Register
Forgot your password?

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

For correspondence:  Sign in or register.

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

Full text:  

 

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.

References

  1. National guidelines for the management of patients with brachiocephalic artery disease. Angiology and vascular surgery. 2013; 19 (2): 4–68 (in Russ.).
  2. Kazantsev A.N., Sultanov R.V., Burkov N.N., Leader R.Yu., Yakhnis E.Ya., Bukhtoyarova V.I., Kazantsev E.G. Long-term results of surgical and conservative treatment of patients with occlusalstenotic lesions of the carotid arteries. Pirogov Russian Journal of Surgery (Khirurgiya. Zhurnal imeni N.I. Pirogova). 2020; 1: 67–73. DOI: 10.17116/hirurgia202001167 (in Russ.).
  3. Alekyan B.G., Pokrovsky A.V., Karapetyan N.G., Revishvili A.Sh. Direct results of endovascular treatment in patients with combined lesions of the coronary and internal carotid arteries. Endovascular Surgery. 2019; 6 (1): 20–6. DOI: 10.24183/2409-4080-2019-6-1-20-26 (in Russ.).
  4. Kazantsev A.N., Tarasov R.S., Burkov N.N. et al. Hospital results of percutaneous coronary intervention and carotid endarterectomy in hybrid and phasedmodes. Angiology and Vascular Surgery. 2019; 25 (1): 101–7. DOI: 10.33529/angio2019114 (in Russ.).
  5. Recommendations of the EOK / EOCH for the diagnosis and treatment of peripheral arterial diseases 2017. Russian Journal of Cardiology. 2018; 23 (8): 164–221 (in Russ.).
  6. Kuzhuget R.A., Karpenko A.A., Kamenskaya O.V., Ignatenko P.V., Starodubtsev V.B., Postnov V.G. Ways to improve the immediate and long-term results of carotid endarterectomy. Angiology and Vascular Surgery. 2016; 22 (1): 111–7 (in Russ.).
  7. Gordeev M.L., Bendov D.V., Gnevashev A.S., Kotin A.N., Grebennik V.K. Ten years of experience in combined operations on the coronary and brachiocephalic arteries. Thoracic and Cardiovascular Surgery. 2015; 57 (6): 18–25 (in Russ.).
  8. Tarasov R.S., Kazantsev A.N., Burkov N.N., Leader R.Yu., Yakhnis E.Ya. The structure of hospital and long-term complications of surgical treatment of stenotic lesions of the coronary and carotid arteries. Angiology and Vascular Surgery. 2020; 26 (1): 89–95. DOI: 10.33529/ANGIO2020113 (in Russ.)
  9. Akchurin R.S., Shiryaev A.A., Galyautdinov D.M., Vlasova E.E., Vasiliev V.P., Ismagilov B.R., Balakhonova T.V. Immediate results of simultaneous coronary bypass surgery and carotid endarterectomy. Cardiology and Cardiovascular Surgery. 2017; 10 (6): 4–8. DOI: 10.17116/kardio20171064-8 (in Russ.).
  10. Chernyavsky M.A., Gusev A.A., Chernova D.V., Yarkov I.V., Gordeev M.L. Stage treatment of multilevel lesions of the brachiocephalic arteries in combination with coronary and valvular pathology of the heart. Angiology and Vascular Surgery. 2018; 24 (2): 165–71 (in Russ.).
  11. Lysenko A.V., Akselrod B.A., Grishin A.V., Fedulova S.V., Belov Yu.V. Choice of tactics for surgical intervention in patients with bilateral lesion of the carotid arteries and multiple lesions of the coronary bed. Cardiology and Cardiovascular Surgery. 2018; 11 (6): 71–4. DOI: 10.17116/kardio20181106171 (in Russ.).
  12. Alekyan B.G., Pokrovsky A.V., Karapetyan N.G., Revishvili A.Sh. A multidisciplinary approach in determining the frequency of detection of coronary heart disease and treatment strategies in patients with pathology of the aorta and peripheral arteries. Russian Journal of Cardiology. 2019; 24 (8): 8–16. DOI: 10.15829/1560-4071-2019-8-8-16 (in Russ.).
