Carotid endarterectomy for symptomic and asymptomic stenosis: Report of 65388 cases (Russian register).

AIM: Analysis of in-hospital and long-term results of carotid endarterectomy in patients with asymptomatic and symptomatic stenoses. MATERIALS AND METHODS: The sample was formed by completely including all cases of carotid endarterectomy (n = 65,388) performed during the period from May 1, 2015 to November 1, 2023. Depending on the symptomatic/asymptomatic nature of the stenosis, all patients were divided into two groups: group 1 - n = 39,172 (75.2%) - patients with asymptomatic stenosis; Group 2 - n = 26216 (24.8%) - patients with symptomatic stenosis. The postoperative follow-up period was 53.5 ± 31.4 months. RESULTS: In the hospital postoperative period, the groups were comparable in the incidence of death (group 1: n = 164 (0.41%); group 2: n = 124 (0.47%); p = .3), transient ischemic attack (group 1: n = 116 (0.29%); group 2: n = 88 (0.33%); p = .37), myocardial infarction (group 1: n = 32 (0.08%); group 2: n = 19 (0.07%); p = .68), thrombosis of the internal carotid artery (group 1: n = 8 (0.02%); group 2: n = 2 (0.007%); p = 0, 19), bleeding (group 1: n = 58 (0.14%); group 2: n = 33 (0.12%); p = .45). In group 2, ischemic stroke developed statistically more often (group 1: n = 328 (0.83%); group 2: n = 286 (1.09%); p = .001), which led to a higher value of the combined endpoint (group 1: n = 640 (1.63%); group 2: n = 517 (1.97%); p = .001). In the long-term postoperative period, the groups were comparable in cases of death (group 1: n = 65 (0.16%); group 2: n = 41 (0.15%); p = .76) and death from cardiovascular causes (group 1: n = 59 (0.15%); group 2: n = 33 (0.12%); p = .4). A greater number of ischemic strokes were detected in patients of group 2 (group 1: n = 213 (0.54%); group 2: n = 187 (0.71%); p = .006). In group 1, hemodynamically significant restenosis (≥70%) of the internal carotid artery was more often diagnosed (group 1: n = 974 (2.49%); group 2: n = 351 (1.34%); p < .0001) and myocardial infarction (group 1: n = 66 (0.16%); group 2: n = 34 (0.13%); p < .0001). When analyzing stroke-free survival, analysis of Kaplan-Meier curves showed that a statistically larger number of strokes were diagnosed in group 2 (p < .0001). CONCLUSION: Due to the fact that the patients were initially not comparable for a number of indicators, to achieve balance, we applied propensity score matching analysis. Thus, group 1 consisted of 24,381 patients, and group 2 consisted of 17,219 patients. In the hospital postoperative period, statistically significant differences were obtained only in the combined end point, which was greater in group 2 (group 1: n = 465 (1.9%); group 2: n = 382 (2.2%); p = .02). In the long-term follow-up period, after applying propensity score matching, no statistically significant differences were obtained between groups.

Isolated liver chemo perfusion for hepatic metastases from uveal melanoma: a report of 38 cases.

Aim: To evaluate the outcomes of isolated liver chemo perfusion in patients with hepatic metastases from uveal melanoma. Materials and methods: Cardiovascular surgeons are often involved in the treatment of oncological diseases. Isolated liver chemoperfusion requires the use a heart-lung machine. A little more than 300 operations of isolated liver chemoperfusion have been performed worldwide. From 2020 to 2023, 38 cases of isolated liver chemoperfusion were performed at the Kostroma Clinical Oncological Dispensary. Results: There were 3 deaths, 2 due to liver failure. The remaining patient had hepatic artery thrombosis, who despite emergency thrombectomy and repair of common hepatic artery succumbed to multiorgan failure. Bleeding was diagnosed in 7 patients in the postoperative period. In all cases, relaparotomy was performed to stop bleeding. Subsequently, no special features were noted. The median disease-free survival was 5.4 months. The median overall survival was 20.3 months at the time of submission of this manuscript. Conclusions: Isolated liver chemoperfusion is a safe method of regional chemotherapy and can be considered in patients with isolated hepatic metastases from uveal melanoma. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01620-6.

