Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?

Belov, Yuri V; Казанцев, А. Н.; Kravchuk, V. N.; Виноградов, Р. А.; Коротких, А. В.; Shmatov, Dmitriy V; Chernykh, K. P.; Zakeryaev, A.B.; Sukhoruchkin, P. V.; Матусевич, В. В.; Lider, R. Yu.; Kazantseva, Elizaveta G.; Zakharova, Christina L.; Bagdavadze, G. Sh.; Zharova, A. S.; Artyukhov, S. V.; Луценко, В. А.; Sultanov, R. V.

doi:10.1016/j.cpcardiol.2022.101272

Cited by 19 publications

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References 44 publications

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“…Во-вторых, имея тропность к эндотелиоцитам, SARS-CoV-2 провоцирует воспаление в этих клетках с развитием эндотелиита [20][21][22][23][24]. В-третьих, с дальнейшим нарастанием коагулопатии, провоцируемой вирусными агентами, данный субстрат становится зоной пристеночного, а затем окклюзионного тромбоза, что вызывает острую ишемию [25][26][27][28][29]. В той ситуации, когда речь идет о пациентах с мультифокальным атеросклерозом, наличие атеросклеротической бляшки (АСБ) может ускорить процесс потери просвета сосуда.…”

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“…В той ситуации, когда речь идет о пациентах с мультифокальным атеросклерозом, наличие атеросклеротической бляшки (АСБ) может ускорить процесс потери просвета сосуда. SARS-CoV-2 дестабилизирует ее "покрышку", что может приводить не только к разрыву АСБ с дистальной эмболией, но и к диссекции артерии [25][26][27][28][29]. Необходимо отметить, что в рамках нашего исследования ретромбоз у пациентов развивался в первые часы после операции.…”

Section: Discussionunclassified

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Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

et al. 2022

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Aim. To analyze the results of thrombectomy in lower-extremity ischemia in patients with coronavirus disease 2019 (COVID-19) and respiratory failure of different severity.Material and methods. This retrospective, cohort, comparative study for the period from May 1, 2020 to March 1, 2022 included 305 patients with acute lower-extremity ischemia and COVID-19. Depending on the type of oxygen support, three groups of patients were formed: group 1 (n=168) — nasal oxygen insufflation; group 2 (n=92) — non-invasive ventilation (NIV); group 3 (n=45) — artificial ventilation (AV). Thrombectomy was carried out according to the standard technique using Fogarty catheters (3F-6F — depending on the vessel size). After the diagnosis was established before and after the start of surgical treatment, all patients received the following therapy: Unfractionated IV heparin infusion at an initial rate of 1000 U/r, adjusted to maintain the activated partial thromboplastin time at 2-3 times the normal value; 2. Oral acetylsalicylic acid 125 mg; 3. Analgesics.Results. Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5,3%, n=9; group 2: 72,8%, n=67; group 3: 100%, n=45; p<0,0001), retrombosis (group 1 : 18,4%, n=31; group 2: 69,5%, n=64; group 3: 91,1%, n=41; p<0,0001) and limb amputations (group 1: 9,5%, n=16; group 2: 56,5%, n=52; group 3: 91,1%, n=41; p<0,0001) was recorded in group 3 patients.Conclusion. In patients receiving mechanical ventilation, COVID-19 have more aggressive course, which is expressed in an increase in laboratory para- meters (C-reactive protein, ferritin, interleukin-6, D-dimer), the severity of pneumonia and location of thrombosis in the tibial arteries. Among patients with COVID-19 receiving mechanical ventilation, the greatest number of rethromboses (91,1%), limb amputations (91,1%), and deaths (100%) are noted, which suggests the expediency of abandoning open thrombectomy in favor of anticoagulant/antiplatelet therapy in this cohort of patients. The development of arterial thrombosis in patients with COVID-19 receiving mechanical ventilation is an indicator of a high risk of death. Open thrombectomy in combination with anticoagulant/antiplatelet therapy is most effective in patients on nasal oxygen insufflation or NIV.

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Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

et al. 2022

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“…Это, в свою очередь, неминуемо приводило к гиперплазии неоинтимы и рестенозу [25,26]. Выходом из положения может быть персонифицированный подбор нужного размера заплаты на основе данных цветного дуплекс-так и отдаленные исходы обоих способов реваскуляризации [12][13][14][15][16]. Как правило, в одних работах авторы демонстрировали отсутствие каких-либо различий по частоте развития осложнений на всех этапах наблюдения, в других же публикациях сообщалось о неоптимальных результатах пластики сонных артерий с применением заплаты [16][17][18][19][20].…”

Section: каротидная эндартерэктомия в россии как действовать если дей...unclassified

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

et al. 2022

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This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events.

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“…В последующем, с созданием национальных рекомендаций, разработанные постулаты были значительно расширены. Подход к направлению пациента на КЭЭ стал более точным [13]. Показания к операции значительно углубились от сугубо морфологической составляющей до личных предпочтений и общих обстоятельств здоровья пациента.…”

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“…Показания к операции значительно углубились от сугубо морфологической составляющей до личных предпочтений и общих обстоятельств здоровья пациента. Основной упор был сделан на персонифицированный подход к выбору стратегии лечения [13]. Стали известны и допустимые пределы внутригоспитальной летальности, частоты послеоперационных ишемических инсультов для каждого конкретного учреждения, которое занимается хирургической реваскуляризацией головного мозга [13].…”

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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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Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?

Cited by 19 publications

References 44 publications

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

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

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