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Endovascular thrombectomy (ET) effectively and safely recanalizes the occluded artery and restores the ischemic area in patients with acute ischemic stroke (IS), improving the clinical prognosis of stroke in the anterior and posterior circulation system, expanding the time therapeutic window from no more than 6 to 24 hours, greatly increasing the chances of functional independence and survival. However, some patients develop an unfavorable postoperative outcome, complications and “ineffectiveness” of revascularization. The thrombectomy result depends not only on the patient selection criteria, timing and success of the procedure, but on many other factors as well. Despite the advances in stroke treatment, the issues of neuroimaging and patient selection for ET remain relevant; the pathophysiological mechanisms of the influence of some factors on the effectiveness of the procedure are not completely clear; the causes of “uneffective” revascularization, unfavorable outcome and mortality after ET are unclear. An analysis of global experience in treating ischemic stroke with ET showed the heterogeneity of the patient selection criteria, clinical and neuroimaging variables, prognostic factors and treatment outcomes, which makes it difficult to draw a general conclusion and requires further targeted research. The article discusses the issues of patient selection, pathophysiological mechanisms of the influence of some risk factors on the outcome of ischemic stroke and the causes of unfavorable outcome and death after ET.

AIM OF STUDY. To analyze results of surgical treatment of infective endocarditis in the context of the COVID-19 pandemic at the N. V. Sklifosovsky Research Institute for Emergency Medicine. MATERIAL AND METHODS. From January, 2021 to April, 2022 at N.V. Sklifosovsky Research Institute for Emergency Medicine we performed 59 surgical interventions on patients diagnosed with infective endocarditis, of which 20 patients (33.9%) had a competing diagnosis “new coronavirus infection”. RESULTS. The overall mortality was for the specified period was 18.6 %, 11 patients. In the first group, 5 patients died (25 %). Hospital mortality in the second group was 6 patients (15.4 %). CONCLUSION. Preoperative preparation, as well as the surgical intervention itself, did not differ significantly between patients in the two groups. Hospital mortality in the group of patients with new coronavirus infection was higher than in patients without the virus, despite the fact that the risk of surgical intervention according to EuroSCORE II was higher in the second group. From which we can conclude that the EuroSCORE risk scale II does not fully reflect the initial severity of the condition of patients with COVID-19. Such risk factors as decreased immunity due to immunosuppressive therapy and respiratory failure and coagulopathy influenced the results of surgical treatment of infective endocarditis in this cohort of patients, but not so significantly as to refuse surgical intervention. The significant difference in the postoperative period was the increase in bed days in intensive care and therapeutic departments among patients with COVID-19. This factor is associated with the initial severity and specifics of management of these patients in the postoperative period, which required greater vigilance and attention from cardiac surgeons, resuscitators and infectious disease doctors in the “red” zones.

Relevance Abdominal aortic aneurysm is a common disease, manifested by an expansion of the abdominal aorta of more than 3 cm and accompanied by the development of serious complications with high mortality. There are symptomatic aneurysms, asymptomatic aneurysms and ruptured aneurysms. The timing of surgical intervention for symptomatic aneurysms still causes some controversy.Aim of study To determine the tactics and timing of surgery in patients with symptomatic abdominal aortic aneurysms.Material and methods The medical histories of 188 patients with symptomatic abdominal aortic aneurysms admitted to the Department of Vascular Surgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 152 men (80.8%) and 36 women (19.2%). The average age of those admitted was 69.8±2.5 years (from 53 to 84 years).Results All patients were divided into three groups, depending on the time of operation from the moment of admission: those operated in the first 24 hours (n=27); those operated from 24 to 72 hours from the moment of admission (n=20) and those operated later than 72 hours (n=136). The mortality by group was 14.8% in the first group, 20.0% in the second group, 7.3%in the third group.Conclusions Patients with symptomatic abdominal aortic aneurysm should be admitted to the intensive care unit for evaluation and preparation for delayed surgery. In cases where hospitalization in the intensive care unit is impossible or pain persists, the patient should be operated on urgently. When the pain syndrome is relieved and blood pressure is normalized, the patient can be further examined and operated on in a delayed manner.

