Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №1

Structure of in-hospital and remote complications of surgical treatment of stenotic lesions of coronary and carotid arteries

Tarasov R.S.1, Kazantsev A.N.2, Burkov N.N.2, Lider R.Yu.3, Yakhnis E.Ya.3

1) Department of Cardiovascular Surgery, Scientific Research Institute for Complex Problems of Cardiovascular Diseases,
2) Department of Neurosurgery, Kemerovo Regional Clinical Cardiological Dispensary named after Academician L.S. Barbarash,
3) Department of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University of the RF Ministry of Public Health, Kemerovo, Russia

Background. Problems concerning the choice of optimal revascularization strategy in patients with simultaneous atherosclerotic lesions of the coronary and brachiocephalic arteries still remain unsolved, since there are no randomized studies and there is uncertainty in Russian and foreign guidelines.

Objective. The study was aimed at analysing the remote results of surgical treatment of 391 patients with concomitant lesions of the coronary and brachiocephalic arteries within the framework of a single-centre prospective registry.

Patients and methods. Within the timeframe of our study, all patients were divided into 4 groups depending on the method of surgical treatment of the above-mentioned pathology of the coronary and brachiocephalic arteries. Group 1 patients underwent staged surgery in the scope of coronary artery bypass grafting followed by carotid endarterectomy. Group 2 patients endured coronary artery bypass grafting combined with carotid endarterectomy. Group 3 patients were subjected to hybrid revascularization consisting in percutaneous coronary intervention and carotid endarterectomy. Group 4 patients sustained staged surgery consisting of carotid endarterectomy followed by coronary artery bypass grafting. The clinical and demographic characteristics, period of follow up, as well as the results after the respective surgical intervention for each group are presented.

Results. We analysed the frequency and structure of adverse cardiovascular events depending on the time intervals within which complications had occurred resulting from a particular surgical policy used.

Discussion. The obtained findings demonstrated that adverse cardiovascular events in the total sample of patients were mainly observed in the remote period of follow up, which was related primarily to a progressive course of atherosclerosis, the presence of bilateral lesions of the internal carotid arteries, as well as the lack of protocols ensuring complete revascularization in multifocal atherosclerosis within a limited time interval.

Conclusion. We made a conclusion on efficacy of the simultaneous strategy of revascularization by means of coronary artery bypass grafting combined with carotid endarterectomy in regard to decreased incidence of strokes in the remote period of follow up.

KEY WORDS: multifocal atherosclerosis, carotid endarterectomy, coronary artery bypass grafting, simultaneous lesion, revascularization of the brain and myocardium.

P. 95

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