Early and late outcomes of combined and staged surgeries in patients with concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries

Objective. To study the early and late outcomes of surgical treatment of patients with concomitant atherosclerotic lesions of coronary and brachiocephalic arteries while choosing a treatment strategy based on the developed diff erentiated approach algorithm.Material and Methods. The study comprised 243 patients with combined atherosclerotic lesions of the coronary and carotid arteries examined during the period from 01.07.2014 to 01.01.2021. Patients underwent revascularization surgeries based on the algorithm for choosing the volume and stages of surgical intervention, which was previously developed in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov. A single-stage combined surgery of coronary artery bypass grafting (CABG) and carotid endarterectomy (CEE) was performed in 104 patients (42.8%); 139 patients (57.2%) received staged revascularization including 102 patients (73.4%) who received CABG as the fi rst step and 37 patients (26.6%) who received CEE as the fi rst step of surgery. The endpoints for both early and late results were death from all causes, stroke, transient ischemic attack (TIA), acute myocardial infarction (AMI), and combined endpoint that included all of the above. Average follow-up time was 41.1 ± 21.8 months.Results. No fatal outcomes were in any group during the early postoperative period. At the hospital stage, there were 5 cases (2.1%) of stroke, 1 case (0.4%) of TIA, and 3 cases (1.2%) of acute MI. Long-term results were evaluated in 225 patients (92.3%). The overall survival rate was 93.8%. There were 5 cases (2.4%) of MI, 11 cases (4.9%) of stroke, and 1 case (1.0%) of TIA. No signifi cant diff erences were observed in immediate and long-term endpoints between the groups of staged and combined interventions as compared to immediate (AMI: p = 0.680; TIA: p = 0.500; acute cerebrovascular events: p = 0.567; combined: p = 0.940) and long-term results (deaths: 0.860; AMI: p = 0.906; TIA: p = 0.528; acute cerebrovascular events: p = 0.378; combined: p = 0.669).Conclusion. Based on successful experience with treating the concomitant atherosclerotic lesions of the coronary and brachiocephalic arteries, the proposed algorithm allowed to perform safe procedures in both arterial basins and to achieve satisfactory results in in-hospital and long-term periods in the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov (Perm).

Results of activities of the department of vascular surgery amidst COVID-19 pandemic

Aim. To conduct comparative analysis of the activities of the department of vascular surgery before and during the spread of new coronavirus infection COVID-19 (SARS-CoV-2).Methods. The analysis was performed on the number of outpatient visits of vascular surgeon for types of diagnosis, number and type of surgeries performed at the inpatient facilities of the LLC “Grand Medica” over 2019 (whole year) and 2020 (quarterly).Results. Significant decrease was noted in the number of visits of patients with cardiovascular diseases to vascular surgeon in the outpatient facility. The number of surgeries on limb arteries in patients among Kuzbass residents decreased by 26.4 %, among residents of other regions – by 59.5 %; in brachiocephalic arteries – by 12.5 % and 54.5 %, respectively. The number of percutaneous transluminal coronary angioplasty (PTCA) in patients among Kuzbass residents increased by 25.3 %, among residents of other regions remained unchanged.Conclusion. Decrease in the volume of provision of care for patients with cardiovascular diseases over 2–4 quarters of 2020 is caused by two groups of factors. The first one is associated directly to the epidemiological situation and countermeasures against the spread of SARS-CoV-2 while the second one is associated indirectly.

COVID-19-associated stroke: experience of Regional clinical hospital Krasnoyarsk city

Mechanisms of the impact of the new coronavirus infection on nervous system that leads to various neurological complications, including strokes, and disease patterns and prognosis for stroke patients with COVID-19 are actively discussed in the literature. The aim of the research was a comparison of clinical outcomes in stroke patients with SARS-CoV-2 infection and without. Random sampling of patients with stroke and laboratory-confirmed coronavirus infection SARS-CoV-2 (50 patients) was analyzed retrospectively. The control group consisted of 49 patients with stroke who did not have COVID-19. Patients in both groups were comparable by age, sex, rate of variation and type of stroke, localization of stroke and rating on the Rankin scale before the disease. The results showed that diabetes mellitus significantly more often (more than twice) occurred in stroke patients with COVID-19 (16%) in comparison with the control (7%). Atherosclerosis of brachiocephalic arteries prevailed in acute stroke patients without COVID-19 (88%). The mortality rate in acute stroke patients with COVID-19 was higher (22%) than among those without this infection (6%). At the same time, patients without a combination with COVID-19 had more severe disability on the Rankin scale three points (moderate disability) while patients with COVID-19 were discharged with two points on the Rankin scale (slight disability). Probably, this is since SARS-CoV-2 infection more often led to the lethal oucome in patients with more severe stroke and the survived patients were less disabled. Probably in increased samples these differences will be reversed. Thus, this research confirmed data that the association of stroke and COVID-19 significantly worsens clinical outcomes of stroke (2 tables, bibliography: 10 refs)

Pathological brachiocephalic arteries elongation (dolichoarteriopathy): some controversial issues on this problem

See “Carotid artery elongation (dolichoarteriopathy) and cerebral perfusion: results of a pilot study” Golovin D. A., Rostovtseva T. M., Kudryavtsev Yu. S., Berdalin A. B., Lelyuk S. E., Lelyuk V. G. in the Original articles section, pp. 14-22.

