Shcherbiuk A A, Mikhaĭlov I P, Lemenev V L, Akhmetov V V, Koshelev Iu M, Shamshilin A A, Kungurtsev E V, Bondarenko A N
Angiol Sosud Khir. 2009;15(1):127-31.
Presented herein are the outcomes of managing a total of twenty-six patients suffering from an uncomplicated abdominal aorta aneurysm with a concomitant atherosclerotic lesion of the coronary arteries, referred to our Clinic over the period form 2003 to 2006. Of these, nineteen (70%) patients were diagnosed with the first (symptom-free) stage of cerebral ischaemic disease, and six presented with the second stage [to have endured a transient ischaemic attack (TIA) within the terms from 16 to 3 months prior to admission]. Two patients had residual events of the previously sustained acute cerebral ischaemia (ACI) (stage 4). The current stage ofischaemic cerebral disease was determined according to the classification of A. V. Pokrovskii (1979). The haemodynamically significant stenoses of carotid arteries (over 70%) were revealed in five patients, an aneurysm of the internal carotid artery - in one patient, and eighteen patients were presenting with the degree of carotid arteries stenosis varying from 30 to 60% (of these, in two subjects after previously endured TIA, the plaque was heterogeneous and defined as embolism-threatening). No atherosclerotic lesions of the carotid artery were revealed in two patients, though these patients had previously sustained an AIA with the preserved neurological deficit by the moment of examination. Eight patients underwent reconstruction of the internal carotid arteries. The average age amounted to 64.5 years. Al of the eight operated on patients with a combination of ischaemic cerebral disease and an aneurysm of the abdominal aorta were found to have had no neurological complications either after the first, or after the second operations. The devised algorithm of examination and surgical management for patients presenting with an abdominal aorta aneurysm and a combined lesion of the brachiocephalic arteries made it possible to reduce the rate of neurological complication from 4.3% to 1.3%.
本文介绍了2003年至2006年期间转诊至我们诊所的26例患有单纯性腹主动脉瘤并伴有冠状动脉粥样硬化病变患者的治疗结果。其中，19例（70%）患者被诊断为脑缺血性疾病的第一阶段（无症状），6例患者处于第二阶段[在入院前16至3个月内曾经历短暂性脑缺血发作（TIA）]。2例患者有既往急性脑缺血（ACI）的残留事件（4期）。根据A.V.波克罗夫斯基（1979年）的分类确定脑缺血性疾病的当前阶段。5例患者发现颈动脉存在血流动力学显著狭窄（超过70%），1例患者有颈内动脉瘤，18例患者颈动脉狭窄程度在30%至60%之间（其中，2例曾经历TIA的患者，斑块不均匀，被定义为有栓塞风险）。2例患者未发现颈动脉粥样硬化病变，尽管这些患者在检查时既往曾发生AIA且仍有神经功能缺损。8例患者接受了颈内动脉重建术。平均年龄为64.5岁。所有8例接受手术治疗的患有脑缺血性疾病合并腹主动脉瘤的患者在第一次或第二次手术后均未出现神经并发症。为患有腹主动脉瘤和头臂动脉合并病变的患者设计的检查和手术管理算法使神经并发症发生率从4.3%降至1.3%。
