Medium-term results of surgical intervention on brachiocephalic and coronary arteries in patients with multifocal atherosclerosis
Atherosclerosis is a systemic degenerative process that affects the aorta and the great vessels of the brain, heart and other organs. The analysis of the results of surgical treatment of patients with occlusive-stenotic lesion of two vascular pools, heart and brain in the medium-term follow-up period is insufficiently highlighted in the literature.
The purpose of the work. To carry out a comparative analysis of the medium-term results of surgical treatment of patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries.
Materials and methods. The analysis of medium-term results of surgical treatment of 62 patients with combined atherosclerotic occlusive-stenotic lesion of carotid and coronary arteries was carried out. The research protocol included general clinical and special methods: ECG, echocardiography, coronaro-ventriculography, duplex ultrasound scanning of the carotid arteries, perfusion computed tomography of the brain.
Results and discussion. The result of surgical intervention and patient QoL of the first and second study groups in terms of up to 6 months were evaluated from the cardiological point of view, as good in 53 cases (94.6%), and as satisfactory in 3 cases (5.4%). There were no evidence of myocardial ischemia and recurrent myocardial infarction. Neurological status was assessed as good in 49 cases (87.5%), as satisfactory – in 6 cases (10.7%) and unsatisfactory – in 1 case (1.8%), where the cause was cerebral stroke. There were no statistically significant differences in the results of surgical treatment in the groups of single-stage intervention and stepped therapy. The negative dynamics of the clinical state over time was due mainly to the progression of the underlying disease.
Conclusions. The analysis of the results of single-stage intervention and stepped therapy in patients with occlusive-stenotic lesion of two vascular pools established that the tactic of choosing the method of surgical correction of combined lesions of the coronary and brachiocephalic arteries developed by us allows us to obtain good results in the medium-term follow-up period. Angina pectoris and recurrent myocardial infarction at 6 months after surgery were not recorded. Only in 1 patient of the second group, that received stepped therapy on the coronary and brachiocephalic arteries, had acute nonfatal cerebral circulatory disorders. Thus, the choice of the optimal approach to the tactics of the operative intervention allows to safely performing the restoration of blood flow in patients with combined lesions of the carotid and coronary arteries.
2. Характеристика атеросклеротических изменений сонных артерий по данным мультиспиральной компьютерной томографии при метаболическом синдроме / Праскурничий Е. А., Александрова И. И., Костычева Т. В. и др. // Клин. медицина. – 2017. – № 95 (1). – С. 51–6.
3. ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/ SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document / Bates E. R., Babb J. D., Casey D. E. Jr. et al. // J Am Coll Cardiol. – 2007 Jan. – Vol. 49 (1). – P. 126–70.
4. Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis / Barrera J. G., Rojas K. E., Balestrini C. et al. // J Vasc Surg. – 2013 Feb. – Vol. 57 (2 Suppl). – 58S–63S.
5. Boren J., Williams K. J. The central role of arterial retention of cholesterol-rich apolipoprotein-B-containing lipoproteins in the pathogenesis of atherosclerosis: a triumph of simplicity // Curr Opin Lipidol. – 2016 Oct. – Vol. 27 (5). – P. 473–83.
6. Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion. A systematic review and meta-analysis / Gupta A., Chazen J. L., Hartman M. et al. // Stroke. – 2012. – Vol. 43. – P. 2884–91.
7. Noiphithak R., Liengudom A. Recent update on carotid endarterectomy versus carotid artery stenting // Cerebrovasc Dis. – 2017. – Vol. 43 (1/2). – P. 68–75.
8. Rapid progression of coronary atherosclerosis: a review / Shah P., Bajaj S., Virk H. et al. // Thrombosis. – Vol. 2015 (2015). – Article ID 634983. – 6 p.
9. Perioperative strokes following combined coronary artery bypass grafting and carotid endarterectomy: A nationwide perspective / Udesh R., Cheng H., Mehta A. et al. //. Neurol India. – 2018 Jan-Feb. – Vol. 66 (1). – P. 57–64.