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Kazantsev AN, Korotkikh AV, Wang S, Gloria Nonye O, Artyukhov SV, Mukhtorov OS, Roshkovskaya LV, Zakharova KL, Unguryan VM, Shmatov DV, Urokov DA, Choriev AA, Zabolotniy VN, Lebedev OV, Zarkua NE, Kravchuk VN, Alekseyeva EO, Bagdavadze GS, Chernyavin MP, Leader RY, Solobuev AI, Vaiman EF, Kazantseva EG, Lutsenko VA, Sultanov RV, Matusevich VV, Zakeryaev AB, Sukhoruchkin PV. Carotid endarterectomy for symptomic and asymptomic stenosis: Report of 65388 cases (Russian register). Vascular 2024:17085381241259928. [PMID: 38848729 DOI: 10.1177/17085381241259928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
AIM Analysis of in-hospital and long-term results of carotid endarterectomy in patients with asymptomatic and symptomatic stenoses. MATERIALS AND METHODS The sample was formed by completely including all cases of carotid endarterectomy (n = 65,388) performed during the period from May 1, 2015 to November 1, 2023. Depending on the symptomatic/asymptomatic nature of the stenosis, all patients were divided into two groups: group 1 - n = 39,172 (75.2%) - patients with asymptomatic stenosis; Group 2 - n = 26216 (24.8%) - patients with symptomatic stenosis. The postoperative follow-up period was 53.5 ± 31.4 months. RESULTS In the hospital postoperative period, the groups were comparable in the incidence of death (group 1: n = 164 (0.41%); group 2: n = 124 (0.47%); p = .3), transient ischemic attack (group 1: n = 116 (0.29%); group 2: n = 88 (0.33%); p = .37), myocardial infarction (group 1: n = 32 (0.08%); group 2: n = 19 (0.07%); p = .68), thrombosis of the internal carotid artery (group 1: n = 8 (0.02%); group 2: n = 2 (0.007%); p = 0, 19), bleeding (group 1: n = 58 (0.14%); group 2: n = 33 (0.12%); p = .45). In group 2, ischemic stroke developed statistically more often (group 1: n = 328 (0.83%); group 2: n = 286 (1.09%); p = .001), which led to a higher value of the combined endpoint (group 1: n = 640 (1.63%); group 2: n = 517 (1.97%); p = .001). In the long-term postoperative period, the groups were comparable in cases of death (group 1: n = 65 (0.16%); group 2: n = 41 (0.15%); p = .76) and death from cardiovascular causes (group 1: n = 59 (0.15%); group 2: n = 33 (0.12%); p = .4). A greater number of ischemic strokes were detected in patients of group 2 (group 1: n = 213 (0.54%); group 2: n = 187 (0.71%); p = .006). In group 1, hemodynamically significant restenosis (≥70%) of the internal carotid artery was more often diagnosed (group 1: n = 974 (2.49%); group 2: n = 351 (1.34%); p < .0001) and myocardial infarction (group 1: n = 66 (0.16%); group 2: n = 34 (0.13%); p < .0001). When analyzing stroke-free survival, analysis of Kaplan-Meier curves showed that a statistically larger number of strokes were diagnosed in group 2 (p < .0001). CONCLUSION Due to the fact that the patients were initially not comparable for a number of indicators, to achieve balance, we applied propensity score matching analysis. Thus, group 1 consisted of 24,381 patients, and group 2 consisted of 17,219 patients. In the hospital postoperative period, statistically significant differences were obtained only in the combined end point, which was greater in group 2 (group 1: n = 465 (1.9%); group 2: n = 382 (2.2%); p = .02). In the long-term follow-up period, after applying propensity score matching, no statistically significant differences were obtained between groups.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinic, Kostroma, Russian Federation
- Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation
- Kostroma Oncology Dispensary, Kostroma, Russian Federation
| | - Alexander V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russian Federation
| | - Showen Wang
- First Moscow State Medical University. THEM. Sechenov, Moscow, Russian Federation
| | | | - Sergey V Artyukhov
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Lyudmila V Roshkovskaya
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | - Kristina L Zakharova
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Dmitry V Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | | | | | | | | | - Nona E Zarkua
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Vyacheslav N Kravchuk
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Elena O Alekseyeva
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russian Federation
| | | | - Maxim P Chernyavin
- Clinical Hospital of the Administration of the President of the Russian Federation, Moscow, Russian Federation
| | - Roman Yu Leader
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | | | | | | | - Viktor A Lutsenko
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaev, Kemerovo, Russian Federation
