From Big Medical Encyclopedia

INTRAKAROTIDNY MEDICINAL THERAPY (Latin intra inside + carotis, caroti [dis] carotid artery; Greek therapeia treatment) — the method of treatment consisting in administration of medicinal substances in carotid arteries for more effective impact on various pathological processes (inflammations, infections, malignant new growths) which are localized in a brain, the head and a neck.

And. l. t. after single introduction by R. Lerish (1913) antitetanic serums in a carotid artery long time it was applied extremely seldom.

In days of the Great Patriotic War of H. N. Burdenko (1942) for the first time began to administer intrakarotidno the sulfanamide drugs, penicillin at meningoentsefalita, abscesses of a brain for the purpose of leading of medicine directly to patol, to the center and creations in it the maximum concentration of drug (deep antiseptics of fabrics). In wartime and in the first post-war years Burdenko's method gained further theoretical justification and practical development and was widely used for treatment of purulent and inflammatory diseases of a brain, at stump neuralgias, epilepsy, a severe craniocereberal injury, gnoynoseptichesky diseases of the person and a pilar part of the head. In process of accumulation of practical experience and scientific generalizations of the indication made on this basis for And. l. t. became more accurate and limited.

Intrakarotidny administration of medicinal substances is often applied to create if necessary quickly rather high concentration to lay down. drug in patol, the center. Further maintenance to lay down. concentration of drugs is reached in such cases in other ways of their introduction.

And. l. t. by antineoplastic himiopreparata it is applied also to the combined treatment of malignant new growths of a brain, area of the head and a neck.

To lay down. drugs enter into one of carotid arteries or its branch by method of a transdermal puncture a special needle or through the catheter entered into an artery after its operational exposure. For catheterization of an outside carotid artery use superficial temporal, front front or upper thyroid arteries. Catheterization of an internal carotid artery can be made through an upper thyroid artery. The choice of the punktiruyemy or catheterized vessel and a method of carrying out And. l. t. depend on localization and character patol, process; carry out And. l. t. one-time fractional or continuous infusion in one or both carotid arteries.

There is a number of the features limiting an opportunity and efficiency of use of a method: difficulties of overcoming a blood-brain barrier for a number of chemotherapeutic substances, variability of blood supply both all brain, and the struck its sites, impossibility of isolation of cerebral circulation from the general blood-groove, hit of drugs in other systems and bodies, features of distribution of drug depending on the provision of a catheter in a carotid artery, and also such possible complications as a spasm and thrombosis of vessels, a local infection, occlusion of a catheter, developing of bleedings with formation of hematomas of a neck.

Bibliography: Alexandrov H. N and Knotty L. S. Penicillinic epilepsy and the choice of a route of administration of an antibiotic at open injuries of a skull, Minsk, 1966, bibliogr.; Burdenko H. H. Experience of use of penicillin through A. carotis, Surgery. No. I, page 19, 1945; Gasparyan S.A., Ostroverkhov G. E. and Trapeznikov H. H. A regional long vnutriarterialna I am chemotherapy of malignant tumors, M., 1970, bibliogr.; Paches A. I., etc. Regional intra arterial chemotherapy of malignant tumors of the head and neck, M., 1974, bibliogr.; Regional chemotherapy of malignant tumors, under the editorship of G. E. Ostroverkhov and H. N. Trapeznikova, page 26, M., 1967; Creech O. Intra-arterial chemotherapy for recurrent neoplasms, J. Amer. med. Ass., v. 200 p. 983, 1967; Wilson of Page B. Hoshi-n o T. Current trends in the chemotherapy of brain tumors with special reference to glioblastomas, J. Neurosurg., v. 31 p. 589, 1969.

A. P. Romodanov