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).
KazantsevANTarasovRSBurkovNN, et al.Carotid endarterectomythree-year follow-up in a single-center registry. Angiol Vas Surg2018; 24(3): 101–108.
2.
VinogradovRAZakeryaevAB. Features of surgery of the internal carotid arteries with a combination of critical stenosis and pathological tortuosity. Bulletin of the A.N. Baklava RAMS. Cardiovascular diseases2018; 19(3): 305–312. DOI: 10.24022/1810-0694-2018-19-3-305-312
3.
VinokurovIAYasnopolskayaNVHasanovEN, et al.Carotid endarterectomy in the early period after systemic thrombolysis in acute cerebrovascular accident. Cardiol Cardiovascular Surg2021; 14(5): 370–375. DOI: 10.17116/kardio202114051370
4.
ZavaruevAV. Prevention of ischemic brain injury in surgery of the brachiocephalic arteries. Cardiol Cardiovascular Surg2022; 14(5): 376–379. DOI: 10.17116/kardio202114051376
5.
KazantsevANChernykhKPLeaderRY, et al.Glomus-sparing carotid endarterectomy according to A.N. Kazantsev. Hospital and mid-term results. Circulatory Pathol Cardiac Surg2020; 24(3): 70–79. DOI: 10.21688/1681-3472-2020-3-70-79
6.
KazantsevANChernykhKPZarkuaNE, et al.Eversion carotid endarterectomy transposition of the internal carotid artery over the hypoglossal nerve. Surgery2021; 6: 63–71. DOI: 10.17116/hirurgia202106163
7.
KazantsevANVinogradovRAErofeevAA, et al.Extended lesion of the internal carotid artery: Six types of reconstruction. Results of a multicenter study. Cardiol Cardiovascular Surg2021; 14(5): 354–369. DOI: 10.17116/kardio202114051354
8.
KazantsevANChernyavskyMAVinogradovRA, et al.Implantation of a long biological patch during classical carotid endarterectomy for extended atherosclerotic lesions. Long-term results. Bulletin of Transplantol Artificial Organs2021; 23(1): 112–124. DOI: 10.15825/1995-1191-2021-1-112-124
9.
VachevANProzhogaMGDmitrievOV. Influence of systemic hemodynamics on retrograde pressure in the internal carotid artery during carotid endarterectomy. Clin Physiol Blood Circulation2019; 16(4): 293–298. DOI: 10.24022/1814-6910-2019-16-4-293-298
10.
KazantsevANChernykhKPZarkuaNE, et al.A new method of glomus-sparing carotid endarterectomy according to A. N. Kazantsev: Cutting off the internal carotid artery at the site from the external and common carotid artery. Russian J Cardiol2020; 25(8): 10–17. DOI: 10.15829/1560-4071-2020-3851
11.
BelovYVLysenkoAVLednevPV, et al.Application of decellularized xenopericardium patch in brachiocephalic artery surgery. Cardiol Cardiovascular Surg2018; 11(2): 31–34. DOI: 10.17116/kardio201811231-34
12.
BockeriaLAAbdulgasanovRAOShogenovMA, et al.Infection of synthetic patches and prostheses of brachiocephalic arteries: Diagnostic and treatment methods. Breast and Cardiovascular Surg2020; 62(6): 494–505. DOI: 10.24022/0236-2791-2020-626-494-505
13.
DarvishNAMAShogenovMAAbdulgasanovRAO, et al.Surgical treatment methods for atherosclerotic lesions of the carotid arteries. Breast and Cardiovascular Surg2020; 62(5): 405–416. DOI: 10.24022/0236-2791-2020-62-5-405-416
14.
YarikovAVFraermanAPMukhinAS, et al.The history of the development of carotid artery surgery. Neurosurg Neurol Kazakhstan2019; 56(3): 78–90.
15.
FokinAAKuvatovAV. Immediate and long-term results of carotid endarterectomy with dilatation patch repair. Proceedings of higher educational institutions. Ural region2013; 2: 161–166.
16.
KazantsevANSultanovRVBurkovNN, et al.Long-term results of surgical and conservative treatment of patients with occlusive-stenotic lesions of the carotid arteries. Surgery2020;1:67–73. DOI: 10.17116/hirurgia202001167
17.
KazantsevANTarasovRSBurkovNN, et al.Hospital results of percutaneous coronary intervention and carotid endarterectomy in hybrid and phased modes. Angiol Vascular Surg2019; 25(1): 101–107. DOI: 10.33529/angio2019114
18.
National guidelines for the management of patients with brachiocephalic artery disease. Angiol Vascular Surg. 2013; 19(2): 4–68
19.
DudanovIPAbuazabBSAkhmetovVV. Comparative characteristics of classical and eversion endarterectomy of the carotid arteries. Res Pract Med2017; 4(3): 8–15. DOI: 10.17709/2409-2231-2017-4-3-1
20.
KazantsevANBurkovNNAnufrievAI, et al.Medium-term results of carotid endarterectomy in patients with varying degrees of contralateral lesion. Cardiol Cardiovascular Surg2020; 13(2): 95–103. DOI: 10.17116/kardio20201302195
21.
GavrilenkoAVKuklinAVAl-YousefNN, et al.Meta-analysis of the results of eversion carotid endarterectomy and endarterectomy with plastic patch. Angiol Vascular Surg2020; 26(1): 176–183. DOI: 10.33529/ANGIO202012
22.
KazantsevANChernykhKPLeaderRY, et al.Comparative results of classical and eversional carotid endarterectomy. Cardiol Cardiovascular Surg2020; 13(6): 550–555. DOI: 10.17116/kardio202013061550
23.
