Stagewise treatment of tandem lesions of the internal carotid artery in patients with ischaemic stroke

Vakhitov K.M., Cherniakov I.S., Hotchenkov M.V., Vintskovsky S.G., Kmetik E.G., Vinokurov A.Yu.

Department of Vascular Surgery and Renal Transplantation, Leningrad Regional Clinical Hospital, Saint Petersburg, Russia

Objective. The study was aimed at assessing the results of a stagewise approach to surgical treatment of patients with ischaemic stroke and tandem lesions of coronary arteries.

Patients and methods. We analysed the results of treating a total of 19 patients with ischaemic stroke having endured in 2017–2018 surgical interventions for tandem lesions of the internal carotid artery. All 19 patients with tandem lesions underwent as the first stage of surgical treatment recanalization of the intracranial portion of the internal carotid artery. Nine patients were subjected to thromboextraction followed by carotid stenting (Group One), ten underwent thromboextraction and carotid endarterectomy (Group Two). One patient was subjected to simultaneous endovascular intervention at the intra- and extracranial level, in 18 patients reconstruction of the internal carotid artery at the extracranial level (second stage) was performed within a postponed period (3–5 days). In the postoperative period we assessed neurological deficit and the results of 90-day survival.

Results. No deterioration of neurological deficit was observed after the first stage of surgical treatment. There were statistically significant differences in the degree of regression of a stagewise treatment at discharge, with predominance in the second group. The 90-day survival rate had no prevalence in either group, despite 1 lethal outcome in a patient with simultaneous thromboextraction and stenting of the extracranial portion of the internal carotid artery.

Conclusion. Adequate prevention of haemorrhagic transformation of the damaged zone of cerebral tissue in patients with ischaemic stroke caused by tandem lesions of carotid arteries may be ensured by means of selecting stagewise treatment, i. e., postponed elimination of extracranial stenosis of the internal carotid artery. Given a small sample size, the study requires further examination and assessment of the obtained results.

KEY WORDS: stroke, thromboextraction, carotid endarterectomy, tandem lesion, carotid artery

Р. 58

« Back