Evolution of carotid endarterectomy: A literature review

Хубулава, Г.Г.; Kravchuk, V. N.; Ерофеев, А А; Chernykh, K. P.

doi:10.21688/1681-3472-2020-4-22-32

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…Таким образом, это первое исследование, проанализировавшее результаты КЭЭ в зависимости от скорости выполнения анастомоза. Является вполне логичным тот факт, что чем дольше будет пережата ВСА, тем дольше головной мозг будет находиться в условиях неполноценной гемоциркуляции [33][34][35][36][37]. Соответственно, риск развития интраоперационного ишемического события будет также возрастать [38][39][40].…”

Section: Discussionunclassified

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

et al. 2023

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Aim. Analysis of inhospital and long-term outcomes of conventional carotid endarterectomy (CEA) depending on vessel suturing speed.Material and methods. The present prospective multicenter study for the period from March 1, 2017 to October 1, 2020 included 2366 patients who underwent conventional CEA with patch angioplasty. Depending on the time required to apply 1 stitch, 4 groups of patients were formed: group 1 (n=471; 19,9%) — 1 stitch per 2 seconds; group 2 (n=865; 36,5%) — 1 stitch per 3 seconds; group 3 (n=692; 29,2%) — 1 stitch per 4 seconds; group 4 (n=338; 14,3%) — 1 stitch per 5 seconds. The term "stitch" refers to two needle punctures. The follow-up postoperative period was 18,5±11,0 months.Results. There were no deaths and myocardial infarctions (MI) in the inhospital postoperative period. In group 1, anastomotic bleeding (n=93; 19,7%; p<0,0001) and stroke (n=3; 0,63%; p=0,02) due to internal carotid artery (ICA) thrombosis were more common. In the long-term follow-up period, there were no significant differences in mortality and MI rates. However, ICA restenosis requiring repeated CEA (n=37; 7,85%; p<0,0001) and related stroke/transient ischemic attack (n=13; 2,8%; p=0,0001) were more often diagnosed in 1 group of patients. According to Kaplan-Meier curves, restenosis was most often revealed 6 months after CEA in the general sample.Conclusion. 1. Vessel suturing at a speed of 1 stitch per 2 seconds is associated with an increased risk of intraoperative ICA thrombosis, bleeding along the anastomosis, stroke, as well as restenosis and stroke in the long-term follow-up period. 2. Vessel suturing at a speed of 1 stitch per 5 seconds is not accompanied by an increase in inhospital stroke rate, despite the maximum ICA occlusion time relative to other groups of patients. 3. Vessel suturing at a speed of 1 stitch per 3 or 4 seconds characterized by the lowest incidence of all complications at the inhospital and long-term stages of postoperative follow-up.

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"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

et al. 2023

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“…Anzupov (Figure 2). 18,19,28 The endpoints were understood as the development of such adverse cardiovascular events as lethal outcome, The study was carried out in accordance with the standards of Good Clinical Practice and the principles of the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…16,17 On the other hand, it is known that the carotid glomus (CG), which is a kind of bridge between chemo-and baroreceptors and the vasomotor center, is also responsible for the homeostasis of BP in the body. [18][19][20] Thus, its damage or preservation during CEE can affect the course of RAH.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Выполнение реконструктивного вмешательства разрешено как в острейшем, так и в остром периодах ОНМК [65][66][67][68][69]. Тарасов Р.С.…”

Section: каротидная эндартерэктомия или каротидная ангиопластика со с...unclassified

The Three Most Discussed Questions in Carotid Artery Surgery. Review of Russian and Foreign Studies in the Last Five Years

Zharova

Naumets

Trishin

et al. 2023

Neotložnaâ med. pomoŝʹ

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РеЗюМеВ настоящем обзоре литературы проведен анализ российских и зарубежных публикаций за последние 5 лет по трем самым обсуждаемым вопросам, связанным с каротидной хирургией: 1. Что более эффективно: эверсионная или классическая техника операции с пластикой зоны реконструкции заплатой? 2. Что оптимальнее: каротидная эндартерэктомия (КЭЭ) или каротидная ангиопластика со стентированием (КАС)? 3. В какие сроки после развития ишемического инсульта следует выполнять реваскуляризацию головного мозга? Авторы статьи пришли к следующим заключениям: 1. По данным большинства крупных исследований и метаанализов классическая КЭЭ с пластикой зоны реконструкции заплатой сочетается с высоким риском развития рестеноза внутренней сонной артерии относительно эверсионной техники операции. Одноцентровые исследования с небольшими выборками больных статистических различий между результатами применения обоих методов операции не находят. 2. Требуется проведение крупных многоцентровых рандомизированных исследований для решения вопросов эффективности КЭЭ и КАС у симптомных и бессимптомных больных. На сегодняшний день единого мнения по этому поводу не выработано. 3. КЭЭ и КАС могут быть одинаково эффективны и безопасны в острейшем и остром периодах ишемического инсульта при реализации в условиях наличия легкого неврологического дефицита и ишемического очага в головном мозге, не превышающего 2,5 см в диаметре. Тем не менее, выбор стратегии лечения должен осуществляться строго персонифицированно мультидисциплинарным консилиумом на основе опыта учреждения и действующих рекомендаций.

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Evolution of carotid endarterectomy: A literature review

Cited by 10 publications

References 19 publications

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

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

The Three Most Discussed Questions in Carotid Artery Surgery. Review of Russian and Foreign Studies in the Last Five Years

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