THE VALUE OF CT ANGIOGRAPHY IN IDENTIFYING THE PATHOLOGY OF EXTRACRANIAL CAROTID AND VERTEBRAL ARTERIES IN PATIENTS IN THE ACUTE PERIOD OF RUPTURE OF CEREBRAL ANEURYSMS

Abstract

Computed tomography (CT) of the brain and CT angiography (CTAG) are generally accepted radiological diagnostic methods in the examination of patients with suspected acute intracerebral hemorrhage (ICH) due to ruptured cerebral aneurysms (CAA). There are various protocols for performing CT and CTAG, in particular, the study area can be limited only to the brain area or include the brachiocephalic arteries (BCA) with the aortic arch in order to diagnose concomitant vascular pathology. Purpose of the study: To determine the contribution of CTAG in identifying the pathology of the extracranial parts of the BCA and its clinical significance in patients examined for acute intracerebral hemorrhages due to rupture of the ABM. Material and methods: The study included 275 patients treated in the neurosurgical department of the State Budgetary Healthcare Institution Research Institute - KKB No. 1 named after. prof. S.V. Ochapovsky " of the Ministry of Health of the Krasnodar Territory for acute non-traumatic intracranial hemorrhage ( nICH ) due to rupture of the ABM, from September 2017 to August 2020. All patients underwent CT and CTAG. With CTAG, the scanning area included both intracranial and extracranial arteries (from the level of the aortic arch to the skin of the crown). The presence and forms of pathological changes in the BCA (stenoses, occlusions, pathological bends, hypoplasia) were analyzed. Results: Atherosclerotic lesions of the internal carotid arteries and vertebral arteries were diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) stenoses were hemodynamically significant. A high frequency of pathological bends of the BCA (122 patients, 44.3%) and hypoplasia of the vertebral arteries (59 cases, 21.5%) was revealed. It was found that the presence of BCA stenoses and congenital anomalies of the vertebral (but not carotid) arteries was associated with a higher incidence of adverse outcomes after endovascular treatment of AGM. Conclusion: The CTAG protocol for acute nICH should include examination of the arteries of both the head and neck (up to the aortic arch). This algorithm makes it possible to identify a significant number of concomitant anomalies of the BCA, which are of great importance in planning and successful implementation of endovascular treatment of intracranial AGM. Key words: CT angiography, aneurysm, subarachnoid hemorrhage, atherosclerosis of the brachiocephalic arteries, developmental anomalies of the brachiocephalic arteries