In-hospital outcomes of transcutaneous coronary intervention and carotid endarterectomy in hybrid and staged regimens

Казанцев, А. Н.; Tarasov, R. S.; Burkov, N. N.; Volkov, A. N.; Grachev, K I; Iakhnis, E Ia; Лидер, Р. Ю.; Шабаев, А. Р.; Ls, Barbarash

doi:10.33529/angio2019114

Cited by 61 publications

(16 citation statements)

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“…За более чем полвека начальную технику по M.E. DeBakey (1953) модернизировали в несколько вариантов реконструкций [6][7][8]. В январе 1985 г. R. Kieny с соавт.…”

Section: Introductionunclassified

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Казанцев¹,

Chernykh²,

Лидер³

et al. 2020

PKiK

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Aim. Analysis of the results of hospital and medium-long-term results obtained using a new method of glomus-saving carotid endarterectomy (CEE) according to A. N. Kazantsev.Methods. This prospective study was conducted during January 2018 to April 2020 on 214 patients who were operated for occlusive stenotic lesions of the internal carotid artery (ICA) using holomus-saving CEE as per the method described by A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months. Glomus-saving CEE as per the method by A. N. Kazantsev is performed as follows. Arteriotomy is performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the mouth, depending on the distribution of atherosclerotic plaque, with a transition to the common carotid artery (also 2–3 cm below the ECA mouth). The ICA was cut off at the site formed by the wall sections of the ECA and the common carotid artery. Thereafter, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from the ECA and OCA. Then, the ICA at the saved site was implanted in the previous position. A 6-0 Prolene thread was used as the suture material for performing a vascular anastomosis.Results. The average ICA clamping time was 33.1 ± 3.4 min. Considering the intraoperative visualisation of an extended atherosclerotic plaque in the ICA, in some cases, there was a need to transform the operation. In 4.7% (n = 10) cases, autologous ICA transplantation was performed as per E. V. Rosseykinu. During the hospitalisation, the observation of cardiovascular complications was not recorded. When analysing the dynamics graph of systolic blood pressure, it was revealed that after glomus-saving CEE as per the method by A. N. Kazantsev, stable numbers are maintained during preoperative antihypertensive therapy and do not rise above 137.9 ± 7.5 mm Hg. In the mid-long-term follow-up, 1 (0.46 %) death was recorded, 1 (0.46%) due to myocardial infarction, 1 (0.46%) due to non-lethal ischaemic stroke, and 2 (0.9%) due to hemodynamically significant restenosis 12 mon after CEE. The combined endpoint (death + myocardial infarction + stroke) was reached in 3 (1.4%) patients. The cause of the lethal outcome was circular myocardial infarction that developed, given the patient's refusal to follow double disaggregant therapy (2 stents were previously implanted in the anterior descending and right coronary arteries). The cause of ischaemic stroke was the development of ICA restenosis (12 mon after CEE) owing to neointimal hyperplasia, as shown by histological examination after repeated surgery.Conclusion. CEE as per the method by A. N. Kazantsev is the simplest method of operation for known glomus-preserving reconstructions. The absence of complex arteriotomy, the preservation of carotid bifurcation structures, and the possibility of transformation of the intervention into autologous autologous transplantation with prolonged lesion is preferred over other methods. An additional opportunity for high-quality endarterectomy from ЕCA also creates preventive conditions in the prevention of cerebral haemodynamics. Stable blood pressure indicators in the hospital and mid-term follow-up periods demonstrate the importance of the preservation of the carotid glomus during reconstructive surgery on the carotid arteries. Thus, the presented type of CEE meets all the requirements of modern carotid surgery and can be an elective operation in the personalised treatment of patients with occlusal-stenotic lesions of the carotid arteries.Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Method development and testing: A.N. Kazantsev Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev Drafting the article: A.N. Kazantsev Drawing up tables: E.Yu. Kalinin Statistical analysis: K.P. Chernykh Literature review: R.Yu. Leader, G.Sh. Bagdavadze Critical revision of the article: N.E. Zarkua, K.G. Kubachev Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets

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Section: Introductionunclassified

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Казанцев¹,

Chernykh²,

Лидер³

et al. 2020

PKiK

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“…и применяемым до сих пор [4,5] . При этом, эффективность механизмов компенсации церебрального кровотока во время пережатия ВСА во многом отражает способность головного мозга (ГМ) адаптироваться к искусственной ишемии, что также сопряжено с риском послеоперационного острого нарушения мозгового кровообращения (ОНМК) / транзиторной ишемической атаки (ТИА) [6][7][8][9] . Как интраоперационная гипоперфузия, так и развитие гиперперфузии ГМ после снятия зажима с ВСА, являются критическими триггерами, повышающими вероятность ишемического инсульта и сопровождающими КЭЭ [10,11] .…”