| | - Roman V Sultanov
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaev, Kemerovo, Russian Federation
| | - Vyacheslav V Matusevich
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
| | - Aslan B Zakeryaev
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
| | - Pavel V Sukhoruchkin
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
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Kazantsev AN, Lider RY, Korotkikh AV, Kazantseva EG, Bagdavadze GS, Kravchuk VN, Shmatov DV, Lebedev OV, Lutsenko VA, Zakeryaev AB, Artyukhov S, Palagin PD, Sirotkin AA, Sultanov RV, Taits D, Taits B, Snopova EV, Zharova AS, Zarkua N, Zakharova K, Belov Y. Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension. Vascular 2024; 32:458-466. [PMID: 36409961 DOI: 10.1177/17085381221140620] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
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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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinical Hospital Named after E. I. Korolev, Kostroma, Russia
| | - Roman Yu Lider
- Ministry of Health of the Russian Federation, Kemerovo State Medical University, Kemerovo, Russia
| | - Alexander V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russia
| | - Elizaveta G Kazantseva
- Ministry of Health of the Russian Federation, Kemerovo State Medical University, Kemerovo, Russia
| | - Goderzi Sh Bagdavadze
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Vyacheslav N Kravchuk
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Dmitriy V Shmatov
- Clinic of High Medical Technologies Named after N. I. Pirogov, St Petersburg State University, Saint Petersburg, Russia
| | - Oleg V Lebedev
- Kostroma Regional Clinical Hospital Named after E. I. Korolev, Kostroma, Russia
| | - Victor A Lutsenko
- Kemerovo Regional Clinical Hospital Named after S. V. Belyaeva, Kemerovo, Russia
| | - Aslan B Zakeryaev
- Research Institute Regional Clinical Hospital No. 1 Named Prof. S. V. Ochapovsky, Krasnodar, Russia
| | - Sergey Artyukhov
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Petr D Palagin
- Kostroma Regional Clinical Hospital Named after E. I. Korolev, Kostroma, Russia
| | - Alexey A Sirotkin
- Kostroma Regional Clinical Hospital Named after E. I. Korolev, Kostroma, Russia
| | - Roman V Sultanov
- Kemerovo Regional Clinical Hospital Named after S. V. Belyaeva, Kemerovo, Russia
| | - Denis Taits
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Boris Taits
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Elena V Snopova
- Kostroma Regional Clinical Hospital Named after E. I. Korolev, Kostroma, Russia
| | - Alina S Zharova
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Nona Zarkua
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Kristina Zakharova
- North-Western State Medical University Named after I. I. Mechnikov, Saint Petersburg, Russia
| | - Yuriy Belov
- Russian Scientific Center of Surgery Named after Academician B. V. Petrovsky, Moscow, Russia
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Kazantsev AN, Korotkikh AV, Wang S, Nonye OG, Artyukhov SV, Mukhtorov OS, Roshkovskaya LV, Unguryan VM, Shmatov DV, Urokov DA, Choriev AA, Zabolotniy VN, Lebedev OV, Zarkua NE, Kravchuk VN, Koplik VO, Kudryavtsev ME, Bagdavadze GS, Chernyavin MP, Leader RY, Kazantseva EG, Belov YV. Hospital and long-term results of carotid endarterectomy in patients with different severity of coronary artery lesion according to syntax score. Curr Probl Cardiol 2024; 49:102244. [PMID: 38043882 DOI: 10.1016/j.cpcardiol.2023.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
AIM Analysis of in-hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis. MATERIAL AND METHODS This comparative, retrospective, open study for the period from January 2013 to April 2020 included 1719 patients operated on for occlusive-stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEA were used as revascularization strategies. The criteria for inclusion in the study were: 1. Presence of coronary angiography within six months before the present CEE; 2. A history of myocardial revascularization in patients with severe coronary lesions. