PLANNING A RECONSTRUCTION METHODFOR DOLICHOARTERIOPATHIES OF THE INTERNAL CAROTIDARTERY BASED ON MULTISPIRAL COMPUTED TOMOGRAPHY

Abstract

Introduction: The choice of the method of reconstruction on the carotid arteries (CA) depends on the type of
dolichoarteriopathies of the internal carotid artery (DICA) and is selected based on the data of visual research methods.
Recent advances in multispiral computed tomography (MSCT) and imaging techniques using the Software enable 3D
images to be reconstructed for more accurate analysis.
The purpose of this study is to optimize preoperative planning for DICA based on contrast-enhanced MSCT data.
Methods: The study included 167 patients with clinical signs of cerebrovascular insufficiency (CVD) and
hemodynamically significant DICA, who underwent contrast-enhanced MSCT. MSCT with contrast was performed on a
Philips Brilliance iCT tomograph, the thickness of the resulting sections was not more than 0.6 mm. Three-dimensional
images of CT scans were obtained using RadiAnt DICOM Viewer 2020.2.3 software. Based on the 3D image of MSCT with
contrast, before surgical treatment, we compiled a protocol for assessing the state of the deformed area of the ICA. All
patients were operated on, 30 patients had a bilateral lesion. They were operated on from the collateral side, as they had a
clinic on both sides.
Results: In 137 patients, unilateral DICA was identified, kinking prevailed - 64%, C- and S-shaped tortuosities were less
common - 26%, and coiling - 10%; bilateral DICA was much less common than unilateral - in 30 patients. The location of the
deformed segment of the ICA relative to the angle of the mandibular (at the level / above / below): at the level - 75 (38%);
higher - 94 (48%); below - 28 (14%). In 69 out of 197 cases, the excess of the ICA after its conditional straightening was less
than 2 cm, in other cases (162) it was more than 2 cm. Out of 197 reconstructions on the CA for DICA, 69 operations were
performed by the 1st method, 105 by the 2nd method, 21 by the 3rd method, 2 by the 4th method.
Conclusions: MSCT with contrasting allows obtaining information about the level of location of the pathologically altered
ICA area, the type of deformation, and also allows calculating the excess of the artery after conditional straightening. All
these data make it possible to correctly choose the method of reconstruction on the CA in DICA.