The value of revascularisation of atherosclerotic lesions of the innominate artery at the asymptomatic stage of the disease

Beloyartsev D.F.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-7808-3454

Polyansky D.V.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0003-3077-8801

Adyrkhaev Z.A.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-6013-4017

The value of revascularisation of atherosclerotic lesions of the innominate artery at the asymptomatic stage of the disease

Authors:

Beloyartsev D.F., Polyansky D.V., Adyrkhaev Z.A.

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Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(8‑2): 72‑82

DOI: 10.17116/jnevro202412408272

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To cite this article:

Beloyartsev DF, Polyansky DV, Adyrkhaev ZA. The value of revascularisation of atherosclerotic lesions of the innominate artery at the asymptomatic stage of the disease. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(8‑2):72‑82. (In Russ.)
https://doi.org/10.17116/jnevro202412408272

Подписка 2025 (S.S. Korsakov Journal of Neurology and Psychiatry (special issues))

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OBJECTIVE

To analyze the natural course of asymptomatic atherosclerotic lesions of the innominate artery and to study the long-term results of surgical interventions performed at the asymptomatic stage and to compare them with similar results at the symptomatic stage of the disease.

MATERIAL AND METHODS

The analysis of the natural course of the disease was performed in 74 asymptomatic patients who were divided into 3 groups depending on the initial degree of severity of the stenosis of the innominate artery: insignificant stenoses (less than 50%), moderate stenoses (50—69%) and haemodynamically significant lesions (70% and more). The analysis of the long-term results of surgical treatment was performed in 62 patients, in 29 of whom intrathoracic reconstructions were performed at the asymptomatic stage of the disease, in 33 — at the symptomatic stage.

RESULTS

Cumulative freedom from stroke by the 10th year of follow-up was significantly higher in patients with insignificant stenoses and amounted to 100% in the groups of moderate stenoses and hemodynamically significant lesions — 25% and 0, respectively (log-rank p=0.000). Neurological fatality in patients with hemodynamically significant (initial or developed) lesions was 26.3%, while in patients with hemodynamically insignificant lesions it was 0 (log-rank p=0.004), which is confirmed by cumulative indices (log-rank p=0.008). Asymptomatic innominate artery reconstructions were associated with a lower incidence of stroke: the long-term incidence of stroke in such patients was 3.4%, while in initially symptomatic patients it was 18.2% (p=0.038). Initial degree II or IV cerebrovascular insufficiency was a predictor of stroke in the long-term period (OR=1.71; p=0.000). The cumulative freedom from stroke in asymptomatic patients by the 20th year of follow-up was 95% compared with 74% in symptomatic patients (log-rank p=0.032).

CONCLUSION

Surgical interventions in asymptomatic hemodynamically significant lesions of the innominate artery should be performed to prevent primary cerebral circulatory disorders.

Keywords:

brachiocephalic trunk

innominate artery

aortic arch branch reconstructions

intrathoracic reconstructions

atherosclerosis

natural history

asymptomatic patients

cerebrovascular insufficiency

Authors:

Beloyartsev D.F.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-7808-3454

Polyansky D.V.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0003-3077-8801

Adyrkhaev Z.A.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-6013-4017

Received:

29.11.2023

Accepted:

15.01.2024

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