Section: обоснованиеunclassified

Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

Казанцев¹,

Chernykh

Виноградов

et al. 2021

I.P. Pavlov Russian Medical Biological Herald

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BACKGROUND: The circle of Willis (CW) is an important network of collaterals that provide compensatory redistribution of hemodynamic load. Several studies showed that the CW is open in approximately 50%90% of cases, and the number of missing segments correlates with low brain tolerance to ischemia in internal carotid artery (ICA) compression. Currently, studies dedicated to the relationship of different configurations of CW with the risk of ischemic brain damage. AIM: The analyze the immediate results of eversion carotid endarterectomy (CEA) in patients with different configurations of the structure of the CW. MATERIALS AND METHODS: We included 641 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) in a study period from 2010 to 2020. All patients underwent multispiral computed tomography with angiography of the extracranial and CW arteries. Based on the structural variants of the CW, six groups of patients were studied: group 1 (64.9%, n = 416) closed posterior part (CPP) with the existence of posterior communicative artery (PCA) and P1 segment of the posterior cerebral artery (PCerA); group 2 (27%, n = 173) an intermediate structure of the posterior part (IPP) with hypoplasia of the PCA or PCerA; group 3 (8.1%, n = 52) open posterior part (OPP) with the absence of PCA or PCerA; group 4 (85.95%, n = 551) closed anterior part (CAP) with the presence of the anterior communicating artery (ACA) and A1 segment of the anterior cerebral artery (ACerA); group 5 (7.95%, n = 51) an intermediate structure of the anterior part (IAP) with hypoplasia of ACA or ACerA; group 6 (6.1%, n = 39) open anterior part (OAP) with the absence of ACA or ACerA. To assess the compensatory potentials of the brain, all patients underwent measurement of the retrograde pressure in the ICA and intraoperative cerebral oximetry. RESULTS: In the postoperative period, 1 death was recorded in group 4 (CAP) due to a hemorrhagic transformation in the zone of ischemic stroke, on the background development of hyperperfusion syndrome. The largest number of ischemic strokes of the cardioembolic subtype was diagnosed in the ACerA territory in the presence of an unstable atherosclerotic plaque: group 1 (CPP) 0%; group 2 (IPP) 0%; group 3 (OPP) 0.24%, n = 1; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 1.96%, n = 1; group 6 (OAP) 5.1%, n = 2; p 0.9999. The probable cause was embolization against the background increase in the arterial pressure before ICA clamping. In turn, the majority of ischemic strokes of the hemodynamic subtype developed in the territory of PCerA: group 1 (CPP) 0%; group 2 (IPP) 1.73%, n = 3; group 3 (OPP) 3.8%, n = 2; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 0%; group 6 (OAP) 2.56%, n = 1; p 0.9999. This pattern coincided with the largest number of patients with CW of the IPP and OPP types among all open variants of the structure. CONCLUSION: Parameters of retrograde pressure in the ICA and intraoperative cerebral oximetry do not always demonstrate the need for a temporary shunt (TS). Due to the opened structure of CW, the redistribution of blood flow occurs with the formation of zones of hypo- and hyperperfusion, causing ischemic alterations in the brain matter. Thus, in order to maintain adequate cerebral hemodynamics, to mitigate the effect of hypo- and hyperperfusion, and reduce the risk of ischemic stroke, the open variant of the CW structure should be considered as an indication for a TS.

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“…Мировым медицинским сообществом признано, что у пациентов с ЗАНК, нуждающихся в реваскуляризации коронарных артерий, лечение ИБС обычно приоритетно, за исключением случаев критической ишемии нижних конечностей [1,2,5,8,10]. Открытым в настоящее время также остается вопрос, касающийся выбора между коронарным шунтированием (КШ) и чрескожным коронарным вмешательством (ЧКВ), поэтому в отсутствии надежных данных он должен придерживаться мультидисциплинарного подхода [11,12].…”

Section: клинический примерunclassified

Endovascular recanalization of chronic infrarenal aortic occlusion in a patient with two-vessel coronary artery disease: a case report

Чернявский¹,

Белова²,

Komakha³

et al. 2021

Russ J Cardiol

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A case report on endovascular treatment of occlusion of the infrarenal aorta and iliac arteries in a patient with hemodynamically significant two-vessel coronary artery disease is presented. After a thorough examination and assessment of surgical risks, a multidisciplinary team meeting chose a staged revascularization strategy: stage 1 — percutaneous coronary intervention in the left anterior descending artery and right coronary artery; stage 2 — endovascular recanalization of aorto-iliac segment occlusion using the kissing stents technique. There were no perioperative complications and the patient was discharged on the 4th day after surgery in a satisfactory condition. The choice in favor of these types of reconstruction and staged revascularization strategy was substantiated. A conclusion was made about the effectiveness and safety of implemented measures.

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In-hospital outcomes of transcutaneous coronary intervention and carotid endarterectomy in hybrid and staged regimens

Cited by 61 publications

References 6 publications

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

Endovascular recanalization of chronic infrarenal aortic occlusion in a patient with two-vessel coronary artery disease: a case report

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