[Tactics and indications in the surgical treatment of patients with combined extra- and intracranial lesions of the carotid arteries].

The article deals with the results of surgical treatment of 159 patients with concomitant extra-intracranial and bilateral lesions of the carotid arteries; 163 operations were conducted for the formation of an extra-intracranial microanastomosis (EICMA) among which 75 operations comprised reconstruction of extracranial segments with creation of EICMA. In 66 cases EICMA was performed in contralateral stenosis of the internal carotid artery (in 22 with subsequent carotid endarterectomy), in 14 cases as the first stage before reconstruction of the iliofemoral segment, and in 8 cases in occlusion of the middle cerebral artery or in tortuous carotid arteries. Complex examination was conducted, including ultrasonic dopplerography, transcranial dopplerography, study of cerebral blood flow according to Xe-133 clearance, and angiography. The late-term results of surgery were studied in follow-up periods of 6 months to 5 years. It was found that to appraise the indications for surgical treatment it is necessary to take into account the data obtained in studying the regional cerebral blood flow. Surgical treatment is indicated in occlusion of the internal carotid artery (with preliminary reconstruction of extracranial segments when they are involved) in patients with unstable type of cerebral hemodynamics, which is most characteristic in patients with transitory ischemic episodes, dyscirculatory encephalopathy, small apoplexy and predominantly with mild sequelae of ischemic apoplexy.