RISK FACTORS FOR PRE AND POSTOPERATIVE COMPLICATIONSOF INTRA-EXTRACRANIAL ATHEROSCLEROTIC ARTERIAL LESIONS

Abstract

Background. Arterial hypertension, high cholesterol, blood sugar, smoking and old age are risk factors for
atherosclerotic ischemic stroke and transient ischemic attack. Other risk factors that are also considered as causes of
atherosclerotic ischemic stroke require confirmation: obesity, lack of physical activity, psychosocial factors, dietary patterns.
The surgical standard for the treatment of atherosclerotic diseases of intra-extracranial vessels is endovascular stenting and
carotid endarterectomy. The aim of this study was to identify the main risk factors for pre- and postoperative complications
and to determine the criteria for the correct selection of patients for surgical treatment with intra- and extracranial
atherosclerotic arterial disease.
Methods. A retrospective analysis of 725 case histories of treated cases with atherosclerotic lesions of extra- and
intracranial arteries, operated on the basis of the clinic of JSC "Central Clinical Hospital" in Almaty in the Department of
Neurosurgery for the period from 2016 to 2021, was carried out. The main group included 212 cases with intracranial
atherosclerotic plaques, the control group included 513 cases with extracranial plaques.
Results. The predictors of the development of complications (stroke) in atherosclerosis before surgery were determined:
the presence of coronary artery disease increased the chance of developing stroke by 4.882 (95% CI: 3.313–7.194),
smoking by 2.659 times (95% CI: 2.151–3.288), diabetes mellitus by 1.2 times (95% CI: 0.868-1.648), hypercholesterolemia
- 1.248 times (95% CI: 1.099 - 1.416), hypertensive crisis - 1.04 times (95% CI: 1.000-1.085). Extracranial vascular lesions
had an inverse relationship with the development of complications. The presence of diabetes in 3.870 increased the chance
of developing a complication after surgery (stent thrombosis) (95% CI: 0.959 -15.614).
Conclusion. In the presence of risk factors: smoking, diabetes mellitus, hypercholesterolemia, hypertensive crisis and
age over 60 years, closer monitoring is necessary for the implementation of preventive measures and treatment, especially
for intracranial arterial disease. Before a planned operation, stabilization of blood sugar levels and strict adherence to the
recommendations of an endocrinologist regarding therapy during the treatment of atherosclerosis are especially necessary.