Меню

Arterial hypertension after carotid endarterectomy and internal carotid artery stenting

Abstract

We performed a comparative analysis of the course of arterial hypertension after internal carotid artery stenting (CAS) (group I, n=31) and carotid endarterectomy with glomectomy (Keni’s modification) (SEA) (group II, n=32). The study was randomized, including patients with grade 2 and higher arterial hypertension, ischemic stroke ipsilateral to carotid lesion, stenosis of the internal carotid artery exceeding 70%, no clinical signs of vertebrobasilar insufficiency, renal artery stenosis, or diabetes mellitus, with the glomerular filtration rate exceeding 80.

In the early postoperative period, the mean values of blood pressure decreased significantly after both CEA and CAS, with the Wilcoxon criteria amounting to 293.5 and 27, respectively (p<0.05). However, a statistically significant difference between the baseline and 1-year values was observed only in the CEA group (р<0.001). Long-term follow-up revealed a statistically significant decrease in the proportion of patients with grade 3 hypertension in the CEA group (р<0.001). Whereas after carotid stenting, the difference turned out to be statistically insignificant. There were between-group statistically significant differences in the Kaplan–Meier estimates for arterial hypertension recurrence and freedom from cardiovascular events, thus suggesting clinical advantage of CEA with glomectomy over CAS in patients with arterial hypertension (р<0.005).

Conclusion. When choosing a method of reconstruction in patients with initially uncontrolled hypertension, unilateral carotid bifurcation stenosis, a history of ischemic stroke ipsilateral to carotid lesion, preference should be given to CEA with glomectomy, as it leads to a long-term (over 1 year) blood pressure decrease.

Keywords:arterial hypertension; carotid endarterectomy; internal carotid artery stenting; symptomatic stenosis of carotid artery; glomectomy

Funding. The study had no financial support.

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

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Frolova E.V., Sevryukova V.N.; statistical processing – Frolova E.V., Sevryukova V.N.; functional and clinical examination of patients – Tereshina O.V., Lebedev P.A.; draft manuscript preparation – Frolova E.V., Sevryukova V.N.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Frolova E.V., Sevryukova V. N., Tereshina O.V., Lebedev P.A. Arterial hypertension after carotid endarterectomy and internal carotid artery stenting. Angiology and Vascular Surgery. Journal named Academician A.V. Pokrovsky. 2022; 28 (3): 68–76. DOI: https://doi.org/10.33029/1027-6661-2022-28-3-68-76 (in Russian)

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Akchurin Renat Suleymanovich

Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Deputy General Director for Surgery, Head of the Department of Cardiovascular Surgery, National Medical Research Center for Cardiology named after Academician E.I. Chazov, President of the Russian Society of Angiologists and Vascular Surgeons

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.