Mathematical modeling in assessing the risk of restenosis after carotid endarterectomy

Carotid endarterectomy is the main way to combat atherosclerosis of the carotid arteries, which disrupts cerebral circulation. The generally accepted marker of atherogenesis risk are hemodynamic indices associated with near-wall shear stress. The purpose of the work is to conduct a comparative analysis of hemodynamic indices in various carotid bifurcation models. The influence of a virtual change in the geometric shape of the model in order to optimize hemodynamic indices is also being studied. On the basis of computed angiography data, carotid bifurcation models are constructed, in which critical zones of hemodynamic indices are built using computational fluid dynamics. A comparative analysis of the critical zones for different classes of models is carried out. Comparison of averaged indices for critical zones between 'normal' and post-operative groups gave more than 5-x worse results for the latter. The same results for the near-bifurcation parts of the zones give a 25% better result for postoperative models. Virtual 'removal' of insignificant plaques leads to a deterioration of the indices of up to 40% in the places of the plaque's former location. The described method makes it possible to build the indices critical zones and compare them for various types of models. A technique for virtual changing the shape of a vessel (virtual surgery) is proposed. The novelty of the approach lies in the use for comparative analysis both real vessel models and hypothetical 'improved' virtual ones, as well in the proposed division of post-operative model's critical zones into subzones of different genesis.

[Robot-assisted linear aortofemoral bypass surgery]

Aortofemoral bypass surgery is still the «gold standard» for aortoiliac lesions with excellent results and long-term patency despite improvement of endovascular surgery. Extensive surgical approaches are accompanied by high risk of postoperative complications. Development of minimally invasive surgery and achievements of computerized technologies made a revolution in all surgeries and minimize trauma following complex reconstructive procedures. This also reduces perioperative risks and accelerates recovery. Computerized robotic systems in vascular surgery provide safe complex procedures on aortoiliac segment. We present robot-assisted linear iliofemoral bypass surgery in a 69-year-old patient with chronic arterial insufficiency Fontein grade IV.

[Long-term results of carotid endarterectomy and carotid artery stenting in patients with high bifurcation of common carotid artery: a multiple-center study]

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.

[Different methods of femoropopliteal bypass grafting with autologous vein: propensity score matching analysis]

OBJECTIVE

To analyze immediate and long-term results of various methods of femoropopliteal bypass grafting with autologous vein using propensity score matching.

MATERIAL AND METHODS

A retrospective single-center open study included 464 patients who underwent femoropopliteal bypass grafting with an autologous vein between January 10, 2016 and December 25, 2019 at the Research Institute - Ochapovsky Regional Clinical Hospital No. 1. The following types of autovenous conduits were used: n=266 - reversed autologous vein (group 1); n=59 - in situ autologous vein (group 2); n=73 - upper limb autologous vein (group 3); n=66 - ex situ autologous vein (group 4). The long-term period was 16.6±10.3 months.

RESULTS

We used propensity score matching analysis because patients were not comparable for some indicators. Groups 2-4 included small samples of patients, and their number was reduced to less than 10. This did not allow us to draw reliable conclusions about treatment outcomes. In this situation, we decided to allocate two groups: group 1 - ex situ femoropopliteal bypass grafting; group 2 - other variants of femoropopliteal bypass grafting with autologous vein. Propensity score matching allocated 299 people in group 1 and 46 patients in group 2. There were significant differences in early postoperative incidence of autologous vein thrombosis (group 1: n=3 (6.5%), group 2: n=79 (26.4%), p=0.003; OR= 0.19; 95% CI 0.05-0.64) and postoperative wound suppuration (group 1: n=2 (4.3%), group 2: n=52 (17.4%); p=0.02; OR=0.21; 95% CI 0.05-0.91). In long-term postoperative period, significant differences were obtained in the incidence of limb amputation (group 1: n=6 (13%), group 2: n=85 (28.4%); p=0.02; OR=0.37; 95% CI 0.15-0.92) and myocardial infarction (group 1: n=1 (2.2%), group 2: n=43 (14.4%); p=0.02; OR 0.13; 95% CI 0.01-0.98).

