How we choose between carotid endarterectomy and stenting

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

doi:https://doi.org/10.17116/kardio202417041445

Glushkov N.I.

Mechnikov North-Western State Medical University

ORCID: 0000-0001-8146-4728

Puzdryak P.D.

Mechnikov North-Western State Medical University

ORCID: 0000-0003-2631-3622

Kornievich D.V.

Mechnikov North-Western State Medical University

ORCID: 0000-0001-5800-0570

Vasenina E.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0003-0028-6531

Asadulaeva K.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0002-4203-6306

Ivanov M.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0002-4756-6488

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.

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

DOI: 10.17116/kardio202417041445

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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 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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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

ORCID: 0000-0001-8146-4728

Puzdryak P.D.

Mechnikov North-Western State Medical University

ORCID: 0000-0003-2631-3622

Kornievich D.V.

Mechnikov North-Western State Medical University

ORCID: 0000-0001-5800-0570

Vasenina E.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0003-0028-6531

Asadulaeva K.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0002-4203-6306

Ivanov M.A.

Mechnikov North-Western State Medical University

ORCID: 0000-0002-4756-6488

Received:

24.02.2023

Accepted:

15.03.2023

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References:

Glushkov NI, Ivanov MA, Artemova AS, Apresyan AYu, Gorovaya AD, Uryupina AA. Atherosclerotic lesions of brachiocephalic arteries and surgical correction of symptomatic and asymptomatic carotid stenosis. Grekov’s Bulletin of Surgery. 2018;177(5):17-20. (In Russ.). https://doi.org/10.24884/0042-4625-2018-177-5-17-20
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
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
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
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
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
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
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
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.).
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
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
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
Howell SJ. Carotid endarterectomy. British Journal of Anaesthesia. 2007;99(1):119-131. https://doi.org/10.1093/bja/aem137
Naggara O, Touzé E, Beyssen B, Trinquart L, Chatellier G, Meder J-F, Mas J-L. Anatomical and Technical Factors Associated With Stroke or Death During Carotid Angioplasty and Stenting. Stroke. 2011;42(2):380-388. https://doi.org/10.1161/strokeaha.110.588772
Müller MD, Lyrer P, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database of Systematic Reviews. 2020;2(2):CD000515. https://doi.org/10.1002/14651858.cd000515.pub5
Brooks WH, Jones MR, Gisler P, et al. Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC Cardiovasc Interv. 2014;7(2):163-168. https://doi.org/10.1016/j.jcin.2013.09.010
Cui C, Murphy JD, Dakour-Aridi H, Mathlouthi A, Naazie IN, Malas M. Cost-effectiveness Analysis of Carotid Endarterectomy Versus Transcarotid Artery Stenting. Journal of Vascular Surgery. 2020;72(1):e113-e116. https://doi.org/10.1016/j.jvs.2020.04.204