Email this article Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke
- Authors: Kazantsev A.N.1, Chernykh K.P.1, Zarkua N.E.1,2, Lider R.Y.3, Burkova E.A.3, Bagdavadze G.S.1, Kalinin E.Y.1,2, Zaitseva T.E.1, Chikin A.E.1, Linets Y.P.1, Kubachev K.G.2
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Affiliations:
- Alexander Hospital
- Mechnikov North-West State Medical University
- Kemerovo State Medical University
- Issue: Vol 28, No 3 (2020)
- Pages: 312-322
- Section: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/26265
- DOI: https://doi.org/10.23888/PAVLOVJ2020283312-322
- ID: 26265
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Abstract
Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE).
Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months.
Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)).
Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.
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##article.viewOnOriginalSite##About the authors
Anton N. Kazantsev
Alexander Hospital
Author for correspondence.
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-1115-609X
SPIN-code: 8396-1845
Cardiovascular Surgeon of the Surgery Department №3
Russian Federation, Saint-PetersburgKonstantin P. Chernykh
Alexander Hospital
Email: cvs.doc@yandex.ru
ORCID iD: 0000-0002-5089-5549
SPIN-code: 3968-2649
Cardiovascular Surgeon of the Surgery Department №3
Russian Federation, Saint-PetersburgNona E. Zarkua
Alexander Hospital; Mechnikov North-West State Medical University
Email: tatazarkua@mail.ru
ORCID iD: 0000-0002-7457-3149
SPIN-code: 4568-4125
Cardiovascular Surgeon of the Surgery Department №3
Russian Federation, Saint-PetersburgRoman Yu. Lider
Kemerovo State Medical University
Email: aaapppmmmooo@rambler.ru
ORCID iD: 0000-0002-3844-2715
SPIN-code: 3723-4648
Student
Russian Federation, KemerovoEkaterina A. Burkova
Kemerovo State Medical University
Email: bomjiha@mail.ru
ORCID iD: 0000-0002-0062-4337
SPIN-code: 3491-8151
Student
Russian Federation, KemerovoGoderzi Sh. Bagdavadze
Alexander Hospital
Email: gud_777@bk.ru
ORCID iD: 0000-0001-5970-6209
SPIN-code: 5321-6136
Cardiovascular Surgeon of the Surgery Department №3
Russian Federation, Saint-PetersburgEvgeny Yu. Kalinin
Alexander Hospital; Mechnikov North-West State Medical University
Email: aaapppmmmooo@gmail.com
ORCID iD: 0000-0003-3258-4365
SPIN-code: 9120-1351
MD, PhD, Head of the Surgery Department №3; Assistant
Russian Federation, Saint-PetersburgTatyana E. Zaitseva
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-8971-7558
SPIN-code: 5323-1513
MD, PhD, Deputy Chief Physician for Medical Work
Russian Federation, Saint-PetersburgAleksander E. Chikin
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-6539-0386
SPIN-code: 3461-6134
MD, PhD, Deputy Chief Doctor for Surgical Care
Russian Federation, Saint-PetersburgYuriy P. Linets
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0002-2279-3887
SPIN-code: 4522-6791
MD, PhD, Professor, Chief Physician
Russian Federation, Saint-PetersburgKubach G. Kubachev
Mechnikov North-West State Medical University
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0002-9858-5355
SPIN-code: 8681-9669
MD, PhD, Professor of the Department of Surgery named after N.D. Monastyrskiy
Russian Federation, Saint-PetersburgReferences
- Natsional’nyye rekomendatsii po vedeniyu patsiy-entov s zabolevaniyami brakhiotsefal’nykh arteriy. Moscow; 2013. (In Russ).
- Kazantsev AN, Tarasov RS, Burkov NN, et al. Carotid endarterectomy: three-year results of follow up within the framework of a single-centre register. Angiology and Vascular Surgery. 2018;24(3):101-8. (In Russ).
