Computer-assisted simulation of haemodynamic parameters of carotid artery bifurcation after carotid endarterectomy

Казанцев, А. Н.; Burkov, N. N.; Борисов, В. Г.; Zakharov, Yu. N.; Sergeeva, T. Yu.; Шабаев, А. Р.; Lider, R. Yu.; Solobuev, A. I.; Рубан, Е. В.; Bukhtoyarova, V. I.

doi:10.33529/angio2019311

Cited by 30 publications

(14 citation statements)

References 7 publications

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“…В результате чего показания для повторного вмешательства должны быть более жесткими, чем при стандартной КЭЭ. Кандидатами для хирургической коррекции рестеноза должны быть пациенты с симптомным поражением, в состоянии субокклюзии, а качество коррекции необходимо подтверждать с помощью послеоперационной ангиографии, особенно в случае протяженного рестеноза и высокой бифуркации сонной артерии [5,10,11].…”

Section: Discussionunclassified

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

Казанцев¹,

Burkov²,

Шабаев³

et al. 2019

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The results of surgical intervention on a patient with stent restenosis at the mouth of the common carotid artery (CCA) and proximal internal carotid artery (ICA) are presented herein. In 2013, the patient underwent stenting of the CCA and ICA. One month later, the aortic valve was replaced with a mechanical prosthesis MedEng-23 (MedEng, Penza, Russia) and mammarocoronary anastomosis with an envelope artery was performed under extracorporeal circulation. After the intervention, the patient regularly received 3.75 mg of warfarin, and was under the observation of a cardiologist. In 2018, the patient suffered a transient ischaemic attack. Subsequent examination of the patient revealed sub-occlusion of the left subclavian artery and signs of vertebral–subclavian steal syndrome on the left, and confirmed patency of the mammarocoronary shunt in envelope artery. The patient underwent carotid–subclavian shunting using the BASEX (A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia) (8-mm prosthesis. Nine months after the patient underwent carotid–subclavian shunting, 85% restenosis was observed in the stent of the left ICA using control multi-spiral computed tomography with angiography (MSCT AG). The patient also exhibited up to 94% restenosis of the stent of the left ICA, occlusion of the right ICA, and up to 81% stenosis of the proximal anastomosis of the carotid–subclavian shunt. The patient underwent surgery for the removal of the following: the stent from the ICA with endarterectomy from the CCA, ICA with arterial plastic patches from the xenopericardium and prosthesis on the left (8-mm Vascutek prosthesis, Vascutek Ltd., UK). The brain was protected by raising the patient’s systemic blood pressure to 180/90 mm Hg. During the postoperative period, MSCT AG was performed to image the ICA. The MSCT AG images indicated that the prosthesis was passable. Presently, no clear standards exist for achieving revascularisation in this category of patients. The present clinical case emphasised the requirement for the detailed observation of patients after reconstructive interventions in different arteries as well as the possibility of surgically correcting the revealed lesions.Received 13 August 2019. Revised 8 November 2019. Accepted 9 November 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Drafting the article: A.N. Kazantsev Literature review: R.Yu. Lider Illustrations: A.R. Shabayev, A.N. Volkov Critical revision of the article: N.N. Burkov, A.I. Anufriyev Preoperative patient preparation: A.R. Shabayev, E.V. Ruban Postoperative care: A.N. Volkov Neurological examination: E.V. Ruban Final approval of the version to be published: A.N. Kazantsev, N.N. Burkov, A.R. Shabayev, A.N. Volkov, E.V. Ruban, R.Yu. Lider, A.I. Anufriyev

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Section: Discussionunclassified

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

Казанцев¹,

Burkov²,

Шабаев³

et al. 2019

PKiK

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“…Несмотря на фундаментальный вклад данных исследований в представление патогенеза ресте-ноза, среди практикующих врачей признана гемодинамическая теория прогрессирования заболевания [11]. На основе методов компьютерного моделирования некоторые авторы продемонстрировали, что эверсионная КЭЭ незначительно усугубляет гемодинамические характеристики потока крови относительно классической КЭЭ [19]. При этом заплата может вызывать реакцию организма на инородный материал с последующей грубой деформацией зоны реконструкции [19].…”

Section: каротидная эндартерэктомия в острейшем периоде ишемического unclassified