Hospital and long-term results of carotid endarterectomy in patients with different severity of coronary artery lesion according to syntax score.

AIM: Analysis of in-hospital and long-term results of carotid endarterectomy (CEE) in patients with different severity of coronary atherosclerosis. MATERIAL AND METHODS: This comparative, retrospective, open study for the period from January 2013 to April 2020 included 1719 patients operated on for occlusive-stenotic lesions of the internal carotid arteries (ICA). Classical and eversion CEA were used as revascularization strategies. The criteria for inclusion in the study were: 1. Presence of coronary angiography within six months before the present CEE; 2. A history of myocardial revascularization in patients with severe coronary lesions. Depending on the severity of coronary atherosclerosis, all patients were divided into 3 groups: Group 1-871 (50.7 %) patients - with the presence of hemodynamically significant stenosis of the coronary arteries (CA) with a history of myocardial revascularization; Group 2-496 (28.8 %) patients - with the presence of hemodynamically insignificant lesions of the coronary artery (up to 70 %, not inclusive, and the trunk of the left coronary artery, up to 50 %, not inclusive); Group 3-352 (20.5 %) patients - without signs of atherosclerotic lesions of the coronary artery. In group 1, the observation period was 56.8±23.2 months, in group 2-62.0±15.6 months, in group 3-58.1±20.4 months. RESULTS: During the hospital observation period, there were no significant intergroup differences in the number of complications. All cardiovascular events were detected in isolated cases. The most common injury was damage to the cranial nerves, diagnosed in every fifth patient in the total sample. The combined endpoint (CET), including death + myocardial infarction (MI) + acute cerebrovascular accident/transient ischemic attack (stroke/TIA), was 0.75 % (n=13). In the long-term follow-up period, when comparing survival curves, group 3 revealed the largest number of ischemic strokes (p = 0.007), myocardial infarction (p = 0.03), and CCT (p = 0.005). There were no intergroup differences in the number of deaths (p=0.62). CONCLUSION: The results of the study showed that there was no significant intergroup difference in the development of complications at the hospital postoperative stage. However, in the long-term follow-up period, a group of patients with isolated lesions of the ICA demonstrated a rapid increase in the number of MI, stroke/TIA, and a combined endpoint, which was apparently associated with low compliance and progression of atherosclerosis in previously unaffected arteries.

Some Topical Aspects of the "Sports Heart" Problem (Literature Review). Part I.

The cardiovascular system experiences the greatest overload, morphological and functional changes inelite sport, which in a number of athletes undergoes nonadaptive (pathological) remodeling both functional and morphological. The latter is characterized by certain objective features, including echocardiography indicators, which occupies a special place in sports cardiology. Structural and functional changes beyond the generally accepted norm (pronounced cardiac hypertrophy or dilatation, high arterial hypertension) can be associated with systolic or diastolic myocardial dysfunction and impaired electrical properties, some of which are predictors of severe complications up to sudden cardiac death and pose a serious problem regarding the admission of athletes to training and competition. This review is devoted to summarizing the views of authoritative specialists in the field of sports medicine on the criteria of pathological remodeling of the heart muscle, the role of echocardiography in its diagnosis, the discussion of the limits of the norm of response to blood pressure load, the analysis of the main causes of sudden cardiac death of athletes, the realities and prospects of genetic selection in sports.

Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment.

We have described a variant of the structure of the vertebral artery. In the V3 segment, the vertebral artery bifurcated and then joined again. This building looks like a triangle. Such anatomy has not been previously described in the world literature. By the right of the first description, this anatomical formation was called the «vertebral triangle of Dr A.N. Kazantsev¼. This discovery was made during stenting of the V4 segment of the left vertebral artery in the most acute period of stroke.

The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure.

GOAL: Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure. MATERIALS AND METHODS: This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation. RESULTS: Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5.3%, n = 9; group 2: 72.8%, n = 67; group 3: 100%, n = 45; p < 0.0001), rethrombosis (group 1 : 18.4%, n = 31; group 2: 69.5%, n = 64; group 3: 91.1%, n = 41; p < 0.0001), and limb amputations (group 1: 9.5%, n = 16; group 2: 56.5%, n = 52; group 3: 91.1%, n = 41; p < 0.0001) was recorded in group 3 (ventilated) patients. CONCLUSION: In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial.