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1-871 (50.7 %) patients - with the presence of hemodynamically significant stenosis of the coronary arteries (CA) with a history of myocardial revascularization; Group 2-496 (28.8 %) patients - with the presence of hemodynamically insignificant lesions of the coronary artery (up to 70 %, not inclusive, and the trunk of the left coronary artery, up to 50 %, not inclusive); Group 3-352 (20.5 %) patients - without signs of atherosclerotic lesions of the coronary artery. In group 1, the observation period was 56.8±23.2 months, in group 2-62.0±15.6 months, in group 3-58.1±20.4 months. RESULTS During the hospital observation period, there were no significant intergroup differences in the number of complications. All cardiovascular events were detected in isolated cases. The most common injury was damage to the cranial nerves, diagnosed in every fifth patient in the total sample. The combined endpoint (CET), including death + myocardial infarction (MI) + acute cerebrovascular accident/transient ischemic attack (stroke/TIA), was 0.75 % (n=13). In the long-term follow-up period, when comparing survival curves, group 3 revealed the largest number of ischemic strokes (p = 0.007), myocardial infarction (p = 0.03), and CCT (p = 0.005). There were no intergroup differences in the number of deaths (p=0.62). CONCLUSION The results of the study showed that there was no significant intergroup difference in the development of complications at the hospital postoperative stage. However, in the long-term follow-up period, a group of patients with isolated lesions of the ICA demonstrated a rapid increase in the number of MI, stroke/TIA, and a combined endpoint, which was apparently associated with low compliance and progression of atherosclerosis in previously unaffected arteries.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinic, Kostroma, Russian Federation; Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation; Kostroma Oncology Dispensary, Kostroma, Russian Federation.
| | - Alexander V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russian Federation
| | - Showen Wang
- First Moscow State Medical University, THEM. Sechenov, Moscow, Russian Federation
| | | | - Sergey V Artyukhov
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Lyudmila V Roshkovskaya
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Dmitry V Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | | | | | | | | | - Nona E Zarkua
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Vyacheslav N Kravchuk
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Victoria O Koplik
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russian Federation
| | - Mikhail E Kudryavtsev
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russian Federation
| | | | - Maxim P Chernyavin
- Clinical Hospital of the Administration of the President of the Russian Federation, Moscow, Russian Federation
| | - Roman Yu Leader
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | | | - Yuri V Belov
- Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation; First Moscow State Medical University, THEM. Sechenov, Moscow, Russian Federation
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4
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Kazantsev AN, Korotkikh A, Dzhanelidze M, Kharchilava E, Zarkua N, Alekseeva E, Staroverova V, Koplik V, Leader R, Zakeryaev A, Bagdavadze G, Zakharova K, Semyin I, Kostenkov A, Chernykh K, Shmatov D, Lebedev O, Artyukhov S, Mukhtorov O, Wang S, Komarov R, Roshkovskaya L, Khetagurov M, Unguryan V, Chernyavin M, Palagin P, Sirotkin A, Belov Y. Prospective multicenter online testing of the carotid endarterectomy risk stratification calculator carotidscore.ru. Indian J Thorac Cardiovasc Surg 2023; 39:608-614. [PMID: 37885939 PMCID: PMC10597897 DOI: 10.1007/s12055-023-01538-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 10/28/2023] Open
Abstract
Aim To evaluate the incidence of complications, including fatal outcomes, ischemic strokes, and transient ischemic attacks, associated with carotid endarterectomy (CEA) in patients categorized as low-, medium-, and high-risk based on their CarotidSCORE (carotidscore.ru). Material and Methods This prospective, multicenter study was conducted from January 1, 2022, to December 20, 2022, and enrolled 5,496 patients with stenosis of the internal carotid artery (ICA), who were categorized into four groups according to their risk level. Group 1 (n=1,759) included patients at low risk; Group 2 (n=2,483) included those at medium risk; Group 3 (n=429) included those at high risk, who underwent carotid angioplasty with stenting (CAS) due to the high risk of complications associated with carotid endarterectomy (CEA); and Group 4 (n=825) did not use CarotidSCORE (carotidscore.ru). Patients in Groups 1, 2, and 4 underwent CEA. Results During the postoperative hospital stay, the highest number of complications, including fatal outcomes (p=0.0007), ischemic strokes (p<0.0001), and the combined endpoints (p<0.0001) were observed in Group 4. No complications were reported in Group 1. Conclusion The use of CarotidSCORE (carotidscore.ru) allows for the identification of high-risk patients, enabling clinicians to opt for CAS instead of CEA and reduce the incidence of complications.
