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

Казанцев, А. Н.; Zharova, A. S.; Sokolova, Ekaterina V.; Коротких, А. В.

doi:10.1016/j.radcr.2022.07.034

Cited by 12 publications

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“…Российский кардиологический журнал 2022; 27 (11) обусловлено тремя патологическими процессами. Во-первых, больные, страдающие COVID-19, в связи с ДН длительно находятся в положении пронпозиции, что может приводить к стазу крови в дистальных отделах конечности (первый компонент триады Вирхова) [20][21][22][23][24]. Во-вторых, имея тропность к эндотелиоцитам, SARS-CoV-2 провоцирует воспаление в этих клетках с развитием эндотелиита [20][21][22][23][24].…”

Section: Discussionunclassified

“…Во-первых, больные, страдающие COVID-19, в связи с ДН длительно находятся в положении пронпозиции, что может приводить к стазу крови в дистальных отделах конечности (первый компонент триады Вирхова) [20][21][22][23][24]. Во-вторых, имея тропность к эндотелиоцитам, SARS-CoV-2 провоцирует воспаление в этих клетках с развитием эндотелиита [20][21][22][23][24]. В-третьих, с дальнейшим нарастанием коагулопатии, провоцируемой вирусными агентами, данный субстрат становится зоной пристеночного, а затем окклюзионного тромбоза, что вызывает острую ишемию [25][26][27][28][29].…”

Section: Discussionunclassified

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Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

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Aim. To analyze the results of thrombectomy in lower-extremity ischemia in patients with coronavirus disease 2019 (COVID-19) and respiratory failure of different severity.Material and methods. This retrospective, cohort, comparative study for the period from May 1, 2020 to March 1, 2022 included 305 patients with acute lower-extremity ischemia and COVID-19. Depending on the type of oxygen support, three groups of patients were formed: group 1 (n=168) — nasal oxygen insufflation; group 2 (n=92) — non-invasive ventilation (NIV); group 3 (n=45) — artificial ventilation (AV). Thrombectomy was carried out according to the standard technique using Fogarty catheters (3F-6F — depending on the vessel size). After the diagnosis was established before and after the start of surgical treatment, all patients received the following therapy: Unfractionated IV heparin infusion at an initial rate of 1000 U/r, adjusted to maintain the activated partial thromboplastin time at 2-3 times the normal value; 2. Oral acetylsalicylic acid 125 mg; 3. Analgesics.Results. Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5,3%, n=9; group 2: 72,8%, n=67; group 3: 100%, n=45; p<0,0001), retrombosis (group 1 : 18,4%, n=31; group 2: 69,5%, n=64; group 3: 91,1%, n=41; p<0,0001) and limb amputations (group 1: 9,5%, n=16; group 2: 56,5%, n=52; group 3: 91,1%, n=41; p<0,0001) was recorded in group 3 patients.Conclusion. In patients receiving mechanical ventilation, COVID-19 have more aggressive course, which is expressed in an increase in laboratory para- meters (C-reactive protein, ferritin, interleukin-6, D-dimer), the severity of pneumonia and location of thrombosis in the tibial arteries. Among patients with COVID-19 receiving mechanical ventilation, the greatest number of rethromboses (91,1%), limb amputations (91,1%), and deaths (100%) are noted, which suggests the expediency of abandoning open thrombectomy in favor of anticoagulant/antiplatelet therapy in this cohort of patients. The development of arterial thrombosis in patients with COVID-19 receiving mechanical ventilation is an indicator of a high risk of death. Open thrombectomy in combination with anticoagulant/antiplatelet therapy is most effective in patients on nasal oxygen insufflation or NIV.

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Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

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Section: безопасна ли кээ в острейшем периоде онмк?unclassified

“…Споры о том, насколько безопасна экстренная КЭЭ у пациентов в острейшем периоде ОНМК, про-должаются [39][40][41][42][43]. С одной стороны, наличие свежего ишемического очага в головном мозге и хирургическая реперфузия могут привести к геморрагической трансформации с последующим негативным прогнозом течения заболевания [40][41][42][43][44]. С другой стороны, сам по себе гемодинамически значимый стеноз, особенно при наличии нестабильной АСБ, может стать причиной повторного ОНМК, развитие которого способно достичь пределов целого полушария [40][41][42][43][44].…”

Section: безопасна ли кээ в острейшем периоде онмк?unclassified

“…С одной стороны, наличие свежего ишемического очага в головном мозге и хирургическая реперфузия могут привести к геморрагической трансформации с последующим негативным прогнозом течения заболевания [40][41][42][43][44]. С другой стороны, сам по себе гемодинамически значимый стеноз, особенно при наличии нестабильной АСБ, может стать причиной повторного ОНМК, развитие которого способно достичь пределов целого полушария [40][41][42][43][44]. Поэтому взвешенная оценка пользы/ вреда от ургентной реваскуляризации должна быть основополагающим фактором при выборе оптимальной тактики лечения этой когорты больных [40][41][42][43][44].…”

Section: безопасна ли кээ в острейшем периоде онмк?unclassified

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Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

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This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events.

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Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery — analysis of the multicenter Russian register

Казанцев¹,

Коротких

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et al. 2023

Indian J Thorac Cardiovasc Surg

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

Cited by 12 publications

References 32 publications

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery — analysis of the multicenter Russian register

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