Introduction According to domestic and foreign authors, the leading cause of death in victims with polytrauma is blood loss. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the new promising ways to manage bleeding in patients in a state of traumatic shock. There are a large number of publications in the world scientific literature indicating the high effectiveness of this technology in the treatment of bleeding. However, in the Russian Federation, this method has not yet entered into everyday practice, and scientific research on this matter is scarce. AIM Based on literature data and analysis of our own sample, to justify the need to use REBOA technology for the treatment of victims with polytrauma.Material and methods A retrospective analysis of the medical records of patients with polytrauma admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021 was carried out. Data from medical records and the Results of forensic medical examinations were studied. The main sample included victims with polytrauma (Injury Severity Score, ISS, of more than 17 points) delivered from the scene of the incident in a state of traumatic shock (systolic blood pressure, SBP, of less than 90 mm Hg) and a verified source of bleeding. To assess the potential survival of victims, we used the Trauma Score and Injury Severity Score (TRISS) scale.Results Of the 92 patients with polytrauma, 19 patients (20.6%) had indications for REBOA. The most common sources of bleeding were injuries to the pelvic ring, 14 (73.7%), abdomen, 11 (57.9%), and chest, 7 (36.8%). In 6 victims (31.5%), there were combined abdomen and pelvic injuries as the area of blood loss. The mean age of the victims was 48.8±19.9 years, the mean ISS value was 39.4±20.1. On admission, the mean SBP was 62.4±31.5 mm Hg, and heart rate — 91.8±43.3 beats/min. In 8 victims (42.1%), norepinephrine was administered immediately upon hospitalization at an average dose of 837.5±537.0 ng/kg/min. As a result of their injuries, 15 patients (78.9%) died, and 4 were discharged from the hospital. According to the Conclusions of forensic experts, the leading cause of death was blood loss in 11 (61.1%), severe traumatic brain injury (TBI) in 4 (22.2%), and infectious complications in 3 cases (16.7%).The TRISS was calculated for each patient. In order to identify the most potentially viable patients with indications for REBOA, we excluded 5 patients with severe TBI (the mean TRISS was 20.9±11.1%), and 5 patients with the TRISS of less than 50% (the mean TRISS was 10.0±14.1%), the latter died from hemorrhagic shock. Among the remaining 9 patients with higher TRISS values, 5 (26.3%) who died had the mean TRISS of 80.5±15.8%, comparable to the mean TRISS of 83.3±2.4% in the 4 survivors.Conclusion 1. According to foreign and domestic publications, the technology of resuscitation endovascular balloon occlusion of the aorta (REBOA) is effective for stopping internal bleeding in patients with polytrauma. 2. When analyzing our own sample of patients, it was proven that 20.6% of patients with polytrauma had indications for the use of REBOA. Most of them (78.9%) died. The main cause of death was hemorrhagic shock. 3. About a quarter of patients (26.3%) with indications for REBOA had a potentially high chance of survival. In the future, the use of this technology may reduce the number of deaths.

Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.

Introduction. Ischemic stroke (IS) remains one of the significant problems of modern medicine to this day. Cardioembolic stroke (CEI) accounts for 20 % of all cases of IS and is characterized by acuteness, severity of the disease and high mortality.Aim of study. An observation is presented in patient Sh., 51 years old, who was urgently transferred from another medical institution on the 3rd day after the development of acute recurrent anterior myocardial infarction with ST segment elevation complicated by early post-infarction angina pectoris. During the additional examination, in addition to severe multifocal atherosclerosis and multivessel coronary artery disease, a floating thrombus in the cavity of the left ventricle was detected. At the stage of preparing the patient for coronary artery bypass grafting, the patient developed stroke. Thrombextraction from the basilar artery (BA) was performed urgently. As a result, a complete regression of neurological symptoms was achieved. This made it possible to continue the preparation and successfully perform coronary artery bypass grafting. The patient was discharged on the 10th day after the operation, the entire hospitalization period was 28 bed-days.Discussion. In the presented case, a patient with a clinic of unstable angina pectoris, severe multifocal atherosclerosis, and multivessel coronary artery disease was in a specialized multidisciplinary hospital at the time of the development of stroke. The well-coordinated work of the multidisciplinary team, the possibility of performing thromboaspiration in the shortest possible time allowed not only to save the patient's life and achieve complete regression of neurological symptoms, but also to improve the quality of life through surgical treatment of coronary heart disease.

Background. Abdominal aortic aneurysm – is a widespread disease, which in some cases does not have any specific clinical symptoms, but possible complications of this pathology are characterized by high mortality. Aortic aneurism rupture is an extremely serious condition that requires emergency surgical treatment. A timely diagnosis of abdominal aortic aneurysm’s rupture risk remains extremely important, since the patient mortality rate is up to 7 times higher when performing an emergency surgery, than when performing a planned surgery. Aim of study: to improve the diagnosis of abdominal aortic aneurysms instability by creating an assessing scale of aortic rupture risk according to computed tomography data. Materials and methods. CT studies were performed by a 160-slice CT scanner and included the native and arterial phases of the scanning. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm were retrospectively studied, in 46 of whom the condition was complicated by an aortic rupture. CT scans can reveal a number of specific structural changes in the aorta and also surrounding tissues, which can be regarded as aortic wall rupture prediction. That specific structural changes were stratified by severity and the preliminary results were compared with the treatment tactics and the outcome of the disease. Results. The MSCT data of 179 patients with diagnosed abdominal aortic aneurysm shows that the minimum and sufficient set of abdominal aortic aneurysm rupture predictions are: aneurysm size, a sickle sign, aortic wall draping sign, paraaortic fat induration, the thickness of parietal thrombotic masses. The obtained parameters give the possibility to predict the risks of AAA rupture. The prognostic scale is represented by a 4-point scale for assessing aneurysm parameters. Depending on the influence degree of each parameter, it is assigned a number of points corresponding to the level of prognostic significance. The maximum number of risk factors is 17 points. Finding. The assessing scale of the abdominal aortic aneurysm rupture’s risk according to computed tomography data was developed.

