Results of carotid endarterectomy in the acutest period of ischemic stroke

Zharova A.S.; Abramov O.O.; Golets K.O.; Gaganova T.S.; Ryl’skiy R.M.; Kokaya R.V.; Buksayev D.S.; Solotenkova K.N.; Golokhvastov S.V.; Klimova A.I.; Puchnina L.I.

doi:https://doi.org/10.17116/jnevro202212212255

Zharova A.S.

Mechnikov North-Western State Medical University

Abramov O.O.

Mechnikov North-Western State Medical University

Golets K.O.

Mechnikov North-Western State Medical University

Gaganova T.S.

Mechnikov North-Western State Medical University

Ryl’skiy R.M.

Mechnikov North-Western State Medical University

Kokaya R.V.

Mechnikov North-Western State Medical University

Buksayev D.S.

Mechnikov North-Western State Medical University

Solotenkova K.N.

Mechnikov North-Western State Medical University

Golokhvastov S.V.

Kemerovo State Medical University

Klimova A.I.

Mechnikov North-Western State Medical University

Puchnina L.I.

Mechnikov North-Western State Medical University

Results of carotid endarterectomy in the acutest period of ischemic stroke

Authors:

Zharova A.S., Abramov O.O., Golets K.O., Gaganova T.S., Ryl’skiy R.M., Kokaya R.V., Buksayev D.S., Solotenkova K.N., Golokhvastov S.V., Klimova A.I., Puchnina L.I.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2022;122(12‑2): 55‑59

DOI: 10.17116/jnevro202212212255

Read: 2154 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Zharova AS, Abramov OO, Golets KO, et al. . Results of carotid endarterectomy in the acutest period of ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2022;122(12‑2):55‑59. (In Russ.)
https://doi.org/10.17116/jnevro202212212255

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски (S.S. Korsakov Journal of Neurology and Psychiatry (special issues))

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

Analysis of the results of carotid endarterectomy (CEE) in the acute period of ischemic stroke (IS).

MATERIAL AND METHODS

This retrospective study included 128 patients (mean age 65.2±4.7 years, 84 (65.6%) men) who underwent CEE in the acute period. Inclusion criteria were: an ischemic focus in the brain with a diameter of no more than 2.5 cm according to MRI; mild neurological deficit (from 3 to 8 points on NIHSS); ≤3 points on the modified Rankin Scale (mRS); stenosis of ICA over 60%. Exclusion criteria were: severe neurological deficit; presence of decompensated comorbid dependence; contraindications to CEE.

RESULTS

In the hospital postoperative period, 3.9% of patients were diagnosed with hemorrhagic transformation of the ischemic focus in the brain with progression of neurological deficit and level of consciousness to coma II. In 3.1% cases, a lethal outcome developed on 4—7 days after the operation. In 2.3% patients after CEE, the progression of neurological deficit was noted with the development of new ischemic foci according to postoperative neuroimaging. The probable cause of this event was a distal embolism that developed during the installation of a temporary shunt. Myocardial infarction was diagnosed in 3.9% of patients. The combined end point (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) was 10.1%.

CONCLUSION

CEE in the most acute period of ischemic stroke is accompanied by a high risk of hemorrhagic transformation, myocardial infarction, and death, which characterizes this revascularization option as unsafe.

Keywords:

carotid endarterectomy

acutest period of ischemic stroke

ischemic stroke

acute cerebrovascular accident

hemorrhagic transformation

hyperperfusion syndrome

Authors:

Zharova A.S.

Mechnikov North-Western State Medical University

Abramov O.O.

Mechnikov North-Western State Medical University

Golets K.O.

Mechnikov North-Western State Medical University

Gaganova T.S.

Mechnikov North-Western State Medical University

Ryl’skiy R.M.

Mechnikov North-Western State Medical University

Kokaya R.V.

Mechnikov North-Western State Medical University

Buksayev D.S.

