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Smirnova A.V.
Federal Research Clinical Center for Intensive Care and Rehabilitation
Berikashvili L.B.
Federal Research Clinical Center of Intensive Care and Rehabilitology
Polyakov P.A.
Federal Research Clinical Center for Intensive Care and Rehabilitation
Yadgarov M.Ya.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Shemetova M.M.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Makarevich D.G.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Kuzovlev A.N.
Negovsky Research Institute of Intensive Care
Kadantseva K.K.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Likhvantsev V.V.
Federal Research Clinical Center of Intensive Care and Rehabilitology
Perioperative silent strokes in carotid artery surgery: a systematic review and meta-analysis
Journal: Russian Journal of Anesthesiology and Reanimatology. 2025;(1): 81‑91
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To cite this article:
Smirnova AV, Berikashvili LB, Polyakov PA, et al. . Perioperative silent strokes in carotid artery surgery: a systematic review and meta-analysis. Russian Journal of Anesthesiology and Reanimatology.
2025;(1):81‑91. (In Russ., In Engl.)
https://doi.org/10.17116/anaesthesiology202501181
Carotid artery (CA) atherosclerosis is responsible for up to 20% of all cases of cerebral ischemia and often requires surgical intervention. An important issue in contemporary medicine is perioperative silent brain infarctions (covert strokes) associated with postoperative neurocognitive disorders and subsequent ischemic strokes.
To determine the frequency of covert strokes following elective CA surgery and to identify risk factors for this outcome.
A meta-analysis was conducted in accordance with the PRISMA guidelines and the Cochrane Collaboration’s protocols. Literature searching was performed using PubMed (Medline) and Cochrane Library (CENTRAL) databases. Searching was supplemented by snowball sampling methods (Litmaps web application). The risk of systematic bias was assessed using the CLARITY tool. Internal validity and evidence level were evaluated using the GRADE system.
Analysis included 27 studies and 5644 patients. The incidence of covert strokes after CA surgery was 19%. Risk factors for this complication were diabetes mellitus (p<0.001) and hypertensive disease (p=0.036). Statin intake was a protective factor (p=0.012). Covert stroke detection rate was significantly higher for MRI compared to CT (22% versus 3%, p<0.001). The incidence of covert stroke after CA stenting was 38% compared to 10% after carotid endarterectomy (CEA) (p<0.001). The incidence of covert stroke was 3.75 (95% CI 2.89; 4.87) times higher after CA stenting compared to CEA (relative risk reduction [RRR] 73.3%, p<0.001).
About 20% of patients experience perioperative covert stroke (high evidence level) in elective CA surgery. The risk of covert stroke is 3.75 times higher for CA stenting compared to CEA (moderate evidence level). Moreover, 3 out of 4 covert strokes in patients with CA stenting could be avoided by changing the type of surgical intervention.
Keywords:
Authors:
Smirnova A.V.
Federal Research Clinical Center for Intensive Care and Rehabilitation
Berikashvili L.B.
Federal Research Clinical Center of Intensive Care and Rehabilitology
Polyakov P.A.
Federal Research Clinical Center for Intensive Care and Rehabilitation
Yadgarov M.Ya.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Shemetova M.M.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Makarevich D.G.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Kuzovlev A.N.
Negovsky Research Institute of Intensive Care
Kadantseva K.K.
Federal Research and Clinical Centre of Intensive Care and Rehabilitology
Likhvantsev V.V.
Federal Research Clinical Center of Intensive Care and Rehabilitology
Received:
16.09.2024
Accepted:
06.10.2024
List of references:
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