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Background. One of the most frequent causes of death is considered to be stroke on the back of atherosclerosis of the extracranial carotid arteries. Detection of atherosclerosis at an early stage facilitates timely prevention and reduces the risk of developing of an acute cardiovascular event in the future. Purpose. To evaluate the clinical significance of ultrasound in the diagnosis of atherosclerotic changes in the brachiocephalic arteries in people of different age groups. Materials and methods. Echography of brachiocephalic arteries was performed among 155 people aged 45 to 89 years, who were randomized into 3 age groups. The middle–aged group included 56 people; the elderly group – 54 people; the senile group - 45 people. The processing of the results of the study was carried out in the programs Statistica 10 (StatSoft, USA). Results. According to the data of sonography, atherosclerotic plaques were detected in 62.5% of the middle–aged group, 83.3% of the elderly group and 88.9% of senile age. Heterogeneous hypoechoic and calcified plaques are found only among people who are over 60 years old. Moderate stenosis was observed at the bifurcation of the common carotid artery in all age groups. Pronounced stenosis and critical vascular stenosis in the proximal part of the internal carotid artery are observed in senile age. The index of the maximum systolic velocity among people with atherosclerosis decreases with age. With increasing age, the level of vascular resistance increases. Conclusion. Considering significant changes in the indicators of atherosclerotic manifestations already in middle age, in order to reduce the increase in population mortality from cardiovascular diseases, the healthcare system should introduce early ultrasound screening of brachiocephalic arteries for patients from 18 years of age.

According to the World Health Organization, ischemic stroke is the second leading cause of death in the world. Frequently, it is caused by brachiocephalic artery (BCA) atherosclerosis. Timely detection of atherosclerosis and its unstable course can allow for a timely response to potentially dangerous changes and reduce the risk of vascular complications. Omics technologies allow us to identify new biomarkers that we can use in diagnosing diseases. This research included 90 blood plasma samples. The study group comprised 52 patients with severe atherosclerotic lesions BCA, and the control group comprised 38 patients with no BCA atherosclerosis. Targeted and panoramic lipidomic profiling of their blood plasma was carried out. There was a statistically significant difference (p < 0.05) in the values of the indices saturated fatty acids (FAs), unsaturated FAs, monounsaturated FAs, omega-3, and omega-6. Based on the results on the blood plasma lipidome, we formed models that have a fairly good ability to determine atherosclerotic lesions of the brachiocephalic arteries, as well as a model for identifying unstable atherosclerotic plaques. According only to the panoramic lipidome data, divided into groups according to stable and unstable atherosclerotic plaques, a significant difference was taken into account: p value < 0.05 and abs (fold change) > 2. Unfortunately, we did not observe significant differences according to the established plasma panoramic lipidome criteria between patients with stable and unstable plaques. Omics technologies allow us to obtain data about any changes in the body. According to our data, statistically significant differences in lipidomic profiling were obtained when comparing groups with or without BCA atherosclerosis. [ABSTRACT FROM AUTHOR]

According to the World Health Organization, ischemic stroke is the second leading cause of death in the world. Frequently, it is caused by brachiocephalic artery (BCA) atherosclerosis. Timely detection of atherosclerosis and its unstable course can allow for a timely response to potentially dangerous changes and reduce the risk of vascular complications. Omics technologies allow us to identify new biomarkers that we can use in diagnosing diseases. This research included 90 blood plasma samples. The study group comprised 52 patients with severe atherosclerotic lesions BCA, and the control group comprised 38 patients with no BCA atherosclerosis. Targeted and panoramic lipidomic profiling of their blood plasma was carried out. There was a statistically significant difference (p < 0.05) in the values of the indices saturated fatty acids (FAs), unsaturated FAs, monounsaturated FAs, omega-3, and omega-6. Based on the results on the blood plasma lipidome, we formed models that have a fairly good ability to determine atherosclerotic lesions of the brachiocephalic arteries, as well as a model for identifying unstable atherosclerotic plaques. According only to the panoramic lipidome data, divided into groups according to stable and unstable atherosclerotic plaques, a significant difference was taken into account: p value < 0.05 and abs (fold change) > 2. Unfortunately, we did not observe significant differences according to the established plasma panoramic lipidome criteria between patients with stable and unstable plaques. Omics technologies allow us to obtain data about any changes in the body. According to our data, statistically significant differences in lipidomic profiling were obtained when comparing groups with or without BCA atherosclerosis.

