Differential Approach to Surgical and Endovascular Treatments of Pulmonary Thromboembolism in Patients with Neurological and Neurosurgical Problems
- Authors: Fedorov S.A.1,2,3, Medvedev A.P.1,3, Tselousova L.M.4, Kudykin M.N.5, Pichugin V.V.1,3, Zhurko S.A.1, Chiginev V.A.1,3, Gamzaev A.B.1, Trofimov N.A.2,6, Gamayunov S.V.4, Deryabin R.A.4
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Affiliations:
- Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev
- I. N. Ulyanov Chuvash State University
- Privolzhsky Research Medical University
- Nizhny Novgorod Regional Clinical Oncologic Dispensary
- Clinic of Medical Expertise
- Republican Cardiology Dispensary
- Issue: Vol 30, No 2 (2022)
- Pages: 223-232
- Section: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/88671
- DOI: https://doi.org/10.17816/PAVLOVJ88671
- ID: 88671
Cite item
Abstract
INTRODUCTION: Pulmonary embolism (PE) is one of the most threatening complications in patients with neurological and neurosurgical problems. The high epidemiological threshold values and mortality in the considered group of patients attracted the interest of researchers in the methods of early diagnosis and selection of methods of reperfusion of the pulmonary arterial bed.
AIM: To analyze clinical and hemodynamic results of the surgical and endovascular treatment of PE of the high and intermediate–high risks in the group of patients with neurological and neurosurgical problems.
MATERIALS AND METHODS: This study involved 24 patients with PE of high and intermediate — high-risks. The first group involved seven patients with neurosurgical problems who underwent thromboembolectomy from the main and lobular branches of the pulmonary artery in conditions of parallel perfusion of the artificial circulation. The duration of perfusion was 26.0 ± 7.4 min. The second group consisted of 17 patients with acute hemorrhagic stroke, in whom endovascular mechanical fragmentation of thromboemboli was performed using a modified Pig-Tail type catheter introduced by puncture through the subclavian or jugular vein. The first clinical manifestations of PE appeared 4.78 ± 2.02 days after the neurosurgical intervention and 8.45 ± 2.6 days after the onset of stroke. The initial systolic pressure in the pulmonary artery was 67.24 ± 5.15 mm Hg in the first group and 70.53 ± 4.53 mm Hg in the second group. Both groups had American Society of Anesthesiologist physical status IV and V classes of surgical risk and Pulmonary Embolism Severity Index class V (130–174 points).
RESULTS: The hospital survival rates were 100% and 82.36% in the first and second groups, respectively (three lethal cases due to progressing right-ventricular failure in the first 18 h after the procedure). On discharge, signs of reverse remodeling of the right heart chambers and reduction of the mean and systolic pressure in the pulmonary artery to 21 ± 2.16 and 31 ± 4.12 mm Hg, respectively, were noted in the first group and to 46 ± 5.23 and 57 ± 3.16 mm Hg, respectively, in the second group.
CONCLUSION: Surgical treatment of PE is effective and safe with predictable results. Endovascular catheter — induced destruction of the thromboembolus substrate is an alternative to the surgical treatment of patients with a high-risk of open surgery and absolute contraindications for thrombolytic therapy.
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##article.viewOnOriginalSite##About the authors
Sergey A. Fedorov
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev; I. N. Ulyanov Chuvash State University; Privolzhsky Research Medical University
Email: sergfedorov1991@yandex.ru
ORCID iD: 0000-0002-5930-3941
SPIN-code: 3574-8749
MD, Cand. Sci. (Med.)
Russian Federation, Nizhny Novgorod; Cheboksary; Nizhny NovgorodAleksandr P. Medvedev
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev; Privolzhsky Research Medical University
Email: medvedev.map@yandex.ru
ORCID iD: 0000-0003-1757-5962
SPIN-code: 1844-6384
MD, Dr. Sci. (Med.), Professor
Russian Federation, Nizhny Novgorod; Nizhny NovgorodLada M. Tselousova
Nizhny Novgorod Regional Clinical Oncologic Dispensary
Email: ladamc@rambler.ru
ORCID iD: 0000-0002-6005-2684
SPIN-code: 6833-9852
Russian Federation, Nizhny Novgorod
Maksim N. Kudykin
Clinic of Medical Expertise
Author for correspondence.
Email: mady5@yandex.ru
ORCID iD: 0000-0002-2272-5331
SPIN-code: 2976-8060
MD, Dr. Sci. (Med.), Professor
Russian Federation, VladimirVladimir V. Pichugin
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev; Privolzhsky Research Medical University
Email: pichugin.vldmr@mail.ru
ORCID iD: 0000-0001-7724-0123
SPIN-code: 6986-2331
MD, Dr. Sci. (Med.), Professor
Russian Federation, Nizhny Novgorod; Nizhny NovgorodSergey A. Zhurko
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev
Email: zhurkoser@mail.ru
ORCID iD: 0000-0002-5222-1329
MD, Cand. Sci. (Med.)
Russian Federation, Nizhny NovgorodVladimir A. Chiginev
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev; Privolzhsky Research Medical University
Email: chiginevvladimir@yandex.ru
ORCID iD: 0000-0001-8977-1968
SPIN-code: 2459-4291
MD, Dr. Sci. (Med.)
Russian Federation, Nizhny Novgorod; Nizhny NovgorodAlishir B. Gamzaev
Specialized Cardiac Surgical Clinical Hospital named after Academician B. A. Korolev
Email: a.gamzaev@yandex.ru
ORCID iD: 0000-0001-7617-9578
SPIN-code: 4168-3520
MD, Dr. Sci. (Med.)
Russian Federation, Nizhny NovgorodNikolay A. Trofimov
I. N. Ulyanov Chuvash State University; Republican Cardiology Dispensary
Email: nikolai.trofimov@mail.ru
ORCID iD: 0000-0002-1975-5521
SPIN-code: 6800-8397
MD, Dr. Sci. (Med.)
Russian Federation, Cheboksary; CheboksarySergey V. Gamayunov
Nizhny Novgorod Regional Clinical Oncologic Dispensary
Email: sekretar@nnood.ru
ORCID iD: 0000-0002-0223-0753
SPIN-code: 9828-9522
MD, Cand. Sci. (Med.)
Russian Federation, Nizhny NovgorodRoman A. Deryabin
Nizhny Novgorod Regional Clinical Oncologic Dispensary
Email: rderyabin@nnood.ru
ORCID iD: 0000-0002-6099-644X
SPIN-code: 6630-5982
MD, Cand. Sci. (Med.)
Russian Federation, Nizhny NovgorodReferences
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