Pokrovskiĭ A V, Beloiartsev D F, Adyrkhaev Z A, Shatokhina A D, Vafina G R, Kutyrev O E
Angiol Sosud Khir. 2012;18(3):81-91.
to carry out comparative assessment of the immediate outcomes of eversion carotid endarterectomy, classical carotid endarterectomy and prosthetic repair of the internal carotid artery in atherosclerotic-genesis stenoses thereof.
the study was based on a retrospective analysis of the immediate results of 630 isolated primary open interventions on the bifurcation of the common carotid artery in atherosclerosis, performed at the Department of Vascular Surgery of the A.V. Vishnevsky Institute of Surgery over the period from January 2008 to December 2010. The choice of the method of intervention was based on the indications developed worked out at our Department with due regard for the clinical and morphological peculiarities of the lesion of the carotid bifurcation.
the incidence of performing eversion carotid endarterectomy (416; 66%) in the entire group was significantly higher than that of classical carotid endarterectomy (127; 20%) and that of prosthetic repair of the internal carotid artery (87; 14%) (p=0.000). Thrombosis of the reconstructed internal carotid artery developed significantly more often (p<0.05) after prosthetic repair (4.6%) and classical carotid endarterectomy (3.9%) as compared with the eversion technique (0.7%). Frequency of the development of homolateral stroke after prosthetic repair of the internal carotid artery (4.6%) was higher than after eversion carotid endarterectomy (1.2%) and classical carotid endarterectomy (2.36%), however, these differences were statistically significant only when compared with the group of the eversion technique (p=0.000). All techniques were accompanied by low mortality from stroke (the eversion technique - 0.24%, classical carotid endarterectomy (0%), prosthetic repair of the internal carotid artery - 1.15%), and the groups did not differ significantly by this parameter (p>0.05).
the choice of the method of carotid endarterectomy should be determined by the character of lesions of the carotid bifurcation, anatomical interrelationships in the operation wound, and tolerance of the brain to clamping of carotid arteries. Eversion carotid endarterectomy, once possible to perform, is the most preferable method of reconstruction in atherosclerotic lesions of the carotid bifurcation.
对外翻式颈动脉内膜切除术、经典颈动脉内膜切除术及颈内动脉人工血管修复术治疗动脉粥样硬化性狭窄的近期疗效进行比较评估。
本研究基于对2008年1月至2010年12月期间在A.V. 维什涅夫斯基外科研究所血管外科进行的630例孤立性原发性开放性颈总动脉分叉部动脉粥样硬化干预手术的近期结果进行回顾性分析。干预方法的选择基于我们科室制定的适应证，并充分考虑了颈动脉分叉部病变的临床和形态学特点。
在整个研究组中，外翻式颈动脉内膜切除术的实施率（416例；66%）显著高于经典颈动脉内膜切除术（127例；20%）和颈内动脉人工血管修复术（87例；14%）（p = 0.000）。与外翻技术（0.7%）相比，人工血管修复术（4.6%）和经典颈动脉内膜切除术（3.9%）后重建的颈内动脉血栓形成明显更常见（p < 0.05）。颈内动脉人工血管修复术后同侧卒中的发生率（4.6%）高于外翻式颈动脉内膜切除术（1.2%）和经典颈动脉内膜切除术（2.36%），然而，这些差异仅在与外翻技术组比较时具有统计学意义（p = 0.000）。所有技术的卒中死亡率均较低（外翻技术 - 0.24%，经典颈动脉内膜切除术 - 0%，颈内动脉人工血管修复术 - 1.15%），且各组在该参数上无显著差异（p > 0.05）。
颈动脉内膜切除术方法的选择应取决于颈动脉分叉部病变的特征、手术切口的解剖关系以及大脑对颈动脉夹闭的耐受性。外翻式颈动脉内膜切除术，一旦可行，是颈动脉分叉部动脉粥样硬化病变最优选的重建方法。
