Journal «Angiology and Vascular Surgery» • 

2021 • VOLUME 27 • №2

Extended lesion of the internal carotid artery: carotid autotransplantation, creation of a neobifurcation or prosthetic repair?

Kazantsev A.N.1, Chernykh K.P.1, Kravchuk V.N.2, Vinogradov R.A.3, Abdullaev A.D.4, Povtoreiko A.V.4, Chernyavskiy M.A.5, Khubulava G.G.6

1 Surgical Department № 3, Alexandrovskaya Hospital,
2 Military Medical Academy named after S.M. Kirov, Saint Petersburg,
3 Ochapovsky Regional Clinical Hospital № 1, Krasnodar,
4 Pskov Regional Infection Hospital, Pskov,
5 Research Department of Vascular and Interventional Surgery, National Almazov Medical Research Centre, RF Ministry of Public Health,
6 Pavlov first Saint Petersburg State Medical University, Saint Petersburg, Russia

Objective. 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.

Materials and methods. 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).

Results. 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).

Conclusions. 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.

KEY WORDS: extended atherosclerotic plaque, internal carotid artery, carotid endarterectomy, creation of neobifurcation, autotransplantation of the internal carotid artery, prosthetic repair of the internal carotid artery.

p. 103

« Back

Angiologia.ru - portal for professionals
VLAANT
Lancet
HI-TECHNOLOGY MEDICINE
Transmed