3615 consecutive carotid endarterectomies without intraluminal shunt

• Вачёв А.Н.
• Чернышева Н.И.
• Дмитриев О.В.
• Степанов М.Ю.
• Головин Е.А.
• Прожога М.Г.
• Терёшина О.В.
• Кузнецов П.О.

Резюме

Background. Carotid endarterectomy is one of the most frequently performed peripheral vascular operations. We present herein a retrospective and prospective analysis of carotid endarterectomy performed without an intraluminal arterial shunt in a total of 3615 patients.

Objective. The purpose of this study was to assess efficacy and safety of the technology of perioperative management and the technique of carotid endarterectomy with no intraluminal arterial shunt.

Patients and methods. Our study included 3615 patients successively operated on at the same department. All patients underwent elective carotid endarterectomy without an intraluminal arterial shunt. The stages of perioperative management were standardized. All operations were performed under combined general anesthesia. Prior to clamping carotid arteries, we elevated the level of arterial pressure (AP) by 20-30% above the “working” level. Adequacy of blood supply of the brain was controlled by means of cerebral oximetry using the Somanetics INVOS 3100 unit and by the assessment of retrograde blood flow through the internal carotid artery. 3145 (87%) patients underwent modified carotid endarterectomy with creation of high divarication. 470 (13%) patients were subjected to classical carotid endarterectomy with autovenous plasty of the internal and common carotid arteries. The criteria for making the diagnosis of ischemic stroke with determination of the mechanism of its development were standardized.

Results. 3566 (98.64%) patients had no evidence of perioperative stroke and 49 (1.36%) patients developed intraoperative stroke. In 41 (1.13%) of the 3615 patients, the mechanism of development of intraoperative ischemic stroke was atheroembolic, in five (0.14%) - hemodynamic, and in three (0.08%) - lacunar. Eleven (0.3%) patients died from ischemic stroke.

Conclusion. Carotid endarterectomy without an intraluminal shunt did not increase the risk of developing ischemic stroke. Correction of cerebral hypoperfusion during carotid artery cross-clamping should be recognized as an anesthesiological task.

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 - Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O.; statistical processing - Golovin E.A., Stepanov M.Yu.; draft manuscript preparation - Golovin E.A., Stepanov M.Yu.; manuscript revision - Vachev A.N.

For citation: Vachev A.N., Chernysheva N.I., Dmitriev O.V., Stepanov M.Yu., Golovin E.A., Prozhoga M.G., Tereshina O.V., Kuznetsov P.O. 3615 consecutive carotid endarterectomies without intraluminal shunt. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 78-84. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-78-84

Ключевые слова:carotid endarterectomy; ischemic stroke; intraluminal arterial shunt; carotid artery stenosis; atherosclerosis