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

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

doi:https://doi.org/10.17116/jnevro202412408272

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.

More about the authors

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

DOI: 10.17116/jnevro202412408272

Read: 960 times

Download PDF (RU)

Contact the author

Table of contents

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 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

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

Close metadata

References:

Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2023 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2023;65(1):7-111. https://doi.org/10.1016/j.ejvs.2022.04.011
The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg. 2022;75(1):26-98. https://doi.org/10.1016/j.jvs.2021.04.074
National guidelines for the management of patients with diseases of the brachiocephalic arteries. M. 2013. (In Russ.).
Loenko VB, Smyalovskii VE, Dudarev VE, et al. Remote results of surgical treatment management for atherosclerotic lesions of the brachiocephalic trunk. Angiology and Vascular Surgery. 2009;15(4):106-112. (In Russ.).
Pokrovsky AV, Gashtov AKh. Prophylactic operations on brachiocephalic vessels in cerebral vascular insufficiency. S.S. Korsakov Journal of Neurology and Psychiatry. 1976;76(1):16-23. (In Russ.).
Pokrovsky AV, Beloyartsev DF. Long-term results of intrathoracic reconstructions in atherosclerotic lesions of the innominate artery. Angiology and Vascular Surgery. 2001;7(3):58-67. (In Russ.).
Kieffer E, Sabatier J, Koskas F, et al. Atherosclerotic innominate artery occlusive disease: early and long-term results of surgical reconstruction. J Vasc Surg. 1995;21(2):326-337. https://doi.org/10.1016/s0741-5214(95)70273-3
Levien LJ, Benn CA, Veller MG, et al. Retrograde balloon angioplasty of brachiocephalic or common carotid artery stenoses at the time of carotid endarterectomy. Eur J Vasc Endovasc Surg. 1998;15(6):521-527. https://doi.org/10.1016/s1078-5884(98)80113-5
Berguer R, Morasch MD, Kline RA. Transthoracic repair of innominate and common carotid artery disease: immediate and long-term outcome for 100 consecutive surgical reconstructions. J Vasc Surg. 1998;27(1):34-34. https://doi.org/10.1016/s0741-5214(98)70289-7
Azakie A, McElhinney DB, Higashima R, et al. Innominate artery reconstruction: over 3 decades of experience. Ann Surg. 1998;228(3):402-410. https://doi.org/10.1097/00000658-199809000-00013
Takach TJ, Reul GJ, Cooley DA, et al. Brachiocephalic reconstruction I: operative and long-term results for complex disease. J Vasc Surg. 2005;42(1):47-54. https://doi.org/10.1016/j.jvs.2005.03.027
Paukovits TM, Lukacs L, Berczi V, et al. Percutaneous endovascular treatment of innominate artery lesions: a single-centre experience on 77 lesions. Eur J Vasc Endovasc Surg. 2010;40(1):35-43. https://doi.org/10.1016/j.ejvs.2010.03.017
Sfyroeras GS, Karathanos C, Antoniou GA, et al. A meta-analysis of combined endarterectomy and proximal balloon angioplasty for tandem disease of the arch vessels and carotid bifurcation. J Vasc Surg. 2011;54(2):534-540. https://doi.org/10.1016/j.jvs.2011.04.022
Duran M, Grotemeyer D, Schander O, et al. Transmediastinal repair of the innominate artery: immediate and long-term outcomes of 42 surgical reconstructions. Italian J Vasc Endovasc Surg. 2012;19:253-258.
Bradaric C, Kuhs K, Groha P, et al. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circ J. 2015;79(3):537-543. https://doi.org/10.1253/circj.CJ-14-0855
Yamao Y, Ishii A, Satow T, et al. The Current Status of Endovascular Treatment for Extracranial Steno-occlusive Diseases in Japan: Analysis Using the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). Neurol Med Chir (Tokyo). 2020;60(1):1-9. https://doi.org/10.2176/nmc.st.2018-0315
Ammi M, Henni S, Salomon Du Mont L, et al. Lower Rate of Restenosis and Reinterventions With Covered vs Bare Metal Stents Following Innominate Artery Stenting. J Endovasc Ther. 2019;26(3):385-390. https://doi.org/10.1177/1526602819838867
Zacharias N, Goodney PP, DeSimone JP, et al. Outcomes of Innominate Artery Revascularization Through Endovascular, Hybrid, or Open Approach. Ann Vasc Surg. 2020;69:190-196. https://doi.org/10.1016/j.avsg.2020.06.005