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

Abstract

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.

Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment

“…Kazantsev. In all major studies on the treatment of patients with hemodynamically significant stenoses of the vertebral arteries, such topographic features have not been described [ [7] , [8] , [9] , [10] , 13 ]. Thus, this observation can become an additional educational element in the training of vascular surgeons.…”

“…There is no consensus on the need for urgent surgical interventions on brachiocephalic arteries [1] , [2] , [3] , [4] , [5] . In the presence of hemodynamically significant stenosis of the internal carotid artery (ICA), some studies come to conclusions about the safety and efficacy of both carotid endarterectomy and carotid angioplasty with stenting in the acute period (days 1-3) stroke [6] , [7] , [8] , [9] , [10] . Other authors, referring to the high risk of developing hemorrhagic transformation, in some cases call for postponing emergency brain revascularization until the acute (days 4-28) or early recovery (days 29-6 months) stroke periods [11] , [12] , [13] , [14] , [15] .…”

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

“…Российский кардиологический журнал 2022; 27 (11) обусловлено тремя патологическими процессами. Во-первых, больные, страдающие COVID-19, в связи с ДН длительно находятся в положении пронпозиции, что может приводить к стазу крови в дистальных отделах конечности (первый компонент триады Вирхова) [20][21][22][23][24]. Во-вторых, имея тропность к эндотелиоцитам, SARS-CoV-2 провоцирует воспаление в этих клетках с развитием эндотелиита [20][21][22][23][24].…”

“…Во-первых, больные, страдающие COVID-19, в связи с ДН длительно находятся в положении пронпозиции, что может приводить к стазу крови в дистальных отделах конечности (первый компонент триады Вирхова) [20][21][22][23][24]. 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].…”

CAROTIDSCORE.RU—The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy

“…6 And the choice of treatment strategy should be based on the risk stratification of postoperative complications. [6][7][8] Currently, there are two popular interactive calculators for determining the probability of developing adverse cardiovascular events after interventions on the cardiovascular system-Euro SCORE II and STS Score. [9][10][11][12][13] However, due to their versatility, they do not meet the requirements of personalized medicine.…”