Surgical treatment of internal carotid artery kinking following fibromuscular dysplasia

Gavrilenko A.V.; Paltseva E.M.; Oskolkova S.A.; Abramyan A.V.; Kochetkov V.A.; Timofeeva I.E.

doi:https://doi.org/10.17116/hirurgia202012170

Gavrilenko A.V.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

Paltseva E.M.

Petrovsky Russian Research Center of Surgery

Oskolkova S.A.

Sechenov First Moscow State Medical University

Abramyan A.V.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

Kochetkov V.A.

Petrovsky Russian Research Center of Surgery

Timofeeva I.E.

Petrovsky Russian Research Center of Surgery

Scopus AuthorID: 57221163682

Surgical treatment of internal carotid artery kinking following fibromuscular dysplasia

Authors:

Gavrilenko A.V., Paltseva E.M., Oskolkova S.A., Abramyan A.V., Kochetkov V.A., Timofeeva I.E.

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Journal: Pirogov Russian Journal of Surgery. 2020;(12): 70‑75

DOI: 10.17116/hirurgia202012170

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To cite this article:

Gavrilenko AV, Paltseva EM, Oskolkova SA, Abramyan AV, Kochetkov VA, Timofeeva IE. Surgical treatment of internal carotid artery kinking following fibromuscular dysplasia. Pirogov Russian Journal of Surgery. 2020;(12):70‑75. (In Russ.)
https://doi.org/10.17116/hirurgia202012170

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To evaluate the results of surgical treatment of internal carotid artery kinking following fibromuscular dysplasia.

MATERIAL AND METHODS

There were 32 patients who underwent surgical treatment of internal carotid artery kinking following fibromuscular dysplasia. Structural changes of carotid artery wall were analyzed using immunohistochemical survey. Considering destructive changes revealed, we divided all patients into 2 groups in order to assess long-term postoperative outcomes: 1 — ICA resection followed by anastomosis in end-to-end fashion; 2 — ICA replacement. Postoperative analysis included incidence of stroke, thrombosis and deformities of anastomosis zone, regression of cerebrovascular insufficiency.

RESULTS

The main «phenotype» of arterial wall in patients with ICA kinking following fibromuscular dysplasia is a large number of smooth muscle cells releasing matrix matelloproteinases-2 and -9 and low level of their tissue inhibitor type 1. Postoperative deformities are more common within a year after surgery. Maximum incidence is observed after 12 months. Both ICA resection and replacement are followed by similar incidence of deformity later. No severe deformities were diagnosed. Resection of ICA kinking on the background of fibromuscular dysplasia is followed by comparable results with ICA replacement regarding the incidence stroke, thrombosis and regression of cerebrovascular insufficiency.

CONCLUSION

Despite degradation of extracellular matrix, destruction of elastic fibers and their fragmentation, no significant deformities are observed in long-term postoperative period in patients with ICA kinking and fibromuscular dysplasia.

Keywords:

postoperative carotid artery deformities

resection of kinking

carotid artery replacement

collagen

elastin

matrix metalloproteinase

matrix metalloproteinase inhibitor

MMP-2

MMP-9

TIMP-1

TIMP-2

Authors:

Gavrilenko A.V.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

Paltseva E.M.

Petrovsky Russian Research Center of Surgery

Oskolkova S.A.

Sechenov First Moscow State Medical University

Abramyan A.V.

Petrovsky Russian Research Center of Surgery;
Sechenov First Moscow State Medical University

Kochetkov V.A.

Petrovsky Russian Research Center of Surgery

Timofeeva I.E.

Petrovsky Russian Research Center of Surgery

Scopus AuthorID: 57221163682

Received:

23.12.2020

Accepted:

22.02.2020

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References:

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