Conventional and eversion carotid endarterectomy for internal carotid artery stenosis

Гавриленко, А. В.; Kuklin, A V; Fomina, V V

doi:10.17116/hirurgia2018287-92

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…С одной стороны, проблему риска интраоперационного инсульта, обусловленного длительным пережатием ВСА, можно было бы исключить рутинным применением временного шунта [18][19][20][21][22]. И действующие рекомендации не ограничивают возможность использовать последний в таком режиме [13].…”

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“…И действующие рекомендации не ограничивают возможность использовать последний в таком режиме [13]. Однако по данным ряда публикаций установка временного шунта часто сопровождается развитием дистальной эмболии, не всегда с явным неврологическим дефицитом [18,[20][21][22][23]. В такой ситуации речь идет о "немых" ОНМК, получивших особенно детальное изучение в работе Виноградова Р. А. и др.…”

Section: Discussionunclassified

“…При этом последующий перифокальный отек подобных образований все-таки может индуцировать легкую неврологическую симптоматику, которая в ряде случаев остается не замеченной [24][25][26]. Поэтому установка временного шунта является небезопасной манипуляцией и должна реализовываться только сугубо селективно, при наличии сниженных показателей компенсаторных возможностей коллатерального кровообращения головного мозга [20][21][22][23][24]26].…”

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"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

et al. 2023

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Aim. Analysis of inhospital and long-term outcomes of conventional carotid endarterectomy (CEA) depending on vessel suturing speed.Material and methods. The present prospective multicenter study for the period from March 1, 2017 to October 1, 2020 included 2366 patients who underwent conventional CEA with patch angioplasty. Depending on the time required to apply 1 stitch, 4 groups of patients were formed: group 1 (n=471; 19,9%) — 1 stitch per 2 seconds; group 2 (n=865; 36,5%) — 1 stitch per 3 seconds; group 3 (n=692; 29,2%) — 1 stitch per 4 seconds; group 4 (n=338; 14,3%) — 1 stitch per 5 seconds. The term "stitch" refers to two needle punctures. The follow-up postoperative period was 18,5±11,0 months.Results. There were no deaths and myocardial infarctions (MI) in the inhospital postoperative period. In group 1, anastomotic bleeding (n=93; 19,7%; p<0,0001) and stroke (n=3; 0,63%; p=0,02) due to internal carotid artery (ICA) thrombosis were more common. In the long-term follow-up period, there were no significant differences in mortality and MI rates. However, ICA restenosis requiring repeated CEA (n=37; 7,85%; p<0,0001) and related stroke/transient ischemic attack (n=13; 2,8%; p=0,0001) were more often diagnosed in 1 group of patients. According to Kaplan-Meier curves, restenosis was most often revealed 6 months after CEA in the general sample.Conclusion. 1. Vessel suturing at a speed of 1 stitch per 2 seconds is associated with an increased risk of intraoperative ICA thrombosis, bleeding along the anastomosis, stroke, as well as restenosis and stroke in the long-term follow-up period. 2. Vessel suturing at a speed of 1 stitch per 5 seconds is not accompanied by an increase in inhospital stroke rate, despite the maximum ICA occlusion time relative to other groups of patients. 3. Vessel suturing at a speed of 1 stitch per 3 or 4 seconds characterized by the lowest incidence of all complications at the inhospital and long-term stages of postoperative follow-up.

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"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

et al. 2023

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Implantation of a long biological patch in classical carotid endarterectomy for extended atherosclerotic lesions. Long-term outcomes

