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CNAA / Theses / 2017 / May /

Reconstructive surgery of the carotid arteries in patients with constituted ischemic stroke


Author: Bodiu Adrian
Degree:doctor of medicine
Speciality: 14.00.13 - Neurology
Year:2017
Scientific adviser: Valerii Timirgaz
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Mihai Gavriliuc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:

Status

The thesis was presented on the 23 May, 2017
Approved by NCAA on the 31 May, 2017

Abstract

Adobe PDF document – 0.85 Mb / in romanian

Thesis

CZU 616.133-089.844:616.831-005.4(043.2)

Adobe PDF document 4.23 Mb / in romanian
166 pages

Keywords

ischemic stroke, carotid artery stenosis, atherosclerotic vessel disease, ischemic preconditioning, stupefaction phenomenon of cerebral tissue, ischemic postconditioning

Summary

Thesis structure: Introduction, 5 chapters, general conclusions and recommendations, bibliography, 258 titles, 166 pages, 141 pages of main text, 35 tables, 78 figures and 2 annexes. The obtained results are published in 14 scientific papers.

Field of study: medical sciences.

The purpose of this paper is to research the advantage of carotid endarterectomy in patients with constituted supratentorial ischemic stroke during rehabilitation period.

Objectives of the study:
1. Identification of the optimal surgical management for the treatment of ischemic stroke in patients with carotid artery stenosis.
2. Realization of an optimal diagnostic algorithm for selecting ischemic stroke patients for surgical treatment, comparing data from ultrasound examination, CT angiography, brain perfusion, magnetic resonance examination and laboratory results.
3. Analysis of the phenomenon of cerebral ischemic pre- and postconditioning in patients with constituted supratentorial ischemic stroke with endarterectomy (EC).
4. Assessment of EC effects in patients with constituted ischemic stroke in the sub acute and recovery period.
5. Study of early and delayed postoperative complications preventions methods. Scientific novelty. We have studied the phenomenon of cerebral ischemic pre- and postconditioning in the neurosurgical practice depending on the timing of the surgery after the stroke onset.

It was appreciated the phenomenon of neurological deficit recovery in constituted ischemic stroke patients after surgery, which, in turn, can confirm the phenomenon cerebral stupefaction? We have been also developing optimal intra- and postoperative methods to avoid the phenomenon of “generous reperfusion”.

We studied the effect of the remote ischemic precondition on surgery results. It was realized an optimal diagnostic algorithm for constituted ischemic stroke patients with occlusive and stenotic disease of the main supplying arteries of the brain.

The important solved scientific problem resides in confirming the therapeutic effectiveness of the reconstructive surgery of carotid arteries stenotic pathology in patients with constituted ischemic stroke as recovery method of the neurological deficit. Theoretical significance and practical value. We have developed an optimal algorithm for diagnosis, staging of reconstructive surgery of main brain vessels, application of microsurgical techniques and surgical microscope, prognosis for patients with occlusive and stenotic disease of carotid arteries.

Application of carotid arteries reconstructive surgery in the daily practice of the Institute of Neurology and Neurosurgery.

Implementation of scientific results. The obtained data were presented at national and international scientific conferences. The results were used for the implementation and optimization of carotid stenosis surgical treatment in patients with constituted ischemic stroke within the Institute of Neurology and Neurosurgery. The research results (14 works) were published in professional journals and presented at scientific sessions from Chisinau, Bucharest, Iasi and Cluj (Romania).