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Kazantsev A, Shmatov D, Korotkikh A, Lebedev OV, Artyukhov S, Mukhtorov O, Leader R, Wang S, Roshkovskaya L, Chernyavin M, Unguryan V, Nonye NOG. A Multicentric Study of Different Methods of Open Surgical Cerebral Revascularization for Internal Carotid Artery Orifice Stenosis. Curr Probl Cardiol 2024; 49:102082. [PMID: 37714319 DOI: 10.1016/j.cpcardiol.2023.102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
To analyze the long-term results of transposition of the internal carotid artery (ICA) into the lateral wall of the external carotid artery (ECA) in the presence of hemodynamically significant stenosis of the ICA. During the period from 3.10.2017 to 28.12.2020, 784 patients with isolated hemodynamically significant ICA orifice stenosis were included in the present retrospective multicentric open comparative study "Russian Birch." Depending on the implemented surgical technique, groups were formed: group 1 (n = 517) - eversion carotid endarterectomy (eCEA); group 2 (n = 193) classic CEA with implantation of a xenopericardium patch treated with di-epoxy compounds; group 3 (n = 74) - transposition of the ICA into the lateral wall of the ECA. Transposition of the ICA into the lateral wall of the ECA is performed as follows. The common carotid artery, ECA, and ICA are isolated and then they are clamped with vascular clamps. At the same time, the ICA and ECA are clamped 4 cm above the orifice. The ICA is cut 2.5 cm above the orifice. Then the section of the ICA with local stenosis in the orifice is sutured with a polypropylene suture. At the same time, the redundant nonfunctioning ICA stump is not resected due to the fact that there are receptors of the carotid sinus at the ICA orifice. Thus, such manipulation may damage the sinus, causing arterial hypertension that is difficult to control in the postoperative period. Then, in the lateral wall of the ECA 2.5 cm above the orifice, a 0.5 cm diameter round hole is formed using a scalpel and angled vascular scissors. Then an end-to-side anastomosis between the severed section of the ICA and the rounded opening formed in the lateral wall of the ECA is performed using a polypropylene suture. Vascular clamps are removed and blood flow is started. No complications were detected in the hospital postoperative period. No adverse cardiovascular events were registered in group 3 in the long-term follow-up period. The group of classic CEA with implantation of a xenopericardium patch treated with di-epoxy compounds showed the highest number of fatal outcomes from acute cerebrovascular accident (CVA) (Group 1: 0.2%, n = 1; group 2: 2.6%; n = 5; p = 0.008); nonfatal ischemic CVA (group 1: 0.6%, n = 3; group 2: 14.0%, n = 27; p < 0.0001); ICA restenosis (more than 60%) requiring a repeat revascularization (group 1: 0.8%, n = 4; group 2: 16.6%, n = 32; p < 0.0001). The cause of all CVAs after classical CEA was restenosis of the ICA due to neointimal hyperplasia; after eversion CEA and progression of atherosclerosis. The composite end point was statistically more frequent after classical CEE with plasty of the reconstruction area with a diepoxy-treated xenopericardium patch (group 1: 1.0%, n = 5; group 2: 17.7%, n = 33; p < 0.0001). When analyzing the survival curves free of ICA restenosis, it was determined that the overwhelming number of all ICA restenosis requiring revascularization in the group of classical CEA with implantation of a diepoxy-treated xenopericardium patch is diagnosed as early as 6 months after surgery. In the group of eversion CEA, the loss of the vessel lumen is most often visualized more than a year after the intervention. When comparing the survival curves (Logrank test), it was determined that restenosis of the ICA develops statistically more frequently (p < 0.0001) after classical CEA with implantation of a diepoxytreated xenopericardium patch. Transposition of the ICA into the lateral wall of the ECA is not accompanied by the risk of ICA restenosis due to the absence of inflammation of the internal artery wall after endarterectomy. Thus, this technique can be an alternative to CEA and be routinely used in case of local hemodynamically significant stenosis of the ICA orifice. Classical CEA with patch implantation is the least preferable operation due to the high risk of ICA restenosis in the mid-term and long-term follow-up.