Aim. To identify the characteristic features of patients after ischemic stroke (IS), probably associated with spontaneous dissection of the extracranial sections of carotid and vertebral arteries, and compare such patients with persons with IS of other genesis.Material and methods. The comparison group without signs of dissection included 1326 patients who had IS. The main group of patients with signs of dissection included 122 people aged 54,46±14,68 (21-84) years, 48 (39,3%) women and 74 (60,7%) men, among whom 106 people had IS. The dissection was determined by computed tomographic angiography and/or magnetic resonance angiography and/or duplex ultrasound.Results. Patients with dissection were significantly younger than those without it (p0,05). In the group with the same location of the infarction and dissection, adjusted for age, vertebrobasilar system involvement were more common (p=0,033), while the proportion of men was significantly higher (p=0,021), and the patients were significantly younger (p=0,027).Conclusion. Patients with dissection of the carotid and/or vertebral arteries were significantly younger than those without it. We found that in patients with dissection, BMI was significantly lower and depended on age, while in patients without dissections, BMI did not depend on age. A number of differences were identified in the group of patients with stroke likely associated with dissection, in comparison with those with strokes of another genesis.

In most cases, patients with multifocal atherosclerotic lesions, including brachiocephalic arteries, are denied surgical treatment due to the high risks of intra- and postoperative complications. Despite the severe stenotic lesion of the carotid arteries, which can lead to such a major complication as ischemic stroke, in most cases surgeons refuse to perform the operation. Endovascular surgery is often the only option for these patients. After analyzing the world experience in the treatment of hemodynamically significant lesions of the arteries of the brachiocephalic basin and applying in practice various methods of endovascular interventions in patients with complex stenotic lesions of the internal carotid arteries, we were convinced that endovascular correction of such lesions is often the main method of treatment for patients with multifocal atherosclerosis, and can also be used as a primary method of treatment, as it demonstrates high effectiveness, low risk of complications and good long-term results.

Background and Aim: The cause of most strokes is associated with the pathology of the carotid arteries. Many modern researchers suggest preventive surgery in the presence of arterial deformity to prevent strokes. The hemodynamic significance of carotid deformities is determined by morphological and functional disorders at the level of tortuosity, the reaction of cerebral blood flow is not often considered. Here, we assume that cerebral autoregulation in tortuosity can be different. Methods and Materials/Patients: A total of 64 patients (31-75 years old) with 110 carotid deformities were analyzed. Duplex color mapping, computed tomography angiography of carotid arteries, and computed tomography perfusion were performed by estimating the absolute and average values of cerebral blood flow (mL/100 g/min), cerebral blood volume (mL/100 g), Mean transit time (MTT) (s) in similar areas of the cortex. In 6 patients, the acetazolamide challenge test was used to evaluate the autoregulatory disturbances. Results: According to computed tomography angiography and duplex color mapping, 18(28.1%) patients had unilateral tortuosity, and 46(71.9%) patients had bilateral tortuo s ity. Hemodynamically significant deformities were detected in 33 cases (30% of tortuosity). In 54 cases (49% of tortuosity), the deformities were accompanied by carotid stenosis. Perfusion disorders were detected in 23 of 64 patients (35.9%). In the majority of cases (75% of all perfusion disorders), hypoperfusion was diagnosed on the side corresponding to the maximum degree of stenosis, regardless of the location of the tortuosity. Neurologically significant hypoperfusion, compensated by collateral blood flow revealed only in 7.8% of cases of hemodynamic significant internal carotid artery deformity without concomitant atherosclerosis. Conclusion: The decision on surgical correction of carotid artery tortuosity should be made while considering both local changes in hemodynamics and proven violations of autoregulation of cerebral blood flow, especially in patients with concomitant carotid stenosis. [ABSTRACT FROM AUTHOR]

