Email this article One single or stage carotid endarterectomy from two sides?
- Authors: Kazantsev A.N.1, Chernykh K.P.1, Zarkua N.E.1,2, Leader R.Y.3, Kubachev K.G.2, Bagdavadze G.S.1, Kalinin E.Y.1,2, Zaitseva T.E.1, Chikin A.E.1, Linets Y.P.1
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Affiliations:
- Alexander Hospital
- I.I.Mechnikov Northwest State Medical University
- Kemerovo State Medical University
- Issue: Vol 26, No 3 (2020)
- Pages: 145-151
- Section: Clinical medicine
- URL: https://medjrf.com/0869-2106/article/view/48511
- DOI: https://doi.org/10.17816/0869-2106-2020-26-3-145-151
- ID: 48511
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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. PetersburgRoman 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. PetersburgGoderzi 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. PetersburgTatiana E. Zaitseva
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-8971-7558
MD, PhD
Russian Federation, St. PetersburgAleksandr E. Chikin
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0001-6539-0386
MD, PhD
Russian Federation, St. PetersburgYuriy P. Linets
Alexander Hospital
Email: b17@zdrav.spb.ru
ORCID iD: 0000-0002-2279-3887
MD, PhD, DSc, Professor
Russian Federation, St. PetersburgReferences
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