scholarly journals Significance of lipid peroxidation disorders in genesis of neurological disorders after carotid endarterectomy

2019 ◽  
Vol 1 (16) ◽  
pp. 13-16
Author(s):  
B. A. Shadymov ◽  
M. I. Neimark ◽  
V. V. Shmelyov ◽  
A. A. Shaidurov
Keyword(s):  
Lipid Peroxidation ◽  
Surgical Treatment ◽  
Carotid Artery ◽  
Succinic Acid ◽  
Carotid Endarterectomy ◽  
Postoperative Period ◽  
Neurological Disorders ◽  
Neuronal Damage ◽  
Neurological Complications ◽  
Comparative Characteristic

The article considers the question of the appropriateness of the use of the drug based on succinic acid in the surgical treatment of atherosclerotic occlusion of the carotid artery, for the prevention of neurological complications in the postoperative period. A comparative characteristic of the obtained data of oxidative, antioxidant statuses, as well as markers of neuronal damage in two groups was carried out. The results suggest that the use of cytoflavin during the stages of surgical treatment reduces the number of neurological disorders.

scholarly journals Markers of ischemic neuronal damage, neurological complications of carotid endarterectomy and their management depending on anesthesia type

2013 ◽  
Vol 94 (1) ◽  
pp. 13-17
Author(s):  
V V Shmelev ◽  
M I Neymark
Keyword(s):  
Carotid Endarterectomy ◽  
Neurological Disorders ◽  
Neuronal Damage ◽  
Brain Perfusion ◽  
Neurological Status ◽  
Neurological Complications ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Cervical Plexus Block ◽  
Plexus Block

Aim. to identify the anesthesia method for carotid endarterectomy providing minimal ischemic neuronal damage and decreasing the number of post-surgical complications; to adjust the optimal treatment for associated neurological disorders. Methods. An assessment of anesthesia methods was performed in 190 patients who underwent the carotid endarterectomy. The intravenous anesthesia with propofol (first group, 60 patients), regional anesthesia using deep cervical plexus block (second group, 60 patients), and inhalational anesthesia with sevoflurane (third group, 70 patients) were compared. Brain perfusion parameters, neurological status, ischemic neuronal damage markers were examined. Results. In patients undergoing carotid endarterectomy an ischemic neuronal damage is provoked due to brain perfusion decrease as a result of common carotid artery clipping regardless of anesthesia method. Inhalational anesthesia was associated with relatively lower ischemic neuronal damage markers levels. Some patients form every group have developed serious post-surgical neurological complications (stroke, transient cerebral ischemic attack, neurological status deterioration). Post-surgical complications were registered in 10 (16.7%) patients from the first group, in 9 (15%) patients form the second group, in 3 (4.3%) patients from the third group. Citicoline was the most effective drug for associated neurological disorders treatment. Conclusion. Inhalational anesthesia with sevoflurane compared to intravenous anesthesia with propofol and regional anesthesia using deep cervical plexus block limits the neuronal damage and is associated with lower number of post-surgical neurological complications, which can be treated with citicoline.

scholarly journals Transient iatrogenic Horner’s syndrome following carotid endarterectomy

2019 ◽  
Vol 12 (2) ◽  
pp. e228244 ◽  
Author(s):  
Hena Hidayat ◽  
Mekki Medani ◽  
Eamon Kavanagh
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Postoperative Period ◽  
Horner’S Syndrome ◽  
Horner's Syndrome

We present a case of a 72-year-old man who developed a transient Horner’s syndrome in the immediate postoperative period after right carotid endarterectomy which resolved within 3 months. Although Horner’s syndrome has been reported with several disorders of the carotid artery, our case documents a rare iatrogenic oculosympathetic paresis after elective carotid endarterectomy.

scholarly journals Results of using the modified technique of eversion carotid endarterectomy in patients with extended atherosclerotic disease of bifurcation of common carotid artery