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Affiliation(s)
- Anton Kazantsev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation.
| | - Dmitry Shmatov
- Clinic of High Medical Technologies Named After. N.I. Pirogov St. Petersburg State University, St. Petersburg, Russian Federation
| | - Alexander Korotkikh
- Clinic of Cardiac Surgery, Amur State Medical Academy, Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Oleg Vladimirovich Lebedev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation; Yaroslavl State Medical University, Yaroslavl, Russian Federation
| | - Sergey Artyukhov
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation; City Alexander Hospital, St. Petersburg, Russian Federation
| | - Otabek Mukhtorov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Roman Leader
- Federal State Budgetary Educational Institution of Higher Education "Kemerovo State Medical University" of the Ministry of Health of Russia, Kemerovo, Russian Federation
| | - Shouwen Wang
- First Moscow State Medical University. THEM. Sechenov, Moscow, Russian Federation
| | | | - Maxim Chernyavin
- Clinical Hospital №1 of the Presidential Administration of the Russian Federation, Moscow, Russian Federation
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Kazantsev AN, Korotkikh A, Dzhanelidze M, Kharchilava E, Zarkua N, Alekseeva E, Staroverova V, Koplik V, Leader R, Zakeryaev A, Bagdavadze G, Zakharova K, Semyin I, Kostenkov A, Chernykh K, Shmatov D, Lebedev O, Artyukhov S, Mukhtorov O, Wang S, Komarov R, Roshkovskaya L, Khetagurov M, Unguryan V, Chernyavin M, Palagin P, Sirotkin A, Belov Y. Prospective multicenter online testing of the carotid endarterectomy risk stratification calculator carotidscore.ru. Indian J Thorac Cardiovasc Surg 2023; 39:608-614. [PMID: 37885939 PMCID: PMC10597897 DOI: 10.1007/s12055-023-01538-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 10/28/2023] Open
Abstract
Aim To evaluate the incidence of complications, including fatal outcomes, ischemic strokes, and transient ischemic attacks, associated with carotid endarterectomy (CEA) in patients categorized as low-, medium-, and high-risk based on their CarotidSCORE (carotidscore.ru). Material and Methods This prospective, multicenter study was conducted from January 1, 2022, to December 20, 2022, and enrolled 5,496 patients with stenosis of the internal carotid artery (ICA), who were categorized into four groups according to their risk level. Group 1 (n=1,759) included patients at low risk; Group 2 (n=2,483) included those at medium risk; Group 3 (n=429) included those at high risk, who underwent carotid angioplasty with stenting (CAS) due to the high risk of complications associated with carotid endarterectomy (CEA); and Group 4 (n=825) did not use CarotidSCORE (carotidscore.ru). Patients in Groups 1, 2, and 4 underwent CEA. Results During the postoperative hospital stay, the highest number of complications, including fatal outcomes (p=0.0007), ischemic strokes (p<0.0001), and the combined endpoints (p<0.0001) were observed in Group 4. No complications were reported in Group 1. Conclusion The use of CarotidSCORE (carotidscore.ru) allows for the identification of high-risk patients, enabling clinicians to opt for CAS instead of CEA and reduce the incidence of complications.
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Affiliation(s)
| | - Alexander Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Merab Dzhanelidze
- Western Regional Center for Modern Medical Technologies, Kutaisi, Georgia
| | - Elguja Kharchilava
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Nonna Zarkua
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
| | - Elena Alekseeva
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Valeria Staroverova
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Victoria Koplik
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russia
| | - Roman Leader
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | - Aslan Zakeryaev
- Regional Clinical Hospital No. 1 Named After. Prof. S.V. Ochapovsky, Krasnodar, Russian Federation
| | - Goderzi Bagdavadze
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | | | - Igor Semyin
- Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation
| | - Anton Kostenkov
- Arkhangelsk Regional Clinical Hospital, Arkhangelsk, Russian Federation
| | | | - Dmitry Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | - Oleg Lebedev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
- Yaroslavl State Medical University, St. Petersburg, Yaroslavl, Russia
| | - Sergey Artyukhov
- North-Western State Medical University. Named After I.I. Mechnikov, St. Petersburg, Russian Federation
- City Alexander Hospital, St. Petersburg, Russian Federation
| | - Otabek Mukhtorov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Shuowen Wang
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
| | - Roman Komarov
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
| | | | - Mikhail Khetagurov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | | | - Maxim Chernyavin
- Clinical Hospital of the Administration of the President of the Russian Federation, Moscow, Russian Federation
| | - Petr Palagin
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Alexey Sirotkin
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Yuri Belov
- First Moscow State Medical University Named After Sechenov, Moscow, Russian Federation
- Federal State Budgetary Scientific Institution “Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky”, Moscow, Russian Federation
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