Iasnopolska N. Surgical treatment optimization of patients with carotid arteries bifurcation symptomatic stenoses

The object is brain chronic ischemia caused by carotid arteries stenoses. The aim is to improve the results of surgical treatment of patients with carotid arteries bifurcation affection, due to the development and introduction of mathematically and hemodynamically grounded method of surgical correction of carotid arteries stenoses bifurcation. Methods: general clinical, clinical-laboratorial, morphological, instrumental, mathematical simulation, statistical. Novelty - it has been established morphological substratum of carotid arteries affection that causes patients' symptoms and reflects the degree of atherosclerotic process progress. It has been determined the correlated connection of cytokines level with the process of atherosclerotic plaques destabilization. The new method of eversional carotid endarterectomy has been elaborated. Also it has been created the mathematical model of bloodstream in vascular channel depending on the anastomosis type. The results: the application of the new offered method gives an opportunity to the implementation of eversional methods with any length of atherosclerotic plaque without crimpiness of the interior carotid artery that allows to reduce the duration of the carotid artery cross-clamping from 38,7+- 8,6 to 25,4+-7,2 minutes, and provides the preservation of the outer carotid artery permeability in distant time. It also allows to decrease the number of little complications from 16% and 27,7% to 10%. It has been obtained 92,5% of good results of operation and the number of restenoses has been reduced from 8,3% and 7,6% to 5%; introduced in medical practice in the teaching process; industry - medicine.