ИСТИНА

Objectives: To highlight the algorithms for choosing the tactics of treating patients with cerebral ischemia caused by stenosing and occlusive pathology of the brachycephalic arteries, the features of surgical interventions and the results of this treatment. 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 3500 surgical interventions in Burdenko Neurosurgical Center. The surgical interventions included open reconstructive operations on the carotid and vertebral arteries, cerebral revascularization for acute and chronic ischemia, excision of neurovascular bundle tumors, compressing the carotid arteries, endovascular interventions and various variations of staged and simultaneous surgical interventions using hybrid and pseudohybrid approaches for patients with complex combined pathology. Results: The use of a comprehensive individual approach to the examination and treatment of patients with steno-occlusive and combined pathology of the brachiocephalic arteries, taking into account clinical, angiographic and perfusion factors, made it possible to achieve good results of reconstructions in 88% of cases. 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 that goes beyond the standards. The conditions of the neurosurgical clinic allow the use of a comprehensive individual approach to determine surgical tactics, including a reasonable combination of both endovascular and direct methods of reconstruction and revascularization of both extracranial and intracranial arteries.