Methods of carotid endarterectomy

Казанцев, А. Н.; Виноградов, Р. А.; Chernykh, K. P.; Dzhanelidze, M. O.; Bagdavadze, G. Sh.; Artyukhov, S. V.; Чикин, А. Е.; Linets, G. I.

doi:10.15829/1560-4071-2021-4445

Cited by 9 publications

(9 citation statements)

References 30 publications

(45 reference statements)

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“…Возвращаясь к выбору между КАС и КЭЭ, необходимо помнить, что последнюю чаще всего выполняют по эверсионной или классической технике с пластикой зоны реконструкции заплатой [53][54][55]. Обобщая перечисленные исследования, важно отметить, что в подавляющем большинстве случаев авторы сравнивают общую когорту открытых операций с эндоваскулярной методикой.…”

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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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

Self Cite

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“…Другим существенным фактором, провоцирующим ишемические события у пациентов с СД 2 типа, является прогрессирование стенотических поражений [43][44][45]. В актуальной литературе, посвященной этому вопросу, доказано, что особенно стремительно данный процесс развивается именно у пациентов с нарушением углеводного обмена [43][44][45]. Таким образом, эта когорта больных должна подвергаться прецизионной курации как на протяжении госпитального, так и всего отдаленного периодов наблюдения.…”

Section: результатыunclassified

“…Эту закономерность можно объяснить наличием диабетической нефропатии, формирующейся на фоне СД 2 типа и являющейся маркером развития тяжелых диабет-ассоциированных осложнений [47]. Прогрессирующее течение последних сопровождается вышеописанной дисфункцией эндотелия и связанных с ней последствий, манифестирующих не только рестенозом ВСА, шунта, но и прогрессированием коронарного/прецеребрального атеросклероза [43][44][45][46]. На этом фоне в работе, посвященной влиянию впервые выявленного СД 2 типа на исходы КШ, Сумин А. Н. и др.…”

Section: результатыunclassified

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

IuV

Ustinova

et al. 2022

Russ J Cardiol

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At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p<0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p<0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p<0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p<0,0001) were significantly more often recorded in patients with type 2 diabetes.Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p<0,0001, respectively).Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

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“…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. 18–20 Thus, its damage or preservation during CEE can affect the course of RAH.…”

Section: Introductionmentioning

confidence: 99%

“…The operation itself can be accompanied by both the preservation of the CG (with the implementation of glomus-saving CEE, classical CEE with plasty of the reconstruction zone with patch) and its removal (eversion CEE, the formation of a new bifurcation and autoarterial reconstruction). 3,18,20,24,25 In terms of the frequency of adverse cardiovascular events at different stages of observation, these surgical techniques are well studied and each of them has certain indications for implementation. However, the fact of the presence of RAH has never been considered as a condition for a particular type of reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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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Methods of carotid endarterectomy

Cited by 9 publications

References 30 publications

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

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

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

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

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