Спонтанная гематома правой большой поясничной мышцы, геморрагический васкулит, множественные артериальные тромбозы на фоне COVID-19

Patient A., 65 years old, male. He was admitted to the City Alexandrovskaya Hospital with complaints of fever within 5 days to 39.0°C, dry cough, shortness of breath during exertion, pain in the right fl ank of the abdomen and right lumbar region for 7 days. Three days earlier, the patient had received a positive polymerase chain reaction test for the presence of SARS-CoV-2. Examination of the patient revealed a hemorrhagic rash on both legs. The patient was consulted by a dermatovenerologist, acute infectious hemorrhagic vasculitis, bullous form, was diagnosed.According to multispiral computed tomography with angiography (MSCT AG) of the abdominal organs: the psoas major muscle on the right was thickened, its structure was determined by the accumulation of the contents of hemorrhagic density with signs of partial lysis in the marginal zone, with a total size of 52x48x148 mm. No data available for aortic aneurysm / dissection. The patient denied the presence of injuries, taking anticoagulant drugs. The psoas major muscle hematoma was regarded as spontaneous hematoma against the background of coagulopathy caused by COVID-19.According to the MSCT data of the chest organs, it was visualized: polysegmental lesion in both lungs, numerous areas of compaction of the lung tissue were determined by the type of ground glass, with zones of consolidation and reticular changes in the structure. The degree of damage to the lung tissue was 55%.In view of the fact that the patient had data for the presence of a hematoma of the psoas major muscle on the right, as well as hemorrhagic vasculitis, anticoagulant therapy was contraindicated. Laboratory tests revealed an increase in the level of procalcitonin up to 12.8 ng/ml, C-reactive protein up to 135.1 mg/l, leukocytes up to 13.46 10^9/l, ferritin up to 532.2 ng/ml, D-dimer up to 1145 ng/ml. A multidisciplinary council (infectious disease specialist, general surgeon, therapist, pulmonologist, vascular surgeon, dermatovenerologist, septologist) decided to revise and drain the hematoma of the psoas major muscle on the right, as a likely source of sepsis (increased procalcitonin). Under intravenous anesthesia, the hematoma was opened posteriorly peritoneally, evacuated (about 300 ml in volume), 2 drains were installed. On the 10th day after the operation, a control MSCT was performed, according to which the hematoma of the right psoas muscle decreased in size by half. A decision was made to remove the drains.On the 13th day after admission to the hospital, the patient developed pain in the right forearm, hand, left leg and foot. Performed MSCT revealed hypertension of the arteries of the upper extremities and arteries of the lower extremities: thrombosis of the distal third of the brachial, ulnar and radial arteries; thrombosis of the superfi cial femoral artery (PFA) on the left. An anticoagulant therapy was started (heparin 7500 IU intravenously in a stream with subsequent transfer to continuous intravenous administration using an infusion pump with an initial rate of 1000 IU per hour, under the control of APTT with an indicator reaching 1.5–2.5 times higher than the norm), disaggregant therapy (acetylsalicylic acid 100 mg once a day), analgesic therapy (ketorol 1.0 ml/m). An emergency simultaneous operation was performed: thrombectomy from the brachial, radial, and ulnar arteries on the right under local anesthesia (transverse arteriotomy of the brachial artery, Fogarty catheters 3F, 5F) with satisfactory antegrade and retrograde blood fl ow; plus under spinal anesthesia, an attempt was made to thrombectomy, Fogarty 5 catheter passed freely, a weak retrograde blood fl ow was obtained, but after 3 minutes, repeated thrombosis of the PBA developed). That followed by femoral-popliteal prosthetics (above the knee joint gap) with a synthetic prosthesis “Ekofl on” with obtaining a satisfactory pulsation distally.On the 21st day after the operation, the patient was discharged from the institution in a satisfactory condition.Пациент А., 65 лет, мужчина. Поступил с жалобами на повышение температуры в течение 5 дней до 39,0°С, сухой кашель, одышку при физической нагрузке, болезненность в области правого фланка живота и правой поясничной области на протяжении 7 дней. За 3 дня до этого больной получил положительный тест полимеразной цепной реакции (ПЦР) на наличие SARS-CoV-2. При осмотре пациента выявлена геморрагическая сыпь на обеих голенях. Консультирован дерматовенерологом, выставлен диагноз: «Острый инфекционно-геморрагический васкулит, буллезная форма».По данным мультиспиральной компьютерной томографии с ангиографией (МСКТ АГ): большая поясничная мышца справа утолщена, в ее структуре определяется скопление содержимого геморрагической плотности, общими размерами 52х48х148 мм. Настоящая гематома расценена как спонтанная на фоне коагулопатии, обусловленной COVID-19.По данным МСКТ органов грудной клетки (ОГК): двусторонняя полисегментарная пневмония (55% поражения).Под внутривенным наркозом позадибрюшинно гематома вскрыта, эвакуировано около 300 мл сгустков, установлено 2 дренажа. На 10-е сутки после операции выполнено контрольное МСКТ, по данным которого гематома правой поясничной мышцы уменьшилась в размерах в 2 раза. Принято решение об удалении дренажей.На 13-е сутки после поступления в стационар у пациента диагностирован тромбоз дистальной трети плечевой, локтевой и лучевой артерий; тромбоз поверхностной бедренной артерии (ПБА) слева. Выполнена экстренная симультанная операция: под местной анестезией проведена тромб­эктомия из плечевой, лучевой, локтевой артерий справа (поперечная артериотомия плечевой артерии, катетеры Фогарти 3F, 5F) с получением удовлетворительного антеградного и ретроградного кровотока + под спинальной анестезией выполнена попытка тромбэктомии из ПБА (катетер Фогарти 5F проходил свободно, получен слабый ретроградный кровоток, однако через 3 минуты развился повторный тромбоз ПБА) с последующим бедренно-подколенным протезированием (выше щели коленного сустава) синтетическим протезом «Экофлон» с получением удовлетворительной пульсации дистально.На 21-е сутки после операции пациент был выписан из учреждения в удовлетворительном состоянии