“…На основе методов компьютерного моделирования некоторые авторы продемонстрировали, что эверсионная КЭЭ незначительно усугубляет гемодинамические характеристики потока крови относительно классической КЭЭ [19]. При этом заплата может вызывать реакцию организма на инородный материал с последующей грубой деформацией зоны реконструкции [19].…”

Section: каротидная эндартерэктомия в острейшем периоде ишемического unclassified

Evolution of carotid endarterectomy: A literature review

Хубулава¹,

Kravchuk²,

Ерофеев³

et al. 2020

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This review investigates the various methods used for carotid endarterectomy (CEE). These methods are presented, and allow us to analyse effective revascularisation with extended damage to the internal carotid artery. The data of studies comparing the results of eversion and classical carotid endarterectomy with plasty of the reconstruction zone with a patch made of diepoxy-treated pericardium are presented. Special attention is paid to emergency carotid endarterectomy and carotid endarterectomy in the acute period of ischemic stroke. The important and main aspects of the glomus-saving species of CEE are also demonstrated. The main complications behind operations, and causes of restenosis in long-term follow-up periods are also duly noted. Similarly, suggestions to eliminate these issues are also proposed. This review comprehensively covers the state of the art of carotid endarterectomy and dissects current techniques and methods in the area.Received 16 July 2020. Revised 24 August 2020. Accepted 25 August 2020.Conflict of interest: Authors declare no conflicts of interest.Funding: The study did not have sponsorship.Author contributions Conception and study design: G.G. Khubulava Drafting the article: A.N. Kazantsev Critical revision of the article: A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh Final approval of the version to be published: G.G. Khubulava, A.N. Kazantsev, A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh

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“…Во всех случаях, когда была получена аневризматически расширенная каротидная луковица, авторы выявили рестеноз [11]. Объяснение этому кроется в работах, посвященных изучению физических свойств тока крови в сонных артериях [12,13]. В частности, имплантация заплаты, чрезмерно дилатирующей зону реконструкции, будет сопровождаться формированием турбулентного тока крови, пристеночным тромбозом, усиленной гиперплазией неоинтимы, что рано или поздно манифестирует в рестеноз ВСА [12,13].…”

unclassified

“…Объяснение этому кроется в работах, посвященных изучению физических свойств тока крови в сонных артериях [12,13]. В частности, имплантация заплаты, чрезмерно дилатирующей зону реконструкции, будет сопровождаться формированием турбулентного тока крови, пристеночным тромбозом, усиленной гиперплазией неоинтимы, что рано или поздно манифестирует в рестеноз ВСА [12,13]. Выходом из этой ситуации может быть персонифицированное создание заплаты на дооперационном этапе.…”

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Methods of carotid endarterectomy

et al. 2021

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This literature review is devoted to various carotid endarterectomy (CE) methods that exist today in Russia. The pros and cons of conventional and eversion technique of the operation are given. It is indicated that the former is associated with higher long-term rate of restenosis, aneurysm and patch infection. The second is associated with higher prevalence of intraoperative internal carotid artery (ICA) thrombosis due to intimal detachment distal to endarterectomy area. The following CE methods for patients with prolonged ICA involvement are described: neo bifurcation formation, autoarterial reconstruction, ICA autotransplantation, plastic using an occipital artery flap. The methods of CE with carotid body saving have been demonstrated: 1. Swallow tail type patch repair proposed by R.I. Izhbuldin; 2. S-shaped arteriotomy proposed by K. A. Antsupov; 3. Two types of operations proposed by R. А. Vinogradov; 4. Сutting off the ICA with sections of common and external carotid artery proposed by A. N. Kazantsev; 5. Glomus-saving ICA autotransplantation in patients with prolonged atherosclerotic involvement. The role of ICA transposition over the hypoglossal nerve in eversion CE is presented. The glomus-saving CE with ICA transposition, called Chik-Chirik CE, is described. Conclusions are drawn on the need to demonstrate all CE types in the novel Russian guidelines for the management of patients with of head and neck arterial diseases.

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Computer-assisted simulation of haemodynamic parameters of carotid artery bifurcation after carotid endarterectomy

Cited by 30 publications

References 7 publications

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

Evolution of carotid endarterectomy: A literature review

Methods of carotid endarterectomy

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