Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions

Ignatenko P.V., Gostev A.A., Saaya Sh.B., Rabtsun A.A., Cheban A.V., Starodubtsev V.B., Karpenko A.A.

National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia

Carotid endarterectomy is the main operation carried out for prevention of ischaemic stroke in haemodynamically significant stenoses of the bifurcation of the common carotid artery. Despite the literature data demonstrating some advantages of eversion carotid endarterectomy over the classical technique there arises a series of complicated, as yet unsolved problems. This concerns the control of the distal portion of an atherosclerotic plaque in prolonged lesions of the internal carotid artery, the absence of a temporary bypass graft, necessity of prosthetic repair of the internal carotid artery in detachment of the distal border of the plaque.

We suggested a new technique of carotid endarterectomy making it possible to widen visual removal of atheromatous masses from the internal carotid artery, to improve the control of the distal portion of the plaque in a prolonged lesion of the internal carotid artery.

We carried out a comparative assessment of efficacy and safety of the new method of carotid endarterectomy versus the classical variant in a randomized study. The proposed technique of carotid endarterectomy turned out to be compatible by safety and demonstrated similar results with the classical carotid endarterectomy by the number of ischaemic strokes, transitory ischaemic attacks, and myocardial infarctions in the early and remote postoperative periods.

When comparing the groups by efficiency, the primary efficacy endpoint, including cases of restenosis ≥50% according to the findings of ultrasonographic examination of the brachiocephalic arteries, all cases of ischaemic events (acute impairments of cerebral circulation, transitory ischaemic attacks), as well as the presence of the clinical picture of cranial nerve paresis demonstrated a significant advantage of the new technique versus the comparison group at the expense of a lower incidence of restenoses in the area of the operation during the whole period of follow up. In the group of autoarterial remodelling, the composite endpoint of outcomes occurred in 6 patients (6.1%) and in the group with the classic carotid endarterectomy – in 19 (19.6%) patients, p=0.005.

KEY WORDS: carotid endarterectomy, randomized comparative study, new technique of carotid endarterectomy, autoarterial remodelling, restenosis.

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