Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis
- 作者: Kazantsev A.N.1, Chernykh K.P.2, Vinogradov R.A.3,4, Chernyavskiy M.A.5, Kravchuk V.N.6,7, Shmatov D..8, Sorokin A.A.8, Erofeyev A.А.9, Lutsenko V.A.10, Sultanov R.V.11, Shabayev A.R.11, Radzhabov I.M.12, Bagdavadze G.S.7, Zarkua N.E.7, Matusevich V.V.13, Vayman E.F.14, Solobuyev A.I.14, Lider R..14, Shukurov I.K.7, Baryshev A.G.13, Zakeryayev A.B.13, Veliyev R.A.2, Radzhabov B.E.2, Abdullayev A.D.15, Povtoreyko A.V.15, Artyukhov S.V.2, Porkhanov V.A.13, Khubulava G.G.6,16
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隶属关系:
- Alexander Hospital
- Aleksandrovsky City Hospital
- Kuban State Medical University
- Almazov National Medical Research Center,
- Almazov National Medical Research Center
- Kirov Military Medical Academy
- Mechnikov Northwestern State Medical University
- Saint Petersburg State University
- City Multidisciplinary Hospital № 2
- Belyaev Kemerovo Regional Clinical Hospital
- acad. Barbarash Kemerovo Regional Clinical Cardiologic Dispensary
- acad. Burdenko Main Military Clinical Hospital
- Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
- Kemerovo State Medical University
- Pskov Regional Infectious Hospital
- acad. Pavlov First Saint Petersburg State Medical University
- 期: 卷 29, 编号 3 (2021)
- 页面: 397-409
- 栏目: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/61088
- DOI: https://doi.org/10.17816/PAVLOVJ61088
- ID: 61088
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详细
BACKGROUND: The circle of Willis (CW) is an important network of collaterals that provide compensatory redistribution of hemodynamic load. Several studies showed that the CW is open in approximately 50%–90% of cases, and the number of missing segments correlates with low brain tolerance to ischemia in internal carotid artery (ICA) compression. Currently, studies dedicated to the relationship of different configurations of CW with the risk of ischemic brain damage.
AIM: The analyze the immediate results of eversion carotid endarterectomy (CEA) in patients with different configurations of the structure of the CW.
MATERIALS AND METHODS: We included 641 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) in a study period from 2010 to 2020. All patients underwent multispiral computed tomography with angiography of the extracranial and CW arteries. Based on the structural variants of the CW, six groups of patients were studied: group 1 (64.9%, n = 416) — closed posterior part (CPP) with the existence of posterior communicative artery (PCA) and P1 segment of the posterior cerebral artery (PCerA); group 2 (27%, n = 173) — an intermediate structure of the posterior part (IPP) with hypoplasia of the PCA or PCerA; group 3 (8.1%, n = 52) — open posterior part (OPP) with the absence of PCA or PCerA; group 4 (85.95%, n = 551) closed anterior part (CAP) with the presence of the anterior communicating artery (ACA) and A1 segment of the anterior cerebral artery (ACerA); group 5 (7.95%, n = 51) — an intermediate structure of the anterior part (IAP) with hypoplasia of ACA or ACerA; group 6 (6.1%, n = 39) — open anterior part (OAP) with the absence of ACA or ACerA. To assess the compensatory potentials of the brain, all patients underwent measurement of the retrograde pressure in the ICA and intraoperative cerebral oximetry.
RESULTS: In the postoperative period, 1 death was recorded in group 4 (CAP) due to a hemorrhagic transformation in the zone of ischemic stroke, on the background development of hyperperfusion syndrome. The largest number of ischemic strokes of the cardioembolic subtype was diagnosed in the ACerA territory in the presence of an unstable atherosclerotic plaque: group 1 (CPP) 0%; group 2 (IPP) — 0%; group 3 (OPP) — 0.24%, n = 1; group 4 (CAP) — 0.18%, n = 1; group 5 (IAP) — 1.96%, n = 1; group 6 (OAP) — 5.1%, n = 2; p > 0.9999. The probable cause was embolization against the background increase in the arterial pressure before ICA clamping. In turn, the majority of ischemic strokes of the hemodynamic subtype developed in the territory of PCerA: group 1 (CPP) — 0%; group 2 (IPP) — 1.73%, n = 3; group 3 (OPP) — 3.8%, n = 2; group 4 (CAP) — 0.18%, n = 1; group 5 (IAP) — 0%; group 6 (OAP) — 2.56%, n = 1; p > 0.9999. This pattern coincided with the largest number of patients with CW of the IPP and OPP types among all open variants of the structure.
