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Belov YV, Kazantsev AN, Vinogradov RA, Korotkikh AV, Chernykh KP, Matusevich VV, Kachesov EY, Shmatov DV, Zakeryaev AB, Erofeev AA, Dzhanelidze MO, Karmokov IA, Kuklev AP, Andreeva AI, Taits BM, Taits DB, Bagdavadze GS, Kokaya RV, Zharova AS, Radzhabov IM, Lutsenko VA, Sultanov RV, Alizada FR, Abdullaev AD, Povtoreyko AV, Kapran TI, Lider RY, Vayman EF, Meleshin EO, Ginzburg ER, Makoeva MM, Klimova AI, Vinogradova ER, Zakharova KL, Pachkoriya MG, Alekseeva EO. [Long-term results of carotid endarterectomy and carotid artery stenting in patients with high bifurcation of common carotid artery: a multiple-center study]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:6-16. [PMID: 35758073 DOI: 10.17116/neiro2022860316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE), carotid endarterectomy with patch repair and carotid artery stenting (CAS) in patients with high bifurcation of common carotid artery. MATERIAL AND METHODS A retrospective multiple-center open study included 1983 patients who underwent internal carotid artery (ICA) repair for severe stenosis between 2010 and 2021. Three groups of patients were distinguished depending on revascularization option: group 1 (n=638) - eversion CEE; group 2 (n=351) - CEE with patch repair; group 3 (n=994) - CAS. RESULTS In-hospital postoperative mortality and incidence of stroke and myocardial infarction were similar. All bleedings (n=39) occurred after CEE. ICA thrombosis was diagnosed in groups 1 and 2 due to intimal detachment after insertion of temporary bypass tube. Incidence of laryngeal paresis, neuropathy of hypoglossal and glossopharyngeal nerves, Horner syndrome, damage to salivary glands was comparable in groups 1 and 2. Long-term mortality was the highest (n=10; 2.8%) after CEE with patch repair due to fatal stroke. In turn, the highest incidence of ICA restenosis and restenosis-induced ischemic stroke was observed after CEE with patch repair and CAS. CONCLUSION 1. Classical and eversion CEE in patients with high CCA bifurcation is followed by high in-hospital incidence of damage to cranial nerves and salivary glands, laryngeal paresis, Horner syndrome, bleeding and risk of ICA thrombosis. 2. In patients with high CCA bifurcation, CAS and CEE with patch repair are accompanied by high incidence of ICA restenosis, restenosis-induced stroke and mortality in long-term postoperative period. 3. Eversion CEE demonstrates the lowest rates of all adverse cardiovascular events in long-term follow-up period.
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Affiliation(s)
- Yu V Belov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A N Kazantsev
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - R A Vinogradov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | | | - K P Chernykh
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - V V Matusevich
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - E Yu Kachesov
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - D V Shmatov
- St. Petersburg State University, St. Petersburg, Russia
| | - A B Zakeryaev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A A Erofeev
- City Multidisciplinary Hospital No. 2, St. Petersburg, Russia
| | - M O Dzhanelidze
- Western Regional Center for Modern Medical Technologies, Kutaisi, Georgia
| | - I A Karmokov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A P Kuklev
- St. Petersburg State University, St. Petersburg, Russia
| | - A I Andreeva
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - B M Taits
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - D B Taits
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - G Sh Bagdavadze
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - R V Kokaya
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A S Zharova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I M Radzhabov
- Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - V A Lutsenko
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - R V Sultanov
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - F R Alizada
- Belyaev Kuzbass Regional Clinical Hospital, Kemerovo, Russia
| | - A D Abdullaev
- Pskov Regional Infectious Clinical Hospital, Pskov, Russia
| | - A V Povtoreyko
- Pskov Regional Infectious Clinical Hospital, Pskov, Russia
| | - T I Kapran
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - R Yu Lider
- Kemerovo State Medical University, Kemerovo, Russia
| | - E F Vayman
- Kemerovo State Medical University, Kemerovo, Russia
| | - E O Meleshin
- Podgorbunsky Kuzbass Clinical Hospital for Emergency Care, Kemerovo, Russia
| | - E R Ginzburg
- Podgorbunsky Kuzbass Clinical Hospital for Emergency Care, Kemerovo, Russia
| | - M M Makoeva
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A I Klimova
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | | | - K L Zakharova
- City Aleksandrovskaya Hospital, St. Petersburg, Russia
| | - M G Pachkoriya
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - E O Alekseeva
- Yaroslav the Wise Novgorod State University, Veliky Novgorod, Russia
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Kazantsev AN, Vinogradov RA, Kravchuk VN, Chernyavskiy MA, Shabaev AR, Kachesov EY, Bagdavadze GS, Vayman EF, Porkhanov VA, Khubulava GG. [Stenting of the first segment of the spinal artery in the acutest period of ischemic stroke in the vertebrobasilar territory]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:38-45. [PMID: 33908231 DOI: 10.17116/jnevro202112103238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT). MATERIAL AND METHODS The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis. RESULTS During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure. CONCLUSION Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.
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Affiliation(s)
| | - R A Vinogradov
- Research Institute Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - V N Kravchuk
- Mechnikov North-Western State Medical University, St. Petersburg, Russia.,Kirov Military Medical Academy, St. Petersburg, Russia
| | - M A Chernyavskiy
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - A R Shabaev
- Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.,Barbarash Kuzbass Clinical Cardiology Dispensary, Kemerovo, Russia
| | | | - G Sh Bagdavadze
- Research Institute Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - E F Vayman
- Kemerovo State Medical University, Kemerovo, Russia
| | - V A Porkhanov
- Research Institute Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - G G Khubulava
- Kuban State Medical University, Krasnodar, Russia.,Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
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Smolnikov AV, Kozlov KL, Kachesov EY, Tishko VV, Oleksyuk IB. [CAROTID STENTING EXPERIENCE IN THE ACUTE PHASE OF ISCHEMIC STROKE IN PATIENTS OF ELDERLY AND SENILE AGE]. Adv Gerontol 2015; 28:307-315. [PMID: 26856093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Age has been shown to be a predictor of neurological complications during carotid stenting (CS). However, carotid stenting in acute period of ischemic stroke has recently been demonstrated safely in patients over 70 and even 80 years. Early intervention is desirable in patients presenting with stroke referable to carotid artery stenosis because of the high incidence of recurrent ischemic events. However, he optimal timing to perform CS in the acute phase of ischemic stroke in elderly remains unclear due to the threat of perioperative complications. In our hospital (Aleksandrovskaya) was searched for consecutive cases of extracranial internal CS procedures performed for symptomatic atherosclerotic carotid stenosis in the acute phase of ischemic stroke in a total of 65 elderly patients. The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 5.9 % in patients treated within 2 days, 0% in patients treated between days 3 and 7, 15% in patients treated between days 8 and 14 and 0% in patients treated between days 15 and 30. Our results support the conclusion that early CS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 30 days in elderly.
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