Background and Aim: The cause of most strokes is associated with the pathology of the carotid arteries. Many modern researchers suggest preventive surgery in the presence of arterial deformity to prevent strokes. The hemodynamic significance of carotid deformities is determined by morphological and functional disorders at the level of tortuosity, the reaction of cerebral blood flow is not often considered. Here, we assume that cerebral autoregulation in tortuosity can be different. Methods and Materials/Patients: A total of 64 patients (31-75 years old) with 110 carotid deformities were analyzed. Duplex color mapping, computed tomography angiography of carotid arteries, and computed tomography perfusion were performed by estimating the absolute and average values of cerebral blood flow (mL/100 g/min), cerebral blood volume (mL/100 g), Mean transit time (MTT) (s) in similar areas of the cortex. In 6 patients, the acetazolamide challenge test was used to evaluate the autoregulatory disturbances. Results: According to computed tomography angiography and duplex color mapping, 18(28.1%) patients had unilateral tortuosity, and 46(71.9%) patients had bilateral tortuo s ity. Hemodynamically significant deformities were detected in 33 cases (30% of tortuosity). In 54 cases (49% of tortuosity), the deformities were accompanied by carotid stenosis. Perfusion disorders were detected in 23 of 64 patients (35.9%). In the majority of cases (75% of all perfusion disorders), hypoperfusion was diagnosed on the side corresponding to the maximum degree of stenosis, regardless of the location of the tortuosity. Neurologically significant hypoperfusion, compensated by collateral blood flow revealed only in 7.8% of cases of hemodynamic significant internal carotid artery deformity without concomitant atherosclerosis. Conclusion: The decision on surgical correction of carotid artery tortuosity should be made while considering both local changes in hemodynamics and proven violations of autoregulation of cerebral blood flow, especially in patients with concomitant carotid stenosis.

A clinical case of surgical treatment of a patient with atherosclerotic combined lesions of the coronary and carotid areas is presented. A staged surgery was performed. The first stage was carotid endarterectomy sequentially on both sides. The second stage is three-vessel coronary artery bypass grafting. The patient was examined 2 years after the operation. There are no data on restenosis of the reconstruction zone of the carotid system. The return of angina pectoris is not noted.

Acute aortic dissection is a highly disabling disease, due to severe neurological deficits caused by damage to the brachiocephalous arteries. The study enrolled 92 patients, 74% of them were men and 26% women. Everybody underwent extracranial duplex scanning and/or multispiral computer tomography of neck vessels. The narrowing of the true lumen by 60% and either the occurrence of a stroke or a transient ischemic attack against the background of the involvement of brachiocephalous arteries in the process of delamination was considered to be a significant defeat. Brachiocephalic stem was the most frequently involved (52.1%). Significant lesions were more often identified in the right common carotid artery (10.8%). Higher lethality (33%) was found in the group where brachiocephalous arteries were intervened than in the group of non-operated arteries (24%) (p = 0.048). In the first group ischemic events were revealed only before and during the surgical intervention, in the second group - only in the postoperative period. Interventions on brachiocephalic arteries in acute aortic dissection are associated with higher lethality and occurrence of ischemic events. A classification taking into account pathogenetic mechanisms of acute cerebral ischemia in case of brachiocephalous artery damage has been proposed.

The treatment of coronary artery disease (CAD) in patients with combined pathology of peripheral arteries who are to perform endovascular or surgical interventions is a difficult task. The most important issues are the adequate diagnostics of artery systems’ lesions, determining the most optimal strategy and stages of treatment. This makes a multidisciplinary approach with the involvement of various specialists the most optimal.Aim. Based on multidisciplinary approach, to determine the prevalence of CAD and treatment strategy in patients with lesions of the aorta and peripheral arteries.8Material and methods. The study included 693 patients with pathology of the aorta and peripheral arteries: 171 (32,5%) were female, and 522 (75,3%) were male. The age of patients ranged from 29 to 93 years, an average — 67,2+8,8 years. Also 32,5% of patients (n=223) were older than 71 years. Cardiac complaints were present only in 203 (29,3%) patients, while 490 (70,7%) were asymptomatic. The majority of 693 patients had an isolated lesion of the internal carotid artery (ICA) (n=196, 28,3%), a combined lesion of the ICA and lower limb arteries (n=93, 13,4%), a combined lesion of the iliac and superficial femoral arteries (n=70, 10,1%) and femoral arteries lesions (n=60, 8,6%).Results. Finally, 554 (79,9%) of 693 patients had lesions of at least one coronary artery more than 50%, while 368 (66,4%) of them were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57,0%) patients underwent myocardial revascularization operations: 21 (6,7%) — coronary artery bypass grafting and 295 (50,3%) — percutaneous coronary intervention. Surgical and endovascular operations for pathology of the aorta and peripheral arteries were performed in 486 (70,1%) of 693 patients. Unlike with 260 (53,5%) patients, in 226 (46,5%) patients, in addition to vascular surgery, myocardial revascularization was performed. As a result of 923 (564 endovascular and 359 surgical) operations performed in 580 patients at the hospital stage, 3 (0,51%) of them had a fatal outcome. In other 2 (0,56%) cases, there was stroke: in one case after ICA prosthetics, in the other case — thrombosis of the ICA after the carotid endarterectomy. Acute myocardial infarction at the hospital stage was not detected in any of the patients.Conclusion. In 79,9% of patients with atherosclerosis of the aorta and peripheral arteries, at least one coronary artery lesion of more than 50% is detected. In 66,4% of patients with pathology of the aorta and peripheral arteries and with lesions of the coronary arteries of more than 50%, there are no cardiac complaints. In 45,6% of patients hospitalized with a diagnosis of atherosclerotic lesions of the aorta and peripheral arteries, myocardial revascularization is required. A multidisciplinary approach is an effective and safe treatment strategy for patients with pathology of the aorta and peripheral arteries of atherosclerotic origin and concomitant CAD.