Methods of carotid endarterectomy

This literature review is devoted to various carotid endarterectomy (CE) methods that exist today in Russia. The pros and cons of conventional and eversion technique of the operation are given. It is indicated that the former is associated with higher long-term rate of restenosis, aneurysm and patch infection. The second is associated with higher prevalence of intraoperative internal carotid artery (ICA) thrombosis due to intimal detachment distal to endarterectomy area. The following CE methods for patients with prolonged ICA involvement are described: neo bifurcation formation, autoarterial reconstruction, ICA autotransplantation, plastic using an occipital artery flap. The methods of CE with carotid body saving have been demonstrated: 1. Swallow tail type patch repair proposed by R.I. Izhbuldin; 2. S-shaped arteriotomy proposed by K. A. Antsupov; 3. Two types of operations proposed by R. А. Vinogradov; 4. Сutting off the ICA with sections of common and external carotid artery proposed by A. N. Kazantsev; 5. Glomus-saving ICA autotransplantation in patients with prolonged atherosclerotic involvement. The role of ICA transposition over the hypoglossal nerve in eversion CE is presented. The glomus-saving CE with ICA transposition, called Chik-Chirik CE, is described. Conclusions are drawn on the need to demonstrate all CE types in the novel Russian guidelines for the management of patients with of head and neck arterial diseases

Проблема выбора метода реваскуляризации при сочетанном поражении коронарных и сонных артерий. Обзор действующих рекомендаций и серии статей

