Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p <0.0001), MI (p = 0.011), ischemic stroke (p <0.0001), restenosis / occlusion of the ICA (p <0.0001), combined end point (p <0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period

Ten-year long-term outcomes of conventional and eversion carotid endarterectomy. Multicenter study

Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up

Dynamics of resistant hypertension in the postoperative period of carotid endarterectomy with and without carotid body saving

Aim. To analyze the results of multicenter study on dynamics of resistant hypertension (RH) in patients after various types of carotid endarterectomy (CE) with and without carotid body savingMaterial and methods. During the period from January 2010 to December 2020, 1827 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RH were operated on. Depending on CE type, the two groups were selected. Group 1 (n=1135; 62,2%) consisted of patients received glomus-saving surgery: 19,2% (n=351) -conventional CE with a patch repair of reconstitution point; 13,6% (n=248) — glomus-saving CE sensu R. A. Vinogradov; 7,3% (n=133) — glomus-saving CE sensu K. A. Antsupov; 11,7% (n=214) — glomus-saving CE sensu A. N. Kazantsev; 4,6% (n=84) — Chick-Chirik CE; 5,7% (n=105) — swallow tail type patch repair sensu R. I. Izhbuldin. Group 2 (n=692; 37,8%) consisted of patients received CE without glomus saving: 18,6% (n=341) — eversion CE with carotid body cutoff; 6,3% (n=115) — CE with new bifurcation plasty; 5,85% (n=107) — autoarterial reconstruction; 7,1% (n=129) ICA autotransplantation sensu E. V. Rosseikin.Results. The mortality rate, as well as the prevalence of myocardial infarction (MI) and ischemic strokes were comparable in groups. The incidence of hemorrhagic transformation (group 1: 0%; group 2: 0,6%; p=0,04; OR=0,06; 95% CI, 0,003-1,25) and composite endpoint (death+MI+ischemic stroke+hemorrhagic transformation) (group 1: 1,06%; group 2: 3,0%; p=0,004; odds ratio (OR)=0,34; 95% CI, 0,16-0,69) significantly differs between groups. After glomus-saving CE, the number of patients with the target blood pressure (BP) level reached 51,1% (p <0,0001; OR=0,0009; 95% CI, 6,05-15,9). The number of patients with grade II (31,1%; p<0,0001; OR=12,7; 95% CI, 10,4-15,52) and III (3,6%; p<0,0001; OR=10,26; 95% CI, 6,71-15,67) hypertension significantly decreased. In the group 2, the prevalence grade III hypertension increased (48,0%; p<0,0001; OR=0,23; 95% CI, 0,18-0,3), while the number of patients with grade I (0%; p<0,0001; OR=77,0; 95% CI, 4,71-12,58) and II (52%; p<0,0001; OR=3,06; 95% CI, 2,43-3,86) hypertension decreased.Conclusion. Glomus-saving CE contributes to achieving target BP in patients with RH. Its removal increases the risks of labile hypertension, postoperative hypertensive crisis, hyperperfusion syndrome and hemorrhagic transformation