Evaluation of the severity of atherosclerotic degeneration of the aortic arch wall using computed tomographic angiography to predict the risk of stroke in patients with carotid stenosis in the early postoperative period

Authors: Pak N.T., Kobelev E., Usov V.Yu., Bobrikova E.E., Chernyavskiy A.M., Bergen T.A.

Company: 1 Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
2 Tomsk National Research Medical Center, Tomsk, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2022-16-1-77-91

For citation: Pak N.T., Kobelev E., Usov V.Yu., Bobrikova E.E., Chernyavskiy A.M., Bergen T.A. Evaluation of the severity of atherosclerotic degeneration of the aortic arch wall using computed tomographic angiography to predict the risk of stroke in patients with carotid stenosis in the early postoperative period. Creative Cardiology. 2022; 16 (1): 77–91 (in Russ.). DOI: 10.24022/1997-3187-2022-16-1-77-91

Received / Accepted:  12.12.2021 / 25.03.2022

Keywords: atherosclerosis computed tomography predictors carotid stenosis embolism

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Abstract

Background. The lack of standards when choosing the method of surgical treatment of carotid artery stenosis and objective methods for evaluating predictors of embolic complications determine the need to search for diagnostic algorithms to optimize treatment.

Objective. Search for predictors of acute embolic complications in patients with severe carotid stenosis by using computed tomography angiography (CTA).

Material and methods. Computed tomography angiography of the carotid arteries and the aortic arch of 171 patients performed, of which 72 (42%) patients underwent carotid angioplasty with stenting and 99 (58%) patients – carotid endarterectomy. The CT-signs of atherosclerotic degeneration of the aortic wall were evaluated: the thickness of the aortic wall, the internal contour of the aorta (smooth or uneven), the presence or absence of ulceration of the aortic wall, the presence of an intraluminal thrombus, the extent of the detected changes to the circumference diameter (more or less than half). All patients from the endovascular intervention group underwent magnetic resonance imaging of the brain before the operation and on the first day after the operation.

Results. The most common and significant CT signs were identified, in which the probability of perioperative acute embolic complications increases: wall thickness of 4 mm or more (sensitivity 31,3%, specificity 92,5%), irregular internal contour (sensitivity 84,4%, specificity 45%), the presence of ulceration (sensitivity 53,1%, specificity 80%). The extent of the detected changes to the circumference of more than half (sensitivity 21,9%, specificity 97,5%) and intraluminal thrombus (sensitivity 9,4%, specificity 97,5%) are significant additional signs.

Conclusion. Computed tomography angiography are proposed to be used as objective prognostic criteria for embolic complications of surgical management, which affects the choice of the management, especially in the management of patients with atherosclerotic lesions of the internal carotid arteries with an asymptomatic course and a borderline value of the degree of stenosis.

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About Authors

  • Natal’ya T. Pak, Cand. Med. Sci., Researcher; ORCID
  • Evgeniy Kobelev, Junior Researcher; ORCID
  • Vladimir Yu. Usov, Dr. Med. Sci., Professor, Chief Researcher; ORCID
  • Evgeniya E. Bobrikova, Junior Researcher; ORCID
  • Aleksandr M. Chernyavskiy, Dr. Med. Sci., Professor; ORCID
  • Tat’yana A. Bergen, Cand. Med. Sci., Head of Department; 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