Kazantsev A N, Chernykh K P, Kravchuk V N, Vinogradov R A, Abdullaev A D, Povtoreĭko A V, Cherniavskiĭ M A, Khubulava G G
Surgical Department #3, Alexandrovskaya Hospital, Saint Petersburg, Russia.
Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russia.
Angiol Sosud Khir. 2021;27(3):96-103. doi: 10.33529/ANGIO2021318.
The aim of our investigation was to analyse the results of autotransplantation, creation of a neobifurcation or prosthetic repair of the internal carotid artery during the in-hospital and long-term follow-up periods.
The study included a total of 241 patients presenting with and treated for extended atherosclerotic lesions of the internal carotid artery from 2016 to 2019. The patients were divided into three groups depending on the surgical modality employed: group 1 - autotransplantation of the internal carotid artery (27.8%, n=67), group 2 - creation of a neobifurcation (55.2%, n=133), and group 3 - prosthetic repair of the internal carotid artery (17.0%, n=41). The duration of the postoperative follow-up period amounted to 24.8±11.9 months. The outcome measures selected were as follows: all-cause mortality, myocardial infarction, ischaemic stroke, haemodynamically significant restenosis, and a composite endpoint (death + myocardial infarction + ischaemic stroke + haemodynamically significant restenosis).
During the in-hospital postoperative period we registered 1 (2.4%) ischaemic stroke in the group of prosthetic repair, with no significant inter-group difference revealed (p=0.08). In the remote period of follow-up, no statistical differences were revealed for the following outcome measures: all-cause mortality (group 1: 7.5%, n=5; group 2: 10.5%, n=14; group 3: 14.6%, n=6; p=0.49); cardiovascular-related death (group 1: 4.5%, n=3; group 2: 6.7%, n=9; group 3: 12.2%, n=5; p=0.31); myocardial infarction (group 1: 1.5%, n=1; group 2: 3%, n=4; group 3: 4.9%, n=2; p=0.59). However, the patients in the group of prosthetic repair of the internal carotid artery were found to have the highest incidence rates of ischaemic stroke (group 1: 3%, n=2; group 2: 3%, n=4; group 3: 14.6%, n=6; p1-2=0.1; p1-3=0.02; p2-3=0.008), haemodynamically significant restenosis (group 1: 0%, n=0; group 2: 0%, n=0; group 3: 14.6 %, n=6; p1-2>0.99; p1-3=0.000; p2-3=0.000), and higher values of the composite endpoint (group 1: 12 %, n=8; group 2: 16.5%, n=22, group 3: 48.8%, n=20; p1-2>0.99; p1-3=0.000; p2-3=0.000).
Prosthetic repair of the internal carotid artery for an extended atherosclerotic lesion is a less preferable method compared with autotransplantation and creation of a neobifurcation, as evidenced by the highest incidence rates of ischaemic stroke, haemodynamically significant restenosis, and higher values of the composite endpoint in the remote period of follow up.
我们的研究目的是分析在住院期间和长期随访期内，颈内动脉自体移植、新分叉创建或人工修复的结果。
该研究纳入了2016年至2019年期间共241例因颈内动脉广泛动脉粥样硬化病变而就诊并接受治疗的患者。根据所采用的手术方式，将患者分为三组：第1组 - 颈内动脉自体移植（27.8%，n = 67），第2组 - 创建新分叉（55.2%，n = 133），第3组 - 颈内动脉人工修复（17.0%，n = 41）。术后随访期时长为24.8±11.9个月。所选的结局指标如下：全因死亡率、心肌梗死、缺血性卒中、血流动力学显著再狭窄以及复合终点（死亡+心肌梗死+缺血性卒中+血流动力学显著再狭窄）。
在住院术后期间，我们在人工修复组记录到1例（2.4%）缺血性卒中，未发现组间有显著差异（p = 0.08）。在随访的远期，以下结局指标未发现统计学差异：全因死亡率（第1组：7.5%，n = 5；第2组：10.5%，n = 14；第3组：14.6%，n = 6；p = 0.49）；心血管相关死亡（第1组：4.5%，n = 3；第2组：6.7%，n = 9；第3组：12.2%，n = 5；p = 0.31）；心肌梗死（第1组：1.5%，n = 1；第2组：3%，n = 4；第3组：4.9%，n = 2；p = 0.59）。然而，发现颈内动脉人工修复组患者的缺血性卒中发病率最高（第1组：3%，n = 2；第2组：3%，n = 4；第3组：14.6%，n = 6；p1 - 2 = 0.1；p1 - 3 = 0.02；p2 - 3 = 0.008），血流动力学显著再狭窄发病率最高（第1组：0%，n = 0；第2组：0%，n = 0；第3组：14.6%，n = 6；p1 - 2>0.99；p1 - 3 = 0.000；p2 - 3 = 0.000），并且复合终点值更高（第1组：12%，n = 8；第2组：16.5%，n = 22；第3组：48.8%，n = 20；p1 - 2>0.99；p1 - 3 = 0.000；p2 - 3 = 0.000）。
对于广泛动脉粥样硬化病变，颈内动脉人工修复与自体移植和创建新分叉相比是一种较不理想的方法，随访远期缺血性卒中、血流动力学显著再狭窄发病率最高以及复合终点值更高证明了这一点。