Казанцев

Чернявский

Виноградов

et al. 2021

RJTAO

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Objective: to analyze the in-hospital and long-term outcomes of classical carotid endarterectomy (CEE) in extended atherosclerotic lesions in comparison with the outcomes of this operation in local atherosclerotic plaque (AP). Materials and Methods. This study, which lasted from January 2010 to December 2020, included 148 patients with extended AP and hemodynamically significant internal carotid artery (ICA) stenosis. The term “extended” was understood as a hemodynamically significant lesion ≥ 5 cm long. These patients made up Group 1. Group 2 was formed over the same period of time from 632 patients with hemodynamically significant stenosis <5 cm long. In both cohorts, CEE with repair of the reconstruction zone with a diepoxide-treated xenopericardial patch was performed. Long-term follow-up was 71.4 ± 45.6 months. Results. The groups were comparable in terms of frequency of in-hospital complications: death (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% Cl 0.14-13.6), myocardial infarction (MI) (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% CI 0.14-13.6), ischemic stroke (group 1: 0%; group 2: 0.5%, n = 3; p = 0.91; OR = 0.6; 95% CI 0.03-11.8), combined endpoint (death + MI + stroke) (group 1: 1.35%, n = 2; group 2: 1.4%, n = 9; p = 0.74; OR = 0.94; 95% CI 0.2-4.43). The groups were also comparable in terms of frequency of long-term complications: death (group 1: 2.0%, n = 3; group 2: 2.05%, n = 13; p = 0.76; OR = 0.98; 95% CI 0.27-3.5), MI (group 1: 2.7%, n = 4; group 2: 2.4%, n = 15; p = 0.95; OR = 1.14; 95% CI 0.37-3.49), ischemic stroke (group 1: 5.4%, n = 8; group 2: 5.2%, n = 33; p = 0.9; OR = 1.03; 95% CI 0.46-2.29), ICA occlusion and restenosis (group 1: 12.8%, n = 19; group 2: 13.3%, n = 84; p = 0.99; OR = 0.96; 95% CI 0.56-1.63), combined endpoint (death + MI + stroke) (group 1: 10.1%, n = 15; group 2: 9.6%, n = 61; p = 0.98; OR = 1.05; 95% CI 0.58-1.91). Analysis of survival graphs revealed no significant intergroup differences for all types of complications (lethal outcome: p = 0.56; MI: p = 0.73; stroke/mini-stroke: p = 0.89; ICA restenosis/occlusion: p = 0.82; combined end point: p = 0.71). Their increase was uniform in both groups. However, more than half of all ICA restenoses and occlusions were visualized in the first 6 months after CEE. Conclusion. Implantation of a long patch (≥ 5 cm) is not characterized by increased incidence of restenosis and all adverse cardiovascular events during in-hospital and long-term follow-up.

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Tissue-engineered vascular patches: comparative characteristics and preclinical test results in a sheep model

Антонова

Миронов

Шабаев

et al. 2022

RJTAO

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Carotid endarterectomy (CEA) with patch angioplasty is the most effective treatment for carotid artery stenosis. However, the use of existing vascular patches is often associated with thrombosis, restenosis, calcification and other complications.Objective: to develop biodegradable patches for arterial reconstruction, containing vascular endothelial growth factor (VEGF) or arginyl-glycyl-aspartic acid (RGD), and comparatively evaluate their biocompatibility and efficacy in in vitro experiments and during preclinical trials in large laboratory animal models.Materials and methods. Biodegradable patches, made from a mixture of poly(3-hydroxybutyrate-co-3- hydroxyvalerate (PHBV) and poly(ε-caprolactone) (PCL), were fabricated by electrospinning and modified with VEGF or the peptide sequence RGD in different configurations. In in vitro experiments, the surface structure, physicomechanical and hemocompatibility properties were evaluated. In in vivo experiments, we evaluated the effectiveness of the developed vascular patches for 6 months after implantation into the carotid artery of 12 sheep. The quality of remodeling was assessed using histological and immunofluorescence studies of explanted specimens.Results. The PHBV/PCL/VEGF patches had physicomechanical characteristics closer to those of native vessels and their biofunctionalization method resulted in the smallest drop in strength characteristics compared with their unmodified PHBV/PCL counterparts. Modification with RGD peptides reduced the strength of the polymer patches by a factor of 2 without affecting their stress-strain behavior. Incorporation of VEGF into polymer fibers reduced platelet aggregation upon contact with the surface of the PHBV/PCL/VEGF patches and did not increase erythrocyte hemolysis. At month 6 of implantation into the carotid artery of sheep, the PHBV/PCL/ VEGF patches formed a complete newly formed vascular tissue without signs of associated inflammation and calcification. This indicates the high efficiency of the VEGF incorporated into the patch. In contrast, the patches modified with different configurations of RGD peptides combined the presence of neointimal hyperplasia and chronic granulomatous inflammation present in the patch wall and developed during bioresorption of the polymer scaffold.Conclusion. PHBV/PCL/VEGF patches have better biocompatibility and are more suitable for vascular wall reconstruction than PHBV/PCL/RGD patches.

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Conventional and eversion carotid endarterectomy for internal carotid artery stenosis

Cited by 6 publications

References 33 publications

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

"<i>Festina lente</i>" — a multicenter study on the outcomes of carotid endarterectomy, depending on vessel suturing speed

Implantation of a long biological patch in classical carotid endarterectomy for extended atherosclerotic lesions. Long-term outcomes

Tissue-engineered vascular patches: comparative characteristics and preclinical test results in a sheep model

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