This article provides data from the current Russian (National guidelines for the management of patients with diseases of the brachiocephalic arteries of 2013; Recommendations “Blockage and stenosis of the carotid artery” of the Ministry of Health of the Russian Federation, 2016) and foreign (European Society of Cardiology / European Society of Vascular Surgeons for Diagnosis and Treatment Peripheral Artery Diseases 2017; Recommendations for myocardial revascularization of the European Society of Cardiology and the European Association of Cardio-Thoracic Surgeons 2018) recommendations regarding the choice of a revascularization strategy for combined coronary and carotid artery disease. Conclusions are drawn about the unresolved issue. A literature review of the largest series of Russian articles by one institution devoted to this topic was carried out. Hospital and long-term outcomes have been demonstrated, as well as predictors of complications for various revascularization strategies. The stages of creation and the results of approbation of a new computer program for risk stratifi cation, which makes it possible to determine the mathematical probability of the development of unfavorable cardiovascular events during the implementation of various surgical tactics, taking into account the individual characteristics of the patient. A conclusion was made about the effectiveness of this development.В настоящей статье приведены данные действующих российских (Национальные рекомендации по ведению пациентов с заболеваниями брахиоцефальных артерий 2013 года; Рекомендации «Закупорка и стеноз сонной артерии» Министерства здравоохранения Российской Федерации, 2016 года) и зарубежных (Европейского общества кардиологов/Европейского общества сосудистых хирургов по диагностике и лечению заболеваний периферических артерий 2017 года; Рекомендации по реваскуляризации миокарда Европейского общества кардиологов и Европейской ассоциации кардиоторакальных хирургов 2018 года) рекомендаций, посвященные выбору стратегии реваскуляризации при сочетанном поражении коронарных и каротидных артерий. Сделаны выводы о нерешенности данного вопроса. Выполнен обзор литературы самой большой серии российских статей одного учреждения, посвященных этой теме. Продемонстрированы госпитальные и отдаленные результаты, а также предикторы развития осложнений различных стратегий реваскуляризации. Представлены этапы создания и результаты апробации новой компьютерной программы стратификации риска, позволяющей определить математическую вероятность развития неблагоприятных кардиоваскулярных событий при реализации разных хирургических тактик с учетом индивидуальных особенностей пациента. Сделано заключение об эффективности этой разработки

Экстренная каротидная эндартерэктомия при тромбозе внутренней сонной артерии на фоне CОVID-19

A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition.Представлен случай успешной экстренной каротидной эндартерэктомии (КЭЭ) в острейшем периоде ишемического инсульта (в течение часа с момента развития симптомов) у пациента с острым окклюзионным тромбозом внутренней сонной артерии на фоне средне-тяжелого течения COVID-19 с положительным результатом полимеразной цепной реакции носоглоточного мазка на наличие SARS-CoV-2. Диаметр ишемического очага в головном мозге по данным мультиспиральной компьютерной томографии не превышал 2,5 см. Течение ишемического инсульта характеризовалось легким неврологическим дефицитом (5 баллов по шкале National Institute of Health Stroke Scale). Продемонстрировано, что тяжесть состояния пациента была обусловлена двусторонней полисегментарной вирусной пневмонией с 65% поражением легочной ткани, снижением SpO2 до 93%. Лабораторно отмечалась коагулопатия с повышением D-димера (2837,0 нг/мл), протромбина по Квику (155,3%), фибриногена (14,5 гр/л) и признаки «цитокинового шторма» с лейкоцитозом (28,4·109/л), повышением уровня С-реактивного белка (183,5 мг/л), ферритина (632,8 нг/мл), интерлейкина-6 (176,9 пг/мл).Пациенту выполнена гломус-сберегающая эверсионная КЭЭ. Вмешательство выполнялось под местной анестезией ввиду высокого риска развития легочной баротравмы при применении искусственной вентиляции легких. Для профилактики развития острой гематомы применялся двойной активный дренаж в паравазальное пространство и подкожно-жировую клетчатку (ПЖК). При тромбозе одного из дренажей второй мог бы выполнять функцию запасного. Также при поступлении геморрагического отделяемого из дренажа, расположенного в ПЖК, не требовалась бы транспортировка больного в операционную. Удаление кожных швов с ревизией и прошиванием источника кровотечения могло бы выполняться под местной анестезией в условиях перевязочного кабинета. Послеоперационный период протекал без осложнений, отмечался полный регресс неврологической симптоматики. Применялась антикоагулянтная (гепарин 5 тысяч ЕД 4 раза в день подкожно) и дезагрегантная терапия (ацетилсалициловая кислота 125 мг в обед). Пациент был выписан из стационара на 12-е сутки после КЭЭ в удовлетворительном состоянии

Экстренный экстра-интракраниальный микроанастомоз после каротидной эндартерэктомии, осложненной тромбозом внутренней сонной артерии

