Implantation of a long biological patch in classical carotid endarterectomy for extended atherosclerotic lesions. Long-term outcomes

Objective: to analyze the in-hospital and long-term outcomes of classical carotid endarterectomy (CEE) in extended atherosclerotic lesions in comparison with the outcomes of this operation in local atherosclerotic plaque (AP). Materials and Methods. This study, which lasted from January 2010 to December 2020, included 148 patients with extended AP and hemodynamically significant internal carotid artery (ICA) stenosis. The term “extended” was understood as a hemodynamically significant lesion ≥ 5 cm long. These patients made up Group 1. Group 2 was formed over the same period of time from 632 patients with hemodynamically significant stenosis <5 cm long. In both cohorts, CEE with repair of the reconstruction zone with a diepoxide-treated xenopericardial patch was performed. Long-term follow-up was 71.4 ± 45.6 months. Results. The groups were comparable in terms of frequency of in-hospital complications: death (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% Cl 0.14-13.6), myocardial infarction (MI) (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% CI 0.14-13.6), ischemic stroke (group 1: 0%; group 2: 0.5%, n = 3; p = 0.91; OR = 0.6; 95% CI 0.03-11.8), combined endpoint (death + MI + stroke) (group 1: 1.35%, n = 2; group 2: 1.4%, n = 9; p = 0.74; OR = 0.94; 95% CI 0.2-4.43). The groups were also comparable in terms of frequency of long-term complications: death (group 1: 2.0%, n = 3; group 2: 2.05%, n = 13; p = 0.76; OR = 0.98; 95% CI 0.27-3.5), MI (group 1: 2.7%, n = 4; group 2: 2.4%, n = 15; p = 0.95; OR = 1.14; 95% CI 0.37-3.49), ischemic stroke (group 1: 5.4%, n = 8; group 2: 5.2%, n = 33; p = 0.9; OR = 1.03; 95% CI 0.46-2.29), ICA occlusion and restenosis (group 1: 12.8%, n = 19; group 2: 13.3%, n = 84; p = 0.99; OR = 0.96; 95% CI 0.56-1.63), combined endpoint (death + MI + stroke) (group 1: 10.1%, n = 15; group 2: 9.6%, n = 61; p = 0.98; OR = 1.05; 95% CI 0.58-1.91). Analysis of survival graphs revealed no significant intergroup differences for all types of complications (lethal outcome: p = 0.56; MI: p = 0.73; stroke/mini-stroke: p = 0.89; ICA restenosis/occlusion: p = 0.82; combined end point: p = 0.71). Their increase was uniform in both groups. However, more than half of all ICA restenoses and occlusions were visualized in the first 6 months after CEE. Conclusion. Implantation of a long patch (≥ 5 cm) is not characterized by increased incidence of restenosis and all adverse cardiovascular events during in-hospital and long-term follow-up.

1. National guidelines for the management of patients with brachiocephalic artery disease. Angiology and vascular surgery. 2013; (19) 2: 4-68.

2. Pokrovsky AV, Beloyartsev DF. The value of carotid endarterectomy in the prevention of ischemic brain damage. Journal of Neurology and Psychiatry. S.S. Korsakov. 2015; 115 (9-2): 4-14. [In Russ, English abstract]. doi: 10.17116/jnevro2015115924-14.

3. Kazantsev AN, Chernykh KP, Leader RYu, Zarkua NE, Kubachev KG, Bagdavadze GSh et al. Glomus-sparing carotid endarterectomy according to A.N. Kazantsev. Hospital and mid-term results. Circulatory pathology and cardiac surgery. 2020; 24 (3): 70-79. [In Russ, English abstract]. doi: 10.21688/1681-3472-20203-70-79.

4. Vinogradov RA, Zakeryaev AB. Features of surgery of the internal carotid arteries with a combination of critical stenosis and pathological tortuosity. Bulletin of the A.N. Bakuleva RAMS. Cardiovascular diseases. 2018; 19 (3): 305-312. [In Russ, English abstract]. doi: 10.24022/1810-0694-2018-19-3-305-312.

5. Kazantsev AN, Tarasov RS, Burkov NN, Shabaev AR, Leader RYu, Mironov AV. Carotid endarterectomy: three-year follow-up in a single-center registry. Angiology and vascular surgery. 2018; 24 (3): 101-108. [In Russ, English abstract].

6. Pokrovsky AV, Zotikov AE, Adyrkhaev ZA, Timina IE, Kozhanova AV, Krasnoshchekova LS et al. The formation of a «new bifurcation» in patients with prolonged atherosclerotic lesion of the ICA. Atherothrombosis. 2018; 2: 141-146. [In Russ, English abstract]. doi: 10.21518/2307-11092018-2-141-146.

