Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions

Ignatenko, Pavel; Гостев, А. А.; Саая, Ш. Б.; Rabtsun, Artem; Чебан, А. В.; Starodubtsev, Vladimir; Карпенко, А. А.

doi:10.33529/angio2020117

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…разработали эверсионную методику операции, которая является доминирующей в современной каротидной хирургии [9][10][11][12]. С популяризацией персонифицированной медицины универсальный подход к этому виду операции претерпел множество преобразований [13][14][15][16][17].…”

Section: Introductionunclassified

“…Проблемой являлись протяженные атеросклеротические бляшки во внутренней сонной артерии [13][14][15]. Изначальный подход к инверсии операции в этих условиях подразумевал выполнение протезирования [3; 7].…”

Section: Introductionunclassified

“…Игнатенко с соавт. предложили аналогичную технику, получившую название «аутоартериальная реконструкция» [14]. Отличие заключалось лишь в том, что вместо внутренней сонной артерии изначально отсекалась наружная сонная артерия.…”

Section: Introductionunclassified

“…Отличие заключалось лишь в том, что вместо внутренней сонной артерии изначально отсекалась наружная сонная артерия. Далее ход операции был подобным [14], тем не менее оба способа коррекции признаны безопасными и эффективными.…”

Section: Introductionunclassified

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Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Казанцев¹,

Chernykh²,

Лидер³

et al. 2020

PKiK

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Aim. 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.Methods. 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 A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months. 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.Results. 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.Conclusion. 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.Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Method development and testing: A.N. Kazantsev Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev Drafting the article: A.N. Kazantsev Drawing up tables: E.Yu. Kalinin Statistical analysis: K.P. Chernykh Literature review: R.Yu. Leader, G.Sh. Bagdavadze Critical revision of the article: N.E. Zarkua, K.G. Kubachev Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets

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Section: Introductionunclassified

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Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Казанцев¹,

Chernykh²,

Лидер³

et al. 2020

PKiK

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Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?

Belov

Казанцев

Kravchuk

et al. 2022

Current Problems in Cardiology

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Dynamics of resistant hypertension in the postoperative period of carotid endarterectomy with and without carotid body saving

et al. 2021

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Aim. To analyze the results of multicenter study on dynamics of resistant hypertension (RH) in patients after various types of carotid endarterectomy (CE) with and without carotid body savingMaterial and methods. During the period from January 2010 to December 2020, 1827 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RH were operated on. Depending on CE type, the two groups were selected. Group 1 (n=1135; 62,2%) consisted of patients received glomus-saving surgery: 19,2% (n=351) -conventional CE with a patch repair of reconstitution point; 13,6% (n=248) — glomus-saving CE sensu R. A. Vinogradov; 7,3% (n=133) — glomus-saving CE sensu K. A. Antsupov; 11,7% (n=214) — glomus-saving CE sensu A. N. Kazantsev; 4,6% (n=84) — Chick-Chirik CE; 5,7% (n=105) — swallow tail type patch repair sensu R. I. Izhbuldin. Group 2 (n=692; 37,8%) consisted of patients received CE without glomus saving: 18,6% (n=341) — eversion CE with carotid body cutoff; 6,3% (n=115) — CE with new bifurcation plasty; 5,85% (n=107) — autoarterial reconstruction; 7,1% (n=129) ICA autotransplantation sensu E. V. Rosseikin.Results. The mortality rate, as well as the prevalence of myocardial infarction (MI) and ischemic strokes were comparable in groups. The incidence of hemorrhagic transformation (group 1: 0%; group 2: 0,6%; p=0,04; OR=0,06; 95% CI, 0,003-1,25) and composite endpoint (death+MI+ischemic stroke+hemorrhagic transformation) (group 1: 1,06%; group 2: 3,0%; p=0,004; odds ratio (OR)=0,34; 95% CI, 0,16-0,69) significantly differs between groups. After glomus-saving CE, the number of patients with the target blood pressure (BP) level reached 51,1% (p <0,0001; OR=0,0009; 95% CI, 6,05-15,9). The number of patients with grade II (31,1%; p<0,0001; OR=12,7; 95% CI, 10,4-15,52) and III (3,6%; p<0,0001; OR=10,26; 95% CI, 6,71-15,67) hypertension significantly decreased. In the group 2, the prevalence grade III hypertension increased (48,0%; p<0,0001; OR=0,23; 95% CI, 0,18-0,3), while the number of patients with grade I (0%; p<0,0001; OR=77,0; 95% CI, 4,71-12,58) and II (52%; p<0,0001; OR=3,06; 95% CI, 2,43-3,86) hypertension decreased.Conclusion. Glomus-saving CE contributes to achieving target BP in patients with RH. Its removal increases the risks of labile hypertension, postoperative hypertensive crisis, hyperperfusion syndrome and hemorrhagic transformation.

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Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions

Cited by 6 publications

References 18 publications

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?

Dynamics of resistant hypertension in the postoperative period of carotid endarterectomy with and without carotid body saving

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