Characteristics of blood pressure in patients with hypertension and carotid atherosclerosis before and after surgery on carotid arteries

Kosacheva, Natalia; Tuev, A V; Агафонов, А. В.; Мухамадеев, И С

doi:10.18705/1607-419x-2010-16-4-396-400

Cited by 4 publications

(7 citation statements)

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“…Marrocco-Trischitta в своих работах [4,22]. Было предложено даже блокировать КГ местным анестетиком для профилактики развития гипертонического криза [4]. Однако эта методика не получила распространения.…”

Section: обсуж дениеunclassified

“…Однако эта методика не получила распространения. Авторы также продемонстрировали, что удаление АСБ приводит к снижению и САД (с 145,1±14,7 до 135,6±12,3 мм рт.ст., р=0,02), и диастолического АД (с 83,3±10,2 до 78,1±9,7 мм рт.ст., р=0,02) [4]. Данное заключение представили А.Н.…”

Section: обсуж дениеunclassified

“…Дополнительно ко всему непонятен эффект данной процедуры в условиях наличия гемодинамически значимого стеноза во внутренней сонной артерии (ВСА) [2,3]. Известно, что после удаления атеросклеротической бляшки (АСБ) возрастает амплитуда пульсовых колебаний стенки сосуда, что вызывает активацию барорецепторов каротидного тельца и снижение АД [4]. Из этого следует, что аблация может быть эффективна только при отсутствии стенотического процесса во ВСА, о чем дополнительно не говорится в рекомендациях.…”

Section: Introductionunclassified

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Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy

Казанцев

Виноградов

Chernyavsky

et al. 2022

Neotložnaâ med. pomoŝʹ

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Aim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, comparative, retrospective, open-label study from January 2014 to December 2020 included 761 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) and RH lasting more than 3 years. Depending on the implemented revascularization strategy, 2 groups were formed: Group 1: 38.0% (n=289) — classical CEE with plasty of the reconstruction zone with a patch (made of diepoxy-treated xenopericardium or synthetic); Group 2: 62% (n=472) — eversion CEE with CB transection. To study the dynamics of systolic blood pressure (SBP) in the preoperative period for 4 days, and in the postoperative period, blood pressure was measured for 10 days (during the period when the patient was in intensive care - according to daily monitoring of blood pressure; in the department - 10 times per day, daily). The average SBP figures for all patients were taken into account when constructing a graph of BP fluctuations.Results. In the postoperative period, the groups were comparable in the frequency of the following events: death (group 1: 0.34% (n=1), group 2: 0.63% (n=3); p=0.98; OR 0.54; 95% CI 0.05–5.21), myocardial infarction (group 1: 0.34% (n=1), group 2: 0.84% (n=4); p=0.71; OR 0, 40; 95% CI 0.04–3.65), ischemic stroke (group 1: 0.34% (n=1), group 2: 1.27% (n=6); p=0.36; OR 0.26; 95% CI 0.03–2.25), hemorrhagic transformation (group 1: 0%, group 2: 0.84% (n=4); p=0.29; OR 0.17; 95% CI 0.009–3.35). However, in terms of the number of all complications (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) presented as a combined endpoint, patients after eversion CEE with CB transection were three times superior to classical surgery (group 1: 1.03% (n=3 ), group 2: 3.60% (n=17); p=0.05; OR 0.28; 95% CI 0.08–0.9).Conclusion. The choice of a revascularization strategy in patients with hemodynamically significant ICA stenosis should be personalized and based on the conclusion of a multidisciplinary consultation, and not only on the preferences of the operating surgeon. In patients with RH, it is more expedient to use classical CEE with plasty of the reconstruction zone with a patch in view of the preservation of the CB during this operation. The intersection of the latter with eversion CEE provokes labile hypertension, progression of RAH and a statistically significant increase in the number of all unfavorable cardiovascular events. Thus, the use of carotid body preserving CEE in patients with RAH confirms the therapeutic mechanism of this manipulation in achieving the target SBP level.

