Prevention of ischemic brain damage in surgery for cerebrovascular disease

Zavaruev, A.V.

doi:10.17116/kardio202114051376

Cited by 3 publications

(4 citation statements)

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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] .…”

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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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confidence: 99%

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

et al. 2022

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“…проф. С. В. Очаповского Минздрава Краснодарского края, Краснодар, Россия; 4 Клиника кардиохирургии ФГБОУ ВО Амурской ГМА Минздрава России, Благовещенск, Россия; 5 Клиника высоких медицинских технологий им. Н. И. Пирогова СПБГУ, Санкт-Петербург, Россия; 6 ГБУЗ Городская многопрофильная больница № 2, Санкт-Петербург, Россия; 7 ГБУЗ Кемеровской области Кемеровский областной клинический кардиологический диспансер, Кемерово, Россия; 8 Западный региональный центр современных медицинских технологий, Кутаиси, Грузия; 9 ФГБОУ ВО Северо-западный государственный медицинский университет им.…”

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“…На протяжении более полувека эверсионная и классическая каротидная эндартерэктомия (КЭЭ) с имплантацией заплаты являются "золотым стандартом" реваскуляризации головного мозга при наличии гемодинамически значимого стеноза внутренней сонной артерии (ВСА) [1][2][3][4][5]. Первая осуществляется благодаря отсечению ВСА от бифуркации и эндартерэктомии из нее путем выворачивания артерии [6,7].…”

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“…При анализе кривых выживаемости и проведении Logrank test такие осложнения, как летальный исход от ОНМК по ишемическому типу (р<0,0001), все ОНМК по ишемическому типу (р<0,0001), рестеноз ВСА (р<0,0001), а также комбинированная конечная точка (р<0,0001), чаще всего выявлялись после классической КЭЭ с имплантацией заплаты (рис. [1][2][3][4].…”

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Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

et al. 2021

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Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up.

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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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Prevention of ischemic brain damage in surgery for cerebrovascular disease

Cited by 3 publications

References 8 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

Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

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

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