Determination of indications for surgical treatment with a combination of stenosis and tortuosity of the internal carotid artery in acute ischemic stroke

From 281 patients operated for acute IS, 112 (39,9%) had associated atherosclerotic stenoses with kinking of the internal carotid artery.
There were 3 groups defined: I group –patients, who had IS or transient ischemic attack and who were operated within 2 weeks from the beginning of acute cerebrovascular accident - 47 (42%) patients. II group - patients, who had IS or transient ischemic attack and who were operated from 2 to 4 weeks from the beginning of acute cerebrovascular accident - 10 (8,9%) patients. III group - patients, who had IS and who were operated later than one month from the beginning of acute cerebrovascular accident - 55 (49,1%) patients.
Research results
For surgery safety evaluation perioperative complications were taken into account, first of all from the position of the evaluation of the risk of hemorrhagic transformation of ischemic stroke after restoration of blood flow through the early carotid reconstruction, made in different periods of acuity.
The positive dynamics of neurological symptoms was observed in group I for 46 (97,9%) patients, in group II for 8 (80%) patients, in group III for 43 (76,2%) patients. It should be noted that full recovery had almost every third patient in group I and II.
It was determined that the most effective terms of reconstructive operations on carotid arteries are the first 2 weeks from the beginning of the development of the brain catastrophe.
Conclusion. Considering the analysis of frequency of postoperative complications, we determined that the patients with combined stenosis and kinking of the internal carotid artery who were operated without significant delay, have higher probability of the complete regression of neurological symptoms and consequently, disability reduction and restoration of the original employability in comparison with patients who were operated it terms of 4 or more weeks after the first symptoms appearance.