Journal «Angiology and Vascular Surgery» • 

2011 • VOLUME 17 • №2

Carotid endarterectomy or carotid stenting: optimal therapeutic decision-making for patients with carotid artery stenoses

Gavrilenko A.V., Sandrikov V.A.,Ivanov V.A., Piven A.V., Kouklin A.V., Dutikova E.F., Antonov G.I., Miklashevich E.R., Trunin I.V., Abugov S.A.
Department of Vascular Surgery, В.V. Petrovsky Russian Research Centre of Surgery under the Russian Academy of Medical Sciences,
Moscow, Russia
Centre of Roentgenosurgical Methods of Diagnosis and Treatment, Federal State Facility «3rd Central Military Clinical Hospital named after A.A. Vishnevsky under the Ministry of Defence of the Russian Federation»,
City of Krasnogorsk, Russia

The work was aimed at comparatively studying the outcomes of carotid endarterectomy and carotid stenting for optimal therapeutic decision-making in patients presenting with carotid artery stenoses. We examined and treated a total of one hundred and sixty-seven patients. In the group of endarterectomy, we performed a total of 91 operations in 85 patients, and in the group of carotid stenting, a total of 87 stenting procedures were carried out on the internal carotid artery with cerebral protection in 82 patients. This was followed by analysing both short- and long-term outcomes with a follow-up period ranging from 1 year to 3 years. We examined the following postoperative parameters: «stroke + lethality», incidence of transitory ischaemic attacks, as well as the rate of craniocerebral neuropathy and acute myocardial infarction. In the remote period we evaluated the prevalence rate of the parameter «stroke + myocardial infarction + lethality», as well as restenosis recurrence. In the carotid-endarterectomy group, the predictors of unfavourable surgical outcomes were contralateral occlusion (p=0.048) and cardial pathology (p=0.0245). In the group of carotid stenting, these predictors turned out to be a heterogeneous atherosclerotic plaque with an uneven or ulcerated contour (p=0.004), and the degree of cerebrovascular insufficiency (p=0.005).

KEY WORDS: carotid angioplasty and stenting, carotid endarterectomy, contralateral occlusion of the carotid artery, heterogeneous atherosclerotic plaque, functional and anatomical risk factors.

P. 74

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