Crimean doctors performed the first hybrid operation on a patient with damage to the brachiocephalic arteries

As the head of the department, Akhtem Ziyadinov, said, a 56-year-old woman was admitted to the hospital, who had previously suffered a stroke twice (in 2021 and 2022 — acute cerebrovascular accident such as ischemia in the right and left internal carotid arteries). Upon admission, the patient noted complaints of periodic moderate headache, general weakness, and fatigue. The patient was oriented in personality, space and time, had moderate cognitive impairment and was not critical enough to assess the severity of her condition.

During the examination, according to the results of CT angiography (X-ray diagnostics of blood vessels) of the brachiocephalic arteries, a violation of the patency of the vessels was revealed as a result of their blockage and narrowing (occlusion of the right internal carotid artery from the mouth, occlusion of the left common carotid artery with estial lesions of the left external and internal carotid arteries, occlusion of the P1 segment of the left vertebral artery, stenosis of the first segment of the left subclavian artery up to 75%).

During CT perfusion with contrast (a radiological method that allows one to evaluate blood flow in brain tissue), a decrease in blood circulation in the left hemisphere was revealed. That is, insufficient blood flow to the tissues.

Surgical intervention on the patient was performed by a multidisciplinary team of doctors, which included x-ray surgeons, cardiovascular surgeons, and neurosurgeons.

The operation was performed in a hybrid way, that is, at the first stage, the intervention was carried out in an open way (an incision was made) to open access to the artery and remove the atherosclerotic plaque in the internal carotid artery, and then using the endovascular method, that is, doctors began intravascular interventions under X-ray control .

The patient had atherosclerotic plaques removed by transverse incision of the vessels (every endarterectomy was performed from the left internal carotid artery and external carotid artery and partially the common carotid artery); the common carotid artery was cleared of plaques (endarterectomy was performed from the left CCA); They expanded the vessel and installed a special structure that will prevent repeated narrowing of the artery (retrograde balloon plasty was performed with stenting of the left common carotid artery).

The operation lasted four hours and was successful. After surgery, the patient woke up without an increase in neurological symptoms. The postoperative period was stable, the patient was discharged home within a week after surgery.

source: press service of the Ministry of Health of the Republic of Crimea