CEREBROVASCULAR DISEASE AND STENOTIC LESION OF THE BRACHIOCEPHALIC ARTERIES: EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, TREATMENT

According to the Ministry of Health of the Russian Federation, in 2016 in Russia, the incidence of cerebrovascular disease was 950.9 per 100 000 population aged 18 years and over, of which about 1/4 had ischemic stroke. Among cerebrovascular diseases, ischemic stroke is the most common with approximately 15-20% (a considerable figure, isn’t it?) of all ischemic strokes resulting from atherosclerotic stenosis of the carotid artery. Carotid reconstruction prevents recurrent ischemic stroke in patients with significant symptomatic carotid artery stenosis. Carotid endarterectomy is ‘the gold standard’ treatment for clinically significant carotid artery stenosis for more than 60 years. Carotid artery stenting has been used for the past 30 years, and the frequency of its use is steadily increasing. Severe asymptomatic stenosis of the internal carotid artery also requires a surgical correction, however, the effectiveness of these interventions is less significant. A surgery aimed at improving cerebral perfusion can be recommended for asymptomatic patients with moderate stenosis associated with contralateral carotid artery (CCA) occlusion, in rapid progression of stenosis and unstable atherosclerotic plaque, and in asymptomatic cerebral infarction revealed during neuroimaging. Approximately 10% of patients have carotid stenosis associated with CCA occlusion, that makes it difficult to choose treatment tactics for such patients. Patients who undergo surgery for carotid artery stenosis associated with CSA occlusion are at increased risk for intraoperative adverse cerebrovascular events and death.

cerebrovascular disease, stroke, transient ischemic attack, carotid artery stenosis, carotid artery occlusion, bilateral stenotic carotid artery disease, contralateral carotid artery occlusion, carotid endarterectomy, carotid artery stenting, antiplatelet agents, statins