7. Rosseykin EV, Voevodin AB, Bazylev VV. Autotransplantation of the internal carotid artery: a new look at the technique of eversion carotid endarterectomy. Bulletin NTSSSH them. A.N. Bakuleva RAMS. Cardiovascular diseases. 2015; 16 (S6): 98. [In Russ, English abstract].

8. Kazantsev AN, Chernykh KP, Zarkua NE, Leader RYu, Kubachev KG, Bagdavadze GSh et al. A new method of glomus-sparing carotid endarterectomy according to A.N. Kazantsev: cutting off the internal carotid artery at the site from the external and common carotid artery. Russian journal of cardiology. 2020; 25 (8): 10-17. [In Russ, English abstract]. doi: 10.15829/15604071-2020-3851.

9. Pokrovsky AV, Beloyartsev DF, Fedorov EE. Longterm results of internal carotid artery replacement in atherosclerotic lesions. Angiology and Vascular Surgery. 2009; 15 (4): 87-97. [In Russ, English abstract].

10. Kazantsev AN, Chernykh KP, Zarkua NE, Leader RYu, Kubachev KG, Bagdavadze GSh et al. Carotid endarterectomy in extended lesions: the formation of a new bifurcation according to A.V. Pokrovsky or autoarterial reconstruction according to A.A. Karpenko? Research and practice in medicine. 2020; 7 (3): 33-42. doi: 10.17709/2409-2231-2020-7-3-3.

11. Kazantsev AN, Bogomolova AV, Burkov NN, Bayandin MS, Grishchenko EV, Guselnikova YuI et al. Morphology of restenosis after classical carotid endarterectomy with diepoxy-treated xenopericardium patch. Cardiology and Cardiovascular Surgery. 2020; 13 (1): 68-71. [In Russ, English abstract]. doi: 10.17116/kardio20201301168.

12. Gavrilenko AV, Kuklin AV, Fomina VV. Classical and eversional carotid endarterectomy in patients with stenosis of the internal carotid artery. Surgery. Journal them. N.I. Pirogov. 2018; 2: 87-92. [In Russ, English abstract]. doi: 10.17116/hirurgia2018287-92.

13. Kazantsev AN, Chernykh KP, Leader RYu, Bagdavadze GSh, Andreychuk KA, Kalinin EYu et al. Comparative results of classical and eversional carotid endarterectomy. Cardiology and Cardiovascular Surgery. 2020; 13 (6): 550-555. [In Russ, English abstract]. doi: 10.17116/kardio202013061550.

14. Chen GZ, Wu YZ, Diao PY, Ma L, Yan S, Chen XY et al. Comparison of Eversion Carotid Endarterectomy and Patch Carotid Endarterectomy: A Retrospective Study of 6 Years of Experience. Med Sci Monit. 2018; 24: 58205825. doi: 10.12659/MSM.907762.

15. Paraskevas KI, Robertson V, Saratzis AN, Naylor AR. Editor's Choice - An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational Studies. Eur J Vasc Endovasc Surg. 2018; 55 (4): 465-473. doi: 10.1016/j.ejvs.2017.12.025.

16. Han Y, Zhang J, Wu X, Jiang H, Gang Q, Shen S et al. A comparative study on medium-long term results of conventional and eversion endarterectomy in management of carotid artery stenosis: a meta-analysis. Zhonghua Yi Xue Za Zhi. 2014; 94 (7): 510-516.

17. Kazantsev AN, Burkov NN, Borisov VG, Zakharov YuN, Sergeeva TYu, Shabaev AR et al. Computer modeling of hemodynamic parameters in the bifurcation of the carotid arteries after carotid endarterectomy. Angiology and Vascular Surgery. 2019; 25 (3): 107-112. [In Russ, English abstract]. doi: 10.33529/ANGIO2019311.

18. Kazantsev AN, Burkov NN, Zakharov YuN, Borisov VG, Lider RYu, Bayandin MS, Anufriev AI. Personalized brain revascularization: a method of computer modeling of the reconstruction area for carotid endarterectomy. Surgery. 2020; (6): 71-75. [In Russ, English abstract]. doi: 10.17116/hirurgia202006171.

19. Kazantsev AN, Chernykh KP, Zarkua NE, Lider RYu, Kubachev KG, Bagdavadze GSh et al. «Chik-chirik» carotid endarterectomy. Bulletin of the A.N. Bakuleva RAMS. 2020; 21 (4): 414-428. [In Russ, English abstract]. doi: 10.24022/1810-0694-2020-21-4-414-428.

