ИСТИНА

Objectives: To determine the algorithm for the treatment of patients with a combination of cerebral aneurysms with carotid stenosis Background: Reconstructive interventions on the carotid arteries in patients with intracranial aneurysms requires an individual patient-selected approach, in contrast to certain standards based only on the principles of evidence-based medicine. The complexity of determining the tactics of treating such patients is due to the competition of mutually opposite pathogenetic mechanisms that determine the risk of ischemic stroke on the one hand and aneurysm rupture on the other. Methods: Cerebral aneurysms were diagnosed in 4.1% of all patients who had indications for carotid endarterectomy during the last 5 years (47 patients). Variants of lesions of intracranial and extracranial arteries are presented by cerebral aneurysms of MCA (39%), ICA (26%), ACA-AComA (22%), Basilar artery (9%), VA (2%), PCA (2%), ACA (2%). Multiple aneurysms were detected in 34%. Critical stenosis of ICA (more than 85%) was seen in 93,6%, subcritical – in 6,4%. Bilateral stenoses were seen in 25,5%. Results: 89 surgical interventions were performed: in all cases, carotid endarterectomy was performed on the side of stenosis. 14 patients (30%) with aneurysms were kept under follow-up. In 33 patients (70%), various surgical options for aneurysms were performed - clipping (55%), flow diversion stents (9%), occlusion of the aneurysm with microcoils (6%). There were no complications after surgical treatment. The second surgical intervention was performed 2-3 months after the first one. Conclusions: The treatment of patients with a combination of steno-occlusive pathology of the main cerebral arteries and intracranial aneurysms is associated with higher perioperative risks and requires an individual differentiated approach based on a comparison of the possible risks of hemorrhage, on the one hand, and ischemic accident on the other. Depending on this, indications for surgical interventions, their sequence and the time between them were determined.