Journal «Angiology and Vascular Surgery» • 

2017 • VOLUME 23 • №1

Efficacy and safety of temporary bypass grafting in carotid endarterectomy

Kuzhuget R.A., Karpenko A.A., Kamenskaya O.V., Ignatenko P.V., Starodubtsev V.B.

Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia

The authors analysed interrelationship between the use of temporary bypass grafting during operations of carotid endarterectomy and the frequency of the development of ischaemic complications (stroke and transitory ischaemic attacks in the early postoperative period).

It was shown that in the group wherein a temporary bypass graft was established only by the criterion of decreasing retrograde pressure ischaemic complications were encountered in ten (4.4%) patients and in the group wherein temporary shunts were established by the criterion of a simultaneous decrease in cerebral oxygenation and retrograde pressure – in two (0.9%) patients (OR 5.28; 95% CI 1.22–24.38; p=0.03). It was demonstrated that using temporary bypass grafting in cases of isolated assessment of the parameters of cerebral oxygenation and retrograde pressure increased the frequency of the development of shunt-related ischaemic complications as compared with the patients in whom shunts were not used due to lack of a synchronous decrease in these parameters (13.5 vs 1.5%, respectively; OR 10.0; 95% CI 1.1–82.2; p=0.039). The findings of the carried out retrospective analysis suggested that the main predictor of the development of the outcome "stroke + transitory ischaemic attack" was the use of a temporary internal shunt during the main stage of the operation (p<0.00001).

KEY WORDS: carotid endarterectomy, ischaemic complications, temporary internal bypass graft, retrograde pressure, cerebral oxygenation, stroke, transitory ischaemic attack.

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