AIM: To compare the long-term results of eversion (ECEA) and conventional carotid endarterectomy (CCEA). METHODS: We designed a retrospective, multicenter study which included 25,106 patients who underwent ECEA (n = 18,362) or CCEA (n = 6744). The duration of follow-up was 124.7 ± 53.8 months. RESULTS: In the postoperative period, none of the interventions showed clear benefits reducing the frequency of complications: fatal outcome (ECEA: 0.19%, n = 36; CCEA: 0.17%, n = 12; OR = 1.1, 95% CI = 0.57-2.11, p = 0.89), myocardial infarction (ECEA: 0.15%, n = 28; CCEA: 0.13%, n = 9; p = 0.87; OR = 1.14; 95% CI = 0.53-2.42); acute cerebrovascular accident (CVA) (Group I: 0.33%, n = 62; Group II: 0.4%, n = 27; p = 0.53; OR = 0.84; 95% CI = 0, 53-1.32); bleeding with acute haematoma appearance in the area of intervention (Group I: 0.39%, n = 73; Group II: 0.41%, n = 28; p = 0.93; OR = 0.95; 95% CI = 0, 61-1.48); internal carotid artery (ICA) thrombosis (Group I: 0.05%, n = 11; Group II: 0.07%, n = 5; OR = 0.80, 95% CI = 0.28-2.32, p = 0.90). During the long-term follow-up, ECEA was associated with lower frequency of fatal outcome (ECEA: 2.7%, n = 492; CCEA: 9.1%, n = 616; OR = 0.27; 95% CI = 0.24-0.3, p < 0.0001), cerebrovascular death (ECEA: 1.0%, n = 180; CCEA: 5.5%, n = 371; OR = 0.17, 95% CI = 0.14-0.21, p < 0.0001), non-fatal ischaemic stroke (ECEA: 0.62%, n = 114; CCEA: 7.0%, n = 472; OR = 0.08; 95% CI = 0.06-0.1, p < 0.0001); repeated revascularization because of >60% restenosis (ECEA: 1.6%, n = 296; CCEA: 12.6%, n = 851; OR = 0.11, 95% CI = 0.09-0.12, p < 0.0001), and combined endpoint (ECEA: 2.2%, n = 397; CCEA: 13.2%, n = 888; OR = 0.14; 95% CI = 0.12-1.16, p < 0.0001). CONCLUSION: ECEA is beneficial over CCEA in a long term.

Computer Modeling of Carotid Endarterectomy With the Different Shape Patches and Prediction of the Atherosclerotic Plaque Formation Zones.

The article describes a method for constructing geometric models of the carotid bifurcation and computer simulation of endarterectomy surgery with the patches of various configurations. The purpose of this work is to identify the areas of the greatest risk of restenosis in the constructed models and to conduct a comparative analysis of risk factors when using the patches of different widths and shapes. The method is demonstrated on a reconstructed model of a healthy vessel. Its building is based on a preoperative computed tomography study of a particular patient's affected vessel. The flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasound Doppler velocimetry. Risk factors are assessed through the hemodynamic indices on the vessel wall associated with Wall Shear Stress. The distribution of risk zones in the healthy vessel, presumably leading to its observed lesion (plaque), is analyzed. Comparative evaluation of 10 various patches implantation results is carried out and the optimal variant is determined. The proposed method can be used to predict the hemodynamic results of surgery using patches of various sizes and shapes.

Mathematical Model for the Choice of Tactics of Revascularization in Case of Combined Lesions of the Carotid and Coronary Arteries.

