Vol. 24 No. 3 (2020)
VASCULAR SURGERY

Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results

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  • A. Kazantsev,
  • K. Chernykh,
  • R. Leader,
  • N. Zarkua,
  • K. Kubachev,
  • G. Bagdavadze,
  • E. Kalinin,
  • T. Zaitseva,
  • A. Chikin,
  • Yu. Linets
A. Kazantsev
Alexander Hospital, Saint Petersburg
Bio
K. Chernykh
Alexander Hospital, Saint Petersburg
R. Leader
Kemerovo State Medical University, Ministry of Health of the Russian Federation, Kemerovo
N. Zarkua
Alexander Hospital, Saint Petersburg, Russian Federation; I.I. Mechnikov North-Western State Medical University, Saint Petersburg
K. Kubachev
I.I. Mechnikov North-Western State Medical University, Saint Petersburg
G. Bagdavadze
Alexander Hospital, Saint Petersburg
E. Kalinin
Alexander Hospital, Saint Petersburg
T. Zaitseva
Alexander Hospital, Saint Petersburg
A. Chikin
Alexander Hospital, Saint Petersburg
Yu. Linets
Alexander Hospital, Saint Petersburg
DOI: https://doi.org/10.21688/1681-3472-2020-3-70-79

Published 2020-09-30

Keywords

  • autotransplantation of the internal carotid artery,
  • carotid endarterectomy,
  • carotid endarterectomy by DeBakey,
  • carotid glomus,
  • classical carotid endarterectomy,
  • eversion carotid enadrectomy,
  • extended lesion,
  • glomus-saving carotid endarterectomy
    • ...More
    Less

How to Cite

Kazantsev, A., Chernykh, K., Leader, R., Zarkua, N., Kubachev, K., Bagdavadze, G., Kalinin, E., Zaitseva, T., Chikin, A., & Linets, Y. (2020). Glomus-saving carotid endarterectomy by A. N. Kazantsev. Hospital and medium-remote results. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 24(3), 70–79. https://doi.org/10.21688/1681-3472-2020-3-70-79

Copyright (c) 2020 Kazantsev A.N., Chernykh K.P., Leader R.Yu., Zarkua N.E., Kubachev K.G., Bagdavadze G.Sh., Kalinin E.Yu., Zaitseva T.E., Chikin A.E., Linets Yu.P.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. Analysis of the results of hospital and medium-long-term results obtained using a new method of glomus-saving carotid endarterectomy (CEE) according to A. N. Kazantsev.
Methods. This prospective study was conducted during January 2018 to April 2020 on 214 patients who were operated for occlusive stenotic lesions of the internal carotid artery (ICA) using holomus-saving CEE as per the method described by A.N. Kazantsev. The average observation duration was 17.2 ± 6.5 months. Glomus-saving CEE as per the method by A. N. Kazantsev is performed as follows. Arteriotomy is performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2–3 cm above the mouth, depending on the distribution of atherosclerotic plaque, with a transition to the common carotid artery (also 2–3 cm below the ECA mouth). The ICA was cut off at the site formed by the wall sections of the ECA and the common carotid artery. Thereafter, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from the ECA and OCA. Then, the ICA at the saved site was implanted in the previous position. A 6-0 Prolene thread was used as the suture material for performing a vascular anastomosis.
Results. The average ICA clamping time was 33.1 ± 3.4 min. Considering the intraoperative visualisation of an extended atherosclerotic plaque in the ICA, in some cases, there was a need to transform the operation. In 4.7% (n = 10) cases, autologous ICA transplantation was performed as per E. V. Rosseykinu. During the hospitalisation, the observation of cardiovascular complications was not recorded. When analysing the dynamics graph of systolic blood pressure, it was revealed that after glomus-saving CEE as per the method by A. N. Kazantsev, stable numbers are maintained during preoperative antihypertensive therapy and do not rise above 137.9 ± 7.5 mm Hg. In the mid-long-term follow-up, 1 (0.46 %) death was recorded, 1 (0.46%) due to myocardial infarction, 1 (0.46%) due to non-lethal ischaemic stroke, and 2 (0.9%) due to hemodynamically significant restenosis 12 mon after CEE. The combined endpoint (death + myocardial infarction + stroke) was reached in 3 (1.4%) patients. The cause of the lethal outcome was circular myocardial infarction that developed, given the patient's refusal to follow double disaggregant therapy (2 stents were previously implanted in the anterior descending and right coronary arteries). The cause of ischaemic stroke was the development of ICA restenosis (12 mon after CEE) owing to neointimal hyperplasia, as shown by histological examination after repeated surgery.
Conclusion. CEE as per the method by A. N. Kazantsev is the simplest method of operation for known glomus-preserving reconstructions. The absence of complex arteriotomy, the preservation of carotid bifurcation structures, and the possibility of transformation of the intervention into autologous autologous transplantation with prolonged lesion is preferred over other methods. An additional opportunity for high-quality endarterectomy from ЕCA also creates preventive conditions in the prevention of cerebral haemodynamics. Stable blood pressure indicators in the hospital and mid-term follow-up periods demonstrate the importance of the preservation of the carotid glomus during reconstructive surgery on the carotid arteries. Thus, the presented type of CEE meets all the requirements of modern carotid surgery and can be an elective operation in the personalised treatment of patients with occlusal-stenotic lesions of the carotid arteries.

Received 10 May 2020. Revised 25 May 2020. Accepted 26 May 2020.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Method development and testing: A.N. Kazantsev
Conception and design: T.E. Zaitseva, A.E. Chikin, A.N. Kazantsev
Drafting the article: A.N. Kazantsev
Drawing up tables: E.Yu. Kalinin
Statistical analysis: K.P. Chernykh
Literature review: R.Yu. Leader, G.Sh. Bagdavadze
Critical revision of the article: N.E. Zarkua, K.G. Kubachev
Final approval of the version to be published: A.N. Kazantsev, K.P. Chernykh, R.Yu. Leader, N.E. Zarkua, K.G. Kubachev, G.Sh. Bagdavadze, E.Yu. Kalinin, T.E. Zaitseva, A.E. Chikin, Yu.P. Linets

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