Aim. To study the effectiveness of determining atherosclerosis and its severity in the brachiocephalic (BCA), coronary (CA) and femoral (FA) arteries based on the endothelial function test proposed by Celermajer DS.Material and methods. The study included 216 patients: 115 men and 101 women aged 24-87 years (mean age, 61,5±10,73 years). All patients underwent coronary angiography to assess the presence and severity of coronary artery atherosclerosis, and duplex ultrasound of BCA and FA atherosclerosis. The functional activity of the endothelium was assessed using the Celermajer test.Results. Depending on the presence and severity of atherosclerosis in each arterial region (BCA, CA and FA), patients were divided into the following groups: group 1 — patients with intact arteries, group 2 — patients with moderate atherosclerosis, group 3 — patients with severe atherosclerosis. Comparative analysis of brachial artery diameters identified by the Celermajer test revealed a significant difference between the groups. Comparison of Celermajer test results in CA groups was as follows: groups 1 and 2 (p=0,34), groups 1 and 3 (p

Background: Stenoses of the brachiocephalic arteries (BCA) are ones of the main causes of ischemic defects of cerebral circulation. From the end of the former century to the current time, the surgical cerebral revascularization in steno-occlusive BCA disturbances occupies the topical place in prevention of acute brain circulation defects. Carotid endarterectomy (CEAE) remains till now a basic method of surgical revascularization. As a result of chronic hypoperfusion, autoregulation of the cerebral circulation can be disturbed with a persistent capillary dilatation which enables development of hyperperfusion syndrome after surgical intervention. Aim: A quantitative assessment of the cerebral tissue perfusion disturbances depending on the variants of the brachiocephalic vessels lesions before and after surgical reconstructions as well as revealing possible prerequisites for hyperperfusion syndrome development during preoperative multislice computed tomography (MSCT) perfusion. Materials and methods: The results of examination and treatment of 65 patients (mean age 64.2±5.0 years) with chronic cerebrovascular IV stage insufficiency were analyzed as well as the hemodynamically significant lesion of the inner carotid arteries. CEAE was planned for all patients. All patients underwent cerebral MSCT angiography and MSCT perfusion in preoperative and early postoperative periods. Results: The majority of patients in preoperative period showed decrease of perfusion parameters at the side of the most expressed defects. The mean circulation deficiency varied from 12 to 15%. Improvement of circulation at the side of surgical intervention formed, on the average, about 12%. The best outcome was noted in patients with bilateral stenoses of the inner carotid arteries (ICA). In one case, in critical unilateral ICA stenosis in preoperative period, MSCT perfusion demonstrated persisting dilatation of the small cerebral arteries of the disturbed hemisphere which led to autoregulation defects of these arteries with a high risk of hyperperfusion syndrome development. On the second day of the postoperative period, the said hyperperfusion syndrome developed but was successfully arrested using hypotensive therapy. Conclusion: CEAE provides circulation improvement in patients with ischemic stroke. MSCT perfusion favors circulation improvement in ischemic stroke patients. MSCT perfusion allows revealing patients with high risk of hyperperfusion syndrome development in postoperative period.

