Meta-analysis of the results of eversion carotid endarterectomy and endarterectomy with patch plasty

Гавриленко, А. В.; Kuklin, A V; Al-Yousef, N. N.; Wang, Xiaochen; Bulatova, L.R.; Li, Rui

doi:10.33529/angio2020121

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…В январе 1985 г. R. Kieny с соавт. разработали эверсионную методику операции, которая является доминирующей в современной каротидной хирургии [9][10][11][12]. С популяризацией персонифицированной медицины универсальный подход к этому виду операции претерпел множество преобразований [13][14][15][16][17].…”

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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“…Однако лучшим индикатором оптимальной техники КЭЭ является сопоставление результатов обоих видов реваскуляризации. Многие исследования неоднократно доказали, что госпитальные исходы классической и эверсионной КЭЭ статистически не различаются [19,[25][26][27]. Однако подавляющее число работ говорит о том, что у пациентов с имплантированной заплатой в отдаленном периоде наблюдения гораздо чаще формируется рестеноз с повторным ишемическим инсультом и необходимостью в ReDo хирургии [19,[25][26][27].…”

Section: обзоры литературыunclassified

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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“…При этом экстренная КЭЭ в острейшем периоде заболевания сочетается с высоким операционным риском. Однако, по мнению ряда авторов, для стабильных пациентов с малым инсультом или транзиторной ишемической атакой операция может быть эффективна в острейшем и начальном сроках острого периода ОНМК, поэтому ранняя КЭЭ считается оправданной [30][31][32] [38][39][40][41][42]. А.В.…”

Section: каротидная эндартерэктомия в острейшем периоде ишемического unclassified

“…Гавриленко с соавт. проанализировали 2 139 статей и выявили, что рестеноз чаще был визуализирован после классической КЭЭ с пластикой зоны реконструкции заплатой [ОШ 0,604; 95% ДИ 0,422-0,864; p = 0,006] [42]. Этой позиции придерживается подавляющее большинство практикующих хирургов и считает, что имплантированная заплата нарушает гемодинамические свойства каротидной бифуркации и создает усло-вия для развития турбулентного кровотока и дальнейшей цепочки патологических явлений [41][42][43][44].…”

Section: каротидная эндартерэктомия в острейшем периоде ишемического unclassified

“…можно установить только интраоперационно, во время повторного вмешательства. Однако наиболее частой причиной формирования рестеноза является неоинтимальная гиперплазия [40][41][42][43][44], при этом предпосылки можно установить только во время повторной КЭЭ и после гистологического изучения образцов [43]. Причиной ранней потери просвета сосудов являются технические особенности первичной КЭЭ, к примеру, зауживание артерии в результате наложения дополнительных сосудистых швов, распространение атеросклеротической бляшки выше подъязычного нерва [11; 43].…”

Section: каротидная эндартерэктомия в острейшем периоде ишемического unclassified

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Evolution of carotid endarterectomy: A literature review

Хубулава¹,

Kravchuk²,

Ерофеев³

et al. 2020

PKiK

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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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Meta-analysis of the results of eversion carotid endarterectomy and endarterectomy with patch plasty

Cited by 19 publications

References 22 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

Methods of carotid endarterectomy

Evolution of carotid endarterectomy: A literature review

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