THE FOLLOW-UP OF SYMPTOMATIC PATIENTS WITH PATHOLOGY OF THE EXTRACRANIAL PART OF THE VERTEBRAL ARTERIES AND PROBLEMS OF THE INDICATIONS FOR SURGICAL TREATMENT

D.N. Dzhibladze, A.V. Pokrovsky, T.I. Glazunova, S.E. Lelyuk
Research Institute of Neurology, Russian Academy of Medical Sciences,
Moscow, Russia

The aim of the present study was to analyze the "natural course" of the clinical manifestations of cerebral circulation insufficiency in patients with two forms of pathology of the extracranial part of the vertebral arteries (atherosclerotic lesions and structural anomalies and deformities) from the standpoint of the indications for surgical treatment of such patients. Altogether 162 patients (30 women and 132 men) aged 32 to 71 years were followed up over 3 to 10 years. In addition to standard clinical and laboratory examinations, all the patients underwent Doppler ultrasound and contrast angiography of the cerebral arteries. The first group patients (n=62) presented with atherosclerotic lesions (stenosis and thrombosis) of the extracranial part of the vertebral arteries. The second group patients (n=100) had different anomalies and deformities of the vertebral arteries (hypoplasia, lateral displacement of the vertebral artery opening, tortuosity, kinking, etc). The majority of both group patients were examined in the presence of the non-gross steady symptoms of previous infarction in the area of blood supply to the arteries of the vertebrobasilar system. Some patients were found to have transient disorders of cerebral circulation in the arteries of the vertebrobasilar system together with the symptoms of chronic blood supply insufficiency in the arteries of the vertebrobasilar system. The results of many years of observation demonstrate that patients with atherosclerotic lesion of the vertebral arteries had a more severe disease course. Improvement was noted in 7 patients, the condition remained unchanged in 22, and deterioration was recorded in 28 patients. Five patients died. Of these, 2 patients died as a result of recurrent infarctions in the brain stem, one patient died because of recurrert infarctions in the system of blood supply to the carotid arteries, and the remaining two subjects died from non-brain complications. The deterioration was marked by repeated disorders of cerebral circulation and chronic vertebrobasilar insufficiency. It should be kept in mind that these phenomena were seen more often in patients with bilateral lesion of the vertebral arteries. The second group patients had a more favourable disease course: improvement was recorded in 42 patients; the condition of 18 patients remained unchanged, 34 patients deteriorated, 6 patients died (none of them died of cerebral disorders). The problem of surgical treatment of symptomatic patients with pathologies of the extracranial part of the vertebral arteries is more difficult than that in patients with carotid artery pathology. Based on the results of many years of the follow-up of these patients wey, similarly to the majority of researchers, have a restrained attitude to their surgical treatment, especially of patients with structural anomalies and deformities of the vertebral arteries. The problem requires further studies.

P. 54-64

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