RELEVANCE Thrombosis of a popliteal artery aneurysm is an intractable problem. For decades, the number of amputations in this disease has remained at the level of 20% and does not have a significant downward trend due to the fact that during thrombosis of an aneurysm, the infragenicular arteries, the only “outflow paths” for bypass surgery, are also thrombosed. Currently, in order to increase the capacity of the peripheral bloodstream, thrombolytic therapy has been proposed.AIM To evaluate the effectiveness of preoperative and intraoperative thrombolytic therapy in the surgical treatment of thrombosed popliteal aneurysms.MATERIAL AND METHODS In the period from 1997 to 2020, 94 patients with acute ischemia of the lower extremities caused by thrombosed popliteal aneurysms underwent 98 reconstructive surgeries at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The age of the patients was 62.5±10.1 years. Group I (n=66/98 patients, 67.3%) consisted of patients after primary reconstructive surgery; Group II (n=32/98, 32.7%) consisted of patients who, in order to improve the patency of the infragenicular arteries, underwent thrombolytic therapy in addition to surgery (12 preoperative catheter-directed, 20 intraoperative). A retrospective analysis was carried out.RESULTS Limb preservation was achieved in 86.7% of patients. In Group I, early postoperative thrombosis occurred in 22.7% of cases (n=13/98), in Group II — in 6.3% (n=2/32), p

BACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority.

Clinical case. A patient after mitral valve replacement surgery for infective endocarditis was hospitalized with a new coronavirus infection. The examination revealed a left ventricular-right atrial communication. The complex treatment with a good clinical effect was performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Conclusions In the context of a pandemic of a new coronavirus infection, patients with a new coronavirus infection who have undergone a history of heart surgery are subject to greater clinical vigilance regarding the development of postoperative complications, including rare ones.

ABSTRACT Acute lower limb ischemia (ALLI) is a limb threatening condition with high risk of adverse outcomes. The timely and proper diagnosis of the severity of limb ischemia is crucial in selecting the optimal treatment method.AIM OF STUDY To evaluate the advantages of hybrid imaging in diagnosis of ALLI, patient selection and its severity in order to choose an optimal revascularization method.MATERIAL AND METHODS we examined 163 patients with grade 1–3A ALLI based on I.I. Zatevakhin et al. classification (2002) on a Discovery 670 NM/CT hybrid device, using X-ray (computed tomographic angiography) and radionuclide method (three-phase scintigraphy/single photon emission computed tomography with osteotropic or perfused radiopharmaceutical).RESULTS CT angiography accurately showed level of acute occlusion as well as distal arterial blood flow in all ALLI cases, thus allowing optimal choice of possible revascularization. CT angiography findings alone did not allow optimal staging of ALLI, which is essential for choosing an optimal revascularization method and were considered as supplementary. Three-phase scintigraphy allowed to differentiate the degrees of ALLI based on the visual picture and calculated data, while studies with osteotropic radiopharmaceutical 99mТс-PYP provided information on viability of affected tissues showing the areas of muscle necrosis, compared to perfused radiopharmaceutical.CONCLUSION 1. CT angiography makes it possible to assess in detail the level and severity of occlusive lesions of the arterial system and study the vascular anatomy of the lower limb to resolve the issue of the possibility of revascularization, and also indirectly characterizes the presence of ischemic changes in soft tissues. 2. The radionuclide method (three-phase scintigraphy with an osteotropic radiopharmaceutical/single photon emission computed tomography), performed in addition to computed tomographic angiography, allows not only to detect the presence of ischemic changes in soft tissues, but also to differentiate the degree of acute ischemia of the lower. 3. The hybrid method (three-phase scintigraphy in combination with computed tomographic angiography) contributes to an objective assessment of the state of blood flow in the lower extremities in acute ischemia, both at the main and at the microcirculatory

Radiological methods are usually applied for the diagnosis of tuberculous spondylitis. Any of the imaging techniques (radiography, CT and MRI) has its own possibilities and limitations in the detection of this disease. Objective was to clarify the possibility of using a multislice linear tomography (digital tomosynthesis) of the spine and an automated classifi ed system of experimental scientific association in physics science and technology (ACS ESAPST) in detecting bone destructive changes in tuberculous spondylitis. The correlation was carried out between X-ray techniques (computed tomography and tomosynthesis and data obtained during treatment with ACS ESAPST. Tomosynthesis also allows to obtain a highly informative digital X-ray image and is almost comparable to CT for the detection of bone destructions in patients with tuberculous spondylitis. Tomosynthesis can replace computed tomography in some cases and provides many of the tomographic benefits (simplicity, speed, a reduced radiation dose and cost) in comparison with CT. In addition to the main radiology techniques, we found that using an automated classified system of experimental scientific association in physics, science and technology (ACS ESAPST) may help to detect tuberculous changes in the osteo-articular system.. ACS ESAPST can be used in patients with suspected development of a specific process in the osteo-articular system. An integrated approach in the diagnosis of tuberculous spondylitican be useful for diagnosis of bone tuberculosis at an early stage of the disease. And timely examination of this group of patients may prevent the development of irreversible complications.