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Affiliation(s)
| | - Alexander Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Merab Dzhanelidze
- Western Regional Center for Modern Medical Technologies, Kutaisi, Georgia
| | - Elguja Kharchilava
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Nonna Zarkua
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Elena Alekseeva
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Valeria Staroverova
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Victoria Koplik
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Roman Leader
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - Aslan Zakeryaev
- Regional Clinical Hospital No. 1 Named After. Prof. S.V. Ochapovsky, Krasnodar, Russian Federation
| | - Goderzi Bagdavadze
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | | | - Igor Semyin
- Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation
| | - Anton Kostenkov
- Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation
| | | | - Dmitry Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | - Oleg Lebedev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
- Yaroslavl State Medical University, St. Petersburg, Yaroslavl, Russia
| | - Sergey Artyukhov
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
- City Alexander Hospital, St. Petersburg, Russian Federation
| | - Otabek Mukhtorov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Shuowen Wang
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
| | - Roman Komarov
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
| | | | - Mikhail Khetagurov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | | | - Maxim Chernyavin
- Clinical Hospital of the Administration of the President of the Russian Federation, Moscow, Russian Federation
| | - Petr Palagin
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Alexey Sirotkin
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Yuri Belov
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
- Federal State Budgetary Scientific Institution “Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky”, Moscow, Russian Federation
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Kazantsev AN, Korotkikh AV, Chernyavin MP, Domke AP, Medvedev VM, Lider RY, Mukhtorov OS, Palagin PD, Sirotkin AA, Lebedev OV, Kazantsva EG. Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment. Radiol Case Rep 2023; 18:2370-2375. [PMID: 37179809 PMCID: PMC10172637 DOI: 10.1016/j.radcr.2023.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 05/15/2023] Open
Abstract
We have described a variant of the structure of the vertebral artery. In the V3 segment, the vertebral artery bifurcated and then joined again. This building looks like a triangle. Such anatomy has not been previously described in the world literature. By the right of the first description, this anatomical formation was called the «vertebral triangle of Dr A.N. Kazantsev». This discovery was made during stenting of the V4 segment of the left vertebral artery in the most acute period of stroke.
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Affiliation(s)
- Anton N. Kazantsev
- Kostroma Regional Clinical Hospital named after E.I. Korolev, Kostroma, Russian Federation
- Corresponding author.
| | - Alexander V. Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Maxim P. Chernyavin
- Clinical Hospital №1 of the Presidential Administration of the Russian Federation, Moscow, Russian Federation
| | - Alexey P. Domke
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Vasily M. Medvedev
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Roman Yu. Lider
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - Otabek Sh. Mukhtorov
- Kostroma Regional Clinical Hospital named after E.I. Korolev, Kostroma, Russian Federation
| | - Petr D. Palagin
- Kostroma Regional Clinical Hospital named after E.I. Korolev, Kostroma, Russian Federation
| | - Alexey A. Sirotkin
- Kostroma Regional Clinical Hospital named after E.I. Korolev, Kostroma, Russian Federation
| | - Oleg V. Lebedev
- Kostroma Regional Clinical Hospital named after E.I. Korolev, Kostroma, Russian Federation
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Kazantsev A, Korotkikh A, Lider R, Lebedev O, Sirotkin A, Palagin P, Mukhtorov O, Shmatov D, Artyukhov S, Ageev I, Rogova A, Kalichkin I, Beglaryan J, Snigur A, Belov Y. 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. Indian J Thorac Cardiovasc Surg 2023; 39:244-250. [PMID: 37124591 PMCID: PMC10140191 DOI: 10.1007/s12055-023-01487-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