Topsy-Turvy Heart with Aortopulmonary Window and Severe Airway Malacia: Prenatal Diagnosis and Review of the Literature

The topsy-turvy heart is a very rare cardiac malformation that involves a global 90° clockwise rotation of the heart along its long axis. This rotation results in the displacement of the great arteries and severe elongation and stretching of the brachiocephalic arteries and the bronchi. We present an unusual case of topsy-turvy heart diagnosed prenatally with a large aorto-pulmonary window and. This case gives an insight into the morphological details and clinical presentation of this rare malformation and its associated complications. We also present a review of the literature of this rare anomaly showing only 15 live cases that have been published with only three cases diagnosed prenatally.

DeBakey type I acute aortic dissection with circular separation of the intima of the brachiocephalic trunk

Surgical treatment of DeBakey type I acute aortic dissection is still accompanied by a relatively high mortality rate and complications. Organ malperfusion makes a serious contribution to the structure of mortality in the surgical treatment of patients with acute aortic dissection. At the same time, the spread of dissection to the brachiocephalic arteries is observed in 15–40 % of cases. Some of these patients suffer a transient ischemic attack or stroke in the preoperative period, which significantly aggravates the patient’s condition. We present a clinical case of successful surgical treatment of a patient with DeBakey type I acute aortic dissection, in whom intraoperatively a circular separation of intima from the mouth of the brachiocephalic trunk with its invagination into the lumen of the aortic arch was detected. The patient underwent supracoronary prosthetics of the ascending aorta with incomplete prosthetics of the entire arch and prosthetics of the brachiocephalic trunk. This clinical case demonstrates a variant of the natural course of DeBakey type I acute aortic dissection with a complete separation of intima, which requires active surgical tactics. Currently, due to the lack of sufficient clinical experience in the treatment of patients with such a diagnosis, the question of choosing the optimal surgical tactics remains open.

Determination of barometric criteria for rupture of atherosclerotic plaques in the brachiocephalic arteries

The sequence of determining determination of the critical value of blood pressure for the occurrence of dissection of atherosclerotic intima of the internal carotid artery according to the experimental study. Atherosclerotic lesion of the brachiocephalic arteries was modeled on a vascular silicone phantom of the carotid arteries, in which the surgical material (intact annular area of atherosclerotic intima with plaque), obtained after eversion endarterectomy in a patient with atherosclerotic lesions, was placed and fixed in the region of the mouth of the internal carotid artery. A total of 30 models were created. To determine the critical values of the pressure on the intima with the plaque, at which it ruptures, balloon catheters were used, controlling the pressure with a manometer. The results were compared with the preoperative data of ultrasound and computed tomography examinations of patients. Dissection of the intima in the area of the plaque occurred in 6 cases at a pressure of 150180 mm Hg; in 9 cases at 180200 mm Hg, in 3 cases at a pressure of more than 200 mmHg, in 12 when exposed to more than 300 mm Hg. All patients, whose intima ruptured at a pressure of less than 200 mm Hg, had a fluid component of the plaque on preoperative examination, and in 6 patients, the critical pressure on the plaque was 150 mm Hg., there was also a thinned "cover" of the plaque. In the rest of the cases, the plaques were stable without a liquid component. Dissection of the intima in these cases did not occur when the exposure value was more than 300 mm Hg. The presence of a fluid component in an atherosclerotic plaque of the carotid artery in combination with a thinned cover of the plaque indicates the extreme danger of its destruction and embolism during a hypertensive crisis. The degree of stenosis of the carotid artery was found to be a less significant risk factor for unstable plaque rupture than the presence of a fluid component.

The case of posterior ischemic optic neuropathy in patient with multiple sclerosis

A case of posterior ischemic optic neuropathy (PION) in a 41-year-woman with 19 years remission of multiple sclerosisis presented.She had complaints of acute unilateral loss of vision and underwent complex clinical and instrumental examination including B-scan of orbit, color duplex sonography (CDS) of orbital vessels and brachiocephalic arteries, magnetic resonance imaging (MRI). The significant stenosis of internal carotid artery due to its dissection was detected on the affected eye side. The results of ultrasound examinations and MRI excluded demyelinative retrobulbar neuritis (RBN) and determined the signs of blood flow impairment in vessels of orbital part of the optic nerve. Differential diagnostics of PION and RBN required the investigations of blood flow in orbital vessels and brachiocephalic arteries. Key words: posterior ischemic optic neuropathy, multiple sclerosis, retrobulbar neuritis, color duplex sonography, internal carotid artery.