We report a case of emergency extra- intracranial microanastomosis in a patient with acute thrombosis of the internal carotid artery, formed on the first day after classical carotid endarterectomy using a temporary by-pass under conditions of contralateral occlusion. The causes of the complication are analyzed. A set of instrumental examinations was demonstrated, including multispiral computed tomography with angiography of the brain and extracranial arteries, as well as multispiral computed tomography with the study of parameters of cerebral perfusion after acetazolamide. The main stages of surgical correction, the dynamics of clinical indicators are presented. The conclusion was made about the effectiveness and safety of the chosen revascularization strategy.Представлен случай экстренного экстра-интракраниального микроанастомоза у пациента с острым тромбозом внутренней сонной артерии, сформировавшимся в первые сутки после классической каротидной эндартерэктомии с применением временного шунта в условиях контралатеральной окклюзии. Разобраны причины осложнения. Продемонстрирован комплекс инструментальных обследований, включающих мультиспиральную компьютерную томографию с ангиографией головного мозга и экстракраниальных артерий, а также мультиспиральную компьютерную томографию с изучением показателей перфузии головного мозга после приема ацетазоламида. Представлены основные этапы оперативной коррекции, динамика клинических показателей. Сделано заключение об эффективности и безопасности выбранной стратегии реваскуляризации

SYNTHESIS OF GOLD NANOPARTICLES BY BLUE-GREEN ALGAE Spirulina platensis

Kalabegishvili T. et al. E14-2012-31 Synthesis of Gold Nanoparticles by Blue-Green Algae Spirulina platensis The synthesis of gold nanoparticles by one of the many popular microorganisms Å blue-green algae Spirulina platensis was studied. The complex of optical and analytical methods was applied for investigation of experimental samples after exposure to chloroaurate (HAuCl4) solution at different doses and for different time intervals. To characterize formed gold nanoparticles UV-vis, TEM, SEM, EDAX, and XRD were used. It was shown that after 1.5Ä2 days of exposure the extracellular formation of nanoparticles of spherical form and the distribution peak within the interval of 20Ä30 nm took place. To determine gold concentrations in the Spirulina platensis biomass, neutron activation analysis (NAA) and atomic absorption spectrometry (AAS) were applied. The results obtained evidence that the concentration of gold accumulated by Spirulina biomass is rapidly growing in the beginning, followed by some increase for the next few days. The obtained substance of Spirulina biomass with gold nanoparticles may be used for medical, pharmaceutical, and technological purposes. The investigation has been performed a

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p<0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p<0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p<0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p<0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p<0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p <0.0001), MI (p = 0.011), ischemic stroke (p <0.0001), restenosis / occlusion of the ICA (p <0.0001), combined end point (p <0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period

CarotidSCORE.RU — risk stratification for complications after carotid endarterectomy

Aim. To demonstrate the first Russian computer program (carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CE).Material and methods. The present study is based on the analysis of a multicenter Russian database including 25812 patients after CE operated on from January 1, 2010 to April 1, 2022. The following types of CE were implemented: conventional CE with patch angioplasty — 6814 patients; eversion CE — 18998 patients. Following postoperative complications were assessed during the study: death, stroke, myocardial infarction (MI), composite endpoint (death + stroke + MI).Results. During inhospital postoperative period, 0,18% of participants died, while 0,14% had MI, 0,35% — stroke. The composite endpoint was recorded in 0,68%. For each factor present in patients, a predictive coefficient was estimated. The predictive coefficient was considered as a numerical parameter reflecting the strength of the effect of each factor on the development of postoperative complications. Based on this equation, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected as a percentage and denoted the risk of postoperative complications with a minimum of 0% and a maximum of 100%. On the basis of obtained calculations, a CarotidSCORE program was created. Its graphical interface is based on the QT framework. It is possible not only to estimate the risk of a complication, but also to save all data about a patient in JSON format. The CarotidSCORE program contains 47 patient parameters, including clinical, demographic, anamnestic and angiographic characteristics. It makes it possible to choose one of the four CE types, which will provide an accurate stratification of the complication risk for each of them.Conclusion. CarotidSCORE (carotidscore.ru) may determine the probability of postoperative complications in patients undergoing CE

Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up