The influence of occlusive-stenotic lesions of the arteries of the head and neck on the methods and results of surgical treatment of ruptured arterial aneurysms

Abstract

Aim: to analyze the results of surgical treatment of patients with ruptured arterial aneurysms in the presence of occlusive-stenotic lesions of cerebral arteries and to evaluate the impact of combined lesions on the choice of surgical treatment method. Materials and methods. A retrospective study was conducted on the medical histories of patients with aneurysmal disease of cerebral arteries from 2006 to 2022. The main group consisted of 63 patients with occlusive-stenotic lesions of cerebral arteries who underwent surgery for ruptured arterial aneurysm. The comparison group included 63 patients without occlusive-stenotic lesions. The analysis included an assessment of neurological status, examination results, and statistical data processing. Results. Occlusive-stenotic lesions of the head and neck arteries were more frequently observed in men, the maximum difference in age was found at a stenosis of 50–75 % (men – 48.30 ± 2.51 years; women – 62.00 ± 5.06 years, p < 0.01). Cerebral artery stenosis was more commonly observed in cases of ruptured middle cerebral artery aneurysms. The main group had more fatal cases (n = 5) compared to the comparison group (n = 2), p = 0.25. Conclusions. Ruptured arterial aneurysms are more frequently diagnosed in the presence of middle cerebral artery stenosis (p < 0.05). Ruptured aneurysms in patients with occlusive-stenotic lesions of cerebral arteries are more often diagnosed in middle age (p = 0.0001). The combination of stenosis and aneurysm complicates the disease course and affects the choice of surgical method. Patients with combined lesions have a higher risk of ischemic complications (p = 0.03). The greatest life risks arise from ruptured arterial aneurysms in men with concomitant arterial stenosis. The main risk factors are occlusive-stenotic lesions of the arteries, recurrent hemorrhages, and large intracranial hemorrhages.

Keywords

• arterial aneurysm
• occlusive-stenotic lesions
• cerebral arteries
• brachiocephalic trunk
• operative surgical procedures