METHODS OF SURGICAL PREVENTION OF THE ISCHEMIC STROKE

Objective: to estimate the clinical safety of open and endovascular interventions in the carotid arteries in the treatment and prevention of ischemic stroke.

Material and methods: 317 patients (61 women and 256 men) aged 41 to 82 were examined. Carotid endarterectomy (CEA) (Group 1) was performed in 246 patients. Carotid transluminal balloon angioplasty with stenting (CAS) (Group 2) was performed in 71 patients. Symptomatic stenosis of the internal carotid artery (ICA) was detected in 85 patients (in Group1 in 53 patients, in Group2 in 32 patients). Asymptomatic stenosis of the ICA was detected in 232 patients (in Group1 in 193 patients, in Group2 in 39 patients).

Results: in the immediate postoperative period in Group 1 of patients 15 complications (6,1%) developed. Ischemic stroke was stated in 8 cases (3,3%), 3 of which were lethal (1,2%). Transient ischemic attack was observed in 2 patients (0,8%). Myocardial infarction developed in 5 cases (2,0%). In the immediate postoperative period in the Group 2 of patients 4 complications (5,6%) was observed. Complications were demonstrated as an ischemic stroke in 2 cases (2,8%), myocardial infarction - in 1 observation (1,4%), a transient ischemic attack - in 1 patient (1,4%). In 1 observation (1,4%) there was a fatal outcome due to myocardial infarction in the background of hemorrhagic shock because of bleeding from an unidentified source. In the late postoperative period 12 complications developed in Group 1 of patients (6,0%). Th e restenosis of the operatedICA was observed in 8 cases (4,0%). An ipsilateral ischemic stroke was registered in 2 cases (1%). A myocardial infarction was stated in 2 cases (1%). A fatal outcome occurred in 3 cases (1,5%). In the late postoperative period 4 complications (6,8%) developed in Group 2 of patients. The restenosis of the operated ICA was stated in 1 observation (1,7%). A contralateral ischemic stroke was observed in 2 patients (3,4%). A myocardial infarction was registered in 1 observation (1,7%). A fatal outcome resulted from a myocardial infarction occurred in 1 case (1,7%).

Conclusions: CEA and CAS of carotid arteries have the same effi cacy and safety in the immediate and late postoperative periods.

1. Kuznetsov AN. Modern principles of treatment of multifocal atherosclerosis // Vestnik Natsionalnogo medikokhirurgicheskogo Tsentra. 2008;3(1):78–83. (In Russ).

2. Shevchenko YuL, Odinak MM, Kuznetsov AN, Erofeev AA. Cardiogenic and angiogenic cerebral embolic stroke. Moscow: Geotar – Med.; 2006. (In Russ).

3. Adams RJ, Alberts G, Alberts MJ, Benavente O, Furie K, Goldstein LB et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008;39(5):1647–1652. doi: 10.1161/STROKEAHA.107.189063

4. Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, et al. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N. Engl. J. Med. 2016;374(11):1021–1031. doi: 10.1056/NEJMoa1505215

5. Brott TG, Hobson RW, Howard G, CREST Investigators. Stenting versus endarterectomy for treatment of carotidartery stenosis. N. Engl. J. Med. 2010;363(1):11–23. doi: 10.1016/j.jvs.2010.07.042

6. Chambers B. Carotid angioplasty and stenting: will it ever replace endarterectomy? Intern. J. Stroke. 2009;4(6):456–457. doi: 10.1111/j.1747-4949.2009.00350.x

7. Donnan GA. Th e year in stroke. Intern. J. Stroke. 2009;4(6):421. doi: 10.1111/j.1747-4949.2009.00390.x

8. Lal BK, Brott TG. Th e carotid revascularization endarterectomy vs stenting trial completes randomization. J. Vasc. Surg. 2009;50(5):1224–1231. doi: 10.1016/j. jvs.2009.09.003

9. Marulanda – Londono E, Chaturvedi S. Stroke due to large vessel atherosclerosis. Neurol. Clin. Pract. 2016;6(3):252–258. doi: 10.1212/CPJ.0000000000000247

10. Noiphithak R., Liengudom A. Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting // Cerebrovasc. Dis. – 2017. – Vol. 43, №1–2. – P. 68 – 75. doi: 10.1159/000453282

11. Rosenfi eld K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N. Engl. J. Med. 2016;374(11):1011–1020. doi: 10.1056/NEJMoa1515706

12. Rothwell PM. Th e year in stroke: endarterectomy vs angioplasty and stenting. Intern. J. Stroke. 2009;4(6):422. doi: 10.1111/j.1747-4949.2009.00390_1.x