[Long-term results conventional and eversion carotid endarterectomy]. / Otdalennye rezul'taty klassicheskoi i eversionnoi karotidnoi endarterektomii.

OBJECTIVE: To analyze immediate and long-term results of conventional and eversion carotid endarterectomy (CEA) within a multicenter registry. MATERIAL AND METHODS: This retrospective, multi-center, comparative study included 375 patients who underwent CEA between February 1, 2018 and February 1, 2022. Depending on the type of operation, the sample was stratified into the eversion CEA (group 1, n=218) and conventional CEA with plasty of the reconstruction area with a diepoxy-treated xenopericardium patch (group 2, n=157). The long-term follow-up period was 26.5±18.3 months. Information about the condition of patients and the development of complications was obtained by telephone questioning and calling patients to the clinic for a follow-up examination. RESULTS: No myocardial infarction was diagnosed in the hospital postoperative period. There were no statistically significant differences in the frequency of acute cerebrovascular accident. The only cause of death after conventional CEA was hemorrhagic stroke. According to the section study, the cause of death was edema with dislocation of the brain stem. The remaining strokes in both groups (1 case each) were of the ischemic type. The probable cause was a distal embolism following the use of a temporary shunt. During conservative treatment, the neurological deficit completely regressed on days 21 and 26, respectively. In the late postoperative period, significant differences were obtained in the incidence of stroke (group 1: n=2; 0.91%; group 2: n=6; 3.8%; p=0.05; OR - 0.23; 95% CI=0.04-1.17) and restenosis of the internal carotid artery (ICA) more than 60% (group 1: n=0; group 2: n=11; 7.0%; p<0.0001; OR - 0.03, 95% CI=0.001-0.49). CONCLUSION: The eversion CEA technique demonstrated a lower risk of developing hemodynamically significant restenosis of the internal carotid artery in the long-term follow-up period. To obtain convincing evidence of the effectiveness of eversion or conventional CEA, additional randomized multicenter trials with the inclusion of results in clinical guidelines are required.

Carotid Enadrterectomy for Thrombosis of the Internal Carotid Artery in Patients With COVID-19.

Analysis of the results of emergency carotid endarterectomy (CEE) against the background of internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVA) in patients with COVID-19. During the COVID-19 pandemic (April 1, 2020-May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019-March 1, 2020). According to laboratory parameters, patients with COVID-19 had severe coagulopathy (with an increase in D-dimer: 3832 ± 627.2 ng/mL, fibrinogen: 12.6 ± 3.1 g/L, prothrombin: 155.7 ± 10, 2%), inflammatory syndrome (increased ferritin: 646.2 ± 56.1 ng/mL, C-reactive protein: 161.3 ± 17.2 mg/L, interleukin-6: 183.3 ± 51.7 pg/mL, leukocytosis: 27.3 ± 1.7 10E9/L). In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n = 1; group 2: 1.1%, n = 1; P= 0.81; OR=2.09; 95 % CI = 0.12-34.3) myocardial infarction (group 1: 2.3%, n = 1; group 2: 0%; P= 0.7; OR = 6.3; 95% CI = 0.25-158.5), CVA (group 1: 2.3%, n = 1; group 2: 2.2%, n = 2; P= 0.55; OR = 1.03; 95% CI = 0,.09-11.7). ICA thrombosis and hemorrhagic transformations were not recorded. However, due to severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n = 5; group 2: 1.1%, n = 1; P= 0.02; OR = 11.5; 95% CI = 1.3-102.5). In all cases, the flow of hemorrhagic discharge came from the drainage localized in the subcutaneous fat. This made it possible to remove skin sutures in a dressing room, suturing the source of bleeding and applying secondary sutures under local anesthesia. Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.

[Results of carotid endarterectomy in the acutest period of ischemic stroke]. / Rezul'taty karotidnoi endarterektomii v ostreishem periode ishemicheskogo insul'ta.

OBJECTIVE: Analysis of the results of carotid endarterectomy (CEE) in the acute period of ischemic stroke (IS). MATERIAL AND METHODS: This retrospective study included 128 patients (mean age 65.2±4.7 years, 84 (65.6%) men) who underwent CEE in the acute period. Inclusion criteria were: an ischemic focus in the brain with a diameter of no more than 2.5 cm according to MRI; mild neurological deficit (from 3 to 8 points on NIHSS); ≤3 points on the modified Rankin Scale (mRS); stenosis of ICA over 60%. Exclusion criteria were: severe neurological deficit; presence of decompensated comorbid dependence; contraindications to CEE. RESULTS: In the hospital postoperative period, 3.9% of patients were diagnosed with hemorrhagic transformation of the ischemic focus in the brain with progression of neurological deficit and level of consciousness to coma II. In 3.1% cases, a lethal outcome developed on 4-7 days after the operation. In 2.3% patients after CEE, the progression of neurological deficit was noted with the development of new ischemic foci according to postoperative neuroimaging. The probable cause of this event was a distal embolism that developed during the installation of a temporary shunt. Myocardial infarction was diagnosed in 3.9% of patients. The combined end point (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) was 10.1%. CONCLUSION: CEE in the most acute period of ischemic stroke is accompanied by a high risk of hemorrhagic transformation, myocardial infarction, and death, which characterizes this revascularization option as unsafe.

