Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy
Aim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, co...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | Russian |
| Published: |
Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
2022-01-01
|
| Series: | Неотложная медицинская помощь |
| Subjects: | |
| Online Access: | https://www.jnmp.ru/jour/article/view/1265 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849699697585815552 |
|---|---|
| author | A. N. Kazantsev R. A. Vinogradov M. A. Chernyavsky V. N. Kravchuk D. V. Shmatov A. A. Sorokin A. A. Erofeyev V. A. Lutsenko R. V. Sultanov A. R. Shabayev I. M. Radjabov G. Sh. Bagdavadze N. E. Zarkua V. V. Matusevich E. F. Vaiman A. I. Solobuyev R. Yu. Lider V. A. Porkhanov G. G. Khubulava |
| author_facet | A. N. Kazantsev R. A. Vinogradov M. A. Chernyavsky V. N. Kravchuk D. V. Shmatov A. A. Sorokin A. A. Erofeyev V. A. Lutsenko R. V. Sultanov A. R. Shabayev I. M. Radjabov G. Sh. Bagdavadze N. E. Zarkua V. V. Matusevich E. F. Vaiman A. I. Solobuyev R. Yu. Lider V. A. Porkhanov G. G. Khubulava |
| author_sort | A. N. Kazantsev |
| collection | DOAJ |
| description | Aim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, comparative, retrospective, open-label study from January 2014 to December 2020 included 761 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) and RH lasting more than 3 years. Depending on the implemented revascularization strategy, 2 groups were formed: Group 1: 38.0% (n=289) — classical CEE with plasty of the reconstruction zone with a patch (made of diepoxy-treated xenopericardium or synthetic); Group 2: 62% (n=472) — eversion CEE with CB transection. To study the dynamics of systolic blood pressure (SBP) in the preoperative period for 4 days, and in the postoperative period, blood pressure was measured for 10 days (during the period when the patient was in intensive care - according to daily monitoring of blood pressure; in the department - 10 times per day, daily). The average SBP figures for all patients were taken into account when constructing a graph of BP fluctuations.Results. In the postoperative period, the groups were comparable in the frequency of the following events: death (group 1: 0.34% (n=1), group 2: 0.63% (n=3); p=0.98; OR 0.54; 95% CI 0.05–5.21), myocardial infarction (group 1: 0.34% (n=1), group 2: 0.84% (n=4); p=0.71; OR 0, 40; 95% CI 0.04–3.65), ischemic stroke (group 1: 0.34% (n=1), group 2: 1.27% (n=6); p=0.36; OR 0.26; 95% CI 0.03–2.25), hemorrhagic transformation (group 1: 0%, group 2: 0.84% (n=4); p=0.29; OR 0.17; 95% CI 0.009–3.35). However, in terms of the number of all complications (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) presented as a combined endpoint, patients after eversion CEE with CB transection were three times superior to classical surgery (group 1: 1.03% (n=3 ), group 2: 3.60% (n=17); p=0.05; OR 0.28; 95% CI 0.08–0.9).Conclusion. The choice of a revascularization strategy in patients with hemodynamically significant ICA stenosis should be personalized and based on the conclusion of a multidisciplinary consultation, and not only on the preferences of the operating surgeon. In patients with RH, it is more expedient to use classical CEE with plasty of the reconstruction zone with a patch in view of the preservation of the CB during this operation. The intersection of the latter with eversion CEE provokes labile hypertension, progression of RAH and a statistically significant increase in the number of all unfavorable cardiovascular events. Thus, the use of carotid body preserving CEE in patients with RAH confirms the therapeutic mechanism of this manipulation in achieving the target SBP level. |
| format | Article |
| id | doaj-art-2571aa4d6f8847a7a67a5a6e03fcb709 |
| institution | DOAJ |
| issn | 2223-9022 2541-8017 |
| language | Russian |
| publishDate | 2022-01-01 |
| publisher | Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department |
| record_format | Article |
| series | Неотложная медицинская помощь |
| spelling | doaj-art-2571aa4d6f8847a7a67a5a6e03fcb7092025-08-20T03:18:31ZrusSklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare DepartmentНеотложная медицинская помощь2223-90222541-80172022-01-0110464965810.23934/2223-9022-2021-10-4-649-658727Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid EndarterectomyA. N. Kazantsev0R. A. Vinogradov1M. A. Chernyavsky2V. N. Kravchuk3D. V. Shmatov4A. A. Sorokin5A. A. Erofeyev6V. A. Lutsenko7R. V. Sultanov8A. R. Shabayev9I. M. Radjabov10G. Sh. Bagdavadze11N. E. Zarkua12V. V. Matusevich13E. F. Vaiman14A. I. Solobuyev15R. Yu. Lider16V. A. Porkhanov17G. G. Khubulava18St. Petersburg City Alexandrovskaya HospitalS.V. Ochapovsky Research Institute and Regional Clinical Hospital No. 1 of the Ministry of Health of Russian Federation; Kuban State Medical UniversityV.A. Almazov National Medical Research Center of the Ministry of Health of Russian FederationS.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation; I.I. Mechnikov North-Western State Medical UniversitySaint-Petersburg State UniversitySaint-Petersburg State UniversityCity Multidisciplinary Hospital No. 2S.V. Belyaev Kuzbass Regional Clinical HospitalS.V. Belyaev Kuzbass Regional Clinical HospitalL.S. Barbarash Kuzbass Clinical Cardiological ClinicN.N. Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian FederationI.I. Mechnikov North-Western State Medical UniversityI.I. Mechnikov North-Western State Medical UniversityS.V. Ochapovsky Research Institute and Regional Clinical Hospital No. 1 of the Ministry of Health of Russian FederationKemerovo State Medical University of the Ministry of Health of the Russian FederationKemerovo State Medical University of the Ministry of Health of the Russian FederationKemerovo State Medical University of the Ministry of Health of the Russian FederationS.V. Ochapovsky Research Institute and Regional Clinical Hospital No. 1 of the Ministry of Health of Russian FederationS.