Affiliation:
1. Russian Research center of Surgery named after Academician B.V. Petrovsky
2. Federal Scientific and clinical center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
3. Tyumen State Medical University
4. Regional Clinical Hospital № 2
5. City Hospital of St. Martyr Elizabeth
6. Pavlov University
Abstract
The OBJECTIVE was to identify significant risk factors of complications after carotid endarterectomy in the acute period of ischemic stroke, thus improving the outcomes of surgical treatment of symptomatic internal carotid artery stenosis.METHODS AND MATERIALS. The results of treatment of 776 patients after carotid endarterectomy in the acute period of stroke operated in the State Budgetary Institution of Tuberculosis «Regional Clinical Hospital № 2» were subjected to the factor analysis. catamnesis of the disease was traced for at least one year from the surgical intervention.RESULTS. Repeated ispilatory stroke occurred in 13 patients. Significant factors were tortuosity of the target artery (OR, 6.94; 95 % cI=2.21–21.86; p=0.003), aneurysm in the tortuosity zone (OR, 138.5; 95 % cI=11.6–1643.1; p=0.001), the presence of an electric cardiac pacemaker in the patient (OR, 31.71; 95 % cI=2.69–373.84; p=0.05), and need for IcA resection (OR, 6.83; 95 % cI=2.1–21.48; p=0.004). The risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt (OR – 35.86; 95 % cI=2.17–592.92; p=0.05). Tortuosity of the target artery (OR – 4.6; 95 % cI=1.1–18.3; p=0.017), the need for IcA resection and in the presence of complicated atherosclerotic plaque in the reconstruction area (OR – 6.84; 95 % cI=1.89–24.85; p=0.01) turned out to be the sig nificant risk of death in the immediate postoperative period.CONCLUSIONS. Significant risk factors for recurrent stroke and death after carotid endarterectomy performed in the acute period of stroke were the tortuosity of the target artery, an aneurysm in the tortuosity zone, the presence of an electric cardiac pacemaker in the patient and the need for IcA resection in the presence of complicated atherosclerotic plaque in the reconstruction zone. The only risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt. Further large trials are needed to clarify the obtained results.
Publisher
FSBEI HE I.P. Pavlov SPbSMU MOH Russia
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