Surgical treatment of patients during the acute period of ischemic stroke

We analysed the results of 56 reconstructive surgeries of the carotid arteries during the acute period of ischemic stroke in 55 patients who underwent treatment in the Division of Cardiovascular Surgery at the Samara City Clinical Hospital No. 1 named after N.I. Pirogov between June 2015 and August 2016. Surgical intervention was performed 1-18 days post ischemic stroke onset. Neurological status was assessed using the USA National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Before surgery, 18 patients demonstrated neurological deficit of 4 points according to the mRS. Carotid endarterectomy (CEA) was performed in 55 patients; of them 25 patients underwent eversion carotid endarterectomy (eCEA). Ten patients simultaneously underwent eCEA and resection of the internal carotid artery in the case of stenosis and tortuosity. One patient underwent eCEA and carotid-subclavian bypass grafting. CEA with application of autovenous patch in the common carotid artery (CCA) and internal carotid artery (ICA) was performed in 8 patients. Reconstructive surgery of the external carotid artery (ECA) with the resection of occlusional ICA was performed in 7 patients. ICA resection complicated by pathological tortuosity was performed in 2 patients. By the moment of discharge 46 (83 %) of participants had a regression of neurological symptoms. Of them, 9 (20 %) demonstrated complete recovery of neurological deficit, whereas 2 (4 %) had increased neurological deficit. Two patients died during the postoperative period: one of them 24 days post surgery due to increasing respiratory and heart failure, another one - 29 days post surgery due to increasing renal and heart failure. No recurrent strokes were observed in both cases (according to autopsy results). Surgical interventions during the first 18 days after the development of ischemic stroke facilitates the regression of neurological deficit in most of the cases; they are safe in terms of hemorrhagic transformation development if the surgery is performed in a special vascular center.