actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problemsactabiomedica-108Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEРЕВАСКУЛЯРИЗАЦИЯ ГОЛОВНОГО МОЗГА У БОЛЬНЫХ СТАРШЕ 70 ЛЕТCEREBRAL REVASCULIZATION IN PATIENTS OF 70 YEARS AND OLDERКосенковА. Н.KosenkovA. N.alenkos@rambler.ruВиноградовР. А.VinogradovR. A.viromal@mail.ruВинокуровИ. А.VinokurovI. A.docvin.med@gmail.comГБОУ ВПО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииThe First Sechenov Moscow State Medical UniversityГБУЗ «Научно-исследовательский институт - Краевая клиническая больница № 1 им. проф. С. В. Очаповского» Министерства здравоохранения Краснодарского края; ГБОУ ВПО «Кубанский государственный медицинский университет» Минздрава РФScientific Research Institute - Krasnodar Region Clinical Hospital N 1; Kuban State Medical University201528092015052123Copyright © Косенков А.Н., Виноградов Р.А., Винокуров И.А., 20152015Косенков А.Н., Виноградов Р.А., Винокуров И.А.Kosenkov A.N., Vinogradov R.A., Vinokurov I.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.actabiomedica.ru/jour/article/view/108

Оценены особенности ведения больных старшей возрастной группы при хирургической реваскуляризации головного мозга. Исследовано 813 больных старше 70 лет. Первой группе (392 человека] была выполнена каротидная эндартерэктомия (КЭАЭ), второй группе (421 больной] выполнена ангиопластика сонных артерий [АПСА]. Частота острых нарушений мозгового кровоснабжения [ОНМК] после КЭАЭ была значительно меньше, чем при АПСА (р = 0,04]. Частота периоперационных инфарктов миокарда - выше в 3 раза при КЭАЭ (р = 0,03].

The aim of the work was to evaluate the perioperative management of aged patients after elective surgical cerebral revascularization. We analyzed the outcomes of 813 patients of 70 years and older who had surgery for stenosis of the internal carotid artery [ІСА]. There were two groups: 392 patients who had carotid endarterectomy [CEA] and 421 patients who had the stenting. Age of the patients, severity of disease and comorbidity were similar in both groups In aged patients, the incidence of acute disorders of cerebral circulation (stroke] after CEA was significantly lower than the one after stenting (p = 0,04]. Frequency of perioperative myocardial infarction [MI] was 3 times higher in cases with CEA (p = 0,03]. in patients of 70 years and older, CEA shown lower incidence of stroke, however, there is increase of perioperative MI while using this method. Endovascular treatment could be chosen in patients with severe cardiac disease according to atherosclerotic plaques with no risk of embolism. In addition, the individual approach and assessment of social aspect are necessary.

стентирование сонных артерийкаротидная эндарктерэктомияреваскуляризация головного мозгаострое нарушение мозгового кровообращенияпациенты старше 70 летcarotid artery stentingcarotid endarterectomycerebral revascularizationacute cerebrovascular diseasepatients of 70 years and olderReferencesAqel R, Dorfman ТА [2009]. The brain first or the heart: the approach to revascularizing severe co-existing carotid and coronary artery disease. Clin. Cardiol, 32, 418-425.Aqel R, Dorfman ТА [2009]. The brain first or the heart: the approach to revascularizing severe co-existing carotid and coronary artery disease. Clin. Cardiol, 32, 418-425.Bonati LH, Dobson J, Algra A et al. [2010]. Shortterm outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patientdata. Lancet, 376,1062-1073.Bonati LH, Dobson J, Algra A et al. [2010]. Shortterm outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patientdata. Lancet, 376,1062-1073.Brott TG, Hobson RW II, Howard G et al. [2010] Stenting versus endarterectomy for treatment of carotid-artery stenosis. N. Engl.J. Med., 363,11-23.Brott TG, Hobson RW II, Howard G et al. [2010] Stenting versus endarterectomy for treatment of carotid-artery stenosis. N. Engl.J. Med., 363,11-23.Chastain HD, Gomez CR, Iyer S etal. [1999]. Influence of age upon complications of carotid artery stenting. J. Endovasc. Surg., 6,217-222.Chastain HD, Gomez CR, Iyer S etal. [1999]. Influence of age upon complications of carotid artery stenting. J. Endovasc. Surg., 6,217-222.Chiappini B, Dell’AmoreA, Di Marco L etal. [2005]. Simultaneous carotid and coronary arteries disease: staged or combined surgical approach?J. Card. Surg., 20,234-240.Chiappini B, Dell’AmoreA, Di Marco L etal. [2005]. Simultaneous carotid and coronary arteries disease: staged or combined surgical approach?J. Card. Surg., 20,234-240.Executive Committee for the Asymptomatic Carotid Atherosclerosis Study [1995]. Endarterectomy for asymptomatic carotid artery stenosis. JAMA, 273, 1421-1428.Executive Committee for the Asymptomatic Carotid Atherosclerosis Study [1995]. Endarterectomy for asymptomatic carotid artery stenosis. JAMA, 273, 1421-1428.HallidayA, Mansfield A, Marro J etal. [2004]. MRC Asymptomatic Carotid Surgery Trial [ACST] Collaborative Group: Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet, 363,1491-1502.HallidayA, Mansfield A, Marro J etal. [2004]. MRC Asymptomatic Carotid Surgery Trial [ACST] Collaborative Group: Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet, 363,1491-1502.Lam RC, Lin SC, DeRubertis В et al. [2007]. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting./. Vase. Surg., 45,875-880.Lam RC, Lin SC, DeRubertis В et al. [2007]. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting./. Vase. Surg., 45,875-880.Wang H, Dwyer-Lindgren L, Lofgren KT et al. [2012]. Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the global burden of disease study 2010. Lancet, 380,2071-2094.Wang H, Dwyer-Lindgren L, Lofgren KT et al. [2012]. Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the global burden of disease study 2010. Lancet, 380,2071-2094.Zahn R, Ischinger T, Hochadel M et al. [2007]. Carotid artery stenting in octogenarians: results from the ALKK Carotid Artery Stent [CAS] Registry. Eur. Heart J., 28, 370-375.Zahn R, Ischinger T, Hochadel M et al. [2007]. Carotid artery stenting in octogenarians: results from the ALKK Carotid Artery Stent [CAS] Registry. Eur. Heart J., 28, 370-375.

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