neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2016-0-4-108-114neurosurgery-382Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWТАКТИКА ЛЕЧЕНИЯ ПАЦИЕНТОВ С СОЧЕТАНИЕМ ОККЛЮЗИОННО-СТЕНОТИЧЕСКОГО ПОРАЖЕНИЯ ШЕЙНОГО ОТДЕЛА ВНУТРЕННЕЙ СОННОЙ АРТЕРИИ И ИНТРАКРАНИАЛЬНЫХ АНЕВРИЗМThe treatment strategy for patients with combination of occlusive-stenotic damages of cervical part of carotid artery and intracranial aneurysmsНекрасовДмитрий АлександровичNekrasovD. A.da.nekrasov@mail.ruГосударственное бюджетное учреждение здравоохранения Тюменской области «Областная клиническая больница №2»Russian Federation20162411201704108114Copyright © Некрасов Д.А., 20172017Некрасов Д.А.Nekrasov D.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/382

Сочетание стенотического поражения шейного отдела внутренней сонной артерии (ВСА) и интракраниальной артериальной аневризмы (АА) является редкой и недостаточно изученной патологией, распространенность которой среди пациентов с гемодинамически значимыми каротидными стенозами составляет 2,1-4,1% и 8,3-21,4% - среди пациентов с нетравматическим субарахноидальным кровоизлиянием вследствие разрыва внутричерепной аневризмы. Выбор тактики лечения пациентов с сочетанием окклюзионно-стенотического поражения сонных артерий и интракраниальных АА представляет собой актуальную на сегодняшний день проблему вследствие особенностей патогенеза заболевания. Не диагностированная интракраниальная АА может явиться причиной жизнеугрожающего внутричерепного кровоизлияния после проведения реконструктивной операции на экстракраниальном отделе ВСА. В то же время у пациентов с вовремя не диагностированным гемодинамически значимым стенозом ВСА во время операции по поводу разрыва АА при временном пережатии церебральных артерий высока вероятность развития необратимой ишемии головного мозга. Представлен обзор литературы о тактике ведения пациентов с одновременным сочетанием окклюзионно-стенотического поражения шейного отдела ВСА и интракраниальной АА. В настоящее время не существует точных алгоритмов ведения пациентов с сочетанием каротидного стеноза и интракраниальной АА, отсутствуют критерии отбора больных для открытых и эндоваскулярных вмешательств, не определена очередность операций на экстракраниальном отделе ВСА и внутричерепной АА.

The combination of stenotic changes of cervical part of internal carotid artery (ICA) and intracranial aneurysm (IA) is the rare and insufficiently examined pathology. The frequency of such pathological combination counts to 2,1-4,1% among all patients suffered from hemodynamically significant ICA stenosis and to 8,3-21,4% - among patients with subarachnoid hemorrhage because of IA rupture. The selection of treatment strategy for such patients with combination of ICA stenotic-occlusive damage and IAs currently presents the challenge in response to the features of disease pathogenesis. The undiagnosed IA may cause the life-threatening intracranial hemorrhage after performance of reconstructive operation on extracranial ICA. Meanwhile patients with undiagnosed hemodynamically significant ICA stenosis are in the group of high risk of cerebral ischemia development because of temporary clipping of intracranial arteries during operation on IA. This article presents the literature review concerning treatment strategy with combination of ICA stenotic-occlusive damage and IAs. Nowadays there are no accurate algorithms for treatment of such patients and definite criteria for selection either microsurgical or endovascular operation as well as the order of operations on cervical part of ICA and IA is not clearly defined.

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