Aim The aim of the study was to assess the role of a temporary carotid shunt in patients undergoing carotid endarterectomy. Materials and methods This was a retrospective, multicentric (n = 159) study carried out between January 2005 and October 2020. The study included 3114 patients undergoing carotid endarterectomy who had a reduced retrograde internal carotid artery pressure (<60% of systolic blood pressure). A temporary carotid shunt was used in 1328 patients and 1786 patients underwent carotid endarterectomy without a shunt. Results The in-hospital outcomes were comparable in terms of the incidence of deaths, myocardial infarctions, and stroke between the two groups. However, asymptomatic strokes (confirmed on computed tomography) occurred more frequently in the group where the temporary shunt was used (34 (2.5%) vs. 10 (0.55%), p < 0.0001). The composite endpoints of adverse events were also higher in the group where a temporary shunt was used (44 (3.3%) vs. 28 (1.5%), p = 0.002). The risk of symptomatic stroke (both fatal and non-fatal) was higher in the group where a temporary shunt was not used, though this was statistically not significant. Logistic regression analysis identified diabetes mellitus and stenosis (81-90%) of the contralateral internal carotid artery to be important predictors for stroke. Conclusion Temporary carotid shunts during carotid endarterectomy were associated with increased rates of asymptomatic stroke. There were no statistically significant differences in the incidence of non-fatal or fatal stroke, myocardial infarction, and mortality.
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Affiliation(s)
- Anton Kazantsev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation
| | - Alexander Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russia
| | - Roman Lider
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Oleg Lebedev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation
| | - Alexey Sirotkin
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation
| | - Petr Palagin
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation
| | - Otabek Mukhtorov
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation
| | - Dmitriy Shmatov
- Clinic of High Medical Technologies Named After N.I. Pirogov St. Petersburg State University, Saint Petersburg, Russian Federation
| | - Sergey Artyukhov
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - Ivan Ageev
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Alexandra Rogova
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Ivan Kalichkin
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Jasmine Beglaryan
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - Alla Snigur
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - Yuri Belov
- Russian Scientific Center of Surgery named after Academician B.V. Petrovsky, Moscow, Russian Federation
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Kazantsev AN, Zharova AS, Shmatov DV, Zakeryaev AB, Lider RY, Kazantseva EG, Bagdavadze GS, Korotkikh AV, Lutsenko VA, Sultanov RV, Lebedev OV, Sirotkin AA, Snopova EV, Palagin PD. The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure. Vascular 2023:17085381231160933. [PMID: 36867526 PMCID: PMC9988629 DOI: 10.1177/17085381231160933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
GOAL Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure. MATERIALS AND METHODS This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation. 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), rethrombosis (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 (ventilated) patients. CONCLUSION In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Alina S Zharova
- North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russian Federation
| | - Dmitriy V Shmatov
- Clinic of High Medical Technologies named after N. I. Pirogov St Petersburg State University, Saint Petersburg, Russian Federation
| | - Aslan B Zakeryaev
- Research Institute Regional Clinical Hospital No. 1 named. prof. S.V. Ochapovsky, Krasnodar, Russian Federation
| | - Roman Yu Lider
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Elizaveta G Kazantseva
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Goderzi S. Bagdavadze
- North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russian Federation
| | - Alexander V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Victor A Lutsenko
- Kemerovo Regional Clinical Hospital named after S. V. Belyaeva, Kemerovo, Russian Federation
| | - Roman V Sultanov
- Kemerovo Regional Clinical Hospital named after S. V. Belyaeva, Kemerovo, Russian Federation
| | - Oleg V Lebedev
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Alexey A Sirotkin
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Elena V Snopova
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Petr D Palagin
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
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Kazantsev AN, Korotkikh AV, Unguryan VM, Belov YV. Update in Carotid Disease. Curr Probl Cardiol 2023; 48:101676. [PMID: 36828045 DOI: 10.1016/j.cpcardiol.2023.101676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
This review of the literature analyzes publications over the past five years on various problems associated with carotid endarterectomy: 1. Is the eversion or classical technique of surgery with plastic repair of the reconstruction area with a patch more effective? 2. Carotid endarterectomy or carotid angioplasty with stenting is more optimal? 3. When should brain revascularization be performed after the development of ischemic stroke? 4. Should a temporary shunt be used to protect the brain during carotid endarterectomy? 5. How to prevent and treat different types of intraoperative ischemic strokes? 6. What tactics of treatment of patients with combined lesions of the carotid and coronary arteries is more effective? 7. What are the causes and methods of elimination of restenosis of the internal carotid artery known? 8. Is carotid endarterectomy safe in old age?
