Pharmacological preconditioning in carotid endarterectomy

Kuznetsov M.R.¹, Karalkin A.V.¹, Fedin A.I.², Virganskii A.O.¹, Kunitsyn N.V.¹, Kholopova E.A.², Yumin S.M.¹

1) Chair of Faculty Surgery No1 of the Therapeutic Faculty of the Russian National Research Medical University named after N.I. Pirogov,
2) Chair of Neurology and Neurosurgery of the Therapeutic Faculty of the Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months.

It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain.

A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

KEY WORDS: chronic cerebrovascular insufficiency, carotid endarterectomy, preconditioning, cognitive function, autoregulation of cerebral blood flow, reperfusion syndrome, actovegin.

P. 35

« Back