Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

Anton N. Kazantsev; Казанцев Антон Николаевич; Konstantin P. Chernykh; Черных  Константин  Петрович; Roman A. Vinogradov; Виноградов Роман Александрович; Mikhail A. Chernyavskiy; Чернявский  Михаил  Александрович; Vyacheslav N. Kravchuk; Кравчук Вячеслав Николаевич; Dmitriy  V. Shmatov; Шматов Дмитрий Викторович; Andrey A. Sorokin; Сорокин Андрей Александрович; Aleksandr А. Erofeyev; Ерофеев Александр Алексеевич; Viktor A. Lutsenko; Луценко Виктор Анатольевич; Roman V. Sultanov; Султанов Роман Владимирович; Amin R. Shabayev; Шабаев Амин Рашитович; Islam M.  Radzhabov; Раджабов Ислам Магомедович; Goderzi S. Bagdavadze; Багдавадзе Годерзи Шотаевич; Nona E. Zarkua; Заркуа Нона Энриковна; Vyacheslav V. Matusevich; Матусевич Вячеслав Викторович; Evgeniy F. Vayman; Вайман Евгений Федорович; Alexey I. Solobuyev; Солобуев Алексей Игоревич; Roman  Y. Lider; Лидер Роман Юрьевич; Inomzhon  K. Shukurov; Шукуров Иномжон Хайрулло угли; Aleksandr G. Baryshev; Барышев Александр Геннадьевич; Aslan  B. Zakeryayev; Закеряев Аслан  Бубаевич; Rauf A. Veliyev; Велиев Рауф Адалат оглы; Behruz E. Radzhabov; Раджабов Бехруз Элбоевич; Artem D. Abdullayev; Абдуллаев Артем Дмитриевич; Anastasiya V. Povtoreyko; Повторейко Анастасия Викторовна; Sergey V. Artyukhov; Артюхов Сергей Викторович; Vladimir A. Porkhanov; Порханов Владимир Алексеевич; Gennadiy G. Khubulava; Хубулава Геннадий Григорьевич

doi:10.17816/PAVLOVJ61088

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
隶属关系:
1. Alexander Hospital
2. Aleksandrovsky City Hospital
3. Kuban State Medical University
4. Almazov National Medical Research Center,
5. Almazov National Medical Research Center
6. Kirov Military Medical Academy
7. Mechnikov Northwestern State Medical University
8. Saint Petersburg State University
9. City Multidisciplinary Hospital № 2
10. Belyaev Kemerovo Regional Clinical Hospital
11. acad. Barbarash Kemerovo Regional Clinical Cardiologic Dispensary
12. acad. Burdenko Main Military Clinical Hospital
13. Research Institute prof. Ochapovsky Regional Clinical Hospital № 1
14. Kemerovo State Medical University
15. Pskov Regional Infectious Hospital
16. 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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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.

关键词

carotid endarterectomy, eversion carotid endarterectomy, retrograde pressure, cerebral oximetry, open circle of Willis, unstable atherosclerotic plaque, SYNTAX, temporary shunt, hemorrhagic transformation

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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-Petersburg

Konstantin 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-Petersburg

Mikhail 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-Petersburg

Vyacheslav 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-Petersburg

Dmitriy 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-Petersburg

Andrey 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-Petersburg

Aleksandr 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-Petersburg

Viktor 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, Kemerovo

Roman 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, Kemerovo

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint-Petersburg

Vyacheslav 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, Kemerovo

MD, Cand. Sci. (Med.), Associate Professor

俄罗斯联邦, Krasnodar

MD, Cand.Sci.(Med.)

俄罗斯联邦, Saint-Petersburg

Vladimir 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, Krasnodar

Gennadiy 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

俄罗斯联邦, Saint-Petersburg; Saint-Petersburg

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Gibello L, Varetto G, Spalla F, et al. Impact of the Supra-Aortic Trunks and Circle of Willis Patency on the Neurological Compensation during Carotid Endarterectomy. Annals of Vascular Surgery. 2019;60:229–35. doi: 10.1016/j.avsg.2019.02.020
Banga PV, Varga A, Csobay-Novák C, et al. Incomplete circle of Willis is associated with a higher incidence of neurologic events during carotid eversion endarterectomy without shunting. Journal of Vascular Surgery. 2018;68(6):1764–71. doi: 10.1016/j.jvs.2018.03.429
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Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

全文:

详细

关键词

全文:

作者简介

Anton Kazantsev

Konstantin Chernykh

Roman Vinogradov

Mikhail Chernyavskiy

Vyacheslav Kravchuk

Dmitriy Shmatov

Andrey Sorokin

Aleksandr Erofeyev

Viktor Lutsenko

Roman Sultanov

Amin Shabayev

Islam Radzhabov

Goderzi Bagdavadze

Nona Zarkua

Vyacheslav Matusevich

Evgeniy Vayman

Alexey Solobuyev

Roman Lider

Inomzhon Shukurov

Aleksandr Baryshev

Aslan Zakeryayev

Rauf Veliyev

Behruz Radzhabov

Artem Abdullayev

Anastasiya Povtoreyko

Sergey Artyukhov

Vladimir Porkhanov

Gennadiy Khubulava

参考

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