Zharova A S, Abramov O O, Golets K O, Gaganova T S, Ryl'skiy R M, Kokaya R V, Buksayev D S, Solotenkova K N, Golokhvastov S V, Klimova A I, Puchnina L I
Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Kemerovo State Medical University, Kemerovo, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(12. Vyp. 2):55-59. doi: 10.17116/jnevro202212212255.
Analysis of the results of carotid endarterectomy (CEE) in the acute period of ischemic stroke (IS).
This retrospective study included 128 patients (mean age 65.2±4.7 years, 84 (65.6%) men) who underwent CEE in the acute period. Inclusion criteria were: an ischemic focus in the brain with a diameter of no more than 2.5 cm according to MRI; mild neurological deficit (from 3 to 8 points on NIHSS); ≤3 points on the modified Rankin Scale (mRS); stenosis of ICA over 60%. Exclusion criteria were: severe neurological deficit; presence of decompensated comorbid dependence; contraindications to CEE.
In the hospital postoperative period, 3.9% of patients were diagnosed with hemorrhagic transformation of the ischemic focus in the brain with progression of neurological deficit and level of consciousness to coma II. In 3.1% cases, a lethal outcome developed on 4-7 days after the operation. In 2.3% patients after CEE, the progression of neurological deficit was noted with the development of new ischemic foci according to postoperative neuroimaging. The probable cause of this event was a distal embolism that developed during the installation of a temporary shunt. Myocardial infarction was diagnosed in 3.9% of patients. The combined end point (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) was 10.1%.
CEE in the most acute period of ischemic stroke is accompanied by a high risk of hemorrhagic transformation, myocardial infarction, and death, which characterizes this revascularization option as unsafe.
分析缺血性卒中（IS）急性期颈动脉内膜切除术（CEE）的结果。
这项回顾性研究纳入了128例在急性期接受CEE的患者（平均年龄65.2±4.7岁，84例（65.6%）为男性）。纳入标准为：根据MRI，脑内缺血灶直径不超过2.5 cm；轻度神经功能缺损（美国国立卫生研究院卒中量表（NIHSS）评分为3至8分）；改良Rankin量表（mRS）评分≤3分；颈内动脉（ICA）狭窄超过60%。排除标准为：严重神经功能缺损；存在失代偿性合并症依赖；CEE的禁忌证。
在术后住院期间，3.9%的患者被诊断为脑缺血灶出血性转化，神经功能缺损和意识水平进展至II级昏迷。在3.1%的病例中，术后4至7天出现致命结局。在CEE后的2.3%患者中，根据术后神经影像学检查发现新的缺血灶，神经功能缺损有所进展。该事件的可能原因是在安装临时分流器期间发生的远端栓塞。3.9%的患者被诊断为心肌梗死。联合终点（死亡+心肌梗死+缺血性卒中+出血性转化）为10.1%。
缺血性卒中最急性期的CEE伴有出血性转化、心肌梗死和死亡的高风险，这表明这种血运重建方法不安全。
