[Surgical prevention of progressive cerebral ischemia after ischemic stroke].

Objective: To evaluate the effectiveness of carotid endarterectomy after ischemic stroke and to analyze postoperative neurological status.

Material And Methods: There were 120 patients with carotid artery stenosis complicated by chronic cerebrovascular insufficiency (CVI). Patients with CVI grade I-III were included in the first group (=70), 50 patients had previous ischemic stroke (the second group). Age of patients was 61-89 years. All patients underwent unilateral carotid endarterectomy.

Results: Over 36-month follow-up period, postoperative stroke occurred in 5 (7.2%) and 9 (18.3%) patients in both groups, respectively. The combined end-point (stroke + mortality) was significantly less common in group I compared to group II (10 (14.5%) and 15 (30%) cases, >0.05). Positive changes in neurological status were found in the 2 group (relief of focal neurological deficit, symptoms of cerebrovascular insufficiency, no progression of vascular dementia). Barthel score increased from 74.3 to 92.8 after carotid endarterectomy in the 2 group. Baseline FAB score <11 was observed in 9% of patients in the 1 group and 22% in the 2 group. No progression of dementia was observed in long-term period.

Conclusion: Carotid endarterectomy is effective in prevention of primary and recurrent stroke. Moreover, this procedure slows down progression of chronic cerebral ischemia and cognitive impairment.