SURGICAL TREATMENT OF PATIENTS WITH VERTEBROBASILAR INSUFFICIENCY.

Relevance. Circulatory disorders in the vertebrobasilar pool (VBP) are widespread and account for 25-30% in the structure of all cerebrovascular disorders. One of the promising methods for the treatment of vertebrobasilar insufficiency (VBI), in particular in hemodynamically significant stenoses, is stenting of the vertebral arteries. Purpose: to study the results of various methods of treating patients with clinical manifestations of vertebrobasilar insufficiency. Material and methods. The results of treatment of 78 (100%) patients with VBI syndrome who were hospitalized at the Republican Specialized Center for Surgical Angioneurology from 2021 to 2023 were analyzed. All patients depending on the tactics of treatment were divided into 3 groups. group 1 - 30 (38.5%) patients who underwent stenting of the 1st segment of the vertebral artery, group 2 - 28 (35.9%) patients who underwent carotid endarterectomy as a treatment method, group 3 - 20 (25.6%) of patients who received conservative treatment. Patients of the 3 groups were comparable in terms of sex and age. All these patients had hemodynamically significant stenoses (more than 65%) in segment I of the vertebral and carotid arteries. Of these, signs of chronic dyscirculation in the VBP were identified in 24 patients (31%), transient ischemic attacks in the VBP were observed in 19 patients (24%), and in 35 patients (45%) a history of ischemic stroke in the VBP was verified. If a hemodynamically significant lesion of the carotid arteries (more than 70% stenosis) and preserved blood flow in the ipsilateral posterior communicating artery were detected, the patients underwent carotid reconstructions of the carotid arteries. Results: The follow-up period averaged 24.6±8.8 months (from 6 months to 2 years). After conservative therapy, 15 (76%) patients showed clinical improvement - regression of VBI symptoms, disappearance of dizziness and unsteadiness when walking, but after 4-6 months these symptoms reappeared. In 5 (24%) patients, no clinical improvement was found after conservative therapy. Among 28 patients who underwent carotid reconstruction of the carotid artery, a clinical improvement in symptoms and velocity parameters of blood flow through the posterior communicating artery was observed in 24 (86%) patients. The rest 4 (14%) patients of this group showed no changes in the VBI clinic. Among patients who underwent stenting of segment I of the vertebral arteries, in 27 (91%) cases, a persistent clinical improvement was observed, manifested in a decrease or disappearance of the VBI clinic during the follow-up. In 3 (9%) patients after X-ray endovascular intervention, no significant clinical improvement was found, although with TCDS they had an increase in the blood flow velocity in the basilar artery. Conclusions: 1. When determining the indications for carotid reconstruction in patients with VBI, the conditions of the circle of Willis should be taken into account. [ABSTRACT FROM AUTHOR]