The aim of study Based on computed tomography data, to determine the most characteristic criteria for true lumen (TL) and false lumen (FL) in aortic dissection. To identify the relationship of the studied features with the stage of aortic dissection.Materials of the study Computed tomography (CT) data of 115 patients diagnosed with aortic dissection (AD) who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The average age of the patients was 54.5 years (median — 56 years), men predominated in the studied group. AD types according to the De Bakey classification were distributed as follows: Type I — in 47% of patients, Type II — in 16.5%, Type III — in 36.5%. Dissection in the acute stage occurred in 62% of the patient, in the subacute — in 16%, in the chronic — 22%.Results In the studied group, FL in all cases prevailed over the TL by size, regardless of the stage and type of AD. Analysis of lumen ratio showed that in 63.55% of patients, FL occupied 75% or more of the aortic cross-sectional area. Location of FL: at the level of the ascending aorta, along the right and anterior walls of the aorta — 94.5%; in the descending thoracic aorta, along the posterior and left walls — 84%; in the abdominal aorta, along the posterior and left walls — 70%. Calcifications of the non- dissected part of the aortic wall, as a sign of a true lumen, were found in 59.1%. There was no correlation between calcification and the AD stage. Partial thrombosis of one of the lumens was detected in 59% (in FL — 85%, in TL — 13%, thrombosis of both lumens — 2%). The beak signs occurred in 85% of patients with AD, however, it was significantly more often detected in patients with acute and subacute AD stages than in the chronic stage (p

Percutaneous interventions for the purpose of sanation of cavities of pancreatogenic destruction can be one of the ways to treat pancreatic necrosis. This leads to a rapid cleansing of the cavities and is an objective method of monitoring the stages of treatment. We present a case of successful treatment of infected pancreatic necrosis using minimally invasive, percutaneous, X-ray endovascular methods. Procedures performed: superselective embolization of the upper and lower pancreaticoduodenal arteries, embolization of the gastroduodenal artery, embolization of the splenic artery, selective catheterization and embolization of the left gastric artery with microemboli and coils.

The course of severe coronavirus infection is accompanied by hypercoagulability with micro- and macroangiopathy, which may be the cause of arterial and venous thrombosis. In March, 2021 — May 2021, 14 patients with COVID-19 and acute ischemia of the lower extremities due to arterial thrombosis were operated in the Infectious Pavilion of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Retrombosis in the immediate postoperative period developed in 4 patients (26.7%). The amputation at the level of the thigh was performed in 2 patients (13.3%) due to the development of ischemic gangrene. The mortality was 71.4%, 10 patients died. The main cause of death was the progression of multiple organ failure in the course of severe viral-bacterial pneumonia. The best results were obtained with a combination of open surgery and endovascular technique, performing hybrid operations.

Abstract We analyzed the clinical condition of patients with COVID-19 of varying severity, changes in instrumental and laboratory parameters, and assessed the impact of the severity of the course of a new coronavirus infection on the outcomes of acute coronary syndrome.AIM OF STUDY To study the mutual influence of acute coronary syndrome and the new coronavirus infection COVID-19 on the nature of the course and outcomes of the disease.Materia l and methods In March 21, 2020 – May 31, 2021, 3 625 patients were treated for COVID-19, including 131 patients with acute coronary syndrome due to COVID-19 disease. All patients underwent a number of studies: computed tomography of the chest, electrocardiography, echocardiography, monitoring of biomarkers of myocardial damage, diagnostic coronary angiography and, if necessary, intracoronary therapeutic intervention.Results Data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on mortality in these groups, are presented. The role of troponin I in the assessment of myocardial ischemia was analyzed. The direct dependence of its level on the volume of lung damage was found. The inverse relationship was shown between the degree of damage to the lung tissue and the indices of oxygen saturation in the blood. A poor prognostic value of low left ventricular ejection fraction in patients with COVID-19 disease has been described.Conclusions The development of acute coronary syndrome in the course of COVID-19 significantly worsens the prognosis of the disease, which requires the development of algorithms for providing medical care to patients in this category, as well as maximum vigilance in their treatment.

Timely diagnosis and treatment of patients with acute aortic dissection continues to be one of the most important and discussed problems in emergency medicine. Due to accurate diagnosis and an effective surgical approach, the results of interventions for acute aortic dissection have improved, at least in specialized centers. However, for patients suffering from malperfusion against the background of acute dissection, the prognosis in some cases remains unfavorable. The cause of malperfusion can be stenosis or occlusion of the main branches of the aorta, which can be detected using computed tomography aortography (CT-AG). Today, it is the method of choice in the diagnosis of not only acute aortic dissection, but also its complications, including malperfusion ones. The purpose of this article is to analyze the capabilities of CT-AG in detecting various types of stenosis arising in the transition of dissection to the main branches of the aorta, as well as the actual manifestations of malperfusion in organs and tissues in acute aortic dissection, according to various authors.

