title: [Early reconstruction of supra-aortic vessels as a prevention of recurrent ischemic stroke].
abstract: OBJECTIVE
  To evaluate the efficacy and safety of supra-aortic vessels reconstruction within acute period of stroke.
  
  
  METHODS
  Early surgery was performed in 7 patients aged 67±9 years. Revascularization was made after 4.6 days after ischemic stroke on the average (range from 2 to 7 days). Neurological status before and after surgery was assessed using NIHSS scale, mean preoperative score was 3.9±2.7 (0-7). All patients had ischemic brain lesions (4-32 mm, mean 10 mm) unilateral with carotid stenosis or occlusion. Carotid artery stenting was performed in 2 patients, carotid endarterectomy - in 4 patients and stenting of segment I of the left subclavian artery was made in 1 case.
  
  
  RESULTS
  There were no mortality and recurrent postoperative ischemic stroke. Complications occurred in two patients: postoperative hematoma and intraoperative transient ischemic attack that developed during CAS after 5 days of a stroke. There was positive neurological dynamics after revascularization: there was almost 2-fold decrease of mean score of neurological deficit (from 3.9±2.7±1.7 to 2).
  
  
  CONCLUSIONS
  Early surgical prevention of recurrent stroke (up to 7 days) can be performed effectively and safely in carefully selected patients with ischemic stroke (neurological deficit less than 3 Rankin scores and less than 7 NIHSS scores, ischemic lesion dimensions lass than 4 cm). Reconstruction of supra-aortic vessels in acute stage of stroke improves the neurological status and reduces the degree of motor and sensory disorders. However, currently there are no clear criteria for inclusion and exclusion of patients for early revascularization using both degree of neurological deficit and size of ischemic lesion. So our results need to be confirmed by large trials.
authors.affiliation: Chair of Surgery and Endoscopy, Faculty of Additional Professional Education of the Pirogov Russian National Research Medical University.
authors.forename: A I
authors.initials: AI
authors.lastname: Khripun
authors.affiliation: Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: A V
authors.initials: AV
authors.lastname: Salikov
authors.affiliation: Chair of Surgery and Endoscopy, Faculty of Additional Professional Education of the Pirogov Russian National Research Medical University; Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: A D
authors.initials: AD
authors.lastname: Pryamikov
authors.affiliation: Chair of Surgery and Endoscopy, Faculty of Additional Professional Education of the Pirogov Russian National Research Medical University; Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: A B
authors.initials: AB
authors.lastname: Mironkov
authors.affiliation: Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: S A
authors.initials: SA
authors.lastname: Asratyan
authors.affiliation: Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: M V
authors.initials: MV
authors.lastname: Abashin
authors.affiliation: Buyanov City Clinical Hospital, Moscow Health Department.
authors.forename: V P
authors.initials: VP
authors.lastname: Mikhaylenko
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013348:Subclavian Artery / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*