Dissertation for a scientific degree of Doctor of Medical Sciences by specialty 14.01.03. - surgery. Kharkiv Medical Academy of postgraduate education, Kharkiv, 2021.
The relevance of the dissertation research is determined by unsatisfactory results of treatment methods, that are currently used, and widespread of ischemic stroke in patients with multifocal atherosclerosis.
The dissertation work presents the results of a complex research and surgical treatment of 440 patients with carotid artery stenosis. Based on the results of the research, a differentiated approach to the choice of surgical tactics for ischemic stroke was developed and scientifically substantiated, taking into account the risk of reperfusion syndrome and hemorrhagic stroke. A diagnostic algorithm has been developed for the treatment of patients with stenosis of the carotid arteries and critical ischemia of the lower extremities, coronary heart disease, severe ischemic stroke.
The dissertation contains a new approach to the theoretical substantiation and practical solution of an urgent scientific problem - improving the results of surgical treatment of carotid artery stenosis by developing and introducing into clinical practice diagnostic and therapeutic algorithms taking into account the state of atherosclerotic plaque, the risk of restenosis and reperfusion syndrome in ischemic stroke.
On the basis of a retrospective analysis, the causes of unfavorable results of the treatment of ischemic stroke were established. An experiment was carried out on rabbits in which it was found that stem cells lead to a statistically significant decrease in the volume of damage by 25% and have a neuroprotective effect, which allowed intra-arterial use of MSCs in patients with ischemic stroke in severe course or intracranial arterial lesions.
A tactic has been developed to protect the brain in patients with multifocal atherosclerosis, with a decrease in Vvol in the middle cerebral artery using a temporary shunt and controlled hypertension under general anesthesia. The developed tactics of hydropreparation of an atherosclerotic plaque was introduced into the clinic, which makes it possible to reduce the time of intraoperative clamping of the ICA by 1.55 times and the need to apply additional sutures to the intima by 2.8 times.
It has been proved that carotid endarterectomy with patch insertion reduces the risk of microembolism by 1.2 times, and restenosis by 2.3 times. Based on the analysis and generalization of the obtained results, a relationship was established between the indicators of CRP, LPNS, EF and the risk of plaque thromboembologicity.
The presence of CA stenosis in patients with ischemic heart disease, chronic ischemia of the lower extremities, who require surgical treatment under general anesthesia, the developed staging of carotid endarterectomy is the first stage in a stable condition of the patient or simultaneous with a high risk of heart attack.
Key words: stenosis of the carotid arteries, multifocal atherosclerosis, ischemic stroke, ischemia of the lower extremities.