CONCLUSION: Parameters of retrograde pressure in the ICA and intraoperative cerebral oximetry do not always demonstrate the need for a temporary shunt (TS). Due to the opened structure of CW, the redistribution of blood flow occurs with the formation of zones of hypo- and hyperperfusion, causing ischemic alterations in the brain matter. Thus, in order to maintain adequate cerebral hemodynamics, to mitigate the effect of hypo- and hyperperfusion, and reduce the risk of ischemic stroke, the open variant of the CW structure should be considered as an indication for a TS.
作者简介
Anton Kazantsev
Alexander Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-1115-609X
cardiovascular surgeon
俄罗斯联邦, Saint-PetersburgKonstantin Chernykh
Aleksandrovsky City Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-5089-5549
SPIN 代码: 3968-2349
俄罗斯联邦, Saint-Petersburg
Roman Vinogradov
Kuban State Medical University; Almazov National Medical Research Center,
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-9421-586X
SPIN 代码: 7211-3229
МD, Dr. Sci. (Med.), Associate Professor
俄罗斯联邦, Krasnodar; Saint-PetersburgMikhail Chernyavskiy
Almazov National Medical Research Center
编辑信件的主要联系方式.
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-1214-0150
SPIN 代码: 5009-7818
МD, Dr. Sci. (Med.)
俄罗斯联邦, Saint-PetersburgVyacheslav Kravchuk
Kirov Military Medical Academy; Mechnikov Northwestern State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-6337-104X
SPIN 代码: 4227-2846
МD, Dr. Sci. (Med.), Professor
俄罗斯联邦, Saint-Petersburg; Saint-PetersburgDmitriy Shmatov
Saint Petersburg State University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-1296-8161
МD, Dr. Sci. (Med.), Professor, Pirogov Clinic of High Medical Technologies
俄罗斯联邦, Saint-PetersburgAndrey Sorokin
Saint Petersburg State University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-0493-4209
Pirogov Clinic of High Medical Technologies
俄罗斯联邦, Saint-PetersburgAleksandr Erofeyev
City Multidisciplinary Hospital № 2
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-3814-9831
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint-PetersburgViktor Lutsenko
Belyaev Kemerovo Regional Clinical Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-3188-2790
MD, Cand. Sci. (Med.)
俄罗斯联邦, KemerovoRoman Sultanov
acad. Barbarash Kemerovo Regional Clinical Cardiologic Dispensary
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-2888-1797
MD, Cand. Sci. (Med.)
俄罗斯联邦, KemerovoAmin Shabayev
acad. Barbarash Kemerovo Regional Clinical Cardiologic Dispensary
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-9734-8462
SPIN 代码: 6119-0504
俄罗斯联邦, Kemerovo
Islam Radzhabov
acad. Burdenko Main Military Clinical Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-7915-1615
俄罗斯联邦, Moscow
Goderzi Bagdavadze
Mechnikov Northwestern State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-5970-6209
俄罗斯联邦, Saint-Petersburg
Nona Zarkua
Mechnikov Northwestern State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-7457-3149
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint-PetersburgVyacheslav Matusevich
Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-9461-2726
俄罗斯联邦, Krasnodar
Evgeniy Vayman
Kemerovo State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-5784-5029
MD, Cand. Sci. (Med.)
俄罗斯联邦, KemerovoAlexey Solobuyev
Kemerovo State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-2832-662X
SPIN 代码: 2859-1096
俄罗斯联邦, Kemerovo
Roman Lider
Kemerovo State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-3844-2715
SPIN 代码: 3723-4648
俄罗斯联邦, Kemerovo
Inomzhon Shukurov
Mechnikov Northwestern State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-9933-7778
俄罗斯联邦, Saint-Petersburg
Aleksandr Baryshev
Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-6735-3877
SPIN 代码: 2924-1648
MD, Cand. Sci. (Med.), Associate Professor
俄罗斯联邦, KrasnodarAslan Zakeryayev
Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-4859-1888
俄罗斯联邦, Krasnodar
Rauf Veliyev
Aleksandrovsky City Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-5089-4490
俄罗斯联邦, Saint-Petersburg
Behruz Radzhabov
Aleksandrovsky City Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-9857-5002
俄罗斯联邦, Saint-Petersburg
Artem Abdullayev
Pskov Regional Infectious Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-1594-7611
俄罗斯联邦, Pskov
Anastasiya Povtoreyko
Pskov Regional Infectious Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-9017-0190
俄罗斯联邦, Pskov
Sergey Artyukhov
Aleksandrovsky City Hospital
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0001-8249-3790
SPIN 代码: 1894-6265
MD, Cand.Sci.(Med.)
俄罗斯联邦, Saint-PetersburgVladimir Porkhanov
Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0003-0572-1395
SPIN 代码: 2446-5933
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, KrasnodarGennadiy Khubulava
Kirov Military Medical Academy; acad. Pavlov First Saint Petersburg State Medical University
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-9242-9941
SPIN 代码: 1007-8730
MD, Dr. Sci. (Med.), Professor
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