Currently, reperfusion therapy is the main method of treating patients with ischemic stroke (IS). The safety and efficacy of systemic thrombolytic therapy with a recombinant tissue plasminogen activator in patients with IS within 3 hours, and then 4.5 hours after the onset of symptoms of the disease was demonstrated in the NINDS (1995) and ECASS III (2008) studies. In 2018, based on the results of five studies, clear indications were formulated for performing thrombectomy (TE) in patients with IS, which involve the detection of thrombosis of a large stroke-associated artery. Given the continuous growth in the number of the adult population, which constitutes the bulk of patients with IS, information on the prevalence of patients with thrombotic occlusion of cerebral arteries, who are potential candidates for TE, may be important for regional vascular centers.Aim of study. To describe IS patients admitted within the 6-hour “therapeutic window”.Materials and methods. The study included 145 patients with cerebral IS who were admitted within the first 6 hours after the onset of symptoms of the disease. All patients underwent computed tomographic (CT) angiography in order to verify the occlusion of the cerebral artery.Results. In our study, a correlation was established between the NIHSS severity of IS and the likelihood of verification of stroke-related artery thrombosis by CT angiography, but in 32.6% of patients with severe stroke (NIHSS at least score 14), no thrombotic occlusion was detected, and in 13% of patients with a clinic of mild acute cerebrovascular accident (NIHSS no more than 6), on the contrary, thrombotic occlusion was detected. Mortality in patients with verified thrombotic occlusion of the cerebral artery was higher than in patients without it (38% versus 10.5%, p˂0.001). Such a significant difference in the mortality rate was due to the initially more severe stroke (NIHSS at admission 17 [10; 23] versus 5 [2; 10], p˂0.001) in patients with thrombotic occlusion of a stroke-related artery, as well as a higher incidence of severe swallowing disorders (30% versus 9.5%, p˂0.002), which are a risk factor for pneumonia, as well as a higher frequency of such a comorbid background as chronic kidney disease and atrial fibrillation (30% versus 13.7%, p=0.018% and 58% versus 29.5%, p=0.001, respectively).Conclusion. 1. Thrombosis of the cerebral stroke-associated artery was detected in 34.5% of patients with ischemic stroke who were admitted within the first 6 hours from the onset of the disease. 2. The main reason for the failure to perform thrombectomy in patients with ischemic stroke admitted within the 6-hour therapeutic window is the lack of verification of stroke-related artery thrombosis using computed tomographic angiography. Due to thrombosis at a different location (other than thrombosis of the internal carotid artery and / or M1 segment of the middle cerebral artery), 10% of patients with verified thrombosis did not meet the currently existing selection criteria for thrombectomy.

Introduction. Aortic valve replacement in cardiopulmonary bypass with suture fixation of the prosthesis is the “gold standard” in cardiac surgery. Currently, the frequency of use of heart valve bioprostheses is increasing in older patients. Despite all the advantages of using heart valve bioprostheses, this type of prosthesis has a major drawback - it is not durable. In most cases, the reason for the dysfunction of prostheses in the late postoperative period is early calcification of the prosthesis valves or their rupture due to degeneration. With the development of new “gentle” techniques for replacing heart valves, transcatheter aortic valve implantation was introduced into clinical practice. The use of transcatheter aortic valve implantation (TAVI) “valve in valve” for reoperations in older patients is of great interest, since in recent years the procedure has been widely used in clinical practice and shows promising data in patients with high surgical risk.Aim of study. Show first experience of using a technique «valve in valve» at N.V. Sklifosovsky Research Institute for Emergency Medicine.Material and methods. The results of surgical treatment of a patient with aortic valve bioprosthesis dysfunction using the TAVI “valve in valve” technique are presented.Results. The use of the TAVI “valve in valve” method made it possible to perform reprosthetics of the aortic valve (AV) from a transfemoral approach, not to increase the volume of intervention during reoperation, to avoid trauma to the structures of the heart and nearby tissues when accessing the AV in a patient with a high surgical risk.Conclusion. The use of the TAVI “valve in valve” method in cardiac surgery makes it possible to achieve good immediate and long-term results when it is necessary to replace the AV in patients with a high surgical risk.

Introduction. This article is devoted to the discussion of a life-threatening condition - basilar artery thrombosis (BAT). The article presents the results of a comparative analysis of two groups of patients with angiographically confirmed BAT: with and without reperfusion therapy.Relevance. Basilar artery thrombosis is a life-threatening condition in which mortality can reach 95%, and severe neurological deficits and dependence in everyday life on others (modified Ran-kin Scale (mRS), score 4–5) are observed in 65% of surviving patients. Ischemic stroke (IS) due to BAT is diagnosed in 1–4% of patients with acute cerebrovascular event (ACVE). Currently, reperfusion therapy (RT) in the form of systemic thrombolytic therapy (sTLT) with rt-PA and/or thrombectomy (TE) is the only effective and safe method for treating patients with IS. In randomized trials, it was found that RT, whether it is sTLT, TE or a combination of these techniques, despite the best degree of functional recovery in patients by day 90 from the onset of the disease, does not lead to a statistically significant decrease in mortality. Nevertheless, the results of 10 prospective studies of the use of endovascular treatment in patients with IS in the posterior circulation system indicate that this type of therapy leads to a decrease in 90-day mortality from 95% to 16–47% in case of successful recanalization (mTICI (modified Thrombolysis in Cerebral Infarction), 2–b–3).Aim of study. To assess the safety and efficacy of TE in patients with BAT.Material and methods. This study included 15 patients with IS, admitted within the 6-hour therapeutic window, and confirmed BAT by CT and/or MRangiography. The baseline level of wakefulness was assessed using the Glasgow Coma Scale (GCS), and the severity of neurological deficit was assessed by the National Institutes of Health Stroke Scale (NIHSS).Results. Basilar artery thrombectomy was performed in 7 patients (endovascular treatment group), 8 patients received no endovascular treatment (standard therapy group). Good clinical outcomes by day 90 from the onset of the disease (mRS, score 0–2) were observed in 57.1% of patients in the endovascular treatment group and in 12.5% of patients in the standard therapy group. However, these differences were not statistically significant (p>0.05). There were also no differences between the two groups in functional outcomes and Rivermead mobility index (RMI) by day 90 from the onset of the disease (Barthel Index of Activities of Daily Living (BI) score 97±5.0 and 100, RMI score 14.0±0.0 and 15 in the endovascular treatment group and standard therapy group, respectively). Mortality by day 90 in the endovascular treatment group was 42.9% (3 patients), in the standard therapy group — 87.5% (7 patients). In the subgroup of patients with GCS score at admission no more than score 8, there was a statistically significant strong two-way negative correlation between TE performance and mortality (r=-1.0; p=0.000), as well as a positive correlation between TE and a Rankine score by day 90 (r=0.956; p=0.003). Mortality was statistically significantly lower in the endovascular treatment group compared to the standard therapy group (0% versus 100%, respectively, p=0.025). Clinical outcomes of the disease by day 90 were statistically significantly better in the endovascular treatment group: mRS, score 0–2 in 100% of cases versus 0% in the standard treatment group (p=0.028).Conclusion. Currently, the only effective treatment for basilar artery thrombosis is thrombectomy. The possibility of performing thromboectomy in these cases should be considered in all patients, regardless of the severity of the stroke and the decrease in the level of wakefulness, since endovascular treatment in this case is a life-saving procedure. The symptom of a hyperdense basilar artery can be used as a diagnostic tool for suspected basilar artery thrombosis, but should not rule out angiography. In our series of observations, the mortality rate in patients who underwent thrombectomy was 42.9%. Good functional outcomes (mRS, score 0–2) and the absence mobility limitation (RMI, score 14) were observed in 57.1% of patients by day 90 after thrombectomy.