20. Tarasov RS, Kazantsev AN, Anufriev AI, Burkov NN, Shabaev AR, Bukhtoyarova VI, Grachev KI. Surgical factors of restenosis of the internal carotid artery after carotid endarterectomy. Cardiology and Cardiovascular Surgery. 2018; 11 (4): 47-53. [In Russ, English abstract]. doi: 10.17116/kardio201811447.

21. Nazarenko MS, Sleptcov AA, Lebedev IN, Markov AV, Golubenko MV, Koroleva IA et al. Genomic structural variations for cardiovascular and metabolic comorbidity. Scientific Reports. 2017; 7: 41268. doi: 10.1038/srep41268.

22. Nazarenko MS, Markov AV, Koroleva YuA, Sleptsov AA, Kazantsev AN, Barbarash OL, Puzyrev VP. Identification of differentially methylated genes potentially associated with atherosclerosis in humans. Russian journal of cardiology. 2017; 22 (10): 42-48. [In Russ, English abstract]. doi: 10.15829/15604071-2017-10-42-48.

23. Pokrovsky AV, Beloyartsev DF, Kolosov RV. What influences the «quality» standards for performing carotid endarterectomy? Angiology and Vascular Surgery. 2003; 9 (3): 80-89. [In Russ, English abstract].

24. Vinogradov RA, Pykhteev VS, Lashevich KA. Long-term results of open surgical and endovascular treatment of stenosis of the internal carotid arteries. Angiology and Vascular Surgery. 2017; 23 (4): 164-170. [In Russ, English abstract].

25. Kazantsev AN, Tarasov RS, Burkov NN, Volkov AN, Grachev KI, Yakhnis EYa et al. Hospital results of percutaneous coronary intervention and carotid endarterectomy in hybrid and phased modes. Angiology and vascular surgery. 2019 25 (1): 101-107. [In Russ, English abstract]. doi: 10.33529/angio2019114.

26. Lysenko AV, Axelrod BA, Grishin AV, Fedulova SV, Belov YuV. Choice of tactics for surgical intervention in patients with bilateral lesion of the carotid arteries and multiple lesions of the coronary bed. Cardiology and cardiovascular surgery. 2018; 11 (6): 71-74. [In Russ, English abstract]. doi: 10.17116/kardio20181106171.

27. Balaji A, Rajagopal N, Yamada Y, Teranishi T, Kawa-se T, Kato Y. Carotid Endarterectomy: The Need for In vivo Optical Spectroscopy in the Decision-Making on Intraoperative Shunt Usage - A Technical Note. Asian J Neurosurg. 2019; 14 (1): 206-210. doi: 10.4103/ajns.AJNS_223_18.

28. Makovec M, Kerin K, SkitekM, Jerin A, Klokocovnik T. Association of biomarker S100B and cerebral oximetry with neurological changes during carotid endarterectomy performed in awake patients. Vasa. 2020; 49 (4): 285-293. doi: 10.1024/0301-1526/a000861.

29. Ignatiev IM, Bredikhin RA, Falina TG, Vinogradova VV, Khismatullina LI. Monitoring of cerebral hemodynamics during operations on the brachiocephalic arteries. Angiology and Vascular Surgery. 2010; 16 (3): 107-112. [In Russ, English abstract].

30. Gavrilenko AV, Kuklin AV, Skrylev SI, Agafonov IN. Indications for the use of an intraluminal temporary shunt in operations on the carotid arteries. Angiology and Vascular Surgery. 2007; 13 (4): 105-112. [In Russ, English abstract].

31. Mikhailov IV, Gusinsky AV, Shlomin VV, Orlova OV, Rakhmatillaev TB, Mohan P. Efficiency of classical carotid endarterectomy using a temporary shunt. Bulletin of surgery I.I. Grekov. 2015; 174 (6): 13-16. [In Russ, English abstract].

32. Zholkovsky AV, Ermolenko VV, Abuazab BS, Zhukova NP, Kolbov EC, Dudanov IP. Intraluminal shunting for carotid endarterectomy. Medical academic journal. 2011; 11 (3): 100-104. [In Russ, English abstract].

33. Vinogradov RA, Pykhteev VS, Martirosova KI, Lashevich KA. Prediction of perioperative complications in carotid endarterectomy. Surgery. 2018; 1: 82-85. [In Russ, English abstract]. doi: 10.17116/hirurgia2018182-85.

34. Vinogradov RA, Kosenkov AN, Vinokurov IA, Zyablova EI, Sidorenko VV. «Dumb» ischemic foci in the brain after revascularization of the brachiocephalic arteries. Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2017; 12 (2): 52-54. (In Russ.).

35. Schnaudigel S, Groschel K, Pilgram SM, Kastrup A. New foci of ischemic injury after carotid artery stenting and carotid endarterectomy. Systematic review. Journal of the National Stroke Association/Stroke/Russian edition. 2008; 4: 74-83.