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation; I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russian FederationAim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, comparative, retrospective, open-label study from January 2014 to December 2020 included 761 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) and RH lasting more than 3 years. Depending on the implemented revascularization strategy, 2 groups were formed: Group 1: 38.0% (n=289) — classical CEE with plasty of the reconstruction zone with a patch (made of diepoxy-treated xenopericardium or synthetic); Group 2: 62% (n=472) — eversion CEE with CB transection. To study the dynamics of systolic blood pressure (SBP) in the preoperative period for 4 days, and in the postoperative period, blood pressure was measured for 10 days (during the period when the patient was in intensive care - according to daily monitoring of blood pressure; in the department - 10 times per day, daily). The average SBP figures for all patients were taken into account when constructing a graph of BP fluctuations.Results. In the postoperative period, the groups were comparable in the frequency of the following events: death (group 1: 0.34% (n=1), group 2: 0.63% (n=3); p=0.98; OR 0.54; 95% CI 0.05–5.21), myocardial infarction (group 1: 0.34% (n=1), group 2: 0.84% (n=4); p=0.71; OR 0, 40; 95% CI 0.04–3.65), ischemic stroke (group 1: 0.34% (n=1), group 2: 1.27% (n=6); p=0.36; OR 0.26; 95% CI 0.03–2.25), hemorrhagic transformation (group 1: 0%, group 2: 0.84% (n=4); p=0.29; OR 0.17; 95% CI 0.009–3.35). However, in terms of the number of all complications (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) presented as a combined endpoint, patients after eversion CEE with CB transection were three times superior to classical surgery (group 1: 1.03% (n=3 ), group 2: 3.60% (n=17); p=0.05; OR 0.28; 95% CI 0.08–0.9).Conclusion. The choice of a revascularization strategy in patients with hemodynamically significant ICA stenosis should be personalized and based on the conclusion of a multidisciplinary consultation, and not only on the preferences of the operating surgeon. In patients with RH, it is more expedient to use classical CEE with plasty of the reconstruction zone with a patch in view of the preservation of the CB during this operation. The intersection of the latter with eversion CEE provokes labile hypertension, progression of RAH and a statistically significant increase in the number of all unfavorable cardiovascular events. Thus, the use of carotid body preserving CEE in patients with RAH confirms the therapeutic mechanism of this manipulation in achieving the target SBP level.https://www.jnmp.ru/jour/article/view/1265carotid endarterectomyclassical carotid endarterectomyeversion carotid endarterectomyresistant arterial hypertensionarterial hypertensionlabile arterial hypertensionpatchhemorrhagic transformation |
| spellingShingle | A. N. Kazantsev R. A. Vinogradov M. A. Chernyavsky V. N. Kravchuk D. V. Shmatov A. A. Sorokin A. A. Erofeyev V. A. Lutsenko R. V. Sultanov A. R. Shabayev I. M. Radjabov G. Sh. Bagdavadze N. E. Zarkua V. V. Matusevich E. F. Vaiman A. I. Solobuyev R. Yu. Lider V. A. Porkhanov G. G. Khubulava Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy Неотложная медицинская помощь carotid endarterectomy classical carotid endarterectomy eversion carotid endarterectomy resistant arterial hypertension arterial hypertension labile arterial hypertension patch hemorrhagic transformation |
| title | Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy |
| title_full | Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy |
| title_fullStr | Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy |
| title_full_unstemmed | Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy |
| title_short | Multicenter Study of Resistant Arterial Hypertension Course After Classic and Eversion Carotid Endarterectomy |
| title_sort | multicenter study of resistant arterial hypertension course after classic and eversion carotid endarterectomy |
| topic | carotid endarterectomy classical carotid endarterectomy eversion carotid endarterectomy resistant arterial hypertension arterial hypertension labile arterial hypertension patch hemorrhagic transformation |
| url | https://www.jnmp.ru/jour/article/view/1265 |
| work_keys_str_mv | AT ankazantsev multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT ravinogradov multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT machernyavsky multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT vnkravchuk multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT dvshmatov multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT aasorokin multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT aaerofeyev multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT valutsenko multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT rvsultanov multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT arshabayev multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT imradjabov multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT gshbagdavadze multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT nezarkua multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT vvmatusevich multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT efvaiman multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT aisolobuyev multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT ryulider multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT vaporkhanov multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy AT ggkhubulava multicenterstudyofresistantarterialhypertensioncourseafterclassicandeversioncarotidendarterectomy |