Methods of carotid endarterectomy

This literature review is devoted to various carotid endarterectomy (CE) methods that exist today in Russia. The pros and cons of conventional and eversion technique of the operation are given. It is indicated that the former is associated with higher long-term rate of restenosis, aneurysm and patch infection. The second is associated with higher prevalence of intraoperative internal carotid artery (ICA) thrombosis due to intimal detachment distal to endarterectomy area. The following CE methods for patients with prolonged ICA involvement are described: neo bifurcation formation, autoarterial reconstruction, ICA autotransplantation, plastic using an occipital artery flap. The methods of CE with carotid body saving have been demonstrated: 1. Swallow tail type patch repair proposed by R.I. Izhbuldin; 2. S-shaped arteriotomy proposed by K. A. Antsupov; 3. Two types of operations proposed by R. А. Vinogradov; 4. Сutting off the ICA with sections of common and external carotid artery proposed by A. N. Kazantsev; 5. Glomus-saving ICA autotransplantation in patients with prolonged atherosclerotic involvement. The role of ICA transposition over the hypoglossal nerve in eversion CE is presented. The glomus-saving CE with ICA transposition, called Chik-Chirik CE, is described. Conclusions are drawn on the need to demonstrate all CE types in the novel Russian guidelines for the management of patients with of head and neck arterial diseases

CarotidSCORE.RU — risk stratification for complications after carotid endarterectomy

Aim. To demonstrate the first Russian computer program (carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CE).Material and methods. The present study is based on the analysis of a multicenter Russian database including 25812 patients after CE operated on from January 1, 2010 to April 1, 2022. The following types of CE were implemented: conventional CE with patch angioplasty — 6814 patients; eversion CE — 18998 patients. Following postoperative complications were assessed during the study: death, stroke, myocardial infarction (MI), composite endpoint (death + stroke + MI).Results. During inhospital postoperative period, 0,18% of participants died, while 0,14% had MI, 0,35% — stroke. The composite endpoint was recorded in 0,68%. For each factor present in patients, a predictive coefficient was estimated. The predictive coefficient was considered as a numerical parameter reflecting the strength of the effect of each factor on the development of postoperative complications. Based on this equation, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected as a percentage and denoted the risk of postoperative complications with a minimum of 0% and a maximum of 100%. On the basis of obtained calculations, a CarotidSCORE program was created. Its graphical interface is based on the QT framework. It is possible not only to estimate the risk of a complication, but also to save all data about a patient in JSON format. The CarotidSCORE program contains 47 patient parameters, including clinical, demographic, anamnestic and angiographic characteristics. It makes it possible to choose one of the four CE types, which will provide an accurate stratification of the complication risk for each of them.Conclusion. CarotidSCORE (carotidscore.ru) may determine the probability of postoperative complications in patients undergoing CE

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

Sedimentary response to a collision orogeny recorded in detrital zircon provenance of Greater Caucasus foreland basin sediments

The Greater Caucasus orogen on the southern margin of Eurasia is hypothesized to be a young collisional system and may present an opportunity to probe the structural, sedimentary and geodynamic effects of continental collision. We present detrital zircon U‐Pb age data from the Caucasus region that constrain changes in sediment routing and source exposure during the late Cenozoic convergence and collision between the Greater Caucasus orogen and the Lesser Caucasus, an arc terrane on the lower plate of the system. During Oligocene to Middle Miocene time, following the initiation of deformation within the Greater Caucasus, marine sandstones and shales were deposited between the Greater and Lesser Caucasus, and detrital zircon age data suggest no mixing of Greater Caucasus and Lesser Caucasus detritus. During Middle to Late Miocene time, Greater Caucasus detritus was deposited onto the Lesser Caucasus basin margin, and terrestrial, largely conglomeratic, sedimentation began between the Greater and Lesser Caucasus. Around 5.3 Ma, upper plate exhumation rates increased and shortening migrated to pro‐ and retro‐wedge fold‐thrust belts, coinciding with the initiation of foreland basin erosion. Sediment composition, provenance and structural data from the orogen together suggest the existence of a wide (230–280 km) marine basin that was progressively closed during Oligocene to Late Miocene time, probably by subduction/lithospheric underthrusting beneath the Greater Caucasus, followed by initiation of collision between the Lesser Caucasus arc terrane and the Greater Caucasus in Late Miocene to Pliocene time. The pace of the transition from hypothesized subduction to collision in the Caucasus is consistent with predictions from numerical modeling for a system with moderate convergence rates (<13 mm/yr) and hot lower plate continental lithosphere. Basement crystallization histories implied by our detrital zircon age data suggest the presence of two pre‐Jurassic sutures between stable Eurasia and the Lesser Caucasus, which likely guided later deformation.The Greater Caucasus may constitute a natural example of early continental collision. New detrital zircon U‐Pb geochronology data, together with published Cenozoic stratigraphy and structural data from the Greater Caucasus, suggests collision began in the Late Miocene to Pliocene, leading to diachronous changes in deformation and sedimentation in the orogen and associated basins.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167026/1/bre12499.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167026/2/bre12499-sup-0002-FigS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167026/3/bre12499-sup-0001-FigS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167026/4/bre12499-sup-0003-FigS3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167026/5/bre12499_am.pd