Comparative study of prosthetic repair of the internal carotid artery and eversion carotid endarterectomy: long-term outcomes

• Mukhamadeev I.S.
• Oborin A.A.
• Vronskiy A.S.

Abstract

Background. Carotid endarterectomy (CEA) is a proven effective method of preventing stroke. However, in significant propagation of the plaque to the distal portion of the internal carotid artery (ICA), prosthetic repair of the latter may be an operation of choice. Currently, there is a small number of published studies concerning long-term results of prosthetic repair of the ICA with an autovein or synthetic graft.

Patients and methods. We conducted a retrospective single-center study enrolling a total of 165 patients divided into two groups. Group I included 61 patients undergoing prosthetic repair of the ICA and Group consisted of 104 patients subjected to eversion carotid endarterectomy. The indications for prosthetic repair were plaques spreading to the distal portion of the ICA and a thrombogenic surface after endarterectomy more than 4 cm in length.

Results. The median follow-up period for both groups was 51.46 months (range, 1–65 months). The average time of carotid artery clamping was significantly longer in the ICA-replacement group than in the CEA group, amounting to 20.59±4.78 minutes and 12.27±3.45 minutes, respectively (p<0.00001). In the early postoperative period, one patient in Group I experienced an ipsilateral stroke. Wound hematoma was observed in two (3.28%) Group I patients and in one (0.96%) Group II patient (p=0.282). Myocardial infarction occurred in two (3.28%) Group I patients and in one Group II patient. Stroke developed in 3 (4.01%) Group I patients and in one (0.96%) Group II patient (p=0.110). One patient developed thrombosis of the prosthesis in the early postoperative period. Two Group I patients experienced cranial nerve neuropathy. The total number of postoperative complications was higher in Group I than in Group II, encountered in 9 (14.51%) and 2 (1.92%) cases, respectively (p=0.0014). Within the 30-day postoperative period, no events of stroke or myocardial infarction were registered in either group.

In the remote period, the results of treatment were assessed in 60 Group I patients and in 104 Group II patients. Long-term survival turned out to be significantly higher in the CEA Group (p=0.007). Long-term freedom from stroke also differed between the two groups and was better in the group of carotid endarterectomy (p=0.032). In 1 patient, after 36 months, restenosis of the proximal anastomosis with the common carotid artery was revealed, requiring carotid artery stenting. Of 18 Group I patients who had experienced stroke, only 6 developed prosthetic thrombosis in the remote period.

Conclusion. In patients with significant carotid stenosis, it is advisable to perform prosthetic repair of the internal carotid artery only in cases when performing eversion carotid endarterectomy is technically impossible.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Oborin A.A., Mukhamadeev I.S., Vronsky A.S.; data collection and handling – Oborin A.A.; statistical processing – Oborin A.A.; draft manuscript preparation – Oborin A.A.; manuscript revision – Mukhamadeev I.S.

For citation: Mukhamadeev I.S., Oborin A.A., Vronsky A.S. Comparative study of prosthetic repair of the internal carotid artery and eversion carotid endarterectomy: long-term outcomes. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 75–81. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-75-81

Keywords:carotid endarterectomy; prosthetic repair of internal carotid artery; stroke; long-term outcomes