Due to significant prevalence of combined cardiac and vascular pathologies in elderly patients with valve diseases, of special importance is the choice of surgical treatment tactics. The point is that despite the advances in diagnostics and management of cardiovascular diseases in patients, as well as in elderly people, and despite the availability of developed standards of medical assistance and clinical recommendations, there is no yet enough evidence on the advantages of one technique over other surgical procedures.

The greater rhea (Rhea americana americana) is a bird of the Rheidae family, and is known as a ratite for being a flightless bird. This animal has great reproductive and productive potential, according to the products and by-products that it can provide such as meat, leather, feathers and fat which are very popular in the world market. Given its economic importance and lack of information in the literature on its morphology, especially in regard to its cardiovascular apparatus, this study aimed to describe the collateral arteries of the aortic arch, in order to establish the origin and distribution of arteries and thus contribute information to the biology of the species. The bodies of 20 young and adult rheas of both sexes which had died from natural causes and were being stored in a freezer at CEMAS / UFERSA were used. The study was approved by CEUA /UFERSA (Opinion No. 09/2015, process No. 23091.004968 / 2015-23). The animals were thawed and had the cannulated thoracic aorta artery and the vascular system perfused with Neoprene 450 latex colored with yellow pigment. Subsequently, the animals were fixed in 3.7% aqueous solution of formaldehyde, and after 72 hours dissections were carried out, images were obtained and schematic drawings were prepared. The right and left brachiocephalic trunks emerged from the aortic arch in 100% of the specimens from the right brachiocephalic trunk origined a common trunk the thyroid arteries, syringotracheal trunk, vertebral artery, superficial lateral cervical artery, basecervical artery, and ascending esophageal artery. The left brachiocephalic trunk collaterally stemmed in the left common carotid artery, which in turn led to the left internal carotid and a common trunk which stemmed the thyroid arteries, the syringotracheal trunk, vertebral artery, superficial lateral cervical artery, basecervical artery and descending esophageal artery. At the end of its trajectory, the right and left brachiocephalic trunks give rise to the right and left subclavian arteries, which in turn, stem the sternoclavicular, axillary, and intercostal arteries, pectoral trunk, cranial pectoral arteries, pectoral caudal artery and collateral branches of the pectoral trunk. Based on the results, it was concluded that the aortic arch in rheas issued right and left brachycephalic trunks.

Aim. To study the association between the presence and type of atrial fibrillation (AF), cognitive dysfunction, and brachiocephalic artery pathology.Material and methods. In total, 54 patients with AF and 20 AF-free patients who had Functional Class I–III chronic heart failure (CHF) underwent cognitive assessment tests, echocardiography, cerebral nuclear magnetic resonance imaging, and duplex brachiocephalic ultrasound.Results. In AF patients, deteriorated parameters of memory and attention were registered. Patients with persistent AF demonstrated worse cognitive function parameters. The characteristics of short-term memory and attention, attainment of visual and motoric skills, and attention shift and span were not associated with the intima-media thickness of common carotid artery and its bifurcation.Conclusion. There is an association between the presence of AF, its type, and the severity of cognitive dysfunction, which is independent of the degree of brachiocephalic artery abnormalities.

Aim. With duplex scanning method, to compare clinical symptoms of non-specific aorto-arteriitis (NAA) to aortic arch pathology registered. Material and methods. In total, 32 women with NAA were examined. Twenty-four patients underwent duplex scanning of aortic arch branches, carotid intima-media thickness measurement (high-definition ultrasound method; Vivid 7 device, GE, USA). All participants underwent clinical and neurological examination, with inflammation activity assessment. Results. Isolated pathology of aortic arch branches (Type I NAA) was observed in 6 (25%) out of 24 patients; Type III NAA (pathology of aortic arch branches, thoraco-abdominal aorta, and its visceral branches) - in 16 (66,7%); Type IV NAA (pulmonary artery pathology, regardless of any other lesion location) - in 2 (8,3%). Arterial hypertension (AH) was diagnosed in 18 (75%) out of 24 participants. In Type I NAA, AH clinical course was milder than in Type III and IV NAA. Functional neurological and emotional-affective disturbances were typical for NAA. Common carotid artery pathology was registered in 19 (79,2%) patients, and cerebral blood flow pathology - in 2 (8,3%) out of 24 participants. Conclusion. In NAA patients, brachiocephalic artery and common carotid artery pathology prevalence is relatively high. At the same time, strokes and transient ischemic attacks are rare.

