[Structure of in-hospital and remote complications of surgical treatment of stenotic lesions of coronary and carotid arteries]

BACKGROUND

Problems concerning the choice of optimal revascularization strategy in patients with simultaneous atherosclerotic lesions of the coronary and brachiocephalic arteries still remain unsolved, since there are no randomized studies and there is uncertainty in Russian and foreign guidelines.

AIM

The study was aimed at analysing the remote results of surgical treatment of 391 patients with concomitant lesions of the coronary and brachiocephalic arteries within the framework of a single-centre prospective registry.

PATIENTS AND METHODS

Within the timeframe of our study, all patients were divided into 4 groups depending on the method of surgical treatment of the above-mentioned pathology of the coronary and brachiocephalic arteries. Group 1 patients underwent staged surgery in the scope of coronary artery bypass grafting followed by carotid endarterectomy. Group 2 patients endured coronary artery bypass grafting combined with carotid endarterectomy. Group 3 patients were subjected to hybrid revascularization consisting in percutaneous coronary intervention and carotid endarterectomy. Group 4 patients sustained staged surgery consisting of carotid endarterectomy followed by coronary artery bypass grafting. The clinical and demographic characteristics, period of follow up, as well as the results after the respective surgical intervention for each group are presented.

RESULTS

We analysed the frequency and structure of adverse cardiovascular events depending on the time intervals within which complications had occurred resulting from a particular surgical policy used.

DISCUSSION

The obtained findings demonstrated that adverse cardiovascular events in the total sample of patients were mainly observed in the remote period of follow up, which was related primarily to a progressive course of atherosclerosis, the presence of bilateral lesions of the internal carotid arteries, as well as the lack of protocols ensuring complete revascularization in multifocal atherosclerosis within a limited time interval.

CONCLUSION

We made a conclusion on efficacy of the simultaneous strategy of revascularization by means of coronary artery bypass grafting combined with carotid endarterectomy in regard to decreased incidence of strokes in the remote period of follow up.

[Predictors of long-term complications after carotid endarterectomy]

AIM

To analyze the predictors of complications within 3 years after carotid endarterectomy (CEE).

MATERIAL AND METHODS

The study included 1035 patients after CEE for the period 2011-2016. Long-term follow-up period was 42.4±18.6 months (≈ 3.5 years). The endpoints were such unfavorable cardiovascular events as death, myocardial infarction, stroke/transient ischemic attack, redo revascularization. Statistical analysis was carried out by using of Statistica for Windows 8.0 software package (StatSoft Inc., USA). Stepwise logistic regression was applied to identify risk factors of adverse outcomes and death in long-term postoperative period.

RESULTS

Comprehensive analysis of numerous factors (anamnestic, instrumental-diagnostic, surgical) allowed us to identify predictors of long-term unfavorable outcomes in patients with occlusive-stenotic lesions of carotid arteries. Risk factors of long-term complications were SYNTAX score ≥33 (high risk), unstable plaque in the contralateral ICA, occlusion of contralateral ICA, LVEF <39%, ICA cross-clamping >40 min, previous CABG.

CONCLUSION

These data are extremely important and can be used to create prognostic models. The last ones are necessary to determine optimal treatment strategy in patients with occlusive-stenotic lesions of supra-aortic vessels.

[Computer-assisted simulation of haemodynamic parameters of carotid artery bifurcation after carotid endarterectomy]

Computer-aided simulation appropriately using the method of computational fluid dynamics (CFD) makes it possible to determine the elevated-risk zones of most probable formation of restenosis. The main idea of the method described in our article consists in a possibility of creating by the model of the geometrical shape of the vessel and characteristics of the flow at inlets and outlets the parameters of flow in each point of a vessel. The curves of velocity are used to create the curves of pressure at inlets and outlets, which are used in a CFD model. The resulting from CFD simulation of blood flow are nonstationary three-dimensional fields of pressure and velocity in the area under study. Visual examination of the dynamics of these fields makes it possible to judge about possible problem zones inside the area of flow and on the internal wall of the vessel. This article also presents a clinical case report illustrating the use of this technique.

[In-hospital outcomes of carotid endarterectomy depending on severity of contralateral lesion]

AIM

To compare in-hospital outcomes of carotid endarterectomy (CEE) in patients with different lesion of contralateral internal carotid artery (ICA).

MATERIAL AND METHODS

There were 730 CEE procedures in patients with bilateral ICA lesion for the period 2011-2016. All patients were divided into 4 groups depending on contralateral ICA stenosis grade: group 1 - stenosis up to 60% (42.6%, n=311); group 2 - 60-90% (18.7%, n=137); group 3 - 90-99% (25.9%, n=189); group 4 - occlusion (12.7%, n=93). Endpoints were unfavorable cardiovascular events including death, myocardial infarction (MI), stroke/TIA, significant hemorrhage by BARC scale (Bleeding Academic Research Consortium).

RESULTS

In-hospital mortality and incidence of MI, stroke/TIA were similar in all groups. However, there were no cardiovascular complications in patients with critical contralateral stenosis or occlusion. Bleeding followed by redo surgery was the most frequent complication. Overall incidence of adverse cardiovascular events did not exceed 1.23%.

CONCLUSION

There was no correlation between contralateral ICA stenosis and incidence of in-hospital adverse events including death, MI, stroke/TIA. Currently, technique of CEE is well developed that is associated with low incidence of postoperative complications.

[Five-year outcomes of aorto-femoral vascular reconstructions in patients with multifocal atherosclerosis]

AIM

To analyze long-term results of surgical treatment of atherosclerotic occlusive-stenotic lesion of aorto-femoral segment within the single-center prospective register.

MATERIAL AND METHODS

The study included 275 patients who underwent aorto-femoral reconstructive interventions for the period 2011-2014. Inclusion criterion was indications for aorto-femoral surgery due to severe atherosclerotic lesions of the infrarenal aorta and/or ilio-femoral arteries. Mean follow-up was 54±11.6 months.

RESULTS

Prognostic significance of various clinical-instrumental, anatomical-angiographic and perioperative variables has been comprehensively analyzed. Five-year outcomes and cardiovascular morbidity were assessed in consecutive patients after reconstructive procedures on the aorto-femoral segment. Multidisciplinary approach to determine optimal revascularization strategy and certain tactical and technical algorithms are necessary to improve the outcomes in these severe patients.

CAROTID­SUBCLAVIAN GRAFTING IN OCCLUSION OF THE FIRST PORTION OF SUBCLAVIAN ARTERY AND MULTIFOCAL ATHEROSCLEROSIS: FIVE YEAR FOLLOW­UP DATA

Aim.Analysis of the prevalence and structure of hospital and five year postsurgical complications in patients with occlusion of the first portion of subclavian artery and multifocal atherosclerosis.

Material and methods.To the study, 45 patients included, who had underwent carotid­subclavian shunting during 2008­2015y.

Results.In hospital period of follow­up there were no significant adverse cardiovascular events. Among the comlications, in several cases there were vocal cords paresis, paresis of the diaphragm dome, limphorrhea. The study shows that significant cardiovascular events occurred only in long term of the disease period and were related to the following stage of revascularization.

Conclusion.The obtained results underscore the significance of risk stratification and selection of the optimal strategy of revascularization in the cohort of patients, that is impossible unless an approach is personified.