Kazantsev A N, Chernykh K P, Bagdavadze G Sh, Baiandin M S
Municipal Aleksandrovskaya Hospital, Saint Petersburg, Russia.
Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia.
Angiol Sosud Khir. 2021;27(2):92-98. doi: 10.33529/ANGIO2021217.
The study was aimed at analysing the in-hospital results of carotid re-endarterectomy and plasty of the zone of reconstruction with a biological patch in patients with haemodynamically significant restenosis and contraindications to carotid angioplasty with stenting.
During the period from 2008 to 2019, we operated on a total of 22 patients presenting with carotid restenosis and found to have contraindications to carotid angioplasty with stenting (an extended lesion, unstable neointima, calcification, pronounced tortuosity). Carotid re-endarterectomy was performed according to the classical technique. The time period after the first intervention to regression of pathology amounted to 48.5±21.3 months. All patients with clinical manifestations of angina pectoris were at the preoperative stage subjected to coronarography, as a result of which in one case a hybrid intervention was performed in the scope of percutaneous coronary intervention and carotid endarterectomy. The endpoints included death, myocardial infarction, acute impairment of cerebral circulation, and lesions of craniocerebral nerves.
Carotid re-endarterectomy was most often carried out according to the classical technique with plasty of the zone of reconstruction using a xenopericardial patch. Only in 1 case it was required to perform eversion carotid re-endarterectomy due to tortuosity of the internal carotid artery. During the in-hospital postoperative period no lethal outcomes, myocardial infarctions, nor haemorrhagic complications were registered. One patient was found to develop acute impairment of cerebral circulation. The most frequent complication was unilateral laryngeal paresis caused by lesions of craniocerebral nerves (n=3; 13.6%), with reversible neurological deficit. No cases of either thrombosis/restenosis or elevated pressure gradient in the area of implantation of the xenopericardial patch were revealed. The composite endpoint amounted to 18.2% (n=4).
The classical carotid re-endarterectomy was not accompanied by cases of thrombosis and restenosis during either the in-hospital or remote period of follow up, however turned out to be associated with a high frequency of the development of complications such as acute impairment of cerebral circulation and lesions of craniocerebral nerves.
本研究旨在分析血流动力学显著狭窄且有颈动脉支架置入术禁忌证的患者行颈动脉再次内膜切除术及生物补片重建区域成形术的院内结果。
2008年至2019年期间，我们共对22例出现颈动脉狭窄且有颈动脉支架置入术禁忌证（病变范围广、新生内膜不稳定、钙化、明显迂曲）的患者进行了手术。颈动脉再次内膜切除术按照经典技术进行。首次干预至病理消退的时间为48.5±21.3个月。所有有胸痛临床表现的患者在术前均接受了冠状动脉造影，结果1例患者在经皮冠状动脉介入治疗和颈动脉内膜切除术范围内进行了杂交手术。观察终点包括死亡、心肌梗死、脑循环急性损害和脑神经损伤。
颈动脉再次内膜切除术最常按照经典技术进行，使用异种心包补片对重建区域进行成形术。仅1例因颈内动脉迂曲需要行外翻式颈动脉再次内膜切除术。在术后院内期间，未记录到死亡、心肌梗死或出血并发症。发现1例患者出现脑循环急性损害。最常见的并发症是由脑神经损伤引起的单侧喉麻痹（n=3；13.6%），伴有可逆性神经功能缺损。未发现异种心包补片植入区域有血栓形成/再狭窄或压力梯度升高的情况。复合终点发生率为18.2%（n=4）。
经典的颈动脉再次内膜切除术在院内或远期随访期间均未出现血栓形成和再狭窄病例，然而结果显示其与脑循环急性损害和脑神经损伤等并发症的高发生率相关。