The ultrasonic location technique was used to measure the intima-media thickness (IMT) as well as the internal systolic diameter of and the linear blood velocity (LBV) in the cervical arteries in subjects with initial stages of hypertension. Correlation analysis elicited a temporal contingency between these parameters and daily average values of atmospheric pressure. Thus, the common carotid artery IMT tended to increase on high-pressure days. In addition, diameters of the common and internal carotid arteries and vertebral artery were narrowed and, consequently, LBV in these vessels increased. This relationship is more evident in men than women and in elderly subjects than young. These results are suggestive of a vasoconstrictive effect of high atmospheric pressure on these arteries. The relationship is not universal, as it is nonlinear for the diameter of the internal carotid artery and inverse for the external one. This implies different sensitivity of arteries to the factor under study and possible blood redistribution in the arterial tree depending on external pressure. The relationship was observed equally on the day of investigation and previous days, which points to its temporal stability. [ABSTRACT FROM AUTHOR]

The article presents analysis of the program of preventive examinations of Moscow residents in the "Healthy Moscow" pavilions and the routing of patients with established atherosclerosis of brachiocephalic arteries. In 2022, within the framework of preventive examinations (check-ups) of Moscow residents in the "Healthy Moscow" pavilions, the pilot project of organization of surgical treatment of patients with established pathology of pre-cerebral arteries. The project included additional ultrasound examination of brachiocephalic arteries of males aged 45-72 years and females aged 54-72 years. the brachiocephalic artery stenosis was detected in 14 688 out of 370 416 people (4.0% of those passed the check-up). The stenosis was diagnosed in more than 50% - 1 369 people, 9.3% of all stenoses or 0.4% of those passed the check-up). At diagnosis of stenosis, more that 70% of patients were offered to undergo screening ultrasound examination at the "N. V. Sklifosovsky Research Institute of Emergency Care of the Moscow Health Department". The consultation was received by 117 patients out of 254 people. Out of them 22 patients were referred for additional examination, 70 patients for outpatient treatment, 25 patients for surgical treatment. The preventive examination of population organized in the "Healthy Moscow" pavilions permitted to identify sufficient number of patients requiring additional examination with following outpatient and/or surgical treatment of brachiocephalic artery stenosis who timely received necessary care. This result was facilitated by a number of organizational methodological measures implemented jointly with the Moscow Health Department".

Selective intra-arterial digital subtraction angiography of the brachiocephalic arteries using the right brachial artery approach was successfully performed for 169 of 173 patients, 33 of whom were outpatients. Catheterization was unsuccessful for four patients; two of them elderly hypertensive men with tortuous brachial arteries, and two of them middle-aged obese women for whom arterial puncture could not be performed. 4-F modified Simmons type catheters were used in this study. Selective catheterizations of both common carotid arteries were successfully performed in all but one patient, a woman whose aberrant right subclavian artery prevented bilateral common carotid arterial catheterizations. Selective catheterizations of the right vertebral and left subclavian arteries, though relatively difficult, were successfully performed in 84.2% and 93.9% of patients, respectively. The mean examination time for a four-vessel study was 24.3 min. No major complications were encountered. Thus, transbrachial selective catheterization of the brachiocephalic arteries proved to be safe, useful, and relatively easy to perform. [ABSTRACT FROM AUTHOR]

The objective of the study was to describe immediate and long-term results of carotid endarterectomy (CEA) versus carotid stenting (CAS) with embolic protection in patients with severe carotid artery stenosis in clinical practice.Materials and Methods: This is a retrospective cohort study, conducted between 2009 and 2017. During the analyzed period, 2132 operations (2006 patients) were performed: 1215 (57%) CEA and 917 (43%) CAS. 278 patients (13.8% of 2006) were not contactable during the follow-up period (>30 days) leaving 1791 cases (1728 patients) for inclusion in the analysis. Propensity score matching was used to compare the treatment results of groups (561 cases were matched out of 1791). The results of 615 CEA (316 eversion, 299 "classic" with patch) and 615 CAS (using a variety of carotid stents) were compared.Results: In the asymptomatic subgroup (n = 455), the 30-day rate of stroke was not significantly different between the CEA group and the CAS group (1.5% versus 2.4%, P = .48). The 5-year rate of stroke was not significantly higher for CAS than for CEA (4.6% versus 3.3%, P = .3). In the symptomatic subgroup (n = 160), the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group (7.5% versus 2.5%, P = .04). The 5-year rate of stroke was 13% for CAS and 8.7% for CEA (P = .2).Conclusions: In the symptomatic subgroup, the 30-day rate of stroke was significantly higher in the CAS group than in the CEA group, therefore the use of CAS for symptomatic patients in routine practice should be limited. Our study demonstrates that the rates of stroke and survival after CEA and CAS in patients aged 80 years or younger with asymptomatic or symptomatic severe carotid stenosis did not differ significantly over a period of 5 years. [ABSTRACT FROM AUTHOR]

