The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

Шукуров, Ф. Б.; Bulgakova, E.S.; Shapieva, Albina; Руденко, Б. А.; Tvorogova, T. V.; Shanoyan, А. S.; Suvorov, А. Yu.; Фещенко, Д. А.; Чигидинова, Д. С.; Vasiliev, D. K.; Kontsevaya, A. V.; Drapkina, О. М.

doi:10.15829/1560-4071-2019-8-17-21

Russ J Cardiol

2019

DOI: 10.15829/1560-4071-2019-8-17-21

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The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

Ф. Б. Шукуров

E.S. Bulgakova

Albina Shapieva³

et al.

Abstract: Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, … Show more

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Cited by 3 publications

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Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

Шукуров¹,

Bulgakova²,

Руденко³

et al. 2020

Cardiovasc Ther Prev

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Aim. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.Material and methods. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.Results. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis >50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age >70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length >15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis <30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis ><30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >< 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis <30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >15 mm, and residual stenosis < 30% may be associated with an increased risk of adverse events.

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Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

Шукуров¹,

Bulgakova²,

Руденко³

et al. 2020

Cardiovasc Ther Prev

Self Cite

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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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Patterns of the association among ultrasound, hemodynamic and biochemical parameters of atherosclerosis of the carotid and coronary arteries in patients with coronary heart disease

Polyakov

Starichkova

Nikolaev

et al. 2021

Sibirskij nauchnyj medicinskij zhurnal

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An increase in the proportion of comorbid cardiac patients with primary nosologies such as arterial hypertension and atherosclerosis actualizes the search for optimal approaches to their diagnosis and treatment. The emerging pathogenetic mechanisms of concomitant diseases must be taken into account on an individual basis. Aim of the study was to investigate the patterns of atherosclerotic changes in carotid arteries in patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty and their correlation with biochemical and hemodynamic markers of atherosclerosis. Material and methods. 53 patients with coronary heart disease (CHD) were examined and treated in the clinic of the Federal Research Center of Fundamental and Translational Medicine. The average age of the patients was 64.73 ± 1.66 years. A comprehensive clinical laboratory examination was conducted, including the blood lipids test to measure content of total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, as well as serum markers of systemic inflammation (concentration of C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR)) and carotid artery duplex scan. Results. A direct correlation between the severity of atherosclerotic changes in the carotid arteries and indicators of systemic inflammation, i.e. CRP, ESR and fibrinogen was found. The study also revealed greater severity of atherosclerotic stenosis of the carotid arteries in patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty with coronary artery stenting compared to patients without any intervention. Conclusion. The obtained data indicate the effectiveness of ultrasound scan of the carotid arteries for the early diagnosis of multifocal atherosclerosis for timely treatment and prevention of cardiovascular polymorbidity in patients with a cardiovascular profile.

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The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

Cited by 3 publications

References 15 publications

Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

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

Patterns of the association among ultrasound, hemodynamic and biochemical parameters of atherosclerosis of the carotid and coronary arteries in patients with coronary heart disease

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