- Volkers EJ, Ale Algra A, Kappelle J, et al. Prediction Models for Clinical Outcome After a Carotid Revascularization Procedure. Stroke. 2018;49(8): 1880-5. doi: 10.1161/STROKEAHA.117.020486
- Tarasov RS, Kazantsev AN, Moldavskaya IV, et al. In-hospital outcomes of carotid endarterectomy in acute period of ischemic stroke: single-center register data. Russian Journal of Cardiology and Cardio-vascular Surgery. 2018;11(5):60-5. (In Russ). doi: 10.17116/kardio20181105160
- Kazantsev AN, Burkov NN, Tarasov RS, et al. Carotid endarterectomy in acute ischemic stroke. Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 2018;22(1):66-72. (In Russ). doi: 10.21688/1681-3472-2018-1-66-72
- Kazantsev AN, Burkov NN, Shabayev AR, et al. Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery. Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 2019;23(3):104-10. (In Russ). doi: 10.21688/1681-3472-2019-3-104-110
- Meschia JF, Hopkins LN, Altafullah I, et al. Time From Symptoms to Carotid Endarterectomy or Stenting and Perioperative Risk. Stroke. 2015;46(12): 3540-2. doi: 10.1161/STROKEAHA.115.011123
- Kazantsev AN, Tarasov RS, Burkov NN, et al. Predictors of long-term complications after carotid endarterectomy. Khirurgiya. Zhurnal im. N.I. Piro-gova. 2019;(6):20-5. (In Russ). doi: 10.17116/hirur-gia201906120
- Kazantsev AN, Burkov NN, Borisov VG, et al. Computer-assisted simulation of haemodynamic para-meters of carotid artery bifurcation after carotid en-darterectomy. Angiology and Vascular Surgery. 2019; 25(3):107-12. (In Russ). doi: 10.33529/ANGIO2019311
- Rantner B, Kollerits B, Roubin GS, et al. Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery: Results From 4 Randomized Controlled Trials. Stroke. 2017; 48(6):1580-7. doi: 10.1161/STROKEAHA.116.016233
- Gavrilenko AV, Kuklin AV, Khripkov AS. Early carotid endarterectomy in patients after endured acute cerebral circulation impairment. Angiology and Vascular Surgery. 2019;25(2):186-92. (In Russ). doi: 10.33529/ANGIO2019203
- Cukurova LA, Timchenko LV, Golovko EN, et al. The successful urgent operations on brachiocephalic arteries at two patients in acute period of ischemic stroke. Russian Journal of Neurosurgery. 2013;(4):70-2. (In Russ).
- Kazantsev AN, Burkov NN, Zakharov YuN, et al. Personalized brain revascularization: computer modeling of the reconstruction zone for carotid endarterectomy. Khirurgiya. Zhurnal imeni N.I. Pirogova. 2020;(6):71-5. (In Russ). doi:10.17116/ hirurgia202006171
- Zakirzhanov NR, Komarov RN, Evseeva VV, et al. Long-term results of carotid endarterectomy performed in the acute period of ischemic stroke. Russian Journal of Cardiology and Cardio-vascular Surgery. 2019;12(4):286-90. (In Russ). doi:10.17116/ kardio201912041286
- Mikhailov MS, Ridel VYu, Zelenkina NYu, et al. Surgical treatment of patients during the acute period of ischemic stroke. Vestnik Meditsinskogo Instituta «REAVIZ»: Reabilitatsiya, Vrach i Zdo-rov’ye. 2017;(3):62-8. (In Russ).
- Lukianchikov VA, Udodov EV, Dalibaldyan VA, et al. Surgical treatment of the patients with brachiocephalic arteries pathology in acute stroke. Russian Neurosurgical Journal named after professor A.L. Polenov. 2017;9(2):22-9. (In Russ).
- Kazantsev AN, Tarasov RS, Burkov NN, et al. Hybrid revascularization of the brain and myocardium: risk stratification for in-hospital complications. Angiology and Vascular Surgery. 2020;(2):118-23. (In Russ). doi: 10.33529/ANGIO2020212
- Polyakova AV, Tokareva DV, Zabirov SSh, et al. The role of early rehabilitation after carotid endarte-rectomy in acute period of ischemic stroke. Russian Journal of the Physical Therapy, Balneotherapy and Rehabilitation. 2018;17(2):98-101. (In Russ). doi: 10.18821/1681-3456-2018-17-2-98-101
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