ASSESSMENT OF EFFICACY OF SURGICAL CEREBRAL REVASCULARIZATION IN PATIENTS WITH LARGE POST-STROKE CYSTS

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Abstract

Background: At present, efficacy of carotid endarterectomy for prevention of cerebrovascular accidents has been convincingly proven. Its results in patients with a history of an ischemic stroke depend on multiple factors.

Aim: To study results of reconstructive interventions on internal carotid arteries in patients with post-stroke cerebral cysts.

Materials and methods: We analyzed data from 210 patients who had undergone an intervention (159 men and 51 women, aged 61 ± 2.7 years) with occluding lesions of the internal carotid artery and a history of an ischemic stroke. Depending on the size of a post-stroke lesion, patients were divided into 5 groups: patients from group 1 had a lesion of more than 5 cm in diameter, from group 2, from 2 to 5 cm, from group 3, ≤ 2 cm, patients from group 4 had a lacunar cysts and patients from group 5 had no focal lesions.

Results: A clear positive correlation between the size of a post-stroke cyst and the degree of hemodynamic abnormalities in internal carotid arteries was found. The most prominent asymmetry of blood flow in the middle cerebral artery (on average, 34.1%) was seen in patients from the group 1. Patients from the group 1 more often had low and critical brain tolerance to ischemia (42.9%). In patients with large post-stroke cysts (group 1) mean Barthell index was 69 ± 8.1, and NIHSS score 8.2 ± 1.6. In patients from other groups neurological deficiency was less pronounced: 80 ± 6.8 and 7.6 ± 1.9 in the group 2, 82 ± 5.7 and 4.1 ± 1.3 in the group 3, 94 ± 4.6 and 3.2 ± 1 in the groups 4 and 5. The differences between groups in the rates of postoperative complications were not statistically significant (p > 0.5). However, signs of hyperperfusion without any clinical manifestations were more often observed in patients from the group 1 (19%). Assessment of changes in neurological status at 1 year after the intervention, depending on the size of post-stroke lesions, showed that in patients with large cysts the regression of neurological deficiency was less obvious, than in other groups (NIHSS 7.5 ± 1.7, Barthell index 76 ± 7.7). The best restoration of impaired neurological functions was seen in patients with small cysts (NIHSS 2.2 ± 0.7, Barthell index 91 ± 3.4).

Conclusion: In patients with large and intermediate post-stroke cerebral cysts surgery is associated with a higher complication rate, and, first of all, of hyperperfusion syndrome. However, the risk of these complications is significantly smaller than the probability of repeated acute cerebrovascular accidents.

About the authors

R. N. Lar'kov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

PhD, Head of Department of Vascular and Ischemic Heart Disease Surgery

Russian Federation

Yu. Yu. Kolesnikov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Junior Research Fellow, Department of Vascular and Ischemic Heart Disease Surgery

Russian Federation

P. G. Sotnikov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

PhD, Leading Research Fellow, Department of Vascular and Ischemic Heart Disease Surgery

Russian Federation

R. A. Lazarev

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru
Junior Research Fellow, Department of Vascular and Ischemic Heart Disease Surgery Russian Federation

S. S. Zagarov

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: szagarov@mail.ru
Junior Research Fellow, Department of Vascular and Ischemic Heart Disease Surgery Russian Federation

A. S. Kotov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Professor, Chair of Neurology, Postgraduate Training Faculty; Deputy in Research of the Head of Department of Pediatric Neurology

Russian Federation

M. A. Litvinenko

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Postgraduate Student, Chair of Neurology, Postgraduate Training Faculty

Russian Federation

E. K. Kazakova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Postgraduate Student, Chair of Neurology, Postgraduate Training Faculty

Russian Federation

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Copyright (c) 2015 Lar'kov R.N., Kolesnikov Y.Y., Sotnikov P.G., Lazarev R.A., Zagarov S.S., Kotov A.S., Litvinenko M.A., Kazakova E.K.

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