COMPARATIVE CHARACTERISTICS OF CLASSICAL AND EVERSION ENDARTERECTOMY OF THE CAROTID ARTERIES

Abstract

Purpose. The effectiveness of classical and eversion carotid endarterectomy (CE) in patients with cerebral ischemia in atherosclerotic stenosing carotid artery disease (ICA) was compared in the article.Material and methods. The examination and analysis of data of 122 patients with more than 60% ICA stenosis was held: men — n = 92 (60.1%), women n = 61 (39.9%). The average age was 52.3 years (ranged from 34 to 74 years). All the patients were symptomatic. 92 patients underwent an eversion endarterectomy (CE), 30 patients underwent classical CE.The effectiveness of surgical treatment was assessed by the dynamics of the neurological status, the change in the parameters of duplex and transcranial studies before the operation, on day 10, at 1, 3, 6, 9 months, 1, 1.5, 2, 3 years.Results. In patients who underwent eversion CE, in the early postoperative period, a significant decrease in the asymmetry coefficient was revealed in the study of background LSC valuesdue to an increase in the blood flow velocity in the ipsilateral middle cerebral artery (MCA) and a decrease in the linear velocity of the blood flow (LVBF) in the posterior cerebral artery (PCA) on the side of the initially stenotic ICA on the background of improvement of hemodynamic conditions in all cases (p < 0.05). In patients, a significant increase in the reactivity factor for the hypercapnic load from the initial value was noted against the background of approaching the normative indices of the pulsation index. The latent period of vascular reactivity was shortened to 24.3 ± 3.7 seconds. In patients who underwent classical CEAE n = 30, in early terms of up to 1 month, a decrease in the coefficient of asymmetry of LVBF was noted due to the normalization of the velocity characteristics of cerebral blood flow in all the main cerebral vessels of the carotid and vertebrobasilar basins. Comparative analysis of the spectral expansion (SE) values obtained initially and recorded in groups with different types of surgical intervention revealed a significant difference in the resulting data (p < 0.05). Restoration of SE parameters to normative ones was registered in the group of classical CEA in 26.7% (n = 8) and 79.3% (n = 73) with an eversion EAE for 1 month. The maximum rate of positive dynamics was traced during the first month after cerebral revascularization, complete recovery was recorded at the end of the 18th month in the group of eversion CE and 24 months in the group of classical CE. There were no significant differences in the resultant indices of regression of neurological disorders in the postoperative period of an eversion EAE and classical EAE (p > 0.05).With the eversion CE, the total number of complications was n = 9 (9.8%), and 1 (1.1%) case — restenosis in the reconstruction zone. In the case of classical CE, the total number of complications was n = 10 (33.3%), of which n = 1 (3.3%) cases of hyperperfusion syndrome were observed; in n = 2 (6.6%) patients, development of a stroke, 1 (3.3%) developed myocardial infarction. Restenosis in the reconstruction zone was formed in n = 2 (6.6%) patients, peripheral nerve damage was in n = 4 (13.3%) patients.Conclusions. Classic and eversion CE are both effective. Short- and long-term clinical and hemodynamic results of surgical treatment by the method of eversion of the CE are somewhat better than the results of classical one.Classical CE is indicated in cases of extended plaque, eversion of the CE is indicated in the cases of short local plaques.