[The value of revascularisation of atherosclerotic lesions of the innominate artery at the asymptomatic stage of the disease]. / Znachenie revaskulyarizatsii pri ateroskleroticheskikh porazheniyakh brakhiotsefal'nogo stvola na asimptomnoi stadii zabolevaniya.
Zh Nevrol Psikhiatr Im S S Korsakova
; 124(8. Vyp. 2): 72-82, 2024.
Article
in Ru
| MEDLINE
| ID: mdl-39166937
ABSTRACT
OBJECTIVE:
To analyze the natural course of asymptomatic atherosclerotic lesions of the innominate artery and to study the long-term results of surgical interventions performed at the asymptomatic stage and to compare them with similar results at the symptomatic stage of the disease. MATERIAL ANDMETHODS:
The analysis of the natural course of the disease was performed in 74 asymptomatic patients who were divided into 3 groups depending on the initial degree of severity of the stenosis of the innominate artery insignificant stenoses (less than 50%), moderate stenoses (50-69%) and haemodynamically significant lesions (70% and more). The analysis of the long-term results of surgical treatment was performed in 62 patients, in 29 of whom intrathoracic reconstructions were performed at the asymptomatic stage of the disease, in 33 - at the symptomatic stage.RESULTS:
Cumulative freedom from stroke by the 10th year of follow-up was significantly higher in patients with insignificant stenoses and amounted to 100% in the groups of moderate stenoses and hemodynamically significant lesions - 25% and 0, respectively (log-rank p=0.000). Neurological fatality in patients with hemodynamically significant (initial or developed) lesions was 26.3%, while in patients with hemodynamically insignificant lesions it was 0 (log-rank p=0.004), which is confirmed by cumulative indices (log-rank p=0.008). Asymptomatic innominate artery reconstructions were associated with a lower incidence of stroke the long-term incidence of stroke in such patients was 3.4%, while in initially symptomatic patients it was 18.2% (p=0.038). Initial degree II or IV cerebrovascular insufficiency was a predictor of stroke in the long-term period (OR=1.71; p=0.000). The cumulative freedom from stroke in asymptomatic patients by the 20th year of follow-up was 95% compared with 74% in symptomatic patients (log-rank p=0.032).CONCLUSION:
Surgical interventions in asymptomatic hemodynamically significant lesions of the innominate artery should be performed to prevent primary cerebral circulatory disorders.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Brachiocephalic Trunk
/
Atherosclerosis
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
Ru
Journal:
Zh Nevrol Psikhiatr Im S S Korsakova
Year:
2024
Document type:
Article