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

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

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

3 Ethiology Atherosclerosis Aortoarteritis Kinking Compression Aneurism

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

5 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

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7 Circle of Vilise

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

10 Clinics Headache Dizziness Memory disoder Sincopa

11 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

12 Angiography

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14 Doppler ultrosound НСА ВСА

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

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

17 Surgery

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19 Carotid endarterectomy

20 Microvessel subdural transplantation of a part of major omentum

21 Технические аспекты субдуральной трансплантации сальника

22 Kinking resection

23 Reimplantation in carotid occlusion