An important place in the structure of cardiovascular morbidity is occupied by myocardial infarction (MI), especially complicated MI, including complicated by the formation of left ventricular (LV) aneurysm. The latter is a very formidable complication and leads to such life-threatening conditions as ventricular arrhythmias, heart failure, thromboembolism. The purpose of the review is to analyze the publications of foreign and Russian authors on risk factors, outcomes and treatment of patients with postinfarction LV aneurysm. Attention is paid to the role of registers in the study of this problem, as well as the analysis of literature data on the prevalence of such a complication as MI during the COVID-19 pandemic (COrona VIrus Disease 2019). It is shown that the registers of acute coronary syndrome, as a rule, do not contain separate data on patients with a formed LV aneurysm, risk factors for its development and outcomes in this group of patients. Postinfarction LV aneurysm can form only after transmural MI; therefore, it is important to keep records of patients diagnosed with transmural MI, primarily in the form of a register.

This review describes the state of the art on the role of various imaging modalities in pre-operative preparation to transcatheter implantation of biological aortic valve prosthesis, based on the literature data published from 2012 to 2020. One of the key source documents is the consensus of the European Society of Cardiovascular Radiology (ESCR) from 2019, providing the standardized protocols for scanning, measurements and description of the abnormalities identified. The final decision on the procedure of transcatheter aortic valve implantation should be based on the combination of all available diagnostic methods, clinical data and results of imaging by different modalities. Given the most comprehensive information content, the main diagnostic method is computed tomography. The radiologist and the multidisciplinary team should form a single entity, combining clinical and technical knowledge, discussing all the images and conclusions with other team members.

Lung ultrasound demonstrates a high diagnostic value in the assessment of lung diseases.Aim. To determine the diagnostic accuracy of lung ultrasound compared to chest computed tomography (CT) in the diagnosis of lung changes in COVID-19. Materials and methods. The retrospective study included 45 patients (28 men) aged 37 to 90 years who underwent polypositional lung ultrasound with an assessment of 14 zones. The study compared lung echograms with chest CT data in assessing the prevalence of the process and the nature of structural changes. The diagnostic accuracy, sensitivity, and specificity of lung ultrasound in comparison with CT scans were determined, 95% confidence intervals (CI) were calculated.Results. In 44 patients (98%), CT revealed pathological changes with subpleural localization in both lungs. Of these, in 30 cases, the inflammation was limited only to the subpleural parts, and in 14 cases, the changes spread to the basal parts of the lungs, while ultrasound revealed changes at the depth of the lesion no more than 4 cm. The lesion of 10–11 zones according to lung ultrasound corresponds to CT 1–2 degrees, the lesion of 13–14 zones — CT 3–4 degrees. The sensitivity of ultrasound to detect lung changes of various types was ≥ 92%. The highest sensitivity of 97.9% (95% CI: 92.8–99.8%) was determined for small consolidations on the background of interstitial changes (degree 1A+, 1B+), which corresponded to “crazy-paving” pattern on CT. The specificity depended on the nature of the changes and varied from 46.7 to 70.0%. Diagnostic accuracy was ≥ 81%, the maximum values of 90.6% (95% CI: 85.6–94.2%) were obtained for moderate interstitial changes (grade 1A) corresponding to ground-glass opacity (type one) according to CT data.Conclusion. The sensitivity of ultrasound to detect lung changes in COVID-19 is more than 90%. Lung ultrasound has some limitations: inability to determine the prevalence of the process clearly and identify centrally located areas of changes in the lung tissue.

