FIELD: medicine; cardiovascular surgery.
SUBSTANCE: open surgical access is performed to the common carotid artery (CCA) in the distal third and, additionally, to the external and internal carotid arteries (ICA) in the proximal third. Then the CCA and ECA are mobilized and fixed with silicone tape. Next, the CCA is clamped in the distal third, and the ECA in the proximal third using clamps. A longitudinal arteriotomy of the carotid artery is performed with a transition to the internal carotid artery (ICA) for 2–3 cm, then thrombotic masses are evacuated from the bifurcation of the carotid artery and the ICA in an accessible area, followed by carotid endarterectomy. Then the clamp is removed from the CCA for not more than 1 second to determine the restoration of blood flow. Then it is re-clamped, after which a 6Fr introducer is installed in the ICA and direct angiography of the precerebral and cerebral arteries is performed to identify the location of thrombotic masses, then a reperfusion catheter is installed through the introducer and local endovascular thrombus aspiration is performed from the intracranial sections of the ICA and the arteries of the anterior circulation of the brain. The catheter is removed, after which control angiography is performed, the catheter and int are removed, the ICA is clamped with a clamp, and the arteriotomy hole is sutured. Restoration of blood flow is performed, then the CCA is punctured and control angiography is performed, followed by drainage and suturing of the wound.
EFFECT: method allows to adequately restore the patency of blood flow through the ICA and arteries of the anterior circulation with regression of neurological deficit, reduce the risk of progression of neurological deficit and the risk of hemorrhagic stroke.
1 cl, 1 ex
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Authors
Dates
2024-01-11—Published
2023-04-19—Filed