[Analysis of remote results of eversion carotid endarterectomy]

Analysed herein are remote results of surgical management of patients presenting with atherosclerotic stenoses of carotid arteries by means of eversion carotid endarterectomy. Over the period from 2002 to 2007 specialists of the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health carried out a total of 393 eversion carotid endarterectomies in 356 patients. We assessed the remote results of 338 (86%) operations in 303 (85%) patients, analysing survival, freedom from stroke, patency of the reconstructed internal carotid artery and effects of risk factors on these indices. The average duration of follow-up amounted to 84 ± 31 months (max - 146 mos). A total of 242 (71.2%) patients survived. The cumulative 5-year survival rate amounted to 84%, with 10-year survival equalling 63%. Severity of the initial atherosclerotic lesion of the arterial bed, progression of atherosclerosis, and control over risk factors for atherosclerosis exerted a statistically significant influence on total survival. Acute disorders of cerebral circulation (of any localization) at a median follow-up of 81 ± 33 months (max - 146 mos) developed in 38 (12.1%) patients, of whom in 15 (4.8%) it terminated with a lethal outcome. Five-year cumulative freedom from stroke amounted to 92%, equalling 80% 10 years after. The risk factors which influenced the freedom from stroke included a history of acute impairments of cerebral circulation, restenoses of the reconstructed ipsilateral internal carotid artery (>70%), and diabetes mellitus. Amongst the examined by means of ultrasonography 164 patients, patency of the reconstructed ipsilateral internal carotid artery at an average follow-up of 75 ± 28 months (max - 135 mos) amounted to 95%. Haemodynamically significant restenoses (≥ 70%) were revealed in eight (5%) cases. Of these, three (2%) patients had narrowing of 70-89% and the remaining five (3%) patients had narrowing of ≥ 90% (including 2 occlusions of the reconstructed ipsilateral internal carotid artery). We revealed no risk factors influencing the development of restenosis of the reconstructed ipsilateral internal carotid artery after eversion carotid endarterectomy. The obtained findings give grounds to consider eversion carotid endarterectomy as a safe and reliable method for treatment of atherosclerotic lesions of carotid arteries and, consequently, for prevention of stroke. Control of risk factors may improve remote results of surgical treatment.