Open AccessRelationship of pharmacotherapy and the incidence of embolic complications of carotid reconstructive surgery
Author(s) -
О. С. Осипова,
Savr Bugurov,
Shoraan Saaya,
А. В. Чебан,
А. А. Гостев,
Artem Rabtsun,
Pavel Ignatenko,
Andrey Karpenko
Publication year - 2022
Publication title -
kardiovaskulârnaâ terapiâ i profilaktika
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.158
H-Index - 16
eISSN - 2619-0125
pISSN - 1728-8800
DOI - 10.15829/1728-8800-2022-3085
Subject(s) - medicine , carotid endarterectomy , incidence (geometry) , revascularization , odds ratio , embolism , carotid stenting , stroke (engine) , surgery , stenosis , intracranial embolism , confidence interval , endarterectomy , transcranial doppler , cardiology , myocardial infarction , mechanical engineering , physics , optics , engineering
Aim . To evaluate the relationship between lipid-lowering and antiplatelet therapy and the incidence of cerebral microembolism and related complications in open and endovascular revascularization of the carotid arteries (CA). Material and methods . This single-center study involved patients with internal CA stenosis. The patients were divided into 2 groups depending on the surgery type performed: carotid endarterectomy (CEA) — 163 patients; CA stenting (CAS) — 71 patients. All patients underwent intraoperative transcranial Doppler monitoring to register cerebral embolism during CAS and CE. Results . In CAS, microembolism episodes were observed in 66,2% vs 22,1% of patients in the CEA group (p=0,04), the largest number of which was recorded during catheterization of the internal CA and embolic filter installation (p=0,000). There were no significant differences between the groups in terms of the stroke incidence. In 8 patients in the CAS group and 1 patient in the CEA group, a transient ischemic attack was observed within 30 days after surgery (p=4x10-4 ). Intraoperative embolism was a predictor of a neurological event in the early postoperative period (odds ratio (OR), 33,08; 95% confidence interval (CI): 3,49-56,37 (p6 months before surgery reduces the likelihood of embolism by 4 times (OR 0,25; 95% CI: 0,11-0,58 (p=0,001), while lipid-lowering and antiplatelet therapy combination — by 12,5 times (OR, 0,08; 95% CI: 0,01-0,40 (p=0,001)). Conclusion . Preoperative antiplatelet and statin therapy reduces the likelihood of embolism during the CA revascularization procedure.