Objective — to evaluate an individual 10-year risk of stroke in patients with chronic cerebral ischemia, identify predictors of this risk and assess its dynamics during therapy with actovegin. Material and methods. The measures of autonomic homeostasis were estimated in 54 patients with chronic brainstem ischemia. The dynamics of these indexes during therapy with actovegin was studied. Results and conclusion. Chronic cerebral ischemia, mostly vertebrobasilar ischemia, is correlated with an increasing individual 10-year risk of stroke. A high positive pharmacologic effect of actovegin on the central and peripheral structures of the autonomic nervous system in chronic cerebral ischemia has been shown. A mediated hypotensive effect of actovegin due to humoral, metabolic and neurogenic influences on a vessel wall has been demonstrated.