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Can the severity of coronary atherosclerosis affect the immediate and long-term results of carotid endarterectomy?

Authors: Kazantsev A.N., Chernykh K.P., Zarkua N.E., Lider R.Yu., Kubachev K.G., Bagdavadze G.Sh., Kalinin E.Yu., Zaytseva T.E., Chikin A.E., Linets Yu.P., Solobuev A.I., Bukhtoyarova V.I.

Company: 1 Alexander Hospital, Saint-Petersburg, 193312, Russian Federation
2/sup> Kemerovo State Medical University, Ministry of Health of the Russian Federation, Department of General Surgery, Kemerovo, 650056, Russian Federation
3 North-Western State Medical University named after I.I. Mechnikov, Department of Surgery named after N.D. Monastyrskiy, Saint-Petersburg, 191015, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2020-14-3-233-244

For citation: Kazantsev A.N., Chernykh K.P., Zarkua N.E., Lider R.Yu., Kubachev K.G., Bagdavadze G.Sh., Kalinin E.Yu., Zaytseva T.E., Chikin A.E., Linets Yu.P., Solobuev A.I., Bukhtoyarova V.I. Can the severity of coronary atherosclerosis affect the immediate and long-term results of carotid endarterectomy? Creative Cardiology. 2020; 14 (3): 233–44 (in Russ.). DOI: 10.24022/1997-3187-2020-14-3-233-244

Received / Accepted:  12.08.2020 / 17.08.2020

Keywords: carotid endarterectomy, classical carotid endarterectomy, patch, eversion carotid endarterectomy, SYNTAX Score, coronary atherosclerosis multifocal atherosclerosis, hospital results, long-term results

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Abstract

Objective. Analysis of hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis.

Material and methods. This comparative, retrospective, open-label study from January 2013 to April 2020 included 1719 patients operated on for occlusive stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEE were used as a revascularization strategy. The criteria for inclusion in the study were: 1. The presence of coronary angiography within six months prior to the present CEE; 2. A history of myocardial revascularization in patients with severe coronary artery disease. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1 – 871 (50.7%) patients – with hemodynamically significant coronary artery (CA) stenosis with a history of myocardial revascularization; Group 2 – 496 (28.8%) patients – with the presence of hemodynamically insignificant coronary artery lesions (up to 70% excluding and the left coronary artery trunk up to 50% excluding); Group 3 – 352 (20.5%) patients – without signs of atherosclerotic coronary artery disease. 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. In the hospital follow-up 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 cranial nerve damage, diagnosed in every fifth patient in the total sample. The combined endpoint (CCP), including death + myocardial infarction (MI) + acute cerebrovascular accident / transient ischemic attack (ACVA / TIA), was 0.75% (n=13). In the long-term follow-up, when comparing the survival curves, in group 3, the greatest number of ischemic strokes (p=0.007), myocardial infarction (p=0.03), and CCT (p=0.005) was revealed. Intergroup differences were not determined by the number of deaths (p=0.62).

Conclusion. In the long-term follow-up, a group of patients with isolated ICA lesions showed a rapid increase in the number of myocardial infarction, ischemic strokes, combined endpoint due to low compliance and progression of atherosclerosis in previously unaffected arteries.

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About Authors

  • Anton N. Kazantsev, Cardiovascular Surgeon, ORCID
  • Konstantin P. Chernykh, Cardiovascular Surgeon, ORCID
  • Nonna E. Zarkua, Cand. Med. Sc., Associate Professor, Surgeon, ORCID
  • Roman Yu. Lider, Student, ORCID
  • Kubach G. Kubachev, Dr. Med. Sc., Professor, Surgeon, ORCID
  • Goderzi Sh. Bagdavadze, Resident Physician, ORCID
  • Evgeniy Yu. Kalinin, Cand. Med. Sc., Head of Department, ORCID
  • Tat’yana E. Zaytseva, Cand. Med. Sc., Deputy Chief Physician, ORCID
  • Aleksander Е. Chikin A.E., Cand. Med. Sc., Deputy Chief Physician, ORCID
  • Yuriy Р. Linets, Dr. Med. Sc., Professor, Chief Physician, ORCID
  • Aleksey I. Solobuev, Assistant Professor, ORCID
  • Valentina I. Bukhtoyarova, Chief of Chair, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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