[Protocol of examination and surgical management of patients with stenosing lesions of the major brain arteries].
The paper contains the protocol of examination and surgical management of patients with stenosing lesions of mail cerebral arteries. Diagnostic algorithm including evaluation of clinical and instrumental data is presented. Indications for ultrasonic (duplex scanning, transcranial Doppler study) and neuroradiological (CT, spiral CT angiography, MRI) methods of assessment of stenosing lesions are described. Indications for digital subtraction angiography as well as CT- and MR-angiographic studies in postoperative period are to be specified. Variants of reconstructive surgical procedures on carotid, vertebral and subclavial arteries, surgical revascularization of the brain and endovascular procedures on brachiocephalic arteries are discussed. Indications and contraindication to different kinds of surgical treatment and selection of anesthesia are listed. Methods of intraoperative multimodal and neurodynamic monitoring and criteria of application of temporary intraluminal shunt on the main stage of carotid reconstructions are described. Tactics of step-by-step surgical management of multiple stenosing lesions of brachiocephalic arteries is presented. The paper also contains recommendations for preoperative preparation and early and delayed postoperative management of patients.
Usachev
D Iu
DIu
Lukshin
V A
VA
Iakovlev
S B
SB
Arustamian
S R
SR
Shmigel'skiĭ
A V
AV
D000465:Algorithms; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D016894:Endarterectomy, Carotid / Q000379:methods; D006801:Humans; D018810:Magnetic Resonance Angiography; D036542:Tomography, Spiral Computed; D017585:Ultrasonography, Doppler, Transcranial; D014656:Vascular Surgical Procedures / Q000379:methods*