CONCLUSION

Femoropopliteal bypass grafting ex situ is characterized by lower incidence of graft thrombosis, amputations of the limb, mild decrease in the incidence of infectious complications and all adverse cardiovascular events in early and late postoperative period compared to conventional surgery (reversed autologous vein, in situ autologous vein, upper limb autologous vein).

[Resection of lumbar arteriovenous malformation]

The authors present a 64-year-old patient with lumbar arteriovenous malformation 22´35´50 mm. Open resection under endotracheal anesthesia was carried out. Postoperative period was uneventful. The patient was discharged in 7 days after surgery. Surgical resection of lumbar AVM is preferable because this approach eliminates cosmetic defect without the risk of soft tissue necrosis. Such an invasive intervention can be performed in case of superficial afferent vessel whose ligation will reduce the risk of intraoperative bleeding.

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p <0.0001), MI (p = 0.011), ischemic stroke (p <0.0001), restenosis / occlusion of the ICA (p <0.0001), combined end point (p <0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period.

[A multicenter study on the influence of different kinds of carotidal endarterectomy on the course of resistant arterial hypertension]

OBJECTIVE

To analyze the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (CEE) in patients with resistant arterial hypertension (RAH).

MATERIALS AND METHODS

The study included 1577 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RAH for more than 3 years. Patients were enrolled from January 2014 to December 2020. Depending on the implemented revascularization strategy, 5 groups were formed: group 1 (n=289 (18.3%)) with classical CEE with plasty of the reconstruction zone with a patch, group 2 (n=472 (29.9%)) with eversional CEE with cut-off of carotid glomus (CG); group 3 (n=109 (6.9%)) with the formation of a new bifurcation; group 4: (n=117 (7.4%)) with autoarterial reconstruction; group 5: (n=590 (37.4%)) with glomus-saving CEE.

RESULTS

In the postoperative period, no significant differences were obtained in the frequency of deaths (0.34% for group 1; 0.63% for group 2; 0% for groups 3, 4 and 5), myocardial infarction (0.34%, 0.84%, 1.83, 0.85%, 0.33%, respectively); ischemic stroke (0.34%, 1.27%, 0.91%, 0.85%, 0.17%, respectively), hemorrhagic transformation (0%, 0.84%, 0.91%, 0.85%, 0%, respectively). 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 (1.03%, 3.6%, 3.67%, 2.56%, 0.5%, respectively). 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.

[Extended lesion of the internal carotid artery: carotid autotransplantation, creation of a neobifurcation or prosthetic repair?]

AIM

The aim of our investigation was to analyse the results of autotransplantation, creation of a neobifurcation or prosthetic repair of the internal carotid artery during the in-hospital and long-term follow-up periods.

PATIENTS AND METHODS

The study included a total of 241 patients presenting with and treated for extended atherosclerotic lesions of the internal carotid artery from 2016 to 2019. The patients were divided into three groups depending on the surgical modality employed: group 1 - autotransplantation of the internal carotid artery (27.8%, n=67), group 2 - creation of a neobifurcation (55.2%, n=133), and group 3 - prosthetic repair of the internal carotid artery (17.0%, n=41). The duration of the postoperative follow-up period amounted to 24.8±11.9 months. The outcome measures selected were as follows: all-cause mortality, myocardial infarction, ischaemic stroke, haemodynamically significant restenosis, and a composite endpoint (death + myocardial infarction + ischaemic stroke + haemodynamically significant restenosis).

