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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, Abdullaev IA, Danilchuk LB, Shramko VA, Korotkikh AV, Chernykh KP, Bagdavadze G, Zharova AS, Kharchilava EU, Lider R, Kazantseva Y, Zakeryayev AB, Shmatov DV, Kravchuk VN, Zakharova KL, Artyukhov SV, Bhand HK, Chernyavtsev IA, Erofeev AA, Khorkova SM, Kulikov KA, Lutsenko VA, Matusevich VV, Morozov D, Peshekhonov KS, Sultanov RV, Zarkua NE, Khasanova DD, Serova NY, Shaikhutdinova RA, Gavrilova OO, Alekseeva EO, Kleschenogov AS, Sukhoruchkin PV, Taits DB, Taits BM, Palagin PD, Lebedev OV, Alekseev MV, Belov Y. CAROTIDSCORE.RU-The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy. Vascular 2024; 32:132-142. [PMID: 36056591 DOI: 10.1177/17085381221124709] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
GOAL Presentation of the first Russian computer program (www.carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CEE). MATERIAL AND METHODS The present study is based on the analysis of a multicenter Russian database that includes 25,812 patients after CEE operated on from 01/01/2010 to 04/01/2022. The following types of CEE were implemented: 6814 classical CEE with plastic reconstruction of the reconstruction zone with a patch; 18,998 eversion CEE. RESULTS In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14%-myocardial infarction, 0.35%-stroke. The combined endpoint was 0.68%. For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. Based on this formula, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. On the basis of the obtained calculations, a computer program CarotidSCORE was created. Its graphical interface is based on the QT framework (https://www.qt.io), which has established itself as one of the best solutions for desktop applications. It is possible not only to calculate the probability of developing a complication, but also to save all data about the patient in JSON format (for the patient's personal card and his anamnesis). The CarotidSCORE program contains 47 patient parameters, including clinical-demographic, anamnestic and angiographic characteristics. It allows you to choose one of the four types of CEE, which will provide an accurate stratification of the risk of complications for each of them in person. CONCLUSION CarotidSCORE (www.carotidscore.ru) is able to determine the likelihood of postoperative complications in patients undergoing CEE.
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Affiliation(s)
- A N Kazantsev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - I A Abdullaev
- St. Petersburg State Pediatric Medical University, Russian Federation
| | - L B Danilchuk
- First St. Petersburg State Medical University Named After Academician I. P. Pavlov, Russian Federation
| | - V A Shramko
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | | | - Gsh Bagdavadze
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A S Zharova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - E U Kharchilava
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - Ryu Lider
- Kemerovo State Medical University, Russian Federation
| | | | - A B Zakeryayev
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - D V Shmatov
- Clinic of High Medical Technologies. N.I. Pirogov St. Petersburg State University, Russian Federation
| | - V N Kravchuk
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | | | - H K Bhand
- Kemerovo State Medical University, Russian Federation
| | - I A Chernyavtsev
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - A A Erofeev
- City Multidisciplinary Hospital No. 2, Russian Federation
| | - S M Khorkova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - K A Kulikov
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - V A Lutsenko
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaeva, Russian Federation
| | - V V Matusevich
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - Dyu Morozov
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | - R V Sultanov
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaeva, Russian Federation
| | - N E Zarkua
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - D D Khasanova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - N Y Serova
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | | | - O O Gavrilova
- Yaroslav-the-Wise Novgorod State University, Russian Federation
| | - E O Alekseeva
- Yaroslav-the-Wise Novgorod State University, Russian Federation
| | | | - P V Sukhoruchkin
- Regional Clinical Hospital No. 1 Named. Prof. S.V. Ochapovsky, Russian Federation
| | - D B Taits
- St. Petersburg State Pediatric Medical University, Russian Federation
| | - B M Taits
- North-Western State Medical University. I.I. Mechnikov, Russian Federation
| | - P D Palagin
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - O V Lebedev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - M V Alekseev
- Kostroma Regional Clinical Hospital Named After E.I. Korolev, Russian Federation
| | - YuV Belov
- Federal State Budgetary Scientific Institution "Russian Scientific Center of Surgery Named B.V. Petrovsky", Moscow, Russian Federation