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Affiliation(s)
- Anton Nikolaevich Kazantsev
- Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma, Russian Federation; Kostroma oncological dispensary, Kostroma, Russian Federation.
| | - Alexander Vladimirovich Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | | | - Yuriy Vladimirovich Belov
- First Moscow State Medical University named after Sechenov, Moscow, Russian Federation; Federal State Budgetary Scientific Institution Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russian Federation
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Kazantsev AN, Korotkikh AV, Lider RY, Lebedev OV, Sirotkin AA, Palagin PD, Mukhtorov OS, Shmatov DV, Sergey A, Kazantseva EG, Bagdavadze GS, Wang S, Roshkovskaya LV, Khetagurov MA, Unguryan VM, Chernyavin MP, Nonye OG, Belov YV. An alternative anatomical classification for carotid bifurcation and impact on outcome of carotid endarterectomy: a multicenter study. THE CARDIOTHORACIC SURGEON 2023. [DOI: 10.1186/s43057-023-00097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Abstract
Background
The present multicenter retrospective study included 7148 patients who underwent carotid endarterectomy (CEA) between 2010 and 2021. Based on the results of angiography (AG)/multislice computed tomography (MSCT) angiography, 3 types of carotid bifurcation were identified depending on the projection of the carotid sinus to the cervical vertebrae: type I (high)—from the upper edge of the body of the II cervical vertebra to the lower edge of intervertebral disc located between III and IV cervical vertebrae; type II (medium)—from the upper edge of the body of the IV cervical vertebra to the lower edge of the body of the V cervical vertebra; and type III (low)—from the upper edge of the intervertebral disc located between the V and VI cervical vertebrae to the lower edge of the body of the VII cervical vertebra.
Purpose of the study
To develop a new classification of the types (high, medium, low) of carotid bifurcations (based on the level of cervical vertebrae) with analysis of the results of CEA depending on the type.
Results
The largest number of ischemic strokes (n = 15; 1.1%; p = 0.0001) was found in type I (high) bifurcation of the carotid artery. The majority of bleedings of type 3b and higher according to the BARC scale with the formation of acute hematomas in the intervention area (n = 14; 1.2%; p = 0.0029) were recorded in type III carotid bifurcation (low).
Conclusions
Type II (medium) carotid bifurcation may be the most preferred for CEA.
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Computer Modeling of Carotid Endarterectomy With the Different Shape Patches and Prediction of the Atherosclerotic Plaque Formation Zones. Curr Probl Cardiol 2023; 48:101505. [PMID: 36402216 DOI: 10.1016/j.cpcardiol.2022.101505] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
The article describes a method for constructing geometric models of the carotid bifurcation and computer simulation of endarterectomy surgery with the patches of various configurations. The purpose of this work is to identify the areas of the greatest risk of restenosis in the constructed models and to conduct a comparative analysis of risk factors when using the patches of different widths and shapes. The method is demonstrated on a reconstructed model of a healthy vessel. Its building is based on a preoperative computed tomography study of a particular patient's affected vessel. The flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasound Doppler velocimetry. Risk factors are assessed through the hemodynamic indices on the vessel wall associated with Wall Shear Stress. The distribution of risk zones in the healthy vessel, presumably leading to its observed lesion (plaque), is analyzed. Comparative evaluation of 10 various patches implantation results is carried out and the optimal variant is determined. The proposed method can be used to predict the hemodynamic results of surgery using patches of various sizes and shapes.
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Kazantsev AN, Korotkikh AV, Lider RY, Lebedev OV, Sirotkin AA, Palagin PD, Mukhtorov O, Shmatov DV, Sergey A. Mathematical model for the choice of tactics of revascularization in case of combined lesions of the carotid and coronary arteries. Curr Probl Cardiol 2022; 48:101436. [DOI: 10.1016/j.cpcardiol.2022.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
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