RESULTS

During the in-hospital postoperative period we registered 1 (2.4%) ischaemic stroke in the group of prosthetic repair, with no significant inter-group difference revealed (p=0.08). In the remote period of follow-up, no statistical differences were revealed for the following outcome measures: all-cause mortality (group 1: 7.5%, n=5; group 2: 10.5%, n=14; group 3: 14.6%, n=6; p=0.49); cardiovascular-related death (group 1: 4.5%, n=3; group 2: 6.7%, n=9; group 3: 12.2%, n=5; p=0.31); myocardial infarction (group 1: 1.5%, n=1; group 2: 3%, n=4; group 3: 4.9%, n=2; p=0.59). However, the patients in the group of prosthetic repair of the internal carotid artery were found to have the highest incidence rates of ischaemic stroke (group 1: 3%, n=2; group 2: 3%, n=4; group 3: 14.6%, n=6; p1-2=0.1; p1-3=0.02; p2-3=0.008), haemodynamically significant restenosis (group 1: 0%, n=0; group 2: 0%, n=0; group 3: 14.6 %, n=6; p1-2>0.99; p1-3=0.000; p2-3=0.000), and higher values of the composite endpoint (group 1: 12 %, n=8; group 2: 16.5%, n=22, group 3: 48.8%, n=20; p1-2>0.99; p1-3=0.000; p2-3=0.000).

CONCLUSION

Prosthetic repair of the internal carotid artery for an extended atherosclerotic lesion is a less preferable method compared with autotransplantation and creation of a neobifurcation, as evidenced by the highest incidence rates of ischaemic stroke, haemodynamically significant restenosis, and higher values of the composite endpoint in the remote period of follow up.

[Transposition of internal carotid artery over hypoglossal nerve in eversion carotid endarterectomy]

OBJECTIVE

To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE) with transposition of internal carotid artery (ICA) over hypoglossal nerve.

MATERIAL AND METHODS

A cohort prospective open-label study included 919 patients with severe ICA stenosis for the period from January 2017 to April 2020. The 1st group (n=172) included patients who underwent eversion CEE with ICA transposition over hypoglossal nerve; the 2nd group (n=747) - who underwent conventional eversion CEE. ICA transposition technique included standard mobilization of the carotid arteries, cross-clamping, arterial wall incision, removal of atherosclerotic plaque and ICA translocation above the hypoglossal nerve for subsequent anastomosis. All patients were examined every 6 months. Mean follow-up period was 17.5±6.9 months.

RESULTS

There were no significant between-group differences in cardiovascular morbidity. However, all complications occurred in the 2nd group (traditional eversion CEE). Nevertheless, incidence of adverse events was minimal and combined endpoint did not exceed 0.6% (n=5). Both groups were also comparable by overall incidence of cardiovascular events in long-term period. All ICA restenoses (over 70%) were symptomatic with similar incidence (4 (2.3%) vs. 18 (2.4%), respectively, p=0.83; OR 0.96; 95% CI 0.32-2.88). Mean restenosis-free period was 7.2±2.6 months. In case of significant restenosis, redo CEE with patch repair was performed. There were no cardiovascular complications. All cases of hypoglossal nerve injury occurred in the 2nd group (0 vs. 18 (100%), respectively; p=0.0001; OR 0.003; 95% CI=5.21-0.17) without ICA transposition over the hypoglossal nerve.

CONCLUSION

Eversion CEE with ICA transposition over the hypoglossal nerve ensures optimal conditions for successful redo CEE in case of restenosis. This technique facilitates ICA mobilization without hypoglossal nerve injury. This aspect is valuable for successful postoperative outcome and adequate quality of life. ICA transposition is not difficult and does not require additional experience. Transposition per se is not a risk factor of ICA restenosis. Thus, ICA transposition may be routinely recommended in patients eligible for eversion CEE.

[Stenting of the first segment of the spinal artery in the acutest period of ischemic stroke in the vertebrobasilar territory]

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.

