[Assessment of efficacy of reconstructive operations on carotid arteries in combination of stenosis and pathological tortuosity].

OBJECTIVE

The purpose of this study was to assess efficacy of reconstructive operations on carotid arteries in patients presenting with stenosis of the internal carotid artery (ICA) combined with its pathological tortuosity.

MATERIAL AND METHODS

We analysed our experience in surgical treatment of 84 patients with pathological tortuosity of the ICA combined with atherosclerotic stenosis. The study included patients with ICA stenosis ≥60% (any type of the atherosclerotic plaque) and with any degree of cerebrovascular insufficiency (CVI), or with ICA stenosis <60% (type I-III atherosclerotic plaque) with degree II-IV CVI in a combination with either S- or C-shaped tortuosity of the ICA, kinking or coiling, with the linear blood flow rate ≥110 cm/s and turbulence of blood flow. Only six (7.1%) patients of the 84 (100%) presented with no clinical signs of CVI and were found to have a past medical history free from episodes of cerebral circulation impairments. The ratio of asymptomatic/symptomatic patients was as follows: in group 1 - 12 (58.7%)/19 (61.3%), in group 2 - 27 (81.8%)/6 (18.2%), and in group 3 - 10 (50%)/10 (50%).

RESULTS

Six months after surgery, the asymptomatic/symptomatic patients ratio was as follows: in group 1 - 22 (70.9%)/9 (29.1%), in group 2 - 28 (84.8%)/5 (15.2%), p=0.045, and in group 3 - 9 (45%)/11 (55%), p=0.024. In group 3, one (5%) patient developed thrombosis of the reconstruction zone with the development of ischaemic-type acute cerebral circulation impairment. Twelve months after surgery the ratio in the groups did not change. Of twelve patients with degree IV chronic CVI, four (33.3%) were found to have partial regression of the focal neurological symptomatology.

CONCLUSION

Surgical method of treatment of patients with ICA stenos combined with pathological tortuosity proved efficient and safe both for asymptomatic patients and patients with clinical manifestations of CVI. Significantly better results were observed in the group subjected to eversion carotid endarterectomy with resection of the excessive ICA, with brining down and reimplantation into the ostium as compared with carotid endarterectomy with a patch and as compared with ICA resection with prosthetic repair.