Endovascular repair of a descending thoracic aortic aneurysm: one-year follow-up results

Казанцев, А. Н.; Kokov, А. N.; Burkov, N. N.; Хаес, Б. Л.; Тарасов, Р. С.

doi:10.33529/angiq2020313

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…For >50 years, both eversion (ECEA) and conventional carotid endarterectomy (CCEA) have been the 'gold standard' of cerebral revascularization, a surgical intervention aimed on treatment of internal carotid artery (ICA) stenosis [1][2][3][4][5] . ECEA is performed by cutting off the ICA from the bifurcation with the further endarterectomy after artery eversion [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial

et al. 2022

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Aim To compare the long-term results of eversion (ECEA) and conventional carotid endarterectomy (CCEA). Methods We designed a retrospective, multicenter study which included 25,106 patients who underwent ECEA ( n = 18,362) or CCEA ( n = 6744). The duration of follow-up was 124.7 ± 53.8 months. Results In the postoperative period, none of the interventions showed clear benefits reducing the frequency of complications: fatal outcome (ECEA: 0.19%, n = 36; CCEA: 0.17%, n = 12; OR = 1.1, 95% CI = 0.57–2.11, p = 0.89), myocardial infarction (ECEA: 0.15%, n = 28; CCEA: 0.13%, n = 9; p = 0.87; OR = 1.14; 95% CI = 0.53–2.42); acute cerebrovascular accident (CVA) (Group I: 0.33%, n = 62; Group II: 0.4%, n = 27; p = 0.53; OR = 0.84; 95% CI = 0, 53–1.32); bleeding with acute haematoma appearance in the area of intervention (Group I: 0.39%, n = 73; Group II: 0.41%, n = 28; p = 0.93; OR = 0.95; 95% CI = 0, 61–1.48); internal carotid artery (ICA) thrombosis (Group I: 0.05%, n = 11; Group II: 0.07%, n = 5; OR = 0.80, 95% CI = 0.28–2.32, p = 0.90). During the long-term follow-up, ECEA was associated with lower frequency of fatal outcome (ECEA: 2.7%, n = 492; CCEA: 9.1%, n = 616; OR = 0.27; 95% CI = 0.24–0.3, p < 0.0001), cerebrovascular death (ECEA: 1.0%, n = 180; CCEA: 5.5%, n = 371; OR = 0.17, 95% CI = 0.14–0.21, p < 0.0001), non-fatal ischaemic stroke (ECEA: 0.62%, n = 114; CCEA: 7.0%, n = 472; OR = 0.08; 95% CI = 0.06–0.1, p < 0.0001); repeated revascularization because of >60% restenosis (ECEA: 1.6%, n = 296; CCEA: 12.6%, n = 851; OR = 0.11, 95% CI = 0.09–0.12, p < 0.0001), and combined endpoint (ECEA: 2.2%, n = 397; CCEA: 13.2%, n = 888; OR = 0.14; 95% CI = 0.12–1.16, p < 0.0001). Conclusion ECEA is beneficial over CCEA in a long term.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial

et al. 2022

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“…Carotid endarterectomy (CEE) takes the position of one of the most common vascular operations in modern angiosurgery. [1][2][3][4][5] The typical contingent of patients undergoing this intervention most often suffers from coronary heart disease, diabetes mellitus, multifocal atherosclerosis (MFA), chronic renal insufficiency and other comorbid conditions. [6][7][8][9][10] At the same time, the importance of hemodynamically significant stenosis correction may exceed the necessity for full compensation of concomitant pathology (poorly controlled diabetes, uncompensated arterial hypertension), if it comes to, for example, subocclusion or unstable atherosclerotic plaque in the internal carotid artery (ICA).…”