Urgent intervention of hemodynamically significant stenosis of the internal carotid artery in the acutest period of an ischaemic stroke

<p><strong>Aim</strong>. To assess the results of carotid angioplasty with stenting (CAS) performed in the first 3 h after the onset of ischaemic stroke (the most acute period of acute cerebrovascular accident).</p><p><strong>Methods</strong>. This retrospective study included 312 patients from January 2008 to August 2020 with hemodynamically significant stenosis of the internal carotid arteries (ICA) who underwent CAS within 3 h of stroke onset. After a patient was hospitalised in our emergency department, stroke development was assessed by a neurologist. The level of neurological deficit was determined according to the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin scale, the Barthel scale and the Rivermead Mobility Index. Multispiral computed tomography (MSCT) of the brain was then performed. On condition of visualisation of the ischaemic focus, the patient was sent for screening colour duplex scanning of the brachiocephalic arteries (BCA), arteries of the lower extremities, aortic arch and heart. If hemodynamically significant stenosis in the ICA was visualised, the patient underwent MSCT angiography of the BCA. The degree of stenosis was determined using the North American Symptomatic Trial Collaborators (NASCET) classifications. The on-duty ultidisciplinary council determined the tactics of the patient's treatment. Decisions regarding surgical correction and the choice of revascularisation strategy (CAS or carotid endarterectomy) were made based on stratification of the risk of postoperative complications according to the EuroSCORE II scale and the severity of coronary lesions according to the SYNTAX Score (in the presence of a history of coronary angiography). The time between admission to the emergency department and admission to the operating room was 84.5 ± 9.3 minutes. The inclusion criteria were 1. mild neurological disorders from 3 to 8 points on the NIHSS scale, no more than 2 points on the Rankin modification scale and more than 61 points on the Barthel scale; 2. Indication for CAS according to the current national recommendations; 3. Ischaemic focus in the brain no more than 2.5 cm in diameter according to MSCT; 4. Absence of pronounced calcification of the ICA. The exclusion criteria were: 1. Contraindications for CAS; 2. The presence of thrombosis of the ICA requiring the introduction of fibrinolytics (Alteplase), thromboextraction and thromboaspiration.</p><p><strong>Results</strong>. In the hospital postoperative period, 6 (1.92%) patients had lethal outcomes, 5 (1.6%) had myocardial infarctions, 5 (1.6%) had nonfatal stroke, 7 (2.2%) had asymptomatic ‘silent’ stroke, 2 (0.64%) had haemorrhagic transformations and 1 (0.32%) had ICA thrombosis. The combined endpoint (death + stroke + myocardial infarction) was reached in 7.05% of patients (n = 22).</p><p><strong>Conclusion</strong>. CAS is a safe and effective method of brain revascularisation in the first hours after the onset of ischaemic stroke. Interventional correction of hemodynamically significant stenoses of the ICA had permissible levels of ‘stroke + mortality from stroke’ and lethal outcomes, which reached 3.84% and 1.92%, respectively. Urgent implementation of CAS allows a significant regression of neurological deficit which is stable throughout the entire postoperative period.</p><p>Received 21 September 2020. Revised 1 October 2020. Accepted 10 October 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: R.A. Vinogradov, M.A. Chernyavsky, V.A. Porkhanov, E.Yu. Kachesov, G.G. Khubulava<br />Data collection and analysis: V.V. Matusevich, K.P. Chernykh, A.B. Zakeryaev. Drafting the article: A.N. Kazantsev<br />Statistical analysis: G.Sh. Bagdavadze, R.Yu. Leader. Critical revision of the article: <br />Final approval of the version to be published: A.N. Kazantsev, R.A. Vinogradov, M.A. Chernyavsky, V.V. Matusevich, <br />K.P. Chernykh, A.B. Zakeryaev, G.Sh. Bagdavadze, R.Yu. Leader, E.Yu. Kachesov, V.A. Porkhanov, G.G. Khubulava</p>

[Frozen elephant trunk procedure for DeBakey type i acute aortic dissection complicated by lower limb malperfusion]

