Matyushkin A V, Mustafin A Kh
Pirogov Russian National Research Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2021(3):50-56. doi: 10.17116/hirurgia202103150.
To determine the most optimal period of surgical treatment after previous stroke.
There were 186 patients with significant ICA stenosis and previous unilateral stroke for the period 2008-2014 at the Pletnev Hospital (Moscow). Surgical approach was used in 136 (73.1%) patients (group I), conservative treatment at the neurological department - in 50 (26.9%) patients (group II). We analyzed neurological and cognitive status in both groups, regression of symptoms depending on the period after stroke, early and long-term postoperative outcomes.
In early postoperative period, 7 (5.1%) cerebral ischemic events (transient ischemic attack (TIA) and stroke) occurred in the 1st group. No correlation of neurological complications and type of intervention was revealed. In long-term period, stroke occurred in 3.6% in the first group and in 14% in the second group over the same period. Surgical treatment was followed by more complete recovery of neurological functions (NIHSS score 6.2±0.5 versus 7.0±0.8; modified Rankin score 1.5±0.2 versus 2.1±0.5, <0.05) and cognitive mechanisms (MoCA score 22.04±1.48 versus 20.04±1.48, <0.05).
Carotid endarterectomy and carotid artery stenting are effective for prevention of recurrent stroke. Carotid artery repair accelerates recovery of cognitive functions and regression of neurological symptoms in these patients.
确定既往卒中后手术治疗的最佳时期。
2008年至2014年期间，普列特涅夫医院（莫斯科）有186例患有严重颈内动脉狭窄且既往有单侧卒中的患者。136例（73.1%）患者采用手术治疗（第一组），50例（26.9%）患者在神经科接受保守治疗（第二组）。我们分析了两组患者的神经和认知状态、卒中后不同时期症状的缓解情况、早期和长期术后结果。
术后早期，第一组发生了7例（5.1%）脑缺血事件（短暂性脑缺血发作（TIA）和卒中）。未发现神经并发症与干预类型之间存在相关性。在长期随访中，同期第一组卒中发生率为3.6%，第二组为14%。手术治疗后神经功能恢复更完全（美国国立卫生研究院卒中量表（NIHSS）评分6.2±0.5对7.0±0.8；改良Rankin量表评分1.5±0.2对2.1±0.5，P<0.05），认知功能（蒙特利尔认知评估量表（MoCA）评分22.04±1.48对20.04±1.48，P<0.05）也有所改善。
颈动脉内膜切除术和颈动脉支架置入术对预防复发性卒中有效。颈动脉修复可加速这些患者认知功能的恢复和神经症状的缓解。
