Kazantsev A N, Chernykh K P, Zarkua N E, Vinogradov R A, Chernyavsky M A, Lider R Yu, Bagdavadze G Sh, Kalinin E Yu, Chikin A E, Linets Yu P
Alexander Hospital, St. Petersburg, Russia.
Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.
Khirurgiia (Mosk). 2021(6):63-71. doi: 10.17116/hirurgia202106163.
To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE) with transposition of internal carotid artery (ICA) over hypoglossal nerve.
A cohort prospective open-label study included 919 patients with severe ICA stenosis for the period from January 2017 to April 2020. The 1st group (=172) included patients who underwent eversion CEE with ICA transposition over hypoglossal nerve; the 2nd group (=747) - who underwent conventional eversion CEE. ICA transposition technique included standard mobilization of the carotid arteries, cross-clamping, arterial wall incision, removal of atherosclerotic plaque and ICA translocation above the hypoglossal nerve for subsequent anastomosis. All patients were examined every 6 months. Mean follow-up period was 17.5±6.9 months.
There were no significant between-group differences in cardiovascular morbidity. However, all complications occurred in the 2nd group (traditional eversion CEE). Nevertheless, incidence of adverse events was minimal and combined endpoint did not exceed 0.6% (=5). Both groups were also comparable by overall incidence of cardiovascular events in long-term period. All ICA restenoses (over 70%) were symptomatic with similar incidence (4 (2.3%) vs. 18 (2.4%), respectively, =0.83; OR 0.96; 95% CI 0.32-2.88). Mean restenosis-free period was 7.2±2.6 months. In case of significant restenosis, redo CEE with patch repair was performed. There were no cardiovascular complications. All cases of hypoglossal nerve injury occurred in the 2nd group (0 vs. 18 (100%), respectively; =0.0001; OR 0.003; 95% CI=5.21-0.17) without ICA transposition over the hypoglossal nerve.
Eversion CEE with ICA transposition over the hypoglossal nerve ensures optimal conditions for successful redo CEE in case of restenosis. This technique facilitates ICA mobilization without hypoglossal nerve injury. This aspect is valuable for successful postoperative outcome and adequate quality of life. ICA transposition is not difficult and does not require additional experience. Transposition per se is not a risk factor of ICA restenosis. Thus, ICA transposition may be routinely recommended in patients eligible for eversion CEE.
分析采用颈内动脉（ICA）经舌下神经移位的外翻式颈动脉内膜切除术（CEE）的院内及长期结果。
一项队列前瞻性开放标签研究纳入了2017年1月至2020年4月期间919例重度ICA狭窄患者。第一组（=172例）包括接受ICA经舌下神经移位的外翻式CEE的患者；第二组（=747例）为接受传统外翻式CEE的患者。ICA移位技术包括颈动脉的标准游离、交叉阻断、动脉壁切开、去除动脉粥样硬化斑块以及将ICA移位至舌下神经上方以便后续吻合。所有患者每6个月接受一次检查。平均随访期为17.5±6.9个月。
两组在心血管疾病发生率方面无显著差异。然而，所有并发症均发生在第二组（传统外翻式CEE）。尽管如此，不良事件发生率极低，联合终点不超过0.6%（=5例）。两组在长期心血管事件总体发生率方面也具有可比性。所有ICA再狭窄（超过70%）均有症状，发生率相似（分别为4例（2.3%）对18例（2.4%），=0.83；OR 0.96；95% CI 0.32 - 2.88）。平均无再狭窄期为7.2±2.6个月。对于显著再狭窄病例，进行了带补片修复的再次CEE。无心血管并发症发生。所有舌下神经损伤病例均发生在第二组（分别为0例对18例（100%）；=0.0001；OR 0.003；95% CI = 5.21 - 0.17），即未进行ICA经舌下神经移位的组。
采用ICA经舌下神经移位的外翻式CEE在再狭窄情况下能确保成功进行再次CEE的最佳条件。该技术便于ICA游离且不会损伤舌下神经。这一点对于成功的术后结果和良好的生活质量很有价值。ICA移位并不困难，也不需要额外经验。移位本身并非ICA再狭窄的危险因素。因此，对于适合外翻式CEE的患者，可常规推荐进行ICA移位。
