The article contains a review of the literature devoted to the state-of-the-art data concerning management of patients presenting with an aneurysmal lesion of the extracranial segment of the internal carotid artery. This is followed by describing two clinical case reports regarding aneurysms of the extracranial segment of the internal carotid artery and the outcomes of endovascular treatment.

Purpose. Examine the clinical and cost-effectiveness of the use of methods of measurement of fractional flow reserve in the treatment of coronary heart disease patients with multivessel coronary. Materials and Methods. The study included 62 patients with coronary heart disease and multivessel coronary disease who underwent multi-stage endovascular revascularization. Results. Conducting clinical and economic analysis showed that the use of additional methods of measurement of fractional flow reserve in patients with multivessel coronary disease increases the cost of percutaneous coronary interventions during the first phase of myocardial revascularization. But at the same time, it reduces the cost of treatment of the patient in general, reducing the «cost of disease.» This is achieved by reducing the need for patient readmission rates for the second phase of myocardial revascularization.

Purpose . To evaluate the impact of polyvascular artery disease (PolyVD) and the timing of the second revascularization phase on the treatment results in patients with ST elevation myocardial infarction (STEMI). Materials and methods. During the hospital stay 227 patients had screening ultrasound of the aortic arch branches and lower extremity arteries performed. The patients were classified according to the presence or absence of PolyVD, which refers to the presence of extracardiac artery stenosis ≥ 30 % (lower limb arteries and or extracranial arteries). The first group consisted of patients with STEMI, multivessel coronary disease and PolyVD, who underwent primary PCI (n = 63) (STEMI + IPA), the second group consisted of similar patients without IPA (n = 164) (STEMI). Each of the groups was further subdivided into two subgroups: the second phase of coronary revascularization ≤ 60 days after primary PCI and > 60 days after primary PCI. Results. Preventive revascularization was performed in 84 patients from Group 1 by the cardiac catheterization findings. The overall mortality rate was 4,62 % for Group 1 and 34,15 % for Group 2 (p < 0,001). The factors, increasing the overall mortality rate in both groups, were identified by the univariate analysis: disease course without preventive revascularization, age, peripheral artery interventions, perioperative complications (p < 0,05). The factors reducing the mortality rate were preoperative cardiac catheterization, carotid surgery, β-blockers, ACE inhibitors, aspirin (p < 0,05). The independent risk factors increasing the overall mortality rate were disease course without preventive revascularization, age, perioperative complications (p = 0,05). Conclusion. Screening detection of extracranial artery disease and lower extremity artery disease is a necessary component in the management of patients with STEMI and multivessel disease undergoing primary PCI. In case of peripheral artery stenosis ≥ 30 % detection the second stage of coronary revascularization is required within no more than 60 days after primary PCI.

Purpose. The results of primary percutaneous coronary interventions (PPCI) in the treatment of ST elevation myocardial infarction (STEMI) patients with coronary artery disease (CAD) and peripheral arterial disease (PAD) remain little known. Materials and methods. We analyzed 12-month outcomes of 259 consecutive patients who underwent PPCI with STEMI. The outcomes of 48 patients (18,5 %) with CAD and PAD (CAD + PAD group), who underwent PPCI, were compared with the outcomes of 211 patients (81,5 %) with isolated CAD and without PAD (CAD group), who underwent PPCI. The groups were comparable regarding the incidence of diabetes mellitus, arterial hypertension, smoking and left ventricular ejection fraction. The endpoints at 12 months included all deaths, myocardial infarction (MI), target lesion/vessel revascularization (TLR/TVR) and non target vessel revascularization (non-TVR). Results. Angiographic success (TIMI III flow and residual stenosis < 20 % by QCA) was 93,8 % for CAD + PAD group (n = 45) and 97,2 % for CAD group (n = 205) (р = 0,486). At 12 months CAD + PAD group and CAD group did not differ in the incidence of death (8,3 vs 6,2 % respectively, p = 0,821), TLR/TVR (6,3 vs 2,8 % respectively, p = 0,468), while there were differences in the rates of nonfatal MI (20,8 vs 9 % respectively, p = 0,036) and non-TVR (37,5 vs 16,6 % respectively, p = 0,002). Conclusion. ST-elevation myocardial infarction patients with peripheral arterial disease are a special category of patients having significantly more severe coronary artery stenoses, higher incidence of non-fatal myocardial infarctions and higher incidence of non-target vessel revascularizations during 12 months.

The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency.

AIM:To substantiate administration of <> for prevention of cerebral ischemia in operations on extracranial arteries. MATERIAL AND METHODS:The present prospective randomized trial included a total of 50 patients having endured various operative interventions on extracranial arteries. Of these, 24 subjects were additionally given <> in order to prevent ischaemic complications. Conventionally accepted methods of protection were used in 26 patients. The degree of cerebral ischaemia during surgery was assessed by means of monitoring the lactate content in the blood from the internal carotid artery and internal jugular vein on the side of the operation performed. Also, as an indirect method aimed at evaluating intraoperative cerebral ischaemia we used monitoring of transcutaneous oxygen tension (TcPO2) on the side of the surgical intervention with the placement of the appropriate sensor in the temporal region. RESULTS:The patients receiving perftoran additionally in order to prevent cerebral ischaemia showed a statistically reliable decrease in the blood lactate level at all stages of the operation. Besides, with the statistically similar levels of TcPO2 in the both groups at the stage prior to pinching the major arteries amongst the patients given perftoran the decrease in TcPO2 at the subsequent stages was significantly lower. CONCLUSION:Administration of perftoran during surgery on the extracranial arteries made it possible to substantially improve cerebral oxygenation, rendering it stable at all stages of the surgical intervention. Combining this method with other techniques aimed at protecting the brain makes it possible to increase safety of the operations by promoting additional protection from circulatory hypoxia in multifocal lesions of the carotid arteries and arteries of the circle of Willis.