Unresolved issues of carotid endarterectomy

Казанцев, А. Н.; Виноградов, Р. А.; Zharova, A. S.; Kravchuk, V. N.

doi:10.17116/kardio202215031248

Cited by 2 publications

(3 citation statements)

References 61 publications

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“…There are several facts that attract attention in analysis of SBP graph. (1) In the preoperative period, during 4 days of observation in the clinic, all patients recorded stable maximum indicators without a significant downward trend against the background of ongoing therapy, including more than 4 antihypertensive drugs; (2) In the postoperative period, patients with the implementation of classical CEE with plasty of the reconstruction zone with a patch and glomus-saving CEE had a persistent decrease of SBP level with stabilization and reaching of the target level on the sixth day; (3) After eversion CEE with the CG removal, new bifurcation formation and autoarterial reconstruction there was an SBP increase critical values throughout the postoperative observation during the first 3 days. Subsequently, labile HP was diagnosed without reaching stable target values; (4) In the same groups, the average SBP level exceeded the indicators of the preoperative period at the time of discharge; (5) On the second--third day in all the groups, regardless of the removal or preservation of CG, SBP rise was observed due to local inflammation and tissue edema (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…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%

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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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Section: Resultsmentioning

confidence: 99%

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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“…Restenosis (stenosis greater than 50%) of the internal carotid artery (ICA) remains the main lesion of the carotid arteries. This condition can occur with a frequency of up to 36% in the yearlong postoperative observation period [15,16].…”

Section: Introductionmentioning

confidence: 99%

Eversion Carotid Endarterectomy in a Patient With Complete Blockage of the Carotid Arteries (Clinical Case)

Mykhaylichenko,

Tsaturyan,

Parshin

et al. 2024

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We present a clinical case that reflects the effectiveness of eversion carotid endarterectomy in a patient with complete blockage of the carotid arteries. A 62 y.o. patient was admitted to the clinic with complaints of dizziness and syncopal events such as “blackouts” when turning his head to the side. Angiography revealed that the right external carotid artery is stenotic up to 85%, the internal one is up to 90%, and the circle of Willis is closed. Endarterectomy was performed from the common carotid, internal carotid and external carotid arteries, with their complete cutting off and subsequent plastic suturing, i.e. formation of a trifurcation anastomosis. As shown in control angiography, the patency of the carotid segment was completely restored, and there was no neurological deficit.

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Unresolved issues of carotid endarterectomy

Cited by 2 publications

References 61 publications

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

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

Eversion Carotid Endarterectomy in a Patient With Complete Blockage of the Carotid Arteries (Clinical Case)

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