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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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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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Belov YV, Kazantsev AN, Kravchuk VN, Vinogradov RA, Korotkikh AV, Shmatov DV, Chernykh KP, Zakeryaev AB, Sukhoruchkin PV, Matusevich VV, Yu Lider R, Kazantseva EG, Zakharova CL, Sh Bagdavadze G, Zharova AS, Artyukhov SV, Lutsenko VA, Sultanov RV. FEATURES OF CAROTID ENDARTERECTOMY IN RUSSIA. HOW DO WE RESOLUTION ISSUES? Curr Probl Cardiol 2022; 47:101272. [DOI: 10.1016/j.cpcardiol.2022.101272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 01/21/2023]
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Chernyavsky MA, Susanin NV, Soloviev VA, Kazantsev AN. [Hybrid revascularization in a patient with Covid-19 and chronic limb ischemia stage IV]. Khirurgiia (Mosk) 2022:126-134. [PMID: 35593637 DOI: 10.17116/hirurgia2022051126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The authors report hybrid treatment of a patient with angina pectoris class II, multiple previous reconstructive interventions on the aortofemoral segment and chronic ischemia of the left lower limb stage IV and concomitant COVID-19. Coronary angiography was performed after regression of infectious disease under antiviral therapy. Occlusion of the left anterior descending artery was observed that required LAD stenting. On the next day, hybrid revascularization of the lower extremities was implemented: thrombectomy and endarterectomy from the branch of the aorto-femoral bypass graft and deep femoral artery at the first stage, stenting of the orifice of proximal branch of aorto-femoral bypass graft at the second stage, endarterectomy from superficial femoral artery, recanalization and stenting of superficial femoral artery and popliteal artery at the third stage and prosthetic- femoral bypass with autologous vein at the fourth stage. Postoperative angiography revealed patent stents and no residual stenoses. The choice in favor of these procedures and step-by-step approach has been substantiated. The authors emphasized effectiveness and safety of this treatment strategy.
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Affiliation(s)
- M A Chernyavsky
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - N V Susanin
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - V A Soloviev
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - A N Kazantsev
- St. Petersburg City Alexandrovskaya Hospital, St. Petersburg, Russia
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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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