  13. Spiridonov A.A., Pirtskhalaishvili Z.K. Comparative evaluation of the results of carotid endarterectomy depending on the methods of plasty. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2006; 7 (4): 68–73 (in Russ.).
  14. Bockeria L.A., Sigaev I.Yu., Pirtskhalaishvili Z.K., Nikonov S.F., Darvish N.A., Tereshina Yu.S. Long-term results of surgical treatment of patients with multifocal atherosclerosis after myocardial revascularization, in combination with carotid endarterectomy. forecast and quality of life. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2010; 11 (S6): 150 (in Russ.).
  15. Tarasov R.S., Kazantsev A.N., Zinets M.G., Burkov N.N., Anufriev A.I., Ganyukov V.I. Prospective testing of the program for the choice of surgical tactics for multifocal atherosclerosis. Cardiology and Cardiovascular Surgery. 2019; 12 (5): 402–9. DOI: 10.17116/kardio201912051402 (in Russ.).
  16. Frolov A.V., Barbarash O.L. Dyslipidemia is an important factor in the adverse course of multifocal atherosclerosis in male patients undergoing carotid endarterectomy. Atherosclerosis. 2013; 9 (3–4): 5–11 (in Russ.).
  17. Glushkov N.I., Ivanov M.A., Artemova A.S., Gorovaya A.D., Uryupina A.A. Gender features of the course of atherosclerotic lesions of the carotid arteries. Creative Cardiology. 2019 13 (1): 8–16 (in Russ.).
  18. Genkel V.V., Shaposhnik I.I. Indicators of endothelial shear rate in the carotid artery as a marker of systemic atherosclerosis and cardiovascular diseases caused by atherosclerosis. Cardiology. 2019; 59 (5): 45–52. DOI: 0.18087/cardio.2019.5.2581 (in Russ.).
  19. Ragino Yu.I., Stryukova E.V., Murashov I.S., Polonskaya Ya.V., Volkov A.M., Kashtanova E.V. et al. Association of endothelial dysfunction factors with the presence of unstable atherosclerotic plaques in the coronary arteries. Russian Journal of Cardiology. 2019; 24 (5): 26–9. DOI: 10.15829/1560-4071-2019-5-26-29 (in Russ.).
  20. Nazarenko M.S., Sleptcov A.A., Lebedev I.N., Markov A.V., Golubenko M.V., Koroleva I.A. et al. Genomic structural variations for cardiovascular and metabolic comorbidity. Scientific Reports. 2017; 7: 41268. DOI: 10.1038/srep41268
  21. Bockeria L.A., Sigaev I.Yu., Kazaryan A.V., Starostin M.V., Keren M.A., Morchadze B.D. et al. Immediate results of repeated coronary artery bypass grafting through alternative approaches. Thoracic and Cardiovascular Surgery. 2019; 61 (1): 27–37. DOI: 10.24022/0236-2791-2019-61-1-27-37 (in Russ.).
  22. Vechersky Yu.Yu., Manvelyan D.V., Zatolokin V.V., Shipulin V.M. Venous conduits in coronary surgery: old problems – new solutions. Siberian Medical Journal (Tomsk). 2019; 34 (1): 24–32. DOI: 10.29001/2073-8552-2019-34-1-24-32 (in Russ.).
  23. Kazantsev A.N., Bogomolova A.V., Burkov N.N., Bayandin M.S., Grishchenko E.V., Guselnikova Yu.I. et al. Morphology of restenosis after classical carotid end arterectomy using a patch from diepoxy-treated xenopericardium. Cardiology and Cardiovascular Surgery. 2020; 13 (1): 68–71. DOI: 10.17116/kardio202013011168 (in Russ.).
  24. Kazantsev A.N., Burkov N.N., Shabaev A.R., Volkov A.N., Ruban E.V., Leader R.Yu., Anufriev A.I. Surgical treatment of a patient with restenosis of stents at the mouth of the common carotid artery and proximal internal carotid artery. Circulatory Pathology and Cardiac Surgery. 2019; 23 (3): 104–10. DOI: 10.21688/1681-3472-2019-3-104-110 (in Russ.)

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


Sort by