Rodin Y. Clinical picture, diagnostics and surgical treatment of a chronic insufficiency of a cerebral circulation at atherosclerotic stenosis and curvature of carotid arteries

Object - chronic cerebro-vascular insufficiency, caused by pathological kinking and atherosclerotic stenosis of internal carotid artery; Purpose - is to improve the efficiency of curing patients with chronic insufficiency of cerebral blood circulation under atherosclerotic stenosis and kinking of carotid artery based on the research of pathogenetic mechanism of development complication and optimization methods of diagnostics and complex surgery treatment; Methods - clinic, angiographic, ultrasonic, magnetic resonance tomography and computer tomography, mathematic modeling, histological, biochemical, statistic; Novelty - a new approach to problem solving of surgical treatment of chronic cerebro - vascular insufficiency, evoked by carotid artery pathology in terms of primary and secondary prevention measures of ischemic cerebral lesion. The optimal tactic of diagnostics and treatment of patients with occlusive lesion of magistral cerebral artery has been grounded as well as differentiated testimony to different types of operational interference has been defined. Firstly, the application of physical - mathematical modeling theoretically has been proved in clarifying the mechanism of devastating cavitation of atherosclerotic plaque. The new data of the relationship of development of post operational complexity with method of vessel reconstruction has been established.New data has been obtained about the relationship of intima hyperplasia by vascular anastomotic technique based on mathematical modeling. For the first time the role of hyperfibrinogenemia in the processes of atherosclerosis plague has been determined. For the first time an evolutionary model of pathological kinking of internal carotid artery development has been created and mathematically validated. The link between lesion of internal carotid artery and clinic symptoms of vascular cerebral insufficiency has been established, the character of local and regional disturbance of geodynamics at the pathological kinking of internal carotid artery has been evaluated and its criteria of necessity of operative assistance has been defined. For the first time the concept of safe application of internal shunt for the optimal protection of cerebrum under the brachicephal artery operations has been developed and biomechanical and biochemical criteria of adequacy cerebrum protection at the clasped internal carotid artery has been defined.Uniform security measures of execution and similarity of remote results of "classic" carotid endarterectomy and eversion methods of carotid endarterectomy has been proved; Results - The implementation of developed methods of treatment has enabled to obtain the following results: the decrease of the number of complexities from 29.7% to 15.6%; decrease of significant complexities (stroke + death) to 2.1%; contraction of middle terms of treatment from 17.4% ±3.2 to 9.2±3.1 days; it is inculcated - in medical practices, in an educational process; the sphere is a medicine.