Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results

Abstract

Изучение госпитальных результатов экстренной каротидной эндартерэктомии (КЭЭ) и каротидной ангиопластики со стентированием (КАС) в острейшем периоде острого нарушения мозгового кровообращения (ОНМК). МАТеРИАЛ И МеТОдыC января 2008 по август 2020 г. в исследование вошли 615 пациентов с гемодинамически значимыми стенозами внутренних сонных артерий (ВСА), оперированными в острейшем периоде ишемического инсульта (в течение 3 суток от дебюта ОНМК). В зависимости от реализованного вида реваскуляризации все больные были распределены на две группы: 1-я группа -КАС (n=312); 2-я группа -КЭЭ (n=357). Критериями включения стали: 1. Неврологические нарушения легкой степени: от 3 до 8 баллов по шкале NIHSS; не более 2 баллов по модификационной шкале Рэнкина; более 61 балла по шкале Бартел; 2. Показания для КЭЭ/КАС согласно действующим национальным рекомендациям; 3. Ишемический очаг в головном мозге не более 2,5 см в диаметре.

Stenting of the artery of Dr A.N. Kazantsev in the acute period of ischemic stroke

“…It should also be noted that the choice in favor of emergency CAS and the rejection of CEA was made in view of the analysis of the latest Russian multicenter study that demonstrated a protective mechanism for the prevention of hemorrhagic transformation when using endovascular methods for correcting hemodynamically significant ICA stenosis in the urgent mode [17] .…”

“…However, well-known domestic works are most often devoted to the analysis of the results of only one of these reconstruction methods on an emergency basis [12] , [13] , [14] , [15] , [16] . However, the only Russian multicenter study published in 2021 compared the results of both methods of revascularization [17] . The authors concluded that CEA is a less preferable option for correcting hemodynamically significant ICA stenosis in the urgent mode due to the high risk of developing hemorrhagic transformation of the ischemic focus in the brain and all adverse cardiovascular events [17] .…”

“…However, the only Russian multicenter study published in 2021 compared the results of both methods of revascularization [17] . The authors concluded that CEA is a less preferable option for correcting hemodynamically significant ICA stenosis in the urgent mode due to the high risk of developing hemorrhagic transformation of the ischemic focus in the brain and all adverse cardiovascular events [17] . Thus, according to the main conclusion of this study, ICA stenting is a safer procedure relative to open surgical interventions in patients in the most acute period of stroke [17] .…”

“…The authors concluded that CEA is a less preferable option for correcting hemodynamically significant ICA stenosis in the urgent mode due to the high risk of developing hemorrhagic transformation of the ischemic focus in the brain and all adverse cardiovascular events [17] . Thus, according to the main conclusion of this study, ICA stenting is a safer procedure relative to open surgical interventions in patients in the most acute period of stroke [17] . Some difficulties are caused by the choice of strategy for emergency cerebral revascularization in the presence of a variant structure of the carotid bifurcation.…”

Carotid Enadrterectomy for Thrombosis of the Internal Carotid Artery in Patients With COVID-19

“…The criteria for selecting patients for emergency CEE in "non-covid" surgery have been repeatedly put forward and substantiated: unstable atherosclerotic plaque with a high risk of distal embolization; the diameter of the ischemic focus in the brain, not exceeding 2.5 cm; the absence of a pronounced neurological deficit (stupor, coma); hemorrhagic stroke; hemorrhagic transformation; acute coronary syndrome [ 8 , 11 , 12 , 13 , 14 ]. But in the absence of an alternative, these parameters can be used in the context of COVID-19 as well.…”