EFFECTIVENESS OF ALTERNATIVE METHODS OF SECONDARY RECURRENT CEREBRAL ISCHEMIA PREVENTION AND TREATMENT IN PATIENTS WITH INTRACRANIAL ANEURISM HAEMORRHAGE

Aim. Improvement of the treatment results in patients with intracranial aneurism haemorrhage by means of alternative methods of prevention and treatment of recurrent cerebral ischemia. Materials and Methods. Research: 328 patients with intracranial aneurism haemorrhage and cerebral angiospasm have been included in the research. 257 patients have undergone intracranial operational treatment, i.e., arterial aneurism clipping. 71 patients were operated by endovascular method. To prevent recurrent cerebral ischemia, prophylactic hypothermia was used in 48 patients in the course of the operative treatment. To treat intracranial hypertension and recurrent cerebral ischemia in 29 patients with complications in the postoperative period, therapeutic hypothermia was used. Simvastatin 80mg/d was prescribed to 43 patients with arterial vascular spasm. Results and Discussion. Total numbers of intra- and postsurgery complications in the group of patients where hypothermia had been used were reliably lower (p=0,038 (u=2,08) - OR= 0,531 [0,265; 1,063]. Improvement of general results while using prophylactic hypothermia is due to minor mortality (p=0,002 (u=3,113) and better restoration of neurological functions after the development of complications (p=0,019 (u=-2,337). Usage of therapeutic hypothermia in the post-surgery period in patients with severe intracranial hypertension and recurrent cerebral ischemia led to reliable decrease of mortality (p=0,000001 (u=4,89) and promoted better restoration of neurological deficits (p=0,002 (u=-3,052). The use of simvastatin in patients with cerebral angiospasm reliably decreases the rate of ischemia stroke after operational treatment (p=0,001 (u=3,3) - OR= 3,15 [1,511; 6,568]). The use of simvastatin also leads to better treatment outcomes (OR= 3,26 [1,5; 7,073]) due to restorations of neurological deficits(p=0,008 (u=-2,64) and prevention of disability (p=0,003 (u=2,944). Conclusions. Usage of prophylactic hypothermia during intracranial operational aneurism elimination, and therapeutic hypothermia in the post-surgery period in patients with severe intracranial hypertension and cerebral angiospasm improve general immediate treatment outcomes in patients with intracranial aneurism haemorrhage. Keywords: intracranial aneurism haemorrhage, prophylactic hypothermia, therapeutic hypothermia, simvastatin