Purpose: to evaluate the advantages and disadvantages of a mini-approach for performing EC-IC bypass., Material and Methods: The mini-approach was used in 35 patients (32 males and 3 females) with symptomatic occlusive lesions of the brachiocephalic arteries (BCAs) who were treated at the Department of Vascular Neurosurgery of the Federal Center of Neurosurgery in Novosibirsk in the period between January and December 2014. The mini-approach was performed through a skin incision of up to 5.5 cm in the donor artery projection. The approach was planned based on comparison of the MSCT-angiography data., Results: In all cases, the mini-approach enabled performing EC-IC bypass in the optimal location, with the minimal involvement of the donor artery and the minimal size of craniotomy. Complications (shunt thrombosis) in the early postoperative period occurred in 3 (8.5%) cases. There were no cases of marginal wound necrosis. The mean bed-day was 7 days., Discussion: We analyzed the literature regarding using the mini-approach in combination with various mapping variants based on neuroimaging data., Conclusion: The approach has a high potential for wide application in clinical practice. The disadvantage is the narrowness and depth of the surgical wound, which complicates manipulations when performing EC-IC bypass and requires special skills.

Aim: To present own experience of subclavian-carotid replacement for chronic cerebrovascular insufficiency management., Material and Methods: For 12 years 7 subclavian-carotid reconstructions were performed that was 1.2% of all carotid repairs during this period. Great saphenous vein was always used as a graft. Carotid endarterectomy from proximal internal carotid artery was additionally performed if it was necessary. Patients had severe advanced lesion of supra-aortic vessels including bilateral carotid lesion and significant stenosis of ipsilateral proximal common carotid artery. The vast majority of them had cerebrovascular insufficiency grade 3-4., Results: All patients underwent surgery without significant complications despite initially severe state due to advanced lesion of brachiocephalic arteries. Long-term postoperative patency of the grafts was satisfactory within the period from 12 years to 1.5 months. There were no neurological impairment and stroke., Conclusion: Subclavian-carotid grafting is an effective alternative for carotid endarterectomy in patients with advanced atherosclerotic lesion of common and internal carotid arteries.

Although usually shown in embryology textbooks, the presence of the fifth pair of pharyngeal arch arteries has long been controversial. To the best of our knowledge, six pairs of bilaterally symmetrical arteries developing within the pharyngeal arches are yet to be found in any mammalian or avian species. Collateral channels between the distal ends of the fourth and sixth arch arteries, in contrast, have been found in up to half of all developing mouse embryos. In only one human embryo, again to the best of our knowledge, has a channel been found that extends from the aortic sac to the dorsal aorta, and hence qualifies as an arch artery. Despite these confounding factors in terms of the developmental heritage of the fifth arch arteries, the purported channels are invoked with increasing frequency to describe various lesions discovered in the setting of the congenitally malformed heart. Persistence of the artery of the fifth arch was initially proposed to explain double-barrelled aorta. It was subsequently proposed to account for various systemic-to-pulmonary channels feeding the pulmonary circulation in the setting of pulmonary atresia. It has also been claimed to persist so as to explain abnormal branching of the brachiocephalic arteries from the aortic arch. In the light of the ongoing doubts concerning the existence of the arteries of the fifth arch themselves, we have reviewed the various descriptions of purported fifth arch arteries within the world literature. We have then sought to validate the descriptions on the basis of our own understanding of development, for this purpose providing images of the remoulding arch arteries in the mouse so as to substantiate our conclusions. While accepting that our own interpretations are speculative, we suggest that more convincing alternative explanations can be advanced to account for the majority of lesions currently interpreted on the basis of persistence of the arteries of the fifth arches. Although the interpretations do not necessarily change the therapeutic approaches to the channels, appropriate description is important in terms of their classification.