Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness.

No abstract

<p><strong>Aim.</strong> Analysis of the results of hospital and medium-long-term results obtained using a new method of glomus-saving carotid endarterectomy (CEE) according to A. N. Kazantsev.</p><p><strong>Methods.</strong> This prospective study was conducted during January 2018 to April 2020 on 214 patients who were operated for occlusive stenotic lesions of the internal carotid artery (ICA) using holomus-saving CEE as per the method described by <br />A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months.<br />Glomus-saving CEE as per the method by A. N. Kazantsev is performed as follows. Arteriotomy is performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the mouth, depending on the distribution of atherosclerotic plaque, with a transition to the common carotid artery (also 2–3 cm below the ECA mouth). The ICA was cut off at the site formed by the wall sections of the ECA and the common carotid artery. Thereafter, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from the ECA and OCA. Then, the ICA at the saved site was implanted in the previous position. A 6-0 Prolene thread was used as the suture material for performing a vascular anastomosis.</p><p><strong>Results.</strong> The average ICA clamping time was 33.1 ± 3.4 min. Considering the intraoperative visualisation of an extended atherosclerotic plaque in the ICA, in some cases, there was a need to transform the operation. In 4.7% (n = 10) cases, autologous ICA transplantation was performed as per E. V. Rosseykinu. During the hospitalisation, the observation of cardiovascular complications was not recorded. When analysing the dynamics graph of systolic blood pressure, it was revealed that after glomus-saving CEE as per the method by A. N. Kazantsev, stable numbers are maintained during preoperative antihypertensive therapy and do not rise above 137.9 ± 7.5 mm Hg. In the mid-long-term follow-up, 1 (0.46 %) death was recorded, 1 (0.46%) due to myocardial infarction, 1 (0.46%) due to non-lethal ischaemic stroke, and 2 (0.9%) due to hemodynamically significant restenosis 12 mon after CEE. The combined endpoint (death + myocardial infarction + stroke) was reached in 3 (1.4%) patients. The cause of the lethal outcome was circular myocardial infarction that developed, given the patient's refusal to follow double disaggregant therapy (2 stents were previously implanted in the anterior descending and right coronary arteries). The cause of ischaemic stroke was the development of ICA restenosis (12 mon after CEE) owing to neointimal hyperplasia, as shown by histological examination after repeated surgery.</p><p><strong>Conclusion.</strong> CEE as per the method by A. N. Kazantsev is the simplest method of operation for known glomus-preserving reconstructions. The absence of complex arteriotomy, the preservation of carotid bifurcation structures, and the possibility of transformation of the intervention into autologous autologous transplantation with prolonged lesion is preferred over other methods. An additional opportunity for high-quality endarterectomy from ЕCA also creates preventive conditions in the prevention of cerebral haemodynamics. Stable blood pressure indicators in the hospital and mid-term follow-up periods demonstrate the importance of the preservation of the carotid glomus during reconstructive surgery on the carotid arteries. Thus, the presented type of CEE meets all the requirements of modern carotid surgery and can be an elective operation in the personalised treatment of patients with occlusal-stenotic lesions of the carotid arteries.</p><p>Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Method development and testing: A.N. Kazantsev<br />Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev<br />Drafting the article: A.N. Kazantsev<br />Drawing up tables: E.Yu. Kalinin<br />Statistical analysis: K.P. Chernykh<br />Literature review: R.Yu. Leader, G.Sh. Bagdavadze<br />Critical revision of the article: N.E. Zarkua, K.G. Kubachev<br />Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, <br />G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets</p>

Aim of study. Analysis of the results of a new method of emergency glomus-sparing carotid endarterectomy (CEE) according to A.N. Kazantsev in the acute period of ischemic stroke.Material and methods. This cohort comparative prospective open-label study from January 2017 to April 2020 included 517 patients operated on for occlusive stenotic lesions of the internal carotid arteries (ICA) in the acute period of ischemic stroke (within 24 hours after the development of ischemic stroke). Depending on the implemented revascularization strategy, all patients were divided into three groups: group 1 — 214 patients (41.4%) — glomus-sparing CEE according to A.N. Kazantsev; 2nd group — 145 (28%) — classical CEE with plasty of the reconstruction zone with a patch; 3rd group — 158 (30.6%) — eversion CEE. The observation period was 35.2±9.6 months. Glomus-saving СE according to A.N. Kazantsev was carried out as follows. Arteriotomy with transition to the common carotid artery (CCA) was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the ostium, depending on the spread of atherosclerotic plaque, the ICA was cut off at the site formed by the sections of the wall of the ECA and CCA. Then endarterectomy from the ICA was performed using the eversion technique. The next step was open endarterectomy from ECA and CCA. Then the ICA was implanted in the same position on the saved site.Results. In the hospital follow-up period, there were no significant intergroup differences in the number of complications. However, it should be noted that in the CEE group according to A.N. Kazantsev had no adverse cardiovascular events. In the long-term follow-up period, the smallest number of cardiovascular accidents was detected after CEE according to A.N. Kazantsev. However, intergroup differences were found only in the combined endpoint and the incidence of thrombosis, which were the highest in the 2nd and 3rd groups (p = 0.01). When analyzing the survival curves, it was revealed that the greatest number of cardiovascular accidents in the group of classical and eversion CEE occurred either during the hospital observation period or during the first months after surgery, and after CEE according to A.N. Kazantsev - in a year or more. When analyzing the graph of the dynamics of systolic blood pressure (BP), it was revealed that after glomus-sparing CEE according to A.N. Kazantsev, stable numbers are maintained while receiving preoperative antihypertensive therapy and do not rise above 140 mm Hg. In turn, after classical and eversion CEE, critical hypertension persists in the first three days, which is difficult to treat. In the future, blood pressure figures are unstable and fluctuate in the range from 140 to 160 mm Hg. All cases of myocardial infarction and ischemic stroke were recorded against the background of critical numbers of systolic blood pressure, reaching 180-200 mm Hg.Conclusion. The presented glomus-sparing carotid endarterectomy according to A.N. Kazantsev meets the modern standards of carotid surgery, combined with the minimum permissible risks of developing adverse cardiovascular events, both in hospital and in the long-term follow-up. The confident effect of the developed revascularization is based on the precise removal of plaque from the common, external and internal carotid arteries, as well as maintaining the stability of hemodynamic parameters.