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4 . 2025

Changes in the carotid body during development of carotid atherosclerosis: should be saved during carotid endarterectomy?

Abstract

Background. Carotid endarterectomy (CEA) is an established method for stroke prevention in patients with significant carotid bifurcation stenosis. The carotid body (CB), a peripheral chemoreceptor located at the bifurcation, participates in the regulation of respiration and blood pressure. Whether the CB should be preserved during CEA remains a matter of debate, particularly in patients with atherosclerosis and resistant hypertension.

Objective. To study morphological and histological changes of the CB in patients with significant carotid artery stenosis and resistant arterial hypertension undergoing CEA.

Materials and methods. Thirty-four CBs were excised during unilateral CEA in patients with >70% internal carotid artery stenosis and resistant hypertension. Histological, immunohistochemical, and morphometric analyses were performed to quantify stromal, vascular, neural, and parenchymal components.

Results. The mean CB section area was 31.941 µm². The median number of lobules was 4. The ratio of functional parenchyma (lobules) to connective tissue was 1:2.08. Functional tissue accounted for ~30% of the CB area, whereas connective tissue comprised up to 62%. Morphological examination revealed lobular deformation, intralobular fibrosis, and vascular wall sclerosis. Despite preservation of lobule number, their size and structure showed marked involutional remodeling.

Conclusion. In patients with advanced carotid atherosclerosis and resistant hypertension, the CB exhibits profound involutional changes characterized by connective tissue expansion and loss of functional parenchyma. These findings suggest that CB preservation during unilateral CEA may be unwarranted, as its physiological role appears to be largely abrogated under chronic hypoxia.

Keywords: carotid endarterectomy; atherosclerosis; carotid artery stenosis; resistant hypertension; carotid body; involution; connective tissue

Funding. The study received no financial support.

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Vachev A.N., Sevriukova V.N., Ganina E.S.; processing of the material – Sevriukova V.N.; draft manuscript preparation – Sevriukova V.N.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Sevriukova V.N., Ganina E.S. Changes in the carotid body during development of carotid atherosclerosis: should be saved during carotid endarterectomy? Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (4): 16–21. DOI: https://doi.org/10.33029/1027-6661-2025-31-4-16-21

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, 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.

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