Mechnikov North-Western State Medical University

Solotenkova K.N.

Mechnikov North-Western State Medical University

Golokhvastov S.V.

Kemerovo State Medical University

Klimova A.I.

Mechnikov North-Western State Medical University

Puchnina L.I.

Mechnikov North-Western State Medical University

Received:

11.04.2022

Accepted:

20.04.2022

Close metadata

References:

Belov IuV, Medvedeva LA, Zagorulko OI, et al. Early and long-term cognitive disorders after carotid endarterectomy. Surgery. Journal them N.I. Pirogov. 2018;12:5-12. (In Russ.). https://doi.org/10.17116/hirurgia20181215
Chechulov PV, Voznyuk IA, Soroka VV, et al. Carotid endarterectomy in the first days after ischemic stroke is safe and justified. Thoracic and Cardiovascular Surgery. 2013;3:24-29. (In Russ.).
Kazantsev AN, Tarasov RS, Burkov NN, et al. Carotid endarterectomy: three-year follow-up results in a single-center registry. Angiology and Vascular Surgery. 2018;24(3):101-108. (In Russ.).
Kim AV, Antonov GI, Lazarev VA, et al. Surgical treatment of patients with ischemic stroke in the basin of the middle cerebral artery in the acute period. Neurosurgery. 2014;1:126-131. (In Russ.).
Kazantsev AN, Chernykh KP, Leader RYu, et al. Glomus-sparing carotid endarterectomy according to A.N. Kazantsev. Hospital and mid-term outcomes. Circulatory Pathology and Cardiac Surgery. 2020;24(3):70-79. (In Russ.). https://doi.org/10.21688/1681-3472-2020-3-70-79
National guidelines for the management of patients with diseases of the brachiocephalic arteries. Angiology and Vascular Surgery. 2013;19(2):4-68. (In Russ.).
Aboyans V, Ricco JB, Bartelink MEL, et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816. https://doi.org/10.1093/eurheartj/ehx095
Legotin AP, Burkov NN, Shabaev AR, Lider RYu. Revascularization of the brain in patients with ischemic stroke. Complex Problems of Cardiovascular diseases. 2018;7(S2):45. (In Russ.).
Tsukurova LA, Timchenko LV, Golovko EN, et al. Successful emergency surgical interventions on the brachiocephalic arteries in two patients in the acute period of ischemic stroke. Neurosurgery. 2013;4:70-72. (In Russ.).
Kazantsev AN, Vinogradov RA, Chernyavsky MA, et al. Multicenter study: carotid endarterectomy in the first hours after ischemic stroke. Russian Journal of Cardiology. 2021;26(6):76-80. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4316
Zakirzhanov NR, Komarov RN, Khalilov IG. Surgical revascularization of the carotid basin in the acute period of ischemic stroke. Surgery. Journal them N.I. Pirogov. 2020;2:74-78. (In Russ.). https://doi.org/10.17116/hirurgia202002174
Gavrilenko AV, Kravchenko AA, Kuklin AV. Surgical prevention of progression of cerebral ischemia in patients after stroke. Surgery. Journal them N.I. Pirogov. 2022;2:45-49. (In Russ.).
Bockeria LA, Bakhmetiev AS, Kovalenko VI, et al. The choice of the method of carotid endarterectomy for atherosclerotic lesions of the internal carotid artery. Annals of Surgery. 2017;22(5):265-271. (In Russ.).
Dudanov IP, Abuazab BS, Akhmetov VV. Comparative characteristics of classical and eversion carotid endarterectomy. Research and Practice in Medicine. 2017;4(3):8-15. (In Russ.). https://doi.org/10.17709/2409-2231-2017-4-3-1
Belov YuV, Kazantsev AN, Vinogradov RA, et al. Ten-year long-term results of classical and eversion carotid endarterectomy. Multicenter study. Russian Journal of Cardiology. 2021;26(12):103-112. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4742