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Section: обсуж дениеunclassified

Section: Introductionunclassified

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Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy

Казанцев

Виноградов

Chernyavsky

et al. 2022

Neotložnaâ med. pomoŝʹ

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“…Данная работа стала точкой отсчета в дальнейшем развитии вопроса о роли сохранения КГ во время КЭЭ. Gottlieb [19,20,34]. Однако нужно отметить, что все методы КЭЭ, предложенные в нашей работе, имеют место.…”

Section: материал и методыunclassified

“…Получается, аксиома, доказанная Р. А. Виноградовым, является ошибочной и удаление КГ = аблация наоборот, не усугубляет течения АГ и, соответственно, РАГ? До сегодняшнего дня ни в России, ни за рубежом не проводилось многоцентровых исследований по изучению крупных выборок пациентов с РАГ и стенозом внутренней сонной артерии (ВСА) для решения этого вопроса [18,19]. Известные работы включают лишь несколько сотен наблюдений и чаще всего характеризуют динамику АД без наличия РАГ, что не предает полной уверенности в рутинном применении тех методов, которые они разбирают [19][20][21][22][23].…”

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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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Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension

et al. 2022

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Objective Analysis of the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (СЕЕ) (classical with plasty of the reconstruction zone with a patch, eversion, formation of a new bifurcation, autoarterial reconstruction, glomus-saving techniques) in patients with resistant arterial hypertension (RAH). Materials and methods The actual cohort, comparative, retrospective, open research for the period from January 2013 to December 2021 includes 1577 patients with significant hemodynamic stenosis of the internal carotid artery Depending on revascularization strategy five groups were formed: Group 1: 18.3% ( n = 289) – classical Carotid endarterectomy with plasty of the reconstruction zone with a patch (from diepoxy-treated xenopericardium or synthetic); Group 2: 29.9% ( n = 472) – eversional CEE with cut-off of carotid gloomus (CG); Group 3: 6.9% ( n = 109) – the formation of a new bifurcation; Group 4: 7.4% ( n = 117) - autoarterial reconstruction; Group 5: 37.4% ( n = 590) – glomus-saving CEE (1 technique – according to A. N. Kazantsev; two technicians – according to R.A. Vinogradov; three technicians – according to K.A.Antsupov). According to the 24-h blood pressure monitor in the preoperative period, the following degrees of AH were identified: 1° – 5.7% ( n = 89); 2° – 64.2% ( n = 1013); and 3° – 30.1% ( n = 475). Results In the postoperative period, no significant differences were obtained in the frequency of deaths, myocardial infarction, stroke, hemorrhagic transformation. However, according to the frequency of the combined endpoint (death + myocardial infarction + ischemic stroke + hemorrhagic transformation), the lowest rates were observed in the group of classical carotid endarterectomy with plasty of the reconstruction zone with a patch and glomus-sparing CEE (group 1: 1.03% ( n = 3); group 2: 3.6% ( n = 17); group 3: 3.67% ( n = 4); group 4: 2.56% ( n = 3); group 5: 0.5% ( n = 3); p = 0.10). This is due to the absence of cases of labile AH and hypertensive crises among patients of groups 1 and 5, which was ensured by the preservation of carotid glomus (CG). As a result, the number of patients with 2 and 3 degrees of hypertension in these groups decreased statistically significantly. The vast majority of patients after these operations achieved a stable target SBP. In groups 2, 3, and 4, there was a statistically significant increase in the number of patients with 2 and 3 degrees of AH, which is associated with excision of the CG Conclusion Classical CEE and glomus-sparing CEE techniques make it possible to achieve a stable target SBP level in patients with RAH as a result of CG preservation. Removal or traumatization of the latter during eversional CEE, the formation of a new bifurcation, autoarterial reconstruction is accompanied by the development of labile hypertension, an increase in the degree of hypertension and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE, accompanied by the lowest incidence of adverse cardiovascular events caused by postoperative hypertensive crisis and hyperperfusion syndrome.

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Characteristics of blood pressure in patients with hypertension and carotid atherosclerosis before and after surgery on carotid arteries

Cited by 4 publications

References 5 publications

Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy

Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy

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

Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension

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