Introduction. We present the clinical observation of a 72-year-old female patient with high surgical risk and structural degeneration of a bioprosthetic aortic valve (AV) cusps in the form of stenosis, accompanied by severe dysfunction. Transcatheter implantation of bioprosthesis Medtronic CoreValve™ Evolut™ R-23 was performed using the valve-in-valve technique. The choice of minimally invasive treatment tactics is substantiated, a preoperative examination algorithm and a specific bioprosthesis model for such intervention are provided. Materials and methods. Imaging – echocardiography (Echo), electrocardiography, multispiral computed tomography, coronary angiography. Bioprosthetic valve calcification and stenosis with critical parameters of the bioprosthetic AV peak pressure gradient according to Echo data were the indications for minimally invasive surgery. Results. Dynamic observation revealed a progressive deterioration in the function of the previously implanted bioprosthetic heart valve in the aortic position, and a critical deterioration in the patient’s condition. After additional examination of the patient and selection of a new prosthesis, valve-in-valve transcatheter aortic valve replacement was done. The positive dynamics of the general state of the patient was noted in the early postoperative period. Echo data showed that the bioprosthetic AV peak systolic pressure gradient decreased from 90 to 29 mmHg, average gradient – from 42 to 19 mmHg. Conclusion. The minimally invasive valve-in-valve transcatheter aortic valve replacement used to correct the dysfunction of a bioprosthetic AV that was previously implanted during an open surgery was shown to be safe and effective and can be considered as one of the options for repeat valve replacement.

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Background The use of neuroimaging methods is an integral part of the process of assisting patients with acute cerebrovascular events (ACVE), and computed tomography (CT) is the «gold standard» for examining this category of patients. The capabilities of the analysis of CT images may be significantly expanded with modern methods of machine learning including the application of the principles of radiomics. However, since the use of these methods requires large arrays of DICOM (Digital Imaging and Communications in Medicine)-images, their implementation into clinical practice is limited by the lack of representative sample sets. Inaddition, at present, collections (datasets) of CT images of stroke patients, that are suitable for machine learning, are practically not available in the public domain.Aim of study Regarding the aforesaid, the aim of this work was to create a DICOM images dataset of native CT and CT-angiography of patients with different types of stroke. Material and meth ods The collection was based on the medical cases of patients hospitalized in the Regional Vascular Center of the N.V. Sklifosovsky Research Institute for Emergency Medicine. We used a previously developed specialized platform to enter clinical data on the stroke cases, to attach CT DICOMimages to each case, to contour 3D areas of interest, and to tag (label) them. A dictionary was developed for tagging, where elements describe the type of lesion, location, and vascular territory.Results A dataset of clinical cases and images was formed in the course of the work. It included anonymous information about 220 patients, 130 of them with ischemic stroke, 40 with hemorrhagic stroke, and 50 patients without cerebrovascular disorders. Clinical data included information about type of stroke, presence of concomitant diseases and complications, length of hospital stay, methods of treatment, and outcome. The results of 370 studies of native CT and 102 studies of CT-angiography were entered for all patients. The areas of interest corresponding to direct and indirect signs of stroke were contoured and tagged by radiologists on each series of images.Conclusion The resulting collection of images will enable the use of various methods of data analysis and machine learning in solving the most important practical problems including diagnosis of the stroke type, assessment of lesion volume, and prediction of the degree of neurological deficit.

The objective of the study: to compare the degree of lung damage according to chest CT data to the clinical state of COVID-19 patient, to analyze the semiotics and changes in CT data. Subjects and methods. 317 CT scans were retrospectively analyzed; those scans belonged to 98 patients with COVID-19 treated at N.V. Sklifosovsky Research Institute for Emergency Medicine. Patients were divided into 4 groups, depending on the degree of the lungs damage detected by CT during the primary examination, their clinical state was assessed at each subsequent CT scan. To determine the relationship between the degree of pulmonary changes and the clinical status of patients, a correlation analysis was performed using the rank correlation method, significance was assessed using the Student's coefficient. Results. It was found that CT allowed to identify changes in the lungs typical of COVID-19 and assess their degree, as well as to analyze progression or regression lung changes, including comparison with clinical data. A significant correlation was revealed (rs = 0.577) between the growing degree of lung damage, as determined by CT and deterioration of the clinical status of patients.

The paper describes the first experience with endovascular embolization of artery of kidney graft irreversibly lost its function in fifteen years after transplantation, during preoperative preparation of patient to nefrotransplantatectomy. The purpose of the study – to show the effectiveness of the artery rentgenendovascular embolization of the artery of kidney transplant before the nefrotransplantatektomy as a method of preventing massive intraoperative bleeding and related complications. An angiography and the rentgenendovascular embolization of the artery of kidney transplant executed on the day of surgery allowed us to remove nefrotransplantat without any technical difficulties. The total intraoperative blood loss did not exceed 50 ml.

The article presents the results of a morphological study in 35 operated patients with uterine leiomyoma (lm) of various sizes and localizations, admitted with uterine bleeding. We studied morphological changes which occured in tumors and uterine tissues of patients with lm after therapy with agents and devices for embolization of uterine arteries (eua). The analysis of structural changes in the uterine arteries and body in patients with lm anduterine bleeding made it possible to clarify the mechanism of hemostasis. The obtained morphological data confirmed the validity of eua with a haemostatic purpose for patients with lm and uterine bleeding in the delivery of emergency medical care.

