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Features of Carotid Endarterectomy in Russia. How do we Resolution Issues?
Yuri V Belov1, Anton N Kazantsev2, Vyacheslav N Kravchuk3
1Federal State Budgetary Scientific Institution "Russian Scientific Center of Surgery named B.V. Petrovsky", Moscow, Russian Federation.
Insights
This review addresses carotid endarterectomy challenges in Russia. New techniques and patient selection strategies improve safety and outcomes for carotid artery disease, particularly in complex cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Medical Technology
Background:
- Unresolved issues in carotid endarterectomy (CEA) persist in Russia.
- Simultaneous atherosclerotic lesions in coronary and carotid arteries present complex treatment challenges.
Purpose of the Study:
- To review and propose solutions for critical issues in carotid endarterectomy.
- To enhance patient selection and surgical techniques for improved CEA outcomes.
Main Methods:
- Literature review focusing on Russian contributions to CEA.
- Development of computer modeling and genetic/morphological studies of restenosis.
- Innovation in surgical techniques, including eversion CEA and carotid glomus preservation.
Main Results:
- A program for revascularization tactics in patients with dual artery disease has been created.
- Classic CEA with patch plasty identified as potentially unsafe due to restenosis risks.
- Eversion CEA with internal carotid artery transposition developed to prevent hypoglossal nerve damage.
- High complication risk noted for CEA in patients over 75.
- Emergency CEA within the first hours post-stroke is associated with increased cardiovascular events.
- Three novel CEA techniques preserving the carotid glomus have been developed.
Conclusions:
- Advanced surgical techniques and patient-specific approaches are crucial for safe and effective carotid endarterectomy.
- Age and timing of intervention significantly impact CEA safety and outcomes.
- Ongoing innovation in CEA aims to minimize complications and improve restenosis management.
Abstract:
This review of the literature discusses the solution of unresolved issues related to carotid endarterectomy in Russia: (1) A program has been created for choosing the tactics of revascularization of patients with simultaneous atherosclerotic lesions of the coronary and carotid arteries; (2) Using the methods of computer modeling, studying the genetics and morphology of restenosis, it was found that the classic carotid endarterectomy with plasty of the reconstruction zone with a patch is an unsafe type of revascularization; (3) An eversion carotid endarterectomy with transposition of the internal carotid artery over the hypoglossal nerve has been developed, which makes it possible to prevent damage to the latter during repeated carotid endarterectomy for restenosis; (4) It has been established that carotid endarterectomy is associated with a high risk of complications in patients over 75 years of age; (5) It has been proven that emergency carotid endarterectomy in the first hours after the development of a stroke is not safe because. combined with the maximum number of all non-favorable cardiovascular events; (6) 3 new types of carotid endarterectomy with carotid glomus preservation have been developed.