / European Society of Vascular Surgeons for Diagnosis and Treatment Peripheral Artery Diseases 2017; Recommendations for myocardial revascularization of the European Society of Cardiology and the European Association of Cardio-Thoracic Surgeons 2018) recommendations regarding the choice of a revascularization strategy for combined coronary and carotid artery disease. Conclusions are drawn about the unresolved issue. A literature review of the largest series of Russian articles by one institution devoted to this topic was carried out. Hospital and long-term outcomes have been demonstrated, as well as predictors of complications for various revascularization strategies. The stages of creation and the results of approbation of a new computer program for risk stratifi cation, which makes it possible to determine the mathematical probability of the development of unfavorable cardiovascular events during the implementation of various surgical tactics, taking into account the individual characteristics of the patient. A conclusion was made about the effectiveness of this development.

A rare clinical case of surgical treatment of a 60-year-old patient with acute compartment syndrome that developed in connection with a progressive spontaneous hematoma on the right leg is presented. The patient was hospitalized in the infectious diseases department of the Saint Petersburg “City Multidisciplinary Hospital № 2”for the treatment of coronavirus infection, which was complicated by bilateral polysegmental viral pneumonia and respiratory failure. During treatment, the patient complained of a large subcutaneous mass that developed in the area of the right popliteal fossa, which was moderately painful on palpation. Ultrasound duplex examination revealed a spontaneous intermuscular hematoma of the right leg measuring 10x10 cm without clinical signs of acute blood loss. Despite conservative treatment, the volume of the hematoma increased and spread to the muscle sheath of the posterior and anterior muscle groups of the right tibia. An acute compartment syndrome was diagnosed with signs of acute ischemia of the right lower limb of the IIA degree according to the classification of V. S. Saveliev, in connection with which an operative intervention was performed with a good result.

Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up.

Astrocytes are the most common type of glial cells that provide homeostasis and protection of the central nervous system. Important specific characteristic of astrocytes is manifestation of morphological heterogeneity, which is directly dependent on localization in a particular area of the brain. Astrocytes can integrate into neural networks and keep neurons active in various areas of the brain. Moreover, astrocytes express a variety of receptors, channels, and membrane transporters, which underlie their peculiar metabolic activity, and, hence, determine plasticity of the central nervous system during development and aging. Such complex structural and functional organization of astrocytes requires the use of modern methods for their identification and analysis. Considering the important fact that determining the most appropriate marker for polymorphic and multiple subgroups of astrocytes is of decisive importance for studying their multifunctionality, this review presents markers, modern imaging techniques, and identification of astrocytes, which comprise a valuable resource for studying structural and functional properties of astrocytes, as well as facilitate better understanding of the extent to which astrocytes contribute to neuronal activity.

OBJECTIVE. Assessment of the mid-term results after various types of debranching in hybrid surgery of the aortic arch and descending thoracic aorta.METHODS AND MATERIALS. 47 patients with various pathologies of the aortic arch and descending thoracic aorta were operated on. Six of them suffered from type IIIa dissection and 26 from type IIIb dissection according to DeBakey classification, 15 patients had true aortic aneurysms. The following interventions were performed: total aortic arch debranching (n=5), cross subclavian-subclavian-left-common carotid (n=14) or cross carotid-carotid-subclavian bypass (n=7); subclavian-carotid transposition or bypass (n=12); Chimney technique for the aortic arch aneurysm (n=8); in situ fenestration of the endoprosthesis (n=1). Elective surgery was performed in 32 patients, emergency in 15.RESULTS. Technical success achieved in 100 %. The overall hospital mortality rate was 10.6 % (n=5), elective surgery mortality rate was 9.3 % (n=3), in emergency cases - 13.3 % (n=2). Causes of mortality: stroke (n=1), multiple organ failure after prosthetic ascending aorta due to retrograde dissection after stent graft implantation (n=1), pneumonia (n=1), acute myocardial infarction (n=1), profuse bleeding (n=1). Cumulative survival rate was 87.5 % over 5 years, freedom from reinterventions - 89.1 %. During the first year of observation, 3 patients underwent stent graft replacement of the descending thoracic aorta due to formation of a dissection below the primary stent graft (n=1), open prosthesis of the ascending aorta due to it retrograde dissection (n=1), endofixation of the stent graft with embolization of the false lumen (n=1).CONCLUSION. Hybrid surgery on the aortic arch and the descending thoracic aorta is safe and effective treatment. Regular follow-up and timely treatment of complications in the long term after hybrid or endovascular interventions are necessary to improve long-term results.