AlekyanBGPokrovskyAVZotikovAE, et al.Results of various treatment strategies for patients with combined lesions of the internal carotid and coronary arteries. Endovascular Surg2021; 8(2): 144–153. DOI: 10.24183/2409-4080-2021-8-2-144-153
24.
PokrovskyAVBeloyartsevDFAdyrkhaevZA, et al.Does the method of carotid reconstruction affect the immediate results of the intervention?Angiol Vascular Surg2012; 18(3): 81–91
25.
PokrovskyAVGolovyukAL. The state of vascular surgery in the Russian Federation in 2018. Angiol Vascular Surg App2018; 25(2): 1–40.
26.
KazantsevANVinogradovRAZakharovYN, et al.Prediction of restenosis after carotid endarterectomy by computer simulation. Emerg Medical Care J Them. N.V. Sklifosovsky2021; 10(2): 401–407. DOI: 10.23934/2223-9022-2021-10-2-401-407
27.
KazantsevANBurkovNNZakharovYN, et al.Personalized brain revascularization: A method of computer modeling of the reconstruction area for carotid endarterectomy. Surgery2020; 6: 71–75. DOI: 10.17116/hirurgia202006171
28.
KazantsevANBurkovNNBorisovVG, et al.Computer modeling of hemodynamic parameters in the bifurcation of the carotid arteries after carotid endarterectomy. Angiol Vascular Surg2019; 25(3): 107–112. DOI: 10.33529/ANGIO2019311
29.
KazantsevANBogomolovaAVBurkovNN, et al.Morphology of restenosis after classical carotid endarterectomy with diepoxy-treated xenopericardium patch. Cardiol Cardiovascular Surg2020;13(1):68–71. DOI: 10.17116/kardio202013011168
KazantsevANTarasovRSBurkovNN, et al.Predictors of long-term complications after carotid endarterectomy. Surgery2019; 6: 20–25. DOI: 10.17116/hirurgia201906120
32.
BazylevVVShmatkovMGMorozovZA. Predictors of complications in the early postoperative period after carotid artery stenting and carotid endarterectomy. Diagnostic and Interventional Radiol2019; 13(2): 44–50. DOI: 10.25512/DIR.2019.13.2.05
33.
AnufrievPLTanashyanMMGulevskayaTS, et al.Morphological markers of the main pathogenetic variants of ischemic strokes in cerebral atherosclerosis. An Clin Exp Neurol2018; 12(4): 16–22
34.
VinogradovRAKosenkovANVinokurovIA, et al.“Dumb” ischemic foci in the brain after revascularization of the brachiocephalic arteries. Bulletin of the National Medical and Surgical Center. N.I. Pirogov2017; 12(2): 52–54
35.
KazantsevAN. Multicenter study: Results of classical and eversional carotid endarterectomy with and without type 2 diabetes mellitus. Russian J Cardiol2021; 26(S7): 7
36.
ZybinAVTiminaIEPokrovskyAV, et al.Immediate results of carotid endarterectomy in patients receiving statin therapy. Russian Med Biol Bulletin Named After Acad I.P. Pavlova2017; 25(3): 1189–1414. DOI: 10.23888/PAVLOVJ20173404-414
37.
NazarenkoMSSleptcovAALebedevIN, et al.Genomic structural variations for cardiovascular and metabolic comorbidity. Sci Rep2017; 7: 41268. DOI: 10.1038/srep41268
38.
NazarenkoMSMarkovAVKorolevaYA, et al.Identification of differentially methylated genes potentially associated with atherosclerosis in humans. Russian J Cardiol2017; 22(10): 42–48. DOI: 10.15829/1560-4071-2017-10-42-48
39.
SharyshDVMarkovAVSleptsovAA, et al.Demethylation of line-1 retrotransposon is associated with the destabilization of atherosclerotic plaques. Med Genetics2020; 2020: 19. DOI: 10.25557/2073-7998.2020.05.50-51
40.
SleptsovAANazarenkoMSZaitsevaAV, et al.Structural variability of the apobec3a-apobec3b locus in patients with carotid atherosclerosis in combination with acute cerebrovascular accidents and type 2 diabetes mellitus. Med Genetics2020; 2020: 19. DOI: 10.25557/2073-7998.2020.05.48-49
41.
SleptsovAANazarenkoMSZaitsevaAV, et al.Somatic mosaicism and structural variability of the gbp3 gene in atherosclerosis. Atherosclerosis2019; 15(4): 46–51. DOI: 10.15372/ATER20190404
42.
GuselnikovaYILeaderRYKazantsevAN, et al.Characteristics of restenosis and progression of atherosclerosis after carotid endarterectomy in the long-term follow-up period. Complex Prob Cardiovascular Dis2019; 8(S3–2): 17.
43.
TarasovRSKazantsevANAnufrievAI, et al.Surgical factors of restenosis of the internal carotid artery after carotid endarterectomy. Cardiol Cardiovascular Surg2018; 11(4): 47–53. DOI: 10.17116/kardio201811447
44.
BakhmetyevASChekhonatskayaMLDvoenkoOG, et al.The incidence of residual stenosis after carotid endarterectomy. Bulletin Med Internet Conf2017; 7(4): 683
45.
CherednichenkoYV. Endovascular treatment of acute tandem occlusion of the left internal carotid and middle cerebral arteries as a complication of carotid endarterectomy. Endovascular Neurorentgenosurg2019; 30(4): 68–78. DOI: 10.26683/2304-9359-2019-4(30)-68-78
