Hospital and long-term results of carotid endarterectomy in patients with different severity of coronary artery lesion according to syntax score.

AIM: Analysis of in-hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis. MATERIAL AND METHODS: This comparative, retrospective, open study for the period from January 2013 to April 2020 included 1719 patients operated on for occlusive-stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEA were used as revascularization strategies. The criteria for inclusion in the study were: 1. Presence of coronary angiography within six months before the present CEE; 2. A history of myocardial revascularization in patients with severe coronary lesions. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1-871 (50.7 %) patients - with the presence of hemodynamically significant stenosis of the coronary arteries (CA) with a history of myocardial revascularization; Group 2-496 (28.8 %) patients - with the presence of hemodynamically insignificant lesions of the coronary artery (up to 70 %, not inclusive, and the trunk of the left coronary artery, up to 50 %, not inclusive); Group 3-352 (20.5 %) patients - without signs of atherosclerotic lesions of the coronary artery. In group 1, the observation period was 56.8±23.2 months, in group 2-62.0±15.6 months, in group 3-58.1±20.4 months. RESULTS: During the hospital observation period, there were no significant intergroup differences in the number of complications. All cardiovascular events were detected in isolated cases. The most common injury was damage to the cranial nerves, diagnosed in every fifth patient in the total sample. The combined endpoint (CET), including death + myocardial infarction (MI) + acute cerebrovascular accident/transient ischemic attack (stroke/TIA), was 0.75 % (n=13). In the long-term follow-up period, when comparing survival curves, group 3 revealed the largest number of ischemic strokes (p = 0.007), myocardial infarction (p = 0.03), and CCT (p = 0.005). There were no intergroup differences in the number of deaths (p=0.62). CONCLUSION: The results of the study showed that there was no significant intergroup difference in the development of complications at the hospital postoperative stage. However, in the long-term follow-up period, a group of patients with isolated lesions of the ICA demonstrated a rapid increase in the number of MI, stroke/TIA, and a combined endpoint, which was apparently associated with low compliance and progression of atherosclerosis in previously unaffected arteries.

A Multicentric Study of Different Methods of Open Surgical Cerebral Revascularization for Internal Carotid Artery Orifice Stenosis.

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.

Prospective multicenter online testing of the carotid endarterectomy risk stratification calculator carotidscore.ru.

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.

Research progress on deep learning in magnetic resonance imaging-based diagnosis and treatment of prostate cancer: a review on the current status and perspectives.

Multiparametric magnetic resonance imaging (mpMRI) has emerged as a first-line screening and diagnostic tool for prostate cancer, aiding in treatment selection and noninvasive radiotherapy guidance. However, the manual interpretation of MRI data is challenging and time-consuming, which may impact sensitivity and specificity. With recent technological advances, artificial intelligence (AI) in the form of computer-aided diagnosis (CAD) based on MRI data has been applied to prostate cancer diagnosis and treatment. Among AI techniques, deep learning involving convolutional neural networks contributes to detection, segmentation, scoring, grading, and prognostic evaluation of prostate cancer. CAD systems have automatic operation, rapid processing, and accuracy, incorporating multiple sequences of multiparametric MRI data of the prostate gland into the deep learning model. Thus, they have become a research direction of great interest, especially in smart healthcare. This review highlights the current progress of deep learning technology in MRI-based diagnosis and treatment of prostate cancer. The key elements of deep learning-based MRI image processing in CAD systems and radiotherapy of prostate cancer are briefly described, making it understandable not only for radiologists but also for general physicians without specialized imaging interpretation training. Deep learning technology enables lesion identification, detection, and segmentation, grading and scoring of prostate cancer, and prediction of postoperative recurrence and prognostic outcomes. The diagnostic accuracy of deep learning can be improved by optimizing models and algorithms, expanding medical database resources, and combining multi-omics data and comprehensive analysis of various morphological data. Deep learning has the potential to become the key diagnostic method in prostate cancer diagnosis and treatment in the future.

Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery - analysis of the multicenter Russian register.

Aim: The aim of the study was to assess the role of a temporary carotid shunt in patients undergoing carotid endarterectomy. Materials and methods: This was a retrospective, multicentric (n = 159) study carried out between January 2005 and October 2020. The study included 3114 patients undergoing carotid endarterectomy who had a reduced retrograde internal carotid artery pressure (<60% of systolic blood pressure). A temporary carotid shunt was used in 1328 patients and 1786 patients underwent carotid endarterectomy without a shunt. Results: The in-hospital outcomes were comparable in terms of the incidence of deaths, myocardial infarctions, and stroke between the two groups. However, asymptomatic strokes (confirmed on computed tomography) occurred more frequently in the group where the temporary shunt was used (34 (2.5%) vs. 10 (0.55%), p < 0.0001). The composite endpoints of adverse events were also higher in the group where a temporary shunt was used (44 (3.3%) vs. 28 (1.5%), p = 0.002). The risk of symptomatic stroke (both fatal and non-fatal) was higher in the group where a temporary shunt was not used, though this was statistically not significant. Logistic regression analysis identified diabetes mellitus and stenosis (81-90%) of the contralateral internal carotid artery to be important predictors for stroke. Conclusion: Temporary carotid shunts during carotid endarterectomy were associated with increased rates of asymptomatic stroke. There were no statistically significant differences in the incidence of non-fatal or fatal stroke, myocardial infarction, and mortality.

Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment.

We have described a variant of the structure of the vertebral artery. In the V3 segment, the vertebral artery bifurcated and then joined again. This building looks like a triangle. Such anatomy has not been previously described in the world literature. By the right of the first description, this anatomical formation was called the «vertebral triangle of Dr A.N. Kazantsev¼. This discovery was made during stenting of the V4 segment of the left vertebral artery in the most acute period of stroke.

Computer Modeling of Carotid Endarterectomy With the Different Shape Patches and Prediction of the Atherosclerotic Plaque Formation Zones.

The article describes a method for constructing geometric models of the carotid bifurcation and computer simulation of endarterectomy surgery with the patches of various configurations. The purpose of this work is to identify the areas of the greatest risk of restenosis in the constructed models and to conduct a comparative analysis of risk factors when using the patches of different widths and shapes. The method is demonstrated on a reconstructed model of a healthy vessel. Its building is based on a preoperative computed tomography study of a particular patient's affected vessel. The flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasound Doppler velocimetry. Risk factors are assessed through the hemodynamic indices on the vessel wall associated with Wall Shear Stress. The distribution of risk zones in the healthy vessel, presumably leading to its observed lesion (plaque), is analyzed. Comparative evaluation of 10 various patches implantation results is carried out and the optimal variant is determined. The proposed method can be used to predict the hemodynamic results of surgery using patches of various sizes and shapes.