One single or stage carotid endarterectomy from two sides?

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Abstract

The work aimed to analyze hospital complications of bilateral single-step carotid endarterectomy (CEE): phased CEE with intervals of 7 days and 1 month.

Material and methods. This cohort, comparative, retrospective, open-label study, from January 2008 to April 2020, included 949 patients with bilateral hemodynamically significant stenosis of the internal carotid arteries (ICAs). The inclusion criteria were as follows: (1) asymptomatic ICA stenosis ≥70%, (2) symptomatic ICA stenosis ≥60%, (3) a comparable degree of bilateral ICA stenosis, (4) lack of contralateral ICA occlusion, (5) the implementation of the conventional CEE, (6) visit of patients for both revascularization stages with a phased strategy, and (7) absence of pathology that limits follow-up in the long-term postoperative period. Depending on the time interval between two revascularizations, all patients were divided into three groups: group 1 with single-staged bilateral CEE (n = 178), group 2 with bilateral CEE (n = 312), and group 3 with bilateral CEE with a 1-month interval (n = 459).

Primary control points were taken as the development of adverse cardiovascular events, such as fatal outcome, myocardial infarction, acute cerebrovascular disorder/transient ischemic attack, and thrombosis/restenosis in the reconstruction area, combined endpoint.

Results. In the hospital follow-up period, all cardiovascular events were recorded in Groups 2 and 3. Moreover, the vast majority of them were identified in the intervals between the stages of revascularization.

Conclusion. Simultaneous bilateral CEE has demonstrated its efficacy and safety in the form of absence of adverse cardiovascular events in the postoperative period with respect to phased revascularization methods. An additional advantage of this method is the achievement of complete revascularization of the brain in patients with bilateral ICA stenosis and low compliance, which is protective in case of the patient’s failure to visit the next stage of surgical correction and development of ischemic complications in the nonoperated field.

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About the authors

Anton N. Kazantsev

Alexander Hospital

Author for correspondence.
Email: dr.antonio.kazantsev@mail.ru
ORCID iD: 0000-0002-1115-609X
Russian Federation, St. Petersburg

Konstantin P. Chernykh

Alexander Hospital

Email: cvs.doc@yandex.ru
ORCID iD: 0000-0002-5089-5549
Russian Federation, St. Petersburg

Nonna E. Zarkua

Alexander Hospital; I.I.Mechnikov Northwest State Medical University

Email: tatazarkua@mail.ru
ORCID iD: 0000-0002-7457-3149

MD, PhD

Russian Federation, St. Petersburg

Roman Y. Leader

Kemerovo State Medical University

Email: aaapppmmmooo@gmail.com
ORCID iD: 0000-0002-3844-2715
Russian Federation, Kemerovo

Kubach G. Kubachev

I.I.Mechnikov Northwest State Medical University

Email: tatazarkua@mail.ru
ORCID iD: 0000-0002-9858-5355

MD, PhD, DSc, Professor

Russian Federation, St. Petersburg

Goderzi S. Bagdavadze

Alexander Hospital

Email: gud_777@bk.ru
ORCID iD: 0000-0001-5970-6209
Russian Federation, St. Petersburg

Evgeniy Y. Kalinin

Alexander Hospital; I.I.Mechnikov Northwest State Medical University

Email: aaapppmmmooo@rambler.ru
ORCID iD: 0000-0003-3258-4365

MD, PhD

Russian Federation, St. Petersburg

Tatiana E. Zaitseva

Alexander Hospital

Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-8971-7558

MD, PhD

Russian Federation, St. Petersburg

Aleksandr E. Chikin

Alexander Hospital

Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-6539-0386

MD, PhD

Russian Federation, St. Petersburg

Yuriy P. Linets

Alexander Hospital

Email: b17@zdrav.spb.ru
ORCID iD: 0000-0002-2279-3887

MD, PhD, DSc, Professor

Russian Federation, St. Petersburg

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