Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

Abstract

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE).
 Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.812.5 months.
 Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 0%; group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р=0.16)); myocardial infarction ((group 1 0%; group 2 0.4% (n=2); group 3 0%; group 4 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 4.2% (n=1); group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 4.2% (n=1), in group 2 1.2% (n=6), in group 3 0.4% (n=2), in group 4 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 25% (n=6); group 2 5.5% (n=27); group 3 7.3% (n=35); group 4 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 4.2% (n=1); group 2 3.6% (n=18); group 3 4.8% (n=23); group 4 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 12.5% (n=3); group 2 3.6% (n=18); group 3 5.4% (n=26); group 4 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 16.6% (n=4); group 2 6.3% (n=31); group 3 6% (n=29); group 4 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 54.2% (n=13); group 2 15.4% (n=76); group 3 18.7% (n=90); group 4 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)).
 Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

CAROTIDSCORE.RU—The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy

“…[34][35][36][37][38] According to the severity of the lesion, the following gradation is distinguished on the basis of this calculator: low level (≤22 points), intermediate (23-32 points) and severe (≥33 points). 39 An important shortcoming of this study was the lack of inclusion of clinical characteristics of patients, which was eliminated in the modified SYNTAX II calculator. [32][33][34][35][36] The results of this analysis assessed the 4-year outcomes of the previous study.…”

“…19 b Acutest period of stroke includes 1–3 days after the development of neurological deficit. 19 c Acute period of ischemic stroke includes up to 4–28 days after the development of neurological deficit. 19 d Chronic cerebral ischemia stage 1.…”

“…19 c Acute period of ischemic stroke includes up to 4–28 days after the development of neurological deficit. 19 d Chronic cerebral ischemia stage 1. Anisoreflexia, non-rough reflexes of oral automatism.…”

“…a Note: Acute cerebrovascular accident in history -is a stroke that occurred more than 29 days ago 19. b Acutest period of stroke includes 1-3 days after the development of neurological deficit 19. c…”

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

“…Emergency correction of hemodynamically significant stenosis of the internal carotid artery (ICA) is currently an important and little-studied section of carotid surgery [1] , [2] , [3] , [4] , [5] . Recent studies do not come to a consensus on the need for urgent interventions in the brachiocephalic system in the acute period of acute cerebrovascular accident (ACV) [6] , [7] , [8] , [9] , [10] . But the current Russian recommendations do not prohibit performing carotid endarterectomy (CEE) or (CAS) on an emergency basis [11] .…”