2021 ◽  
Vol 9 (3) ◽  
pp. 415-424
Author(s):  
V.A. Panfilov ◽  
◽  
A.O. Virganskiy ◽  
K.V. Romanenko ◽  
◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Atherosclerotic Plaque ◽  
Postoperative Period ◽  
Internal Carotid ◽  
Early Postoperative Period ◽  
Modified Technique ◽  
Results Of Treatment

BACKGROUND: Eversion carotid endarterectomy is one of the most frequently used methods of carotid endarterectomy. This is primarily due to the relative ease of surgical techniques, reduction in the risk of hemodynamic disorders in the reconstruction zone and the absence of the need to use synthetic material. The main disadvantage of eversion carotid endarterectomy is poor visualization of the distal edge of the atherosclerotic plaque and the lack of control of the unfixed edge of intima in common atherosclerotic lesion of the internal carotid artery. The use of a modified technique of eversion carotid endarterectomy avoids these disadvantages and preserves its advantages. AIM: to analyze the results of the use of modified eversion carotid endarterectomy in patients with extended disease to the internal carotid artery. MATERIALS AND METHODS: The study is based on the analysis of the results of treatment of patients with chronic cerebrovascular insufficiency due to extended atherosclerotic disease of the internal carotid artery, in whom eversion carotid endarterectomy was performed using a modified technique in the conditions of the Department of Vascular Surgery in Vinogradov City Hospital. The presence of an atherosclerotic plaque extending over a distance of more than 2.5 cm from the bifurcation was considered a common damage to the internal carotid artery. The assessment of intraoperative parameters, early postoperative period, as well as treatment results after 3, 6 and 12 months from the moment of surgery was carried out. RESULTS: The results of treatment of 60 patients in the early postoperative and long-term periods were analyzed. The average operation time was 71.37 ± 8.87 minutes. The average time for clamping the ICA was 18.35 ± 3.9 minutes. Transient ischemic attack in the early postoperative period occurred in 1 (1.7%) patient. Restenosis of the internal carotid artery (≥40%) on the side of the performed reconstruction developed in 3 (5.2%) patients. CONCLUSION: The risk of development of neurological disorders in the early postoperative period, as well as of restenosis of the area of surgical intervention in the long-term period when using the modified technique of eversion carotid endarterectomy, correspond to the data of modern world literature.

scholarly journals Combined Endovascular and Surgical Treatment of Chronic Carotid Artery Occlusion: Hybrid Operation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Long Yan ◽  
Zhe Wang ◽  
Zhanchuan Liu ◽  
Haoyuan Yin ◽  
Xuan Chen
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Hybrid Surgery ◽  
Failure Group ◽  
Success Group ◽  
Ischemic Events

Objectives. The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization. Methods. In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016–2018. We extracted and analyzed patients’ demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis. Results. A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; P = 0.042 ). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; P = 0.029 ). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months ( P < 0.01 ). Conclusion. Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.

scholarly journals Prophylaxis of complications in postoperative period in patients, suffering stenosis of carotid arteries

2020 ◽  
Vol 87 (1-2) ◽  
pp. 11-14
Author(s):  
I. S. Pulyaeva ◽  
V. A. Prasol ◽  
Yu. V. Ivanova
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Postoperative Period ◽  
Carotid Arteries ◽  
Conservative Therapy ◽  
Internal Carotid ◽  
Perioperative Period ◽  
Neurological Complications ◽  
Results Of Treatment ◽  
Carotid Arteries Stenosis