Two-stage surgical treatment of a patient with type I acute aortic dissection and lower limb malperfusion is reported in the manuscript. Frozen elephant trunk procedure was applied. A 49-year-old man was hospitalized with a diagnosis of «Debakey type I acute aortic dissection» in 7 hours after manifestation of the disease. At admission, paleness and numbness of both lower limbs with a violation of active movements were observed in addition to pain syndrome. Chest CT revealed false lumen thrombosis within the distal aorta followed by stenosis of aortic bifurcation up to 80% and stenosis of the right common iliac artery up to 80%. Considering critical lower limb ischemia, axillo-bifemoral bypass surgery was performed at the first stage. A day later, the patient underwent replacement of ascending aorta, aortic arch and descending thoracic aorta. E-vita Open Plus № 24 hybrid prosthesis and frozen elephant trunk procedure under hypothermia 25^o C with bilateral antegrade cerebral perfusion were used. CPB time was 285 min, aortic cross-clamping time - 180 min, circulatory arrest - 135 min. Postoperative period was uneventful, ICU-stay - 5 days. The patient was discharged after 20 days. Control CT confirmed false lumen thrombosis throughout the stent-graft. Follow-up survey after 1 year revealed no complaints.

[Use of glomus-sparing techniques in surgery of carotid arteries]

The carotid glomus is an anatomical structure located in the bifurcation of the common carotid artery and consisting of chemo and baroreceptors. It is an important reflexogenic zone participating in provision of constancy of arterial pressure. Performing eversion carotid endarterectomy is accompanied by damage of the structures of the carotid glomus, which is followed by persistent arterial hypertension in the early postoperative period. This complication remains one of the unsolved tasks in surgery of carotid arteries. The article contains a review of the literature concerning the problem of the development of postoperative arterial hypertension in patients after carotid endarterectomy carried out with skeletization of the bifurcation of the common carotid artery and with damage to the structures of the carotid glomus. Many authors report a positive effect of surgical interventions performed with preservation of the carotid body. Further studies of the results of treatment by means of glomus-sparing techniques at a longer postoperative follow-up period are required.

[Comparing the risks for the development of perioperative complications in carotid endarterectomy and carotid angioplasty]

The article is a literature review presenting a comparative analysis of 30-day risks of mortality and complications after carotid endarterectomy and carotid angioplasty with stenting. The risks studied were as follows: myocardial infarction, stroke, transitory ischaemic attacks, bradycardia, hypotension, postoperative haematomas, and damages to the craniocerebral nerves. The authors analysed a series of recently published foreign studies and meta-analyses dedicated to the problem concerned. The obtained findings revealed that carotid endarterectomy turned out to be associated with a higher perioperative risk for the development of myocardial infarction, postoperative haematomas and damages to the craniocerebral nerves, whereas carotid angioplasty with stenting appeared to be associated with an increased risk for the development of stroke, bradycardia and hypotension within the first 30 postoperative days. As far as mortality is concerned, it proved to be relatively similar for both methods of revascularization. The use of systems of protection of the brain from embolism during stenting of carotid arteries decreases the perioperative risks, however, it seems difficult to unequivocally affirm which of the methods of cerebral protection demonstrates better results.

[30th Annual Meeting of the European Society for Vascular Surgery (Copenhagen, Denmark, september 28-30, 2016)]

The article is a brief review of the proceedings of the 30th Annual Meeting of the European Society for Vascular Surgeons, held on September 28-30, 2016 in Copenhagen, Denmark. The papers presented reported the results of managing patients with pathology of carotid arteries, aortic aneurysms, pathology of peripheral arteries, also discussing current achievements and prospects of methods of treatment of arterial and venous diseases.

[Remote results of open surgical and endovascular treatment of internal carotid artery stenoses]

The article is a review containing a comparative analysis of the remote results in patients presenting with carotid artery atherosclerosis and treated by means of either stenting or carotid endarterectomy. More than ten international randomized studies have up to now been conducted. Some of them prove the advantage of using either carotid endarterectomy or stenting of carotid arteries, others show equivalence of both methods of treatment. Carotid endarterectomy is currently a preferred operation for carotid artery stenoses, with lower incidence of the development of postoperative strokes and restenoses in the remote period. But stenting is an alternative technique in patients with high operative risk. Therefore, the question of choosing an appropriate type of the intervention should be decided upon for each patient individually. A more definite conclusion to be made on advantages of carotid endarterectomy over endovascular angioplasty, or vice versa, requires further studying therapeutic outcomes during a longer follow-up period.