ИСТИНА

Background. In the treatment of chronic cerebral ischemia, surgical revascularization still remains controversial due to the difficulty in predicting its results. The aim of the study was to determine the criteria for the effectiveness of surgical revascularization in patients with consequences of stroke caused by steno-occlusive pathology of the brachiocephalic arteries.<BR>Methods. During the period from 2000 to 2023, brain revascularization was performed in Burdenko Center for Neurosurgery in 715 patients with cerebral ischemia, who underwent 805 different surgical interventions. Among them, there were 543 patients with ICA occlusions, 160 with Moyamoya disease, and 87 with MCA occlusions. 267 surgeries were performed in order to prevent cerebrovascular accidents, 497 surgeries were performed to treat the consequences of a stroke and improve the rehabilitation prognosis, and in addition, 26 surgeries were performed in the acute period. Surgical options included single- and double-barrel, proximal anastomoses and combined revascularization. Clinical, perfusion and angiographic data were analyzed.<BR>Results. Surgical revascularization showed the greatest efficiency in restoring cerebral perfusion in patients with smaller foci of ischemia, with a shorter period from the moment of ischemic stroke, as well as in cases of decompensation or subcompensation of cerebral blood flow according to perfusion data. In addition, local hemodynamic studies and the state of the collateral blood flow system turned out to be important components of effective revascularization. In addition, the principles of targeted revascularization and ultrasound navigation were used to select the acceptor branch, taking into account the restructuring of the collateral system.<BR>Conclusions. Understanding the mechanisms of pathophysiology and criteria for the effectiveness of revascularization in the treatment of chronic cerebral ischemia opens the way for their rational use. Modern algorithms for penumbra visualization for stroke patients offer opportunities for use of cerebral revascularization in stroke treatment and rehabilitation.