neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2023-25-1-21-27neurosurgery-1328Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTЦеребральная ауторегуляция и кровоток в прецеребральных артериях при определении показаний к выполнению экстра‑интракраниального микроанастомоза у больных с хронической каротидной окклюзиейCerebral autoregulation and blood flow distribution in the precerebral arteries for determining indications of extra-intracranial bypass in patients with carotid artery occlusionhttps://orcid.org/0000-0002-9248-9821СеменютинВ. Б.SemenyutinV. B.

Владимир Борисович Семенютин 

197341 Санкт-Петербург, ул. Аккуратова, 2

Vladimir Borisovich Semenyutin 

2 Akkuratova St., Saint Petersburg 197341

lbcp@mail.ruhttps://orcid.org/0000-0002-2617-6739НикифороваА. А.NikiforovaA. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., Saint Petersburg 197341

https://orcid.org/0000-0002-7452-0944ВеснинаА. А.VesninaA. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., Saint Petersburg 197341

https://orcid.org/0000-0001-5295-4912СамочерныхК. А.SamochernykhK. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., Saint Petersburg 197341

ФГБУ «Национальный медицинский исследовательский центр им. В. А. Алмазова» Минздрава РоссииРоссияV. A. Almazov National Medical Research Centre, Ministry of Health of the RussiaRussian Federation20232903202325121‑27Copyright © Семенютин В.Б., Никифорова А.А., Веснина А.А., Самочерных К.А., 20232023Семенютин В.Б., Никифорова А.А., Веснина А.А., Самочерных К.А.Semenyutin V.B., Nikiforova A.A., Vesnina A.A., Samochernykh K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1328Введение

Введение. Профилактику ишемического инсульта у больных с каротидными окклюзиями связывают с выполнением реваскуляризирующих операций. Однако определение показаний к ним до сих пор остается актуальной задачей. Показана информативность неинвазивной оценки состояния церебральной ауторегуляции и изменения кровотока в прецеребральных артериях у пациентов с каротидными стенозами. В то же время у пациентов с каротидными окклюзиями данные показатели изучены в меньшей степени.

Цель исследования – оценка информативности показателей церебральной ауторегуляции и кровотока в прецеребральных артериях при определении показаний к экстра‑интракраниальному микроанастомозу у больных с хроническими каротидными окклюзиями.

Материалы и методы

Материалы и методы. Обследовано 54 пациента с каротидными окклюзиями в возрасте от 41 года до 83 лет. Линейную скорость кровотока в интракраниальных артериях определяли с помощью транскраниальной допплерографии (система Multi‑Dop X), индекс кровотока в прецеребральных артериях – с помощью дуплексного сканирования (система Vivid Е). Церебральную ауторегуляцию оценивали по величине фазового сдвига между колебаниями линейной скорости кровотока и артериального давления в диапазоне волн Майера (80–120 мГц).

Результаты

Результаты. У 90 % пациентов с симптомным типом течения каротидной окклюзии церебральная ауторегуляция была нарушена с обеих сторон: фазовый сдвиг составил 0,3 ± 0,3 рад ипсилатерально и 0,7 ± 0,6 рад контрлатерально. У 79 % больных с бессимптомным типом течения заболевания церебральная ауторегуляция была сохранена: фазовый сдвиг составил 1,0 ± 0,3 рад ипсилатерально и 1,1 ± 0,4 рад контрлатерально. Повышение индекса кровотока отмечено в контрлатеральной внутренней сонной артерии (306 ± 109 мл / мин) и ипсилатеральных артериях – позвоночной (139 ± 69 мл / мин) и наружной сонной (175 ± 72 мл / мин).

Заключение

Заключение. Неинвазивная предоперационная оценка состояния церебральной ауторегуляции и кровотока в прецеребральных артериях позволяет количественно оценить состояние цереброваскулярного резерва и может быть использована при определении показаний к реваскуляризирующим операциям у пациентов с хроническими каротидными окклюзиями.

Background

Background. Prevention of ischemic stroke in patients with carotid artery occlusion is conventionally associated with performing cerebral revascularization. However, determining the indications for it is still an actual problem. The informative value of noninvasive assessment of cerebral autoregulation and blood flow distribution in the precerebral arteries in patients with carotid artery stenosis is shown. At the same time, in patients with carotid artery occlusion, these indicators have been studied to a lesser extent.

Aim

Aim. To evaluate the informative value of cerebral autoregulation and blood flow distribution in the precerebral arte ries for determination the indications of extra‑intracranial bypass in patients with carotid occlusion.

Materials and methods

Materials and methods. 54 patients (aged from 41 to 83 y. o.) with carotid artery occlusion were studied. Blood flow velocity in intracranial arteries was determined with transcranial Doppler (system Multi‑Dop X), whereas flow velocity index in precerebral arteries – with duplex scanning (system Vivid Е). Cerebral autoregulation was assessed based on phase shift between spontaneous oscillations of blood flow velocity in basal cerebral arteries and systemic blood pressure within the range of Mayer’s waves (80–120 mHz).

Results

Results. The state of cerebral autoregulation was imparied on both sides in 90 % patients with the symptomatic carotid occlusion (0.3 ± 0.3 rad ipsilateral, 0.7 ± 0.6 rad contralateral). The state of cerebral autoregulation was not impaired in 79 % patients with asymptomatic carotid occlusion (1.0 ± 0.3 rad ipsilateral, 1.1 ± 0.4 rad contralateral). The flow velocity index in the contralateral internal carotid artery (306 ± 109 ml / min) and the ipsilateral vertebral (139 ± 69 ml / min) and external carotid (175 ± 72 ml / min) arteries was increased.

Conclusions

Conclusions. Noninvasive preoperative assessment of cerebral autoregulation and blood flow distribution in the precerebral arteries makes to evaluate the state of the cerebrovascular reserve to quantify and can be used to determining indications for cerebral revascularization in patients with carotid occlusion.

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The authors declare that there are no conflicts of interest present.