Hemodynamic changes in different types of carotid endarterectomy in the short- and long-term postoperative periods in patients with carotid artery stenosis

Ignatenko, Pavel; Гостев, А. А.; Novikova, Olga A.; Саая, Ш. Б.; Rabtsun, Artem; Popova, Irina; Чебан, А. В.; Зейдлиц, Г. А.; Klevanets, Iu E; Starodubtsev, Vladimir; Карпенко, А. А.

doi:10.15829/1728-8800-2020-2381

Cited by 3 publications

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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.…”

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“…Несмотря на отсутствие различий в частоте других осложнений, в арифметическом сравнении их количество в 2-3 раза превышало 1 группу, что отразилось на максимальных значениях комбинированной конечной точки после удаления КГ (р=0,004). Таким образом, при наличии РАГ и гемодинамически значимого стеноза ВСА оперирующему хирургу следует отказаться от следующих видов КЭЭ: эверсионная, формирование новой бифуркации [24], аутоартериальная реконструкция [20], аутотрансплантация ВСА по Е. В. Россейкину [25].…”

Section: материал и методыunclassified

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

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An alternative anatomical classification for carotid bifurcation and impact on outcome of carotid endarterectomy: a multicenter study

et al. 2023

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Background The present multicenter retrospective study included 7148 patients who underwent carotid endarterectomy (CEA) between 2010 and 2021. Based on the results of angiography (AG)/multislice computed tomography (MSCT) angiography, 3 types of carotid bifurcation were identified depending on the projection of the carotid sinus to the cervical vertebrae: type I (high)—from the upper edge of the body of the II cervical vertebra to the lower edge of intervertebral disc located between III and IV cervical vertebrae; type II (medium)—from the upper edge of the body of the IV cervical vertebra to the lower edge of the body of the V cervical vertebra; and type III (low)—from the upper edge of the intervertebral disc located between the V and VI cervical vertebrae to the lower edge of the body of the VII cervical vertebra. Purpose of the study To develop a new classification of the types (high, medium, low) of carotid bifurcations (based on the level of cervical vertebrae) with analysis of the results of CEA depending on the type. Results The largest number of ischemic strokes (n = 15; 1.1%; p = 0.0001) was found in type I (high) bifurcation of the carotid artery. The majority of bleedings of type 3b and higher according to the BARC scale with the formation of acute hematomas in the intervention area (n = 14; 1.2%; p = 0.0029) were recorded in type III carotid bifurcation (low). Conclusions Type II (medium) carotid bifurcation may be the most preferred for CEA.

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Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

et al. 2021

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Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up.

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Hemodynamic changes in different types of carotid endarterectomy in the short- and long-term postoperative periods in patients with carotid artery stenosis

Cited by 3 publications

References 18 publications

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

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

An alternative anatomical classification for carotid bifurcation and impact on outcome of carotid endarterectomy: a multicenter study

Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

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