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

GOAL: Presentation of the first Russian computer program (www.carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CEE). MATERIAL AND METHODS: The present study is based on the analysis of a multicenter Russian database that includes 25,812 patients after CEE operated on from 01/01/2010 to 04/01/2022. The following types of CEE were implemented: 6814 classical CEE with plastic reconstruction of the reconstruction zone with a patch; 18,998 eversion CEE. RESULTS: In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14%-myocardial infarction, 0.35%-stroke. The combined endpoint was 0.68%. For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. Based on this formula, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. On the basis of the obtained calculations, a computer program CarotidSCORE was created. Its graphical interface is based on the QT framework (https://www.qt.io), which has established itself as one of the best solutions for desktop applications. It is possible not only to calculate the probability of developing a complication, but also to save all data about the patient in JSON format (for the patient's personal card and his anamnesis). The CarotidSCORE program contains 47 patient parameters, including clinical-demographic, anamnestic and angiographic characteristics. It allows you to choose one of the four types of CEE, which will provide an accurate stratification of the risk of complications for each of them in person. CONCLUSION: CarotidSCORE (www.carotidscore.ru) is able to determine the likelihood of postoperative complications in patients undergoing CEE.

[Subclavian-carotid transposition and subclavian artery stenting for steal-syndrome]. / Podklyuchichno-sonnaya transpozitsiya i stentirovanie podklyuchichnoi arterii v lechenii stil-sindroma.

OBJECTIVE: To analyze in-hospital results of subclavian-carotid transposition and subclavian artery stenting in patients with steal-syndrome. MATERIAL AND METHODS: A retrospective open study included 137 patients with occlusion or severe stenosis of the first segment of subclavian artery and steal-syndrome. The 1st group included 50 patients who underwent stenting or recanalization with stenting of the first segment of subclavian artery between January 2010 and March 2020. The 2nd group included 87 patients who underwent subclavian-carotid transposition between January 2010 and March 2020. RESULTS: There were no in-hospital mortality, myocardial infarction, ischemic stroke or bleeding. In the second group, damage to recurrent laryngeal nerve with irreversible laryngeal paresis occurred in 6.9% of patients, and one patient had brachial plexus neuropathy. One patient developed lymphorrhea with chylothorax accompanied by shortness of breath on exertion. Conservative management with repeated pleural punctures was not accompanied by clinical compensation. The patient was discharged for outpatient treatment. Thromboembolism of the left branch of the aorto-femoral prosthesis and deep femoral artery on the left was diagnosed in the endovascular correction group after implantation of Protege GPS stent (10´60 mm) and post-dilation with a PowerFlex PRO balloon catheter (9´4 mm). Acute ischemia of the left lower limb required thrombectomy with patch repair of deep femoral artery. The patient was discharged after 5 days. In another case, vertebral artery dissection occurred after implantation of Protege GPS stent (10×40 mm) and post-dilatation with a PowerFlex PRO balloon catheter (8´20 mm). In this regard, the patient underwent stenting of the fourth segment of vertebral artery (Endeavor Resolute 4.0´24 mm stent) with post-dilation (Boston Scientific Samurai balloon catheter 0.014´190 cm). The patient was discharged after 3 days. CONCLUSION: Subclavian-carotid transposition and subclavian artery stenting are safe methods of revascularization that are not accompanied by myocardial infarction, ischemic stroke or mortality. However, subclavian-carotid transposition is characterized by higher risk of neurological disorders (laryngeal paresis, phrenic nerve paresis, brachial plexus neuropathy) and wound complications (lymphorrhea, chylothorax). In turn, subclavian artery stenting is associated with the risk of dissection and embolism. Therefore, the choice of treatment strategy in patients with occlusive-stenotic lesions of the first segment of subclavian artery should be personalized and carried out by a multidisciplinary team.

[Long-term results of carotid endarterectomy and carotid artery stenting in patients with high bifurcation of common carotid artery: a multiple-center study]. / Otdalennye rezul'taty karotidnoi endarterektomii i karotidnoi angioplastiki so stentirovaniem u patsientov s vysokim raspolozheniem bifurkatsii obshchei sonnoi arterii. Rezul'taty mnogotsentrovogo issledovaniya.

OBJECTIVE: To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE), carotid endarterectomy with patch repair and carotid artery stenting (CAS) in patients with high bifurcation of common carotid artery. MATERIAL AND METHODS: A retrospective multiple-center open study included 1983 patients who underwent internal carotid artery (ICA) repair for severe stenosis between 2010 and 2021. Three groups of patients were distinguished depending on revascularization option: group 1 (n=638) - eversion CEE; group 2 (n=351) - CEE with patch repair; group 3 (n=994) - CAS. RESULTS: In-hospital postoperative mortality and incidence of stroke and myocardial infarction were similar. All bleedings (n=39) occurred after CEE. ICA thrombosis was diagnosed in groups 1 and 2 due to intimal detachment after insertion of temporary bypass tube. Incidence of laryngeal paresis, neuropathy of hypoglossal and glossopharyngeal nerves, Horner syndrome, damage to salivary glands was comparable in groups 1 and 2. Long-term mortality was the highest (n=10; 2.8%) after CEE with patch repair due to fatal stroke. In turn, the highest incidence of ICA restenosis and restenosis-induced ischemic stroke was observed after CEE with patch repair and CAS. CONCLUSION: 1. Classical and eversion CEE in patients with high CCA bifurcation is followed by high in-hospital incidence of damage to cranial nerves and salivary glands, laryngeal paresis, Horner syndrome, bleeding and risk of ICA thrombosis. 2. In patients with high CCA bifurcation, CAS and CEE with patch repair are accompanied by high incidence of ICA restenosis, restenosis-induced stroke and mortality in long-term postoperative period. 3. Eversion CEE demonstrates the lowest rates of all adverse cardiovascular events in long-term follow-up period.