ZAPOROZHYE STATE MEDICAL UNIVERSITY CHAIR OF HOSPITAL SURGERY ASSISTANT PROFESSOR KLYMENKO A.V. Cerebrovascular disease

High death rate Over 70% working people Invalids 40-60% 12-20% in general death rate

Ethiology Atherosclerosis Aortoarteritis Kinking Compression Aneurism

Classification by Pokrovskiy A.V.,1979 Asymptomatic disease Transient neurologic or visual episodes Discerculatory encephalopathy Stroke and its outcomes

The brain is supplied by 2 internal carotid arteies 2 vertebral arteries Suffisient blood volume ml. per 100 g. of the brain By carotids ml/min By vertebrals 150 ml/min 4 levels of collateral circulation: one extracranial and three intracranial, the most important are Circle of Vilise and extraintracranial collaterals

Circle of Vilise

Deficiency in kinking Norma С-shaped S-shaped Twist Kink

Clinics Headache Dizziness Memory disoder Sincopa

Carotid occlusion Cross optico-pyramidal syndrom Numbness and parestesia of a hand Monoparesis and hemiparesis Motor aphasia, cortex disartria. Horner syndrome on the ill side

Angiography

Doppler ultrosound НСА ВСА

Surgical reconstruction Evertion endarterectomy Prostesis Resection of kinking Desympatisation, redressation, arteriolys

Collateral improvement 1. Endarterectomy, plastics 2. Extraintracranial microanastomosis. 3. Microvessel subdural transplantation of a part of major omentum

Surgery

Carotid endarterectomy

Microvessel subdural transplantation of a part of major omentum

Технические аспекты субдуральной трансплантации сальника

Kinking resection

Reimplantation in carotid occlusion