Implantation of a long biological patch in classical carotid endarterectomy for extended atherosclerotic lesions. Long-term outcomes

Abstract

Objective: to analyze the in-hospital and long-term outcomes of classical carotid endarterectomy (CEE) in extended atherosclerotic lesions in comparison with the outcomes of this operation in local atherosclerotic plaque (AP). Materials and Methods. This study, which lasted from January 2010 to December 2020, included 148 patients with extended AP and hemodynamically significant internal carotid artery (ICA) stenosis. The term “extended” was understood as a hemodynamically significant lesion ≥ 5 cm long. These patients made up Group 1. Group 2 was formed over the same period of time from 632 patients with hemodynamically significant stenosis <5 cm long. In both cohorts, CEE with repair of the reconstruction zone with a diepoxide-treated xenopericardial patch was performed. Long-term follow-up was 71.4 ± 45.6 months. Results. The groups were comparable in terms of frequency of in-hospital complications: death (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% Cl 0.14-13.6), myocardial infarction (MI) (group 1: 0.67%, n = 1; group 2: 0.5%, n = 3; p = 0.74; OR = 1.42; 95% CI 0.14-13.6), ischemic stroke (group 1: 0%; group 2: 0.5%, n = 3; p = 0.91; OR = 0.6; 95% CI 0.03-11.8), combined endpoint (death + MI + stroke) (group 1: 1.35%, n = 2; group 2: 1.4%, n = 9; p = 0.74; OR = 0.94; 95% CI 0.2-4.43). The groups were also comparable in terms of frequency of long-term complications: death (group 1: 2.0%, n = 3; group 2: 2.05%, n = 13; p = 0.76; OR = 0.98; 95% CI 0.27-3.5), MI (group 1: 2.7%, n = 4; group 2: 2.4%, n = 15; p = 0.95; OR = 1.14; 95% CI 0.37-3.49), ischemic stroke (group 1: 5.4%, n = 8; group 2: 5.2%, n = 33; p = 0.9; OR = 1.03; 95% CI 0.46-2.29), ICA occlusion and restenosis (group 1: 12.8%, n = 19; group 2: 13.3%, n = 84; p = 0.99; OR = 0.96; 95% CI 0.56-1.63), combined endpoint (death + MI + stroke) (group 1: 10.1%, n = 15; group 2: 9.6%, n = 61; p = 0.98; OR = 1.05; 95% CI 0.58-1.91). Analysis of survival graphs revealed no significant intergroup differences for all types of complications (lethal outcome: p = 0.56; MI: p = 0.73; stroke/mini-stroke: p = 0.89; ICA restenosis/occlusion: p = 0.82; combined end point: p = 0.71). Their increase was uniform in both groups. However, more than half of all ICA restenoses and occlusions were visualized in the first 6 months after CEE. Conclusion. Implantation of a long patch (≥ 5 cm) is not characterized by increased incidence of restenosis and all adverse cardiovascular events during in-hospital and long-term follow-up.