Treatment of Internal Carotid Artery Occlusion Using Proximal Cerebral Protection Device and Its Effect on the Blood Pressure Dynamics. Clinical Case

Шукуров, Ф. Б.; Чигидинова, Д. С.; Bulgakova, E.S.; Руденко, Б А; Tvorogova, T. V.; Shanoyan, А. S.; Drapkina, О. М.

doi:10.20996/1819-6446-2018-14-2-266-271

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“…До недавнего времени операция каротидной эндартерэктомии (КЭАЭ) была "золотым стандартом" в лечении стенозирующего поражения каротидных артерий в качестве первичной и вторичной профилактики развития ОНМК. На сегодняшний день транслюминальная баллонная ангиопластика и стентирование каротидных артерий (КАС) становится альтернативой КЭАЭ [3,4]. Такие исследования, как CREST (Carotid Revascularization Endarterectomy versus Stenting Trial), ACT1 (The Asymptomatic Carotid Trial-1), SAPPHIRE (Stenting and Angioplasty With Protection in Patients at HIgh Risk for Endarterectomy), целью которых было сравнение отдаленных результатов после КЭАЭ и КАС, хоть и не выявили достоверных различий в отдаленных результатах после данных вмешательств, указали на слабое место КАС -осложнения, возникающие в интра-и раннем послеоперационном периоде.…”

Section: Introductionunclassified

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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Section: Introductionunclassified