Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

Abstract

<p><strong>Aim.</strong> Analysis of the results of hospital and medium-long-term results obtained using a new method of glomus-saving carotid endarterectomy (CEE) according to A. N. Kazantsev.</p><p><strong>Methods.</strong> This prospective study was conducted during January 2018 to April 2020 on 214 patients who were operated for occlusive stenotic lesions of the internal carotid artery (ICA) using holomus-saving CEE as per the method described by <br />A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months.<br />Glomus-saving CEE as per the method by A. N. Kazantsev is performed as follows. Arteriotomy is performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the mouth, depending on the distribution of atherosclerotic plaque, with a transition to the common carotid artery (also 2–3 cm below the ECA mouth). The ICA was cut off at the site formed by the wall sections of the ECA and the common carotid artery. Thereafter, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from the ECA and OCA. Then, the ICA at the saved site was implanted in the previous position. A 6-0 Prolene thread was used as the suture material for performing a vascular anastomosis.</p><p><strong>Results.</strong> The average ICA clamping time was 33.1 ± 3.4 min. Considering the intraoperative visualisation of an extended atherosclerotic plaque in the ICA, in some cases, there was a need to transform the operation. In 4.7% (n = 10) cases, autologous ICA transplantation was performed as per E. V. Rosseykinu. During the hospitalisation, the observation of cardiovascular complications was not recorded. When analysing the dynamics graph of systolic blood pressure, it was revealed that after glomus-saving CEE as per the method by A. N. Kazantsev, stable numbers are maintained during preoperative antihypertensive therapy and do not rise above 137.9 ± 7.5 mm Hg. In the mid-long-term follow-up, 1 (0.46 %) death was recorded, 1 (0.46%) due to myocardial infarction, 1 (0.46%) due to non-lethal ischaemic stroke, and 2 (0.9%) due to hemodynamically significant restenosis 12 mon after CEE. The combined endpoint (death + myocardial infarction + stroke) was reached in 3 (1.4%) patients. The cause of the lethal outcome was circular myocardial infarction that developed, given the patient's refusal to follow double disaggregant therapy (2 stents were previously implanted in the anterior descending and right coronary arteries). The cause of ischaemic stroke was the development of ICA restenosis (12 mon after CEE) owing to neointimal hyperplasia, as shown by histological examination after repeated surgery.</p><p><strong>Conclusion.</strong> CEE as per the method by A. N. Kazantsev is the simplest method of operation for known glomus-preserving reconstructions. The absence of complex arteriotomy, the preservation of carotid bifurcation structures, and the possibility of transformation of the intervention into autologous autologous transplantation with prolonged lesion is preferred over other methods. An additional opportunity for high-quality endarterectomy from ЕCA also creates preventive conditions in the prevention of cerebral haemodynamics. Stable blood pressure indicators in the hospital and mid-term follow-up periods demonstrate the importance of the preservation of the carotid glomus during reconstructive surgery on the carotid arteries. Thus, the presented type of CEE meets all the requirements of modern carotid surgery and can be an elective operation in the personalised treatment of patients with occlusal-stenotic lesions of the carotid arteries.</p><p>Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 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 />Method development and testing: A.N. Kazantsev<br />Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev<br />Drafting the article: A.N. Kazantsev<br />Drawing up tables: E.Yu. Kalinin<br />Statistical analysis: K.P. Chernykh<br />Literature review: R.Yu. Leader, G.Sh. Bagdavadze<br />Critical revision of the article: N.E. Zarkua, K.G. Kubachev<br />Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, <br />G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets</p>

Dynamics of resistant hypertension in the postoperative period of carotid endarterectomy with and without carotid body saving

“…Однако нужно отметить, что все методы КЭЭ, предложенные в нашей работе, имеют место. Но в условиях наличия РАГ нужно учитывать, что виды реконструкции, сопровождающиеся травмой или удалением КГ, будут усугублять последнее посредством дисфункции барорецепторного рефлекса [6,10,12,14,15]. Это, в свою очередь, спровоцирует повышение САД до критических показателей, развитие гиперперфузионного синдрома, который сопряжен с риском формирования геморрагической трансформации [26].…”

“…Однако изучение различных техник операций показало, что каротидный гломус (КГ), локализующийся в бифуркации сонных артерий, играет важную роль в гомеостазе артериального давления (АД) в организме [6][7][8][9][10]. Удаление последнего во время выполнения эверсионной методики операции, по данным крупного пласта работ, вызывает лабильное течение артериальной гипертензии (АГ) с формированием гипертонического криза и последующих неблагоприятных кардиоваскулярных событий [11][12][13][14][15]. Результатом этого изучения стала докторская диссертация Р. А. Виноградова на тему "Повышение эффектив-ности хирургического лечения атеросклеротических стенозов внутренней сонной артерии", 2019г.…”

Evolution of carotid endarterectomy: A literature review

“…Однако важным условием в достижении успеха данной КЭЭ является полное удаление атеросклеротической бляшки с плотной фиксацией дистального участка интимы. В противном случае вмешательство может закончиться тромбозом ВСА, что долгое время оставалось краеугольным камнем представленной методики и в ряде случаев приводило к протезированию внутренних сонных артерий [21; 22] [18]. При условии наличия протяженной атеросклеротической бляшки такую операцию можно легко трансформировать в аутотрансплантацию ВСА по Е.В.…”

“…При условии наличия протяженной атеросклеротической бляшки такую операцию можно легко трансформировать в аутотрансплантацию ВСА по Е.В. Россейкину, что поможет избежать необходимость в протезировании [18].…”

Carotid Enadrterectomy for Thrombosis of the Internal Carotid Artery in Patients With COVID-19

“…But it must be borne in mind that the listed methods of treatment do not “turn off” one of the main components of the development of this process - the inflamed endothelium. If it is possible to cope with hypercoagulability due to medical support, then within the framework of thrombosis of the internal carotid artery, the most optimal method of revascularization is the removal of the thrombus and the adjacent atherosclerotic plaque along with the endothelium through carotid endarterectomy [ 9 , 10 ]. Thus, within the framework of this pathology, we should talk about the effectiveness of carotid endarterectomy in the most acute period of ischemic stroke in patients with COVID-19.…”