Based on the assessment of the long-term results of various surgical treatment strategies for patients with combined hemodynamically significant lesions of the coronary basin and internal carotid arteries, to develop a model for choosing the optimal revascularization strategy for patients with multifocal atherosclerosis. In 391 patients with combined hemodynamically significant atherosclerotic lesions of the coronary bed and internal carotid arteries, various options for reconstructive operations were performed. 1 - Staged surgery in the volume of coronary artery bypass grafting followed by carotid endarterectomy (n = 151, 38.6%); 2 - Combined coronary bypass surgery and carotid endarterectomy (n=141, 36%); 3 - Hybrid revascularization in the volume of percutaneous coronary intervention and carotidal endarterectomy (n = 28, 7.2%); 4 - Phased surgery in the volume of carotidal endarterectomyand subsequent coronary bypass surgery (n = 71, 18.2%). The study analyzed the frequency and structure of complications in the remote postoperative period (33.95±12.05 months - for of the total sample of patients). To select the optimal tactics of revascularization, the prognostic coefficients of all levels of risk factors for each tactic were evaluated and, on their basis, integral indicators characterizing a comprehensive assessment of risk factors for the corresponding surgical tactics were calculated. The developed model of personalized choice of the optimal surgical strategy, based on a comprehensive assessment of risk factors for an unfavorable outcome (clinical-demographic, coronary and cerebrovascular), makes it possible to predict the likelihood of developing unfavorable cardiovascular ones.

Effects of different types of carotid endarterectomy on the course of resistant arterial hypertension.

OBJECTIVE: Analysis of the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (СЕЕ) (classical with plasty of the reconstruction zone with a patch, eversion, formation of a new bifurcation, autoarterial reconstruction, glomus-saving techniques) in patients with resistant arterial hypertension (RAH). MATERIALS AND METHODS: The actual cohort, comparative, retrospective, open research for the period from January 2013 to December 2021 includes 1577 patients with significant hemodynamic stenosis of the internal carotid artery Depending on revascularization strategy five groups were formed: Group 1: 18.3% (n = 289) - classical Carotid endarterectomy with plasty of the reconstruction zone with a patch (from diepoxy-treated xenopericardium or synthetic); Group 2: 29.9% (n = 472) - eversional CEE with cut-off of carotid gloomus (CG); Group 3: 6.9% (n = 109) - the formation of a new bifurcation; Group 4: 7.4% (n = 117) - autoarterial reconstruction; Group 5: 37.4% (n = 590) - glomus-saving CEE (1 technique - according to A.N. Kazantsev; two technicians - according to R.A. Vinogradov; three technicians - according to K.A.Antsupov). According to the 24-h blood pressure monitor in the preoperative period, the following degrees of AH were identified: 1° - 5.7% (n = 89); 2° - 64.2% (n = 1013); and 3° - 30.1% (n = 475). RESULTS: In the postoperative period, no significant differences were obtained in the frequency of deaths, myocardial infarction, stroke, hemorrhagic transformation. However, according to the frequency of the combined endpoint (death + myocardial infarction + ischemic stroke + hemorrhagic transformation), the lowest rates were observed in the group of classical carotid endarterectomy with plasty of the reconstruction zone with a patch and glomus-sparing CEE (group 1: 1.03% (n = 3); group 2: 3.6% (n = 17); group 3: 3.67% (n = 4); group 4: 2.56% (n = 3); group 5: 0.5% (n = 3); p = 0.10). This is due to the absence of cases of labile AH and hypertensive crises among patients of groups 1 and 5, which was ensured by the preservation of carotid glomus (CG). As a result, the number of patients with 2 and 3 degrees of hypertension in these groups decreased statistically significantly. The vast majority of patients after these operations achieved a stable target SBP. In groups 2, 3, and 4, there was a statistically significant increase in the number of patients with 2 and 3 degrees of AH, which is associated with excision of the CG. CONCLUSION: Classical CEE and glomus-sparing CEE techniques make it possible to achieve a stable target SBP level in patients with RAH as a result of CG preservation. Removal or traumatization of the latter during eversional CEE, the formation of a new bifurcation, autoarterial reconstruction is accompanied by the development of labile hypertension, an increase in the degree of hypertension and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE, accompanied by the lowest incidence of adverse cardiovascular events caused by postoperative hypertensive crisis and hyperperfusion syndrome.

Stenting of the artery of Dr A.N. Kazantsev in the acute period of ischemic stroke.

