ИСТИНА

Background. Treatment of acute and chronic cerebral ischemia remains an urgent problem of world heathcare. A unique opportunity of neurosurgery is the ability to perform surgical interventions at all levels of the vascular system of the brain - from the branches of the aortic arch to cortical and pial arteries for the treatment and prevention of cerebral ischemia. Methods. During the last 20-years over 2500 patients with stenotic and occlusive pathology of brachiocephalic arteries were treated, who underwent over 3000 surgical interventions. The surgical interventions included open reconstructive operations on the carotid (n=2031) and vertebral arteries (n=135), cerebral revascularization (n=658), excision of neurovascular bundle tumors, compressing the carotid arteries (n=51), endovascular interventions (n=223): angioplasty and stenting of extracranial segments of the brachiocephalic arteries (n=185), stenting of intracranial arteries (n=30) and endovascular thrombextraction (n=8). Staged surgical interventions were performed in 541 patients (22.3%). Results. When evaluating the results, the clinical outcomes and the state of the reconstructed vessels and created anastomoses were assessed. In most cases, good results were obtained - 87.6%. In 9% of cases, the results of treatment were assessed as "satisfactory" - patients developed asymptomatic restenosis or thrombosis of the reconstruction area, or failed to achieve the expected clinical effect. In 2.9% of cases, there was a worsening of clinical symptoms as a result of complications (“unsatisfactory” results). Complications of surgical treatment were seen in 4.6% of cases, while persistent neurological defects developed in 2.6% of cases, and lethal outcomes - in 0.5% of cases. Conclusions. Surgical treatment of steno-occlusive pathology of brachiocephalic arteries is a multifaceted interdisciplinary problem. The main modern trends in the neurosurgical approach to this problem are the individual approach of surgical tactics, including a reasonable combination of both endovascular and direct methods of reconstruction and revascularization of both extracranial and intracranial arteries.