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Belov YV, Kazantsev AN, Vinogradov RA, Korotkikh AV. Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial. Vascular 2023; 31:717-724. [PMID: 35321600 DOI: 10.1177/17085381221084803] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To compare the long-term results of eversion (ECEA) and conventional carotid endarterectomy (CCEA). METHODS We designed a retrospective, multicenter study which included 25,106 patients who underwent ECEA (n = 18,362) or CCEA (n = 6744). The duration of follow-up was 124.7 ± 53.8 months. RESULTS In the postoperative period, none of the interventions showed clear benefits reducing the frequency of complications: fatal outcome (ECEA: 0.19%, n = 36; CCEA: 0.17%, n = 12; OR = 1.1, 95% CI = 0.57-2.11, p = 0.89), myocardial infarction (ECEA: 0.15%, n = 28; CCEA: 0.13%, n = 9; p = 0.87; OR = 1.14; 95% CI = 0.53-2.42); acute cerebrovascular accident (CVA) (Group I: 0.33%, n = 62; Group II: 0.4%, n = 27; p = 0.53; OR = 0.84; 95% CI = 0, 53-1.32); bleeding with acute haematoma appearance in the area of intervention (Group I: 0.39%, n = 73; Group II: 0.41%, n = 28; p = 0.93; OR = 0.95; 95% CI = 0, 61-1.48); internal carotid artery (ICA) thrombosis (Group I: 0.05%, n = 11; Group II: 0.07%, n = 5; OR = 0.80, 95% CI = 0.28-2.32, p = 0.90). During the long-term follow-up, ECEA was associated with lower frequency of fatal outcome (ECEA: 2.7%, n = 492; CCEA: 9.1%, n = 616; OR = 0.27; 95% CI = 0.24-0.3, p < 0.0001), cerebrovascular death (ECEA: 1.0%, n = 180; CCEA: 5.5%, n = 371; OR = 0.17, 95% CI = 0.14-0.21, p < 0.0001), non-fatal ischaemic stroke (ECEA: 0.62%, n = 114; CCEA: 7.0%, n = 472; OR = 0.08; 95% CI = 0.06-0.1, p < 0.0001); repeated revascularization because of >60% restenosis (ECEA: 1.6%, n = 296; CCEA: 12.6%, n = 851; OR = 0.11, 95% CI = 0.09-0.12, p < 0.0001), and combined endpoint (ECEA: 2.2%, n = 397; CCEA: 13.2%, n = 888; OR = 0.14; 95% CI = 0.12-1.16, p < 0.0001). CONCLUSION ECEA is beneficial over CCEA in a long term.
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Affiliation(s)
- Yuri V Belov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Vukašinović D, Maksimović M, Tanasković S, Marinković JM, Radak Đ, Maksimović J, Vujčić I, Prijović N, Vlajinac H. Body Mass Index and Late Adverse Outcomes after a Carotid Endarterectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2692. [PMID: 36768056 PMCID: PMC9916381 DOI: 10.3390/ijerph20032692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
A cohort study was conducted to examine the association of an increased body mass index (BMI) with late adverse outcomes after a carotid endarterectomy (CEA). It comprised 1597 CEAs, performed in 1533 patients at the Vascular Surgery Clinic in Belgrade, from 1 January 2012 to 31 December 2017. The follow-up lasted four years after CEA. Data for late myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. Logistic and Cox regressions were used in the analysis. The CEAs in patients who were overweight and obese were separately compared with the CEAs in patients with a normal weight. Out of 1223 CEAs, 413 (33.8%) were performed in patients with a normal weight, 583 (47.7%) in patients who were overweight, and 220 (18.0%) in patients who were obese. According to the logistic regression analysis, the compared groups did not significantly differ in the frequency of myocardial infarction, stroke, and death, as late major adverse outcomes (MAOs), or in the frequency of restenosis. According to the Cox and logistic regression analyses, BMI was neither a predictor for late MAOs, analyzed separately or all together, nor for restenosis. In conclusion, being overweight and being obese were not related to the occurrence of late adverse outcomes after a carotid endarterectomy.
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Affiliation(s)
- Danka Vukašinović
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Miloš Maksimović
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Slobodan Tanasković
- Vascular Surgery Clinic, “Dedinje” Cardiovascular Institute, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena M. Marinković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Đorđe Radak
- Vascular Surgery Clinic, “Dedinje” Cardiovascular Institute, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jadranka Maksimović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Isidora Vujčić
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nebojša Prijović
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Hristina Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Kazantsev AN, Chernykh KP, Zarkua NE, Lider RY, Kubachev KG, Bagdavadze GS, Kalinin EY, Zaitseva TE, Chikin AE, Artyukhov SV, Linets YP. Novel method for glomus-saving carotid endarterectomy sensu A. N. Kazantsev: cutting the internal carotid artery on the site from external and common carotid artery. ACTA ACUST UNITED AC 2020. [DOI: 10.15829/1560-4071-2020-3851] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness.
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Affiliation(s)
| | | | - N. E. Zarkua
- Aleksandrovskaya Hospital; I. I. Mechnikov North-Western State Medical University
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Kazantsev AN, Chernykh KP, Zarkua NE, Leader RY, Kubachev KG, Bagdavadze GS, Kalinin EY, Zaitseva TE, Chikin AE, Linets YP. Carotid endarterectomy with extended lesion: formation of a new bifurcation according to A.V.Pokrovsky or autoarterial reconstruction according to A.A.Karpenko? RESEARCH AND PRACTICAL MEDICINE JOURNAL 2020. [DOI: 10.17709/2409-2231-2020-7-3-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose of the study. Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA). Materials and methods. In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke). Results. The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE. Conclusion. Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.
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Affiliation(s)
| | | | - N. E. Zarkua
- Alexander Hospital; North-western State Medical University named after I.I.Mechnikov
| | | | - K. G. Kubachev
- North-western State Medical University named after I.I.Mechnikov
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