Mukhamadeev IS, Oborin AA. Results of carotid endarterectomy in contralateral atherosclerotic occlusion of the internal carotid artery. Pathology of Blood Circulation and Cardiac Surgery. 2021;25(4):76-84. (In Russ.).
Chernyavsky MA, Komakha BB, Zherdev NN, et al. Annual results of carotid angioplasty with stenting and carotid endarterectomy. Cardiology and Cardiovascular Surgery. 2021;14(6):518-524. (In Russ.). https://doi.org/10.17116/kardio202114061518
Zakirzhanov NR, Komarov RN, Khalilov IG, et al. Comparative safety analysis of carotid endarterectomy in the acute and acute periods of ischemic stroke. Angiology and Vascular Surgery. 2021;27(1):97-106. (In Russ.). https://doi.org/10.33529/ANGIO2021103
Shatravka AV, Sokurenko GYu, Suvorov SA, et al. Emergency angiosurgical care for patients with acute ischemic stroke. Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2015;4:48-52. (In Russ.).
Artemova AS, Ivanov MA, Uryupina AA, Gorovaya AD. Reasons for the development of hyperperfusion syndrome after carotid endarterectomy. Almanac of the Institute of Surgery A.V. Vishnevsky. 2018;1:243-244. (In Russ.).
Vasilchenko NO, Rubleva OV, Verbitsky OP, et al. Cerebral hyperperfusion syndrome after carotid endarterectomy in the acute period of ischemic stroke. Medical Academic Journal. 2017;17(4):17-21. (In Russ.).
Fokin AA, Treiger GA, Vladimirsky VV. Prevention of postoperative hemodynamic dysregulatory complications of carotid endarterectomy by preserving the nerves of the carotid sinus. Journal of Scientific Articles Health and Education in the XXI Century. 2017;19(4):21-25. (In Russ.).
Kazantsev AN, Burkov NN, Tarasov RS, et al. Carotid endarterectomy in the acute period of ischemic stroke. Circulatory Pathology and Cardiac Surgery. 2018;22(1):66-72. (In Russ.). https://doi.org/10.21688/1681-3472-2018-1-66-72
Kazantsev AN, Kravchuk VN, Vinogradov RA, et al. Temporary shunt and carotid endarterectomy (literature review). Bulletin of Surgery I.I. Grekov. 2021;180(3):81-86. (In Russ.). https://doi.org/10.24884/0042-4625-2021-180-3-81-86
Kazantsev AN, Chernykh KP, Lider RYu, et al. Emergency glomus-sparing carotid endarterectomy according to A.N. Kazantsev. Emergency medical care. Zhurnal them N.V. Sklifosovsky. 2020;9(4):494-503. (In Russ.). https://doi.org/10.23934/2223-9022-2020-9-4-494-503
Kazantsev AN, Porkhanov VA, Khubulava GG, et al. Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results. Russian Sklifosovsky Journal of Emergency Medical Care. 2021;10(1):33-47. (In Russ.). https://doi.org/10.23934/2223-9022-2021-10-1-33-47
Tarasov RS, Ivanov SV, Kazantsev AN, et al. Hospital results of various strategies of surgical treatment of patients with combined lesions of the coronary bed and internal carotid arteries. Complex Problems of Cardiovascular Diseases. 2016;5(4):15-24. (In Russ.).
Tarasov RS, Kazantsev AN, Ivanov SV, et al. Surgical treatment of multifocal atherosclerosis: pathology of the coronary and brachiocephalic beds and predictors of early adverse events. Cardiovascular Therapy and Prevention. 2017;16(4):37-44. (In Russ.). https://doi.org/10.15829/1728-8800-2017-4-37-44
Kazantsev AN, Chernykh KP, Zarkua NE, et al. Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke. Russian Medical and Biological Bulletin named after academician I.P. Pavlova. 2020;28(3):312-322. (In Russ.). https://doi.org/10.23888/PAVLOVJ2020283312-322