Aim. To analyze the results of multicenter study on dynamics of resistant hypertension (RH) in patients after various types of carotid endarterectomy (CE) with and without carotid body savingMaterial and methods. During the period from January 2010 to December 2020, 1827 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RH were operated on. Depending on CE type, the two groups were selected. Group 1 (n=1135; 62,2%) consisted of patients received glomus-saving surgery: 19,2% (n=351) -conventional CE with a patch repair of reconstitution point; 13,6% (n=248) — glomus-saving CE sensu R. A. Vinogradov; 7,3% (n=133) — glomus-saving CE sensu K. A. Antsupov; 11,7% (n=214) — glomus-saving CE sensu A. N. Kazantsev; 4,6% (n=84) — Chick-Chirik CE; 5,7% (n=105) — swallow tail type patch repair sensu R. I. Izhbuldin. Group 2 (n=692; 37,8%) consisted of patients received CE without glomus saving: 18,6% (n=341) — eversion CE with carotid body cutoff; 6,3% (n=115) — CE with new bifurcation plasty; 5,85% (n=107) — autoarterial reconstruction; 7,1% (n=129) ICA autotransplantation sensu E. V. Rosseikin.Results. The mortality rate, as well as the prevalence of myocardial infarction (MI) and ischemic strokes were comparable in groups. The incidence of hemorrhagic transformation (group 1: 0%; group 2: 0,6%; p=0,04; OR=0,06; 95% CI, 0,003-1,25) and composite endpoint (death+MI+ischemic stroke+hemorrhagic transformation) (group 1: 1,06%; group 2: 3,0%; p=0,004; odds ratio (OR)=0,34; 95% CI, 0,16-0,69) significantly differs between groups. After glomus-saving CE, the number of patients with the target blood pressure (BP) level reached 51,1% (p <0,0001; OR=0,0009; 95% CI, 6,05-15,9). The number of patients with grade II (31,1%; p<0,0001; OR=12,7; 95% CI, 10,4-15,52) and III (3,6%; p<0,0001; OR=10,26; 95% CI, 6,71-15,67) hypertension significantly decreased. In the group 2, the prevalence grade III hypertension increased (48,0%; p<0,0001; OR=0,23; 95% CI, 0,18-0,3), while the number of patients with grade I (0%; p<0,0001; OR=77,0; 95% CI, 4,71-12,58) and II (52%; p<0,0001; OR=3,06; 95% CI, 2,43-3,86) hypertension decreased.Conclusion. Glomus-saving CE contributes to achieving target BP in patients with RH. Its removal increases the risks of labile hypertension, postoperative hypertensive crisis, hyperperfusion syndrome and hemorrhagic transformation.

The pandemic of the 21st century caused by the SARS-CoV-2 virus has posed a challenge for the global medical community. Community-acquired polysegmental pneumonia caused by the novel coronavirus infection (COVID-19) proceeds in a variety of types and may be complicated by a potentially lethal immune response — the cytokine storm. The latter is characterized by rapid proliferation and increased activity of T cells, macrophages and natural killer cells releasing various inflammatory cytokines and chemical mediators by protective cells. This pathological condition can be treated by recombinant humanized monoclonal antibody against monofunctional cytokine human interleukin-6 receptor. The effect of IL-6 blockers is to selectively bind and inhibit both soluble and membrane IL-6 receptors (sIL-6R and mIL-6R). There are studies demonstrating a positive effect and increased survival rate while using drugs that block the production of interleukin-6. The new coronavirus infection causes inflammation of the artery wall with intravascular thrombogenesis, which justifies the high efficiency of anticoagulant and hormone therapy. The standards of drug treatment of the studied infection include antiviral, anti-inflammatory, anticoagulant, mucolytic, symptomatic, intravenous infusion and oxygen therapy. Methodological recommendations for the diagnosis and treatment of a new coronavirus infection, issued by the Ministry of Health of the Russian Federation, are regularly updated in accordance with the accumulation of positive treatment results by global and local medical communities. In addition to drug therapy, there are other methods of body detoxification. One of the additional methods for treatment of community-acquired pneumonia along with viral “vasculitis” and correction of the immune response can be provided by ultraviolet blood irradiation (UBI). It is well known that ultraviolet radiation has a disinfecting effect. The wavelengths used in UBI affect the efficiency of UV absorption by DNA molecules of the pathogen. Bactericidal UV radiation at certain wavelengths causes thymine dimerization in DNA molecules. The accumulation of such changes in the DNA of microorganisms leads to a slowdown in the rate of their reproduction and extinction. The photohemocorrection method is characterized by immunostimulatory, antiinflammatory, anti-hypoxic, membrane stabilizing, antioxidant and detoxifying effects. In the current study we obtained data on a significant decrease in the systemic inflammatory response, marked and fast decrease of the C-reactive protein in blood tests of patients while receiving ultraviolet blood irradiation. The relief of the systemic inflammatory reaction had a positive effect on the reduction of infiltrative changes in the lung tissue, as well as the timing of discharge from hospital.