Chronic mesenteric ischaemia constitutes a condition characterised by a decreased abdominal blood flow, which is caused by the obstruction of visceral arteries. This short communication paper presents a clinical case of endovascular treatment in a patient with the obstruction of the celiac trunk, superior and inferior mesenteric arteries. Intestinal blood supply was provided through collaterals from the system of internal iliac veins via the inferior mesenteric artery, the arc of Riolan. This clinical case confirmed that percutaneous transluminal angioplasty and stenting of the visceral arteries is the method of choice in the surgical treatment of abdominal angina.

We report results of treatment for 72 patients with uterine leiomyoma (LM) of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE). We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

ABSTRACT. The review analyzes the possibility of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) use in the forensic examination of corpses of adults. We present the critical analysis of literature on post-mortem imaging in terms of forensic thanatology. The review is based on basic Internet resources: Scientific Electronic Library (elibrary), Scopus, PubMed. The review includes articles that discuss both advantages and limitations of post-mortem MSCT and MRI imaging in forensic examination of the corpse.Through studying the available literature, the authors attempted to answer two questions: 1) which method was more suitable for the purposes of forensic examination of the corpse - MSCT or MRI; 2) whether the virtual autopsy replaced the traditional autopsy in the near future?Conclusion: comprehensive study of the corpse often requires both imaging methods; in cases of death under mechanical damage, MSCT exceeds the range of possibilities of MRI; today, virtual autopsy cannot completely replace traditional autopsy in forensic science, since there are no convincing evidence-based comparative studies, as well as the legal framework of the method.

Study objective was to conduct a prospective observational study to assess the effect of pharmacointerventional tactics on the outcome of acute ST-elevation myocardial infarction (STEMI) in terms of mortality.MATERIAL AND METHODS. The study included 405 patients with acute STEMI. The Thrombolysis in Myocardial Infarction (TIMI) Risk Score was used to assess the coronary circulation recovery in a major epicardial coronary artery (CA). Percutaneoous coronary interventions (PCIs) were undertaken either as initial interventions, or in a framework of pharmacointervantional treatment tactics.RESULTS. Among 405 patients with STEMI, 154 (38%) underwent a thrombolytic therapy (TLT). Coronarography performed within 24 h from the onset of disease clinical symptoms demonstrated a completely occluded CA that had supplied blood to the area of present infarction in 73% of patients without previous TLT and in 74% of patients after TLT. TLT proved to be effective only in 36 % of patients. A successful revascularization, compared to that of inefficient, reduced the relative all-cause mortality risk and MI-caused mortality risk in the initially high-risk patients by 74% and 78 %, respectively.concLusIons A timely myocardium revascularization using PCI is effective after successfully performed TLT. This proves the benefit of pharmacointerventional treatment tactics for the patients with STEMI in the cases when initial PCI appeared impossible for some reasons.

Acute traumatic aortic rupture is associated with extremely high mortality rates and requires emergency diagnosis and treatment. This clinical example shows the role of multislice spiral computed tomography in the emergency diagnosis of rupture of two large arterial vessels in severe concomitant injury. It presents the benefits of this rapid and noninvasive imaging technique, an algorithm of the study and the semiotics of injuries in patientswith suspected traumatic aortic rupture. The paper also shows the importance of this method in defining treatment policy and then in the assessment of the results of the performed correction.

Abstract. We report the use of rheolytic thombectomy in two patients with severe pulmonary embolism. In first case RT was performed as the second step in treatment of pulmonary embolism after systemic thrombolytic therapy. In second case systemic thrombolytic therapy was not performed because of extremely high risk of duodenal ulcer bleeding. Hemolysis and acute kidney injure with requirement of plasmapheresis and continuous venovenous hemofiltration was required in patient who received big volume of thrombectomy (500 ml). Rheolytic thrombectomy resulted in good angiographic and clinical effect in both patients.

ABSTRACT. Treatment of acute limb ischemia remains a serious problem in vascular surgery. There are both surgical and conservative therapies. Systemic thrombolysis is one of supplementing methods, and in some cases, it is the method of choice, especially when surgical therapy is not possible. The paper presents our experience of systemic thrombolytic therapy in the treatment of acute limb ischemia.

ABSTRACT. The digital subtraction aortic arteriography with the transaxillar venous approach was successfully performed in a patient with multifocal atherosclerosis and inability to underwent any transarterial procedures. Fine-quality angiographic images of the thoracic and abdominal aorta and the arteries of lower extremities were obtained. The total volume of the injected non-ionic contrast medium Ultravist-370 was 210 ml.

Endovascular methods of diagnostics and treatment of cardiovascular diseases.

Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.

Эндоваскулярная эмболизация маточных артерий (МА) – перспективный метод лечения миом матки. Для успешного выполнения таких операций хирург должен знать анатомию сосудов таза и особенности кровоснабжения матки и придатков в норме и при доброкачественных опухолях. В данной статье мы обобщили работы отечественных и зарубежных авторов, а также собственный опыт по данной проблеме.