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Glushkov N.I.

Mechnikov North-Western State Medical University

Puzdryak P.D.

Mechnikov North-Western State Medical University

Kornievich D.V.

Mechnikov North-Western State Medical University

Vasenina E.A.

Mechnikov North-Western State Medical University

Asadulaeva K.A.

Mechnikov North-Western State Medical University

Ivanov M.A.

Mechnikov North-Western State Medical University

How we choose between carotid endarterectomy and stenting

Authors:

Glushkov N.I., Puzdryak P.D., Kornievich D.V., Vasenina E.A., Asadulaeva K.A., Ivanov M.A.

More about the authors

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(4): 445‑450

DOI: 10.17116/kardio202417041445

Views: 289

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Table of contents

To cite this article:

Glushkov NI, Puzdryak PD, Kornievich DV, Vasenina EA, Asadulaeva KA, Ivanov MA. How we choose between carotid endarterectomy and stenting. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(4):445‑450. (In Russ.)
https://doi.org/10.17116/kardio202417041445

Подписка 2025 (Russian Journal of Cardiology and Cardiovascular Surgery)
 
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OBJECTIVE

To analyze the indications and results of open and endovascular carotid artery repair.

MATERIAL AND METHODS

We enrolled 80 patients after carotid angioplasty / stenting (CAS) and 60 patients after carotid endarterectomy (CEA). Postoperative outcomes were analyzed within 30 days after intervention and throughout long-term period (3 years). Adverse cardiovascular events, lethal outcomes and late restenosis were considered.

RESULTS

Early after surgery, acute myocardial infarction occurred in 1.67% of patients after CEA. There were no similar cases after CAS. Stroke occurred in 3.3% and 1.3% of cases, respectively. Mortality rate was in 5.0% vs 0%, respectively. In long-term period, restenosis occurred in 1.7% of patients after CEA, and no restenosis was observed after CAS. Stroke occurred in 3.3% and 1.3% of cases, respectively. Asymptomatic carotid stenosis, calcified and prolonged plaque, uncontrolled arterial hypertension suggested open surgery. Severe cardiac failure, chronic kidney disease, post-infarction cardiosclerosis, asymptomatic carotid stenosis are common indications for endovascular approach.

CONCLUSION

Less invasive endovascular methods are preferable for patients with high-risk of surgical intervention. Severe atherosclerotic process with calcification requires open surgery.

Keywords:

carotid stenosis
carotid angioplasty and stenting
carotid endarterectomy
indications and outcomes

Authors:

Glushkov N.I.

Mechnikov North-Western State Medical University

Puzdryak P.D.

Mechnikov North-Western State Medical University

Kornievich D.V.

Mechnikov North-Western State Medical University

Vasenina E.A.

Mechnikov North-Western State Medical University

Asadulaeva K.A.

Mechnikov North-Western State Medical University

Ivanov M.A.

Mechnikov North-Western State Medical University

Received:

24.02.2023

Accepted:

15.03.2023

List of references:

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  2. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis. New England Journal of Medicine. 1998;339(20):1415-1425. https://doi.org/10.1056/nejm199811123392002
  3. Saba L, Saam T, Jäger HR, et al. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol. 2019;18(6):559-572.  https://doi.org/10.1016/s1474-4422(19)30035-3
  4. Schnaudigel S, GröSchel K, Pilgram SM, Kastrup A. New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy. Stroke. 2008;39(6):1911-1919. https://doi.org/10.1161/strokeaha.107.500603
  5. Yei KS, Elsayed N, Mathlouthi A, et al. Long-Term Outcomes of Carotid Endarterectomy Versus Transfemoral Carotid Artery Stenting in the VQI-VISION Databas. Journal of Vascular Surgery. 2021;74(3):e23.  https://doi.org/10.1016/j.jvs.2021.06.039
  6. Edla S, Atti V, Kumar V, et al. Comparison of nationwide trends in 30-day readmission rates after carotid artery stenting and carotid endarterectomy. Journal of Vascular Surgery. 2020;71(4):1222-1232.e9.  https://doi.org/10.1016/j.jvs.2019.06.190
  7. Katano H, Nishikawa Y, Yamada H, Mase M. Calcification in original plaque and restenosis following carotid artery stenting. Surg Neurol Int. 2017;8:279.  https://doi.org/10.4103/sni.sni_263_17
  8. Millon A, Mathevet J-L, Boussel L, et al. High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques. Journal of Vascular Surgery. 2013;57(4):1046-1051.e2.  https://doi.org/10.1016/j.jvs.2012.10.088
  9. Glushkov NI, Ivanov MA, Zagorulko AA, et al. Tactical approaches in simultaneous atherosclerotic lesion of coronary and carotid arteries. Preventive and clinical medicine. 2019;72(3):53-59. (In Russ.).
  10. Albu A, Fodor D, Bondor C, Suciu O. Carotid arterial stiffness in patients with chronic obstructive pulmonary disease. Acta Physiol Hung. 2011;98(2):117-127.  https://doi.org/10.1556/aphysiol.98.2011.2.3
  11. Bonati LH, Kakkos S, Berkefeld J, et al. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. European Stroke Journal. 2021;6(2):I-XLVII. https://doi.org/10.1177/23969873211012121
  12. Hokari M, Nakayama N, Kazumata K, et al. Surgical Outcomes for Cervical Carotid Artery Stenosis: Treatment Strategy for Bilateral Cervical Carotid Artery Stenosis. J Stroke Cerebrovasc Dis. 2015;24(8):1768-1774. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.052
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