KED and EDR peptides prevent dendritic spines loss in amyloid synaptotoxicity in in vitro model of Alzheimer’s disease (AD). The objective of this paper was to study epigenetic mechanisms of EDR and KED peptides’ neuroprotective effects on neuroplasticity and dendritic spine morphology in an AD mouse model. Daily intraperitoneal administration of the KED peptide in 5xFAD mice from 2 to 4 months of age at a concentration of 400 μg/kg tended to increase neuroplasticity. KED and EDR peptides prevented dendritic spine loss in 5xFAD-M mice. Their action’s possible molecular mechanisms were investigated by molecular modeling and docking of peptides in dsDNA, containing all possible combinations of hexanucleotide sequences. Similar DNA sequences were found in the lowest-energy complexes of the studied peptides with DNA in the classical B-form. EDR peptide has binding sites in the promoter region of CASP3, NES, GAP43, APOE, SOD2, PPARA, PPARG, GDX1 genes. Protein products of these genes are involved in AD pathogenesis. The neuroprotective effect of EDR and KED peptides in AD can be defined by their ability to prevent dendritic spine elimination and neuroplasticity impairments at the molecular epigenetic level.

This review investigates the various methods used for carotid endarterectomy (CEE). These methods are presented, and allow us to analyse effective revascularisation with extended damage to the internal carotid artery. The data of studies comparing the results of eversion and classical carotid endarterectomy with plasty of the reconstruction zone with a patch made of diepoxy-treated pericardium are presented. Special attention is paid to emergency carotid endarterectomy and carotid endarterectomy in the acute period of ischemic stroke. The important and main aspects of the glomus-saving species of CEE are also demonstrated. The main complications behind operations, and causes of restenosis in long-term follow-up periods are also duly noted. Similarly, suggestions to eliminate these issues are also proposed. This review comprehensively covers the state of the art of carotid endarterectomy and dissects current techniques and methods in the area.Received 16 July 2020. Revised 24 August 2020. Accepted 25 August 2020.Conflict of interest: Authors declare no conflicts of interest.Funding: The study did not have sponsorship.Author contributionsConception and study design: G.G. KhubulavaDrafting the article: A.N. KazantsevCritical revision of the article: A.A. Erofeev, V.N. Kravchuk, K.P. ChernykhFinal approval of the version to be published: G.G. Khubulava, A.N. Kazantsev, A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh

The paper deals with the currently available implants used in optogenetic experiments on laboratory animals in vivo. We present a brief description of the optogenetic investigation stages. Various types of implantable devices generating and recording signals in excitable tissues have been considered. The features of control signal transduction inside living tissues were analyzed. We discussed the possibility of medical and biological use of optical fibers for excitable tissues stimulation. Then we proposed a device of an implantable optical-electrode system for scanning and controlling the bioelectric parameters. The device can be used in medical diagnostics, prosthetics, myostimulation, neurostimulation and cardioacceleration, for instance, at neurological and rehabilitation medical institutions. With this in mind, an attempt will be made to make special combined microelectrode arrays to implant them into living tissue. The arrays should be able to change their profile according to the implantation-area contour and biophysical features of the substrate surface. It is necessary to provide a point generation and layer-by-layer scanning of excitation pulse through integration of individual microelectrode arrays into a single test-system.

The article is devoted to problems of realization and application of optogenetic methods used to identify reasons of various diseases, to monitor the biochemical processes of cell activity and to study various organisms. The problems of delivery, embedding and monitoring the expression of opsin genes into the cell genome of interest have been considered. In the article, the parameters and properties of various opsins and also the main ways of achievement of precise optical control over cell using opsins were presented. The rules for choosing the parameters of a light beam and the features of its putting were pointed out. The characteristic properties of the different measurement technique and recording the experimental quantities were analyzed and given.

The purpose of the research was to give a topographical substantiation of the choice of an approach to the extracranial internal carotid artery (ICA) in view of individual anatomical variability of ICA and various localizations of stenosis or occlusion. In 38 human corpses ICA was uncovered using operative methods proposed by Cooper. DePalma, Pauliukas and Nelson. A comparative estimation of the approaches was given with calculation of standard parameters of the operative wound. It was established that the approach to the subcranial ICA was dependent on the type of constitution, features of the anatomical shape of the mandible, distance between the mandibular angle and mastoid process. The statistical processing of the findings has shown that all the factors in question made up 91.5% which is enough for the mathematical description of the position of ICA. Regression models of accessibility of the ICA segment for each of the four investigated approaches were made. The PC program for Windows 95/NT which allows the estimation of accessibility of ICA in each patient before operation was created. These mathematical models were used in the clinic for surgical treatment of the ICA pathology in 24 patients. The difference between the calculated data of ICA accessibility and intraoperative measurements was +/- 3 mm. It demonstrates reliability of the estimation of the approach parameters before operation.