Section: Introductionmentioning

confidence: 99%

“…The operation itself can be accompanied by both the preservation of the CG (with the implementation of glomus-saving CEE, classical CEE with plasty of the reconstruction zone with patch) and its removal (eversion CEE, the formation of a new bifurcation and autoarterial reconstruction). 3,18,20,24,25 In terms of the frequency of adverse cardiovascular events at different stages of observation, these surgical techniques are well studied and each of them has certain indications for implementation. However, the fact of the presence of RAH has never been considered as a condition for a particular type of reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension

et al. 2022

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Objective Analysis of the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (СЕЕ) (classical with plasty of the reconstruction zone with a patch, eversion, formation of a new bifurcation, autoarterial reconstruction, glomus-saving techniques) in patients with resistant arterial hypertension (RAH). Materials and methods The actual cohort, comparative, retrospective, open research for the period from January 2013 to December 2021 includes 1577 patients with significant hemodynamic stenosis of the internal carotid artery Depending on revascularization strategy five groups were formed: Group 1: 18.3% ( n = 289) – classical Carotid endarterectomy with plasty of the reconstruction zone with a patch (from diepoxy-treated xenopericardium or synthetic); Group 2: 29.9% ( n = 472) – eversional CEE with cut-off of carotid gloomus (CG); Group 3: 6.9% ( n = 109) – the formation of a new bifurcation; Group 4: 7.4% ( n = 117) - autoarterial reconstruction; Group 5: 37.4% ( n = 590) – glomus-saving CEE (1 technique – according to A. N. Kazantsev; two technicians – according to R.A. Vinogradov; three technicians – according to K.A.Antsupov). According to the 24-h blood pressure monitor in the preoperative period, the following degrees of AH were identified: 1° – 5.7% ( n = 89); 2° – 64.2% ( n = 1013); and 3° – 30.1% ( n = 475). Results In the postoperative period, no significant differences were obtained in the frequency of deaths, myocardial infarction, stroke, hemorrhagic transformation. 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 (group 1: 1.03% ( n = 3); group 2: 3.6% ( n = 17); group 3: 3.67% ( n = 4); group 4: 2.56% ( n = 3); group 5: 0.5% ( n = 3); p = 0.10). 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, accompanied by the lowest incidence of adverse cardiovascular events caused by postoperative hypertensive crisis and hyperperfusion syndrome.

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“…Также КЭАЭ может быть рекомендована бессимптомным пациентам со стенозами от 70% до 99%, если операционный риск составляет <3%. Таким образом, оперативное лечение не рекомендовано бессимптомным пациентам с пограничными стенозами ВСА [6][7][8][9][10][11][12][13].…”

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Stress test with physical activity: features of hemodynamics and kinetics of carotid arteries in atherosclerotic stenosis

2023

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Aim. To analyze the effect of exercise on cerebral hemodynamics in borderline stenosis of internal carotid artery (ICA) (40-69%) in asymptomatic patients.Material and methods. The study included 120 patients: group I (n=40) — without signs of carotid bifurcation atherosclerosis; II (40) — with hemodynamically insignificant stenosis of ICA (40-69%): IIA — with ICA stenosis of 40-59% (18); IIB — 60-69% (22); III (40) — with hemodynamically significant stenosis of ICA (≥70%, without occlusion). All patients underwent following investigations: blood coagulation and lipid profile tests; doppler ultrasound of extracranial vessels, sphygmography of the common carotid artery (CCA), brain computed tomography, transcranial doppler ultrasound, cycle ergometer stress echocardiography with determination of ICA stenosis hemodynamics.Results. In most (29 (72,5%)) patients of group II, stress test revealed a decrease in ICA flow, CCA kinetics according to sphygmography compared with group I, as well as a direct correlation between the degree of stenosis and a blood flow decrease. The indicators approached the data of group III patients.Conclusion. With stenosis of the ICA (40-69%), when a submaximal heart rate (HR) is reached, a functional hemodynamically significant stenosis of the ICA develops. An additional indication for carotid endarterectomy is a combination of 40-69% stenosis and functional hemodynamically significant stenosis when submaximal heart rate is reached. Patients with ICA stenosis (40-69%) require a stress test to assess functional hemodynamically significant stenosis when submaximal heart rate is reached.

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Endovascular repair of a descending thoracic aortic aneurysm: one-year follow-up results

Cited by 5 publications

References 12 publications

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial

Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension

Stress test with physical activity: features of hemodynamics and kinetics of carotid arteries in atherosclerotic stenosis

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