Objective. To analyze the surgical treatment results in patients, suffering carotid arteries stenosis, using endarterectomy in combination with conservative therapy. Materials and methods. Results of treatment were analyzed in 58 patients, suffering hemodynamically significant stenosis of carotid arteries and/or presence of embologenic pluck, in whom from 2017 to 2019 yrs in V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkov intraoperative supportive conservative therapy, taking into account the risk for development of the cerebral ischemia and the reperfusion syndrome, was conducted. There were 52 (89.7%) men and 6 (10.3%) women. Middle age of the patients operated on have constituted (65 ± 15) yrs. Results. Basing on the literature data analyzed as well as on investigation of the thrombocytes aggregation in patients in perioperative period the algorithm of supportive conservative therapy was elaborated: injection of 5000 IU heparin 5 min before the internal carotid artery clamping under the ICT control; injection of Citicoline 1000 mg 5 min before the internal carotid artery clamping to the patients with neurological deficiency in accordance to the neurological test data and with application of a temporary by-pass. In all the patients in postoperative period the complications were absent. Control of the carotid arteries passability and the ischemia zone state on the 14th day was conducted, the carotid arteries stenosis was not revealed. Nonsignificant complications, such as the stressed hematoma, demanding postoperative wound revision and hemostasis performance, were observed in 4 patients. In 2 patients postoperative period was complicated by the hypoglossal nerve paresis because of its squeezing by hematoma. Conclusion. Citicoline injection before the carotid artery clamping in the carotid endarterectomy with a temporary by-pass permits to lower the risk for development of neurological complications, and while development of postoperative reperfusion syndrome –to reduce its signs.

scholarly journals The prognostic value of cerebral oxygenation and retrograde pressure during carotid endarterectomy

2016 ◽  
Vol 20 (2) ◽  
pp. 95 ◽  
Author(s):  
A. A. Karpenko ◽  
R. А. Kuzhuget ◽  
O. V. Kamenskaya ◽  
P. V. Ignatenko ◽  
V. B. Starodubtsev ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Oxygenation ◽  
Neuronal Damage ◽  
Area Under The Curve ◽  
Poor Quality ◽  
Predictive Quality ◽  
Close Relationship ◽  
S 100

<p><strong>Aim:</strong> The study aimed to determine the predictive value of retrograde pressure (RP) indicators and cerebral oxygenation in the evaluation of ischemic brain damage during carotid endarterectomy (CEA).<br /><strong>Methods:</strong> This nonrandomized, prospective pilot study included 87 patients with asymptomatic stenosis greater than 70% who underwent carotid endarterectomy under general anesthesia. Brain tolerance to ischemia was determined by measuring and evaluating RP (∆rSO2) and cerebral oxygenation (rSO2) during a trial clamping of the carotid artery. Depending on the degree of reduction of cerebral oxygenation from the baseline (∆rSO2) during a trial clamping of the carotid artery, patients were divided into 3 groups: the first group (n = 35) - ∆rSO2 &lt;9.9%, the second group (n = 35) - ∆rSO2 from 10 to 19.9%, the third group (n = 14) - ∆rSO2 ≥ 20%. The primary end-point of the study was to obtain the AUC value exceeding 0.70, which could mean a high predictive quality of research methods. <br /><strong>Results:</strong> There were no perioperative strokes or myocardial infarctions during the study. Average time of carotid artery clamping was 28 (26-30) minutes. 3 patients who received temporary shunts were excluded from the study because of a simultaneous decrease in the rSO2 and ∆rSO2 indicators. It was found out that S-100 and NSE protein concentration in all groups did not significantly differ at different stages (p&gt; 0.05). A temporary shutdown of blood flow in the carotid artery during CEA is accompanied by significant elevation of cerebral damage markers (S100, NSE) concentration with their subsequent restoration at 3 days after surgery. ROC - analysis revealed that none of the methods for assessing cerebral ischemic tolerance (RP, ∆rSO2 and rSO2) is precise enough (AUC &gt; 0.7) to predict brain injury during carotid endarterectomy. Satisfactory, but a poor quality (AUC&lt; 0.7) of predicting an increase in the reference values of S-100 protein neuromarkers was demonstrated by retrograde pressure, while the other indicators (∆rSO2 and rSO2) did not exceed the area under the curve (AUC) over 0.60. <br /><strong>Conclusion:</strong> Methods of measuring retrograde pressure and cerebral oxygenation are merely a reflection of the collateral blood flow and the cerebral oxygenation level due to their close relationship, but they cannot be used as predictors of ischemic neuronal damage during carotid endarterectomy because of poor predictive quality.</p>

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