CLINICAL AND NEUROPHYSIOLOGICAL CRITERIA OF EFFICIENCY OF CAROTID ENDARTEKTOMY - WITHIN THE ACUTE PERIOD OF THE ISHEMIC INSULT

Open Access Open Access
Restricted Access Subscription Access

Abstract


The dynamics of spectral indexes of the electroencephalography and indexes of somatosensory evoked potentials has been studied during the examination of people suffering with ishemic atherothrombotic insult; in the course of treatment of these patients in the most acute period the carotid endartectomy on the side of the brain infarct has been performed. Materials of the examination. As a basis of the work results of examination of 54 patients have been taken which have the first stroke in their anamnesis, by the ischemic type with hemispheric location of the infarct and atherothrombotic variant of insult development in case of haemodynamically significant involvement of the internal carotid artery. In the course of treatment of all the patients within 2 weeks since the beginning of the disease the carotid endartectomy has been performed. Among them there were 44 men (81%) and 10 women (19%). The average age of patients amounted to 69.14±7.4 years old. The total score in correspondence with the NIHS scale during 1 day amounted to 12.4±2.7. The average value of the constrictive involvement of the internal carotid artery on the side of the infarct amounted to 81.2±3.1. 34 (62%) patients suffered with the bilateral involvement of carotid arteries: bilateral involvement of the internal carotid artery with the medium severity contralateral stenosis (the stenosis covered 61-74% of the lumen) - 31.2% (n=17), bilateral involvement of the internal carotid artery with the low severity contralateral stenosis (stenosis of less than 60% of the lumen) - 16.7% (n=9), at high severity bilateral stenosis of the internal carotid artery the percentage amounted to 14.8% (n=8). The average value of the stenosis on the opposite side amounted to 64.6±2.6. The arterial hypertension was noted in the course of examination of 38 (70.4%) persons. Methods of examination. For registration of the electroencephalography the 19-channel digital electroencephalographic and neurocartographic medical device was used. For the quantitative estimation of the power spectrum the neurocartographic device software („Neuro-cartographer“) was used. The analysis of monopolar derivations of electroencephalography was carried out with referential ear electrodes. The examination of somatosensory evoked potentials was carried out by using the 4-channel electrical neuro myograph medical device with functions of examination of evoked potentials of the brain. Opinion. During the treatment of patients suffering with the medium severity neurological deficit in accordance with the NIHS scale which have been operated within 2 weeks after development of the insult it was definitive that pathological changes of the electroencephalography have been reduced; this was expressed in the form of reduction of the power of slow-wave activity spectrum by the end of the first week after operation. The most expressed degree of these changes was present in frontocentral and frontotemporal parts of the both hemispheres. By the end of the third week after the operation, due to addition of compensatory mechanisms main values are normalized that is expressed in the form of lowering indexes of latency and increase of amplitude of the potential on the side of the involvement.

I V Stafeeva

Petrozavodsk State University

I P Dudanov

Petrozavodsk State University

corresponding member of the RAS

I A Voznyuk

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

  1. Баркаускас Е., Мескаскене А., Лаурикенас К. Риск, связанный с каротидной эндартерэктомией у пациентов с инфарктом головного мозга // Ангиология и сосудистая хирургия. 2005. № 1. С. 103-111. [Barkauskas E., Meskaskene A., Laurikenas K. The risk associated with carotid endarterectomy in patients with cerebral infarction, Angiology and vascular surgery. 2005. No 1. рр. 103-111.]
  2. Дуданов И.П., Белинская В.Г., Жуков А.Е., Зеленин В.В., Меркулов Д.В., Стафеева И.В., Гохман Е.А. Активная реперфузия головного мозга в острейшем периоде ишемического инсульта. Изменение диагностического стандарта // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2015. Т. VII, специальный выпуск. С. 17-19. [Dudanov I.P., Belinskaya V.G., Zhukov A.E., Zelenin V.V., Merkulov D.V., Stafeeva I.V., Gochman E.A. Active reperfusion of the brain in the acute period of ischemic stroke. Changing the diagnostic standard, Russian Neurosurgical Journal. Prof. A.L. Polenov. 2015. vol. VII, specialissue. рр. 17-19.]
  3. Дуданов И.П., Васильченко Н.О., Коблов Е.С. Хирургическое лечение стенозированных сонных артерий у пациентов с выраженным неврологическим дефицитом в остром периоде ишемического инсульта // Нейрохирургия. 2013. № 2. С. 18-24. [Dudanov I.P., Vasilchenko N.O., Koblov E.S. Surgical treatment of stenotic carotid arteries in patients with severe neurologic deficit in acute period of ischemic stroke, Neurosurgery. 2013. No 2. рр. 18-24.]
  4. AbuRahma A.F., Robinson P., Holt S.M., Herzog T.A., Mowery N.T. Perioperative and late stroke rates of carotid endarterectomy contralateral to carotid artery occlusion: results from a randomized trial // Stroke. 2000. No 31 (2). Р. 1566-1571.
  5. Bruls S., Van Damme H., Defraigne J.O. Timing of carotid endarterectomy: a comprehensive review // Acta Chirurgie Belgia. 2012. Vol. 112, No 1. Р. 3-7.
  6. Capoccia L., Sbarigia E., Speziale F., Toni D., Biello A., Montelione N., Fiorani P. The need for emergency surgical treatment in carotid-related stroke in evolution and crescendo transient ischemic attack // Journal Vascular Surgery. 2012. Vol. 55, No 6. Р. 1611-1617.
  7. Crozier J.E., Reid J., Welch G.H., Muir K.W., Stuart W.P. Early carotid endarterectomy following thrombolysis in the hyperacute treatment of stroke // British Journal Surgery. 2011. Vol. 98. No 2. Р. 235-238.
  8. Караваев Б.И., Гавриленко А.В., Скрылев С.И., Куклин А.В. Метаболизм в головном мозге при каротидной эндартерэктомии (оксигенация, электролитный баланс, потребление глюкозы) // Ангиология и сосудистая хирургия. 2006. № 2 (4). С. 43-47. [Karavaev B.I., Gavrilenko A.V., Skrlev S.I., Kuklin A.V. Metabolism in the brain with carotid endarterectomy (oxygenation, electrolyte balance, glucose consumption), Angiology and vascular surgery. 2006. No 2 (4). рр. 43-47.]
  9. Malcharek M.J., Herbst V., Bartz G.J., Manceur A.M., Gille J., Hennig G., Sablotzki A., Schneider G. Multimodal evoked potential monitoring in asleep patients versus neurological evaluation in awake patients during carotid endarterectomy - a single-centre retrospective trial of 651 patients // Minerva Anestesiol. 2015. No 6. Р. 4-10.

Views

Abstract - 19

PDF (Russian) - 0

PlumX

Refbacks

  • There are currently no refbacks.

Copyright (c) 2017 Stafeeva I.V., Dudanov I.P., Voznyuk I.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.