Comparative Immediate Results of Eversion Carotid Endarterectomy Depending on the Application of the Sinus-saving Modification

Georgii A. Treiger ¹, Alexey A. Fokin ¹, Vladimir V. Vladimirskiy ²

¹ South Ural State Medical University, Chelyabisk, Russia; ² Chelyabinsk regional clinical hospital, Chelyabisk, Russia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–B

Abstract

Relevance: To date, several large international studies have shown the benefit of surgical method of correction of hemodynamic stenosis of the internal carotid artery (ICA) - operation carotid endarterectomy (CEA). The most popular of the angiosurgeons today is eversion technique, however, the standard implementation is inevitable trauma of the carotid sinus nerves, which in turn has a negative