The A.N. Kazantsev artery is a vessel starting from the common carotid artery with subsequent bifurcation into 2 vessels of equal size-the internal carotid artery (ICA) and the persistent embryonic hypoglossal artery (PEHA). Until now, this artery has been considered as the ICA. However, according to all existing classifications, the ICA in the cervical segment does not have arterial branches. In addition, in view of the comparable sizes of PEHA and ICA, PEHA itself cannot be considered a branch of the ICA. Thus, by the right of the first description, the authors of the article named this vascular formation as the A.N. Kazantsev artery, which forms a bifurcation of the PEHA and ICA. In this clinical case, carotid angioplasty (CAS) was performed with stenting of 80% stenosis of the A.N. Kazantsev artery in the most acute period of acute cerebrovascular accident (ACV). According to angiography, the following was also revealed: the presence of PEHA, extending from the A.N. Kazantsev artery 5 cm above its mouth, connecting with the main artery; stenosis of the right vertebral artery 60% at the mouth; hypoplastic left vertebral artery with aplasia of the V4 segment; open circle of Willis (VC): absence of both posterior communicating arteries (PCA). Due to the high risk of recurrent CVA due to clamping of the A.N. Kazantsev artery during CEA, a multidisciplinary consultation decided to implement an emergency CAS of the A.N. Kazantsev artery. The distal embolism protection system FilterWire was inserted into the proximal part of the basilar artery through the radial artery on the left. The distal embolism protection system RX Accunet was inserted into the distal parts of the left ICA through the left common femoral artery. According to Seldinger, an Acculink stent 7-10 × 30 mm was inserted into the affected area of the A.N. Kazantsev artery, positioned and opened. The postoperative period was uneventful. ACV did not recur. Conducted dual antiplatelet therapy (acetylsalicylic acid 125 mg in the afternoon + clopidogrel 75 mg in the morning). The patient was discharged from the institution on the 10th day after the operation in a satisfactory condition.

Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?

This review of the literature discusses the solution of unresolved issues related to carotid endarterectomy in Russia: (1) A program has been created for choosing the tactics of revascularization of patients with simultaneous atherosclerotic lesions of the coronary and carotid arteries; (2) Using the methods of computer modeling, studying the genetics and morphology of restenosis, it was found that the classic carotid endarterectomy with plasty of the reconstruction zone with a patch is an unsafe type of revascularization; (3) An eversion carotid endarterectomy with transposition of the internal carotid artery over the hypoglossal nerve has been developed, which makes it possible to prevent damage to the latter during repeated carotid endarterectomy for restenosis; (4) It has been established that carotid endarterectomy is associated with a high risk of complications in patients over 75 years of age; (5) It has been proven that emergency carotid endarterectomy in the first hours after the development of a stroke is not safe because. combined with the maximum number of all non-favorable cardiovascular events; (6) 3 new types of carotid endarterectomy with carotid glomus preservation have been developed.

Clinical case of successful treatment of internal carotid artery dissection during aneurysm embolization in acute period of subarachnoid hemorrhage.

Artery dissection during embolization of an intracranial aneurysm is not a frequent complication. In most cases, the tactics of treatment are limited to the appointment of anticoagulants or balloon angioplasty. We present a clinical case of successful treatment of a woman of 47 years. Dissection of the internal carotid artery occurred during aneurysm embolization in the acute period of subarachnoid hemorrhage and required coronary stent implantation. The absence in the long-term period of signs of restenosis or mechanical damage to the coronary stent in the installed position indicates the possibility of implanting it in the indicated position in urgent situations. The clinical significance of the described case consists in combining sequentially rarely occurring events one after another.

Simultaneous internal carotid artery stenosis and ipsilateral anterior communicating artery saccular aneurysm treatment: a case report.

The presence of ipsilateral aneurysm in the stenosis of the internal carotid artery is determined by computed tomography angiography in 1.8%-3.2% of cases. The literature describes the most varied options for treating this pathology: isolated or alternate, and now the method of simultaneous endovascular treatment - carotid stenting and endovascular embolization of aneurysm - is gaining popularity. We presented a clinical case of treatment of 61 women with critical stenosis (90%) and tortuosity of the internal carotid artery in combination with ipsilateral saccular aneurysm of the anterior connecting artery. The uniqueness of this case lies in the fact that a hybrid approach has been applied in the treatment of pathology, not previously described in the literature. The case is highlighting the potential complexity of concomitant vascular cervical and cerebral pathology and the necessity of surgical and endovascular team interactions to choose the appropriate methods of treatment.