Unresolved issues of carotid endarterectomy

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This review is devoted to all the controversial issues of carotid endarterectomy (CEE). Data on efficiency of classical CEE with patch repair and eversion CEE are presented. The authors analyzed the efficacy and safety of carotid artery stenting compared to in-hospital and long-term results of CEE. Original techniques of CEE for extended atherosclerotic lesions are described. Effectiveness of these techniques compared to internal carotid artery replacement and classical CEE with patch repair is emphasized. Choosing a strategy for surgical treatment of patients with simultaneous atherosclerotic lesions of carotid and coronary arteries is also considered. The authors emphasize an individualized approach to determining the optimal type of treatment based on stratification of risk of complications. A unique computer program allowing analysis of the risk of adverse cardiovascular events for each patient depending on staged, simultaneous or hybrid revascularization strategy is presented. The authors concluded the prospects and necessity of widespread introduction of this technology.

Keywords:

carotid endarterectomy

eversion carotid endarterectomy

classic carotid endarterectomy

emergency carotid endarterectomy

patch

carotid artery stenting

carotid angioplasty with stenting

acute period of ischemic stroke

temporary carotid artery bypass

elderly patients

simultaneous lesion

coronary artery bypass grafting

percutaneous coronary intervention

hybrid revascularization

combined revascularization

risk stratification for complications

Authors:

Kazantsev A.N.

St. Petersburg City Alexandrovskaya Hospital

SPIN RSCI: 8396-1845
Scopus AuthorID: 57196122083
ORCID: 0000-0002-1115-609X

Vinogradov R.A.

Research Institute — Ochapovsky Regional Clinical Hospital No.1;
Kuban State Medical University

ORCID: 0000-0001-9421-586X

Zharova A.S.

Mechnikov North-Western State Medical University

Kravchuk V.N.

Mechnikov North-Western State Medical University;
Kirov Military Medical Academy

Received:

31.10.2020

Accepted:

25.12.2020

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