Goal – analysis of hospital and long-term results of ipsilateral classical carotid endarterectomy (CEE) and contralateral eversion CEE in patients with bilateral stenosis.
Material and methods. From 2011 to 2019 the study included 75 patients. On the ipsilateral side, each patient underwent classical CEE, and on the contralateral side, eversion CEE was performed. Classical CEE was performed using a patch made of diepoxy-treated xenopericardium. When implementing both intervention techniques, a 6/0 prolene thread was used; brain protection was carried out by invasive measurement of retrograde pressure in the internal carotid artery (ICA), intraoperative hypertension. The endpoints were death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), hemorrhagic complications, damage to cranial nerves, restenosis, thrombosis, combined endpoint (death + MI + stroke / TIA + restenosis). Restenosis was understood as narrowing the ICA lumen by more than 50%.
Results. In the hospital period, the observation of cases of death and MI was not recorded. During eversion CEE in 1 (1.3%) patient, ICA thrombosis was detected, which caused stroke acute cerebrovascular accident (ACVA) with a pronounced irreversible neurological deficit due to the detachment of intima immediately after the reconstruction zone after the start of blood flow. There were no cases of restenosis. In the long-term follow-up, no deaths were recorded. In total, 6 MI were identified. In the ICA basin, operated on an eversion method, 5 differentiated nuclear magnetic complexes were differentiated (6.7% versus 9.3%; n = 7; p = 0.76), 3 TIAs (4% versus 8%; n = 6; p = 0.49), 7 restenoses (9.3% versus 17.3%; n = 13; p = 0.22), 21 combined endpoints (28% versus 41.3%; n = 31; p = 0.12).
Conclusion. Due to the lack of significant differences in the formation of all cardiovascular complications and restenosis, both surgical procedures are safe and effective. Nevertheless, there is a negative trend in the increase in the number of ICA restenoses and a combined endpoint in patients after classical CEE with plastic repair of the reconstruction zone with a patch.
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About the authors
- Anton N. Kazantsev, Cardiovascular Surgeon, ORCID
- Roman Yu. Leader, Student, ORCID
- Konstantin P. Chernykh, Cardiovascular Surgeon, ORCID
- Nonna E. Zarkua, Cand. Med. Sc., Associate Professor, General Surgeon, ORCID
- Kubach G. Kubachev, Dr. Med. Sc., Professor, General Surgeon, ORCID
- Vladimir P. Volchik, General Surgeon, ORCID
- Goderzi Sh. Bagdavadze, Intern, ORCID
- Evgeniy Yu. Kalinin, Cand. Med. Sc., Head of Department, ORCID
- Tat'yana E. Zaytseva, Cand. Med. Sc., Deputy Chief Physician for Medical Work, ORCID
- Aleksandr E.Chikin, Cand. Med. Sc., Deputy Chief Physician for Surgical Care, ORCID
- Yuriy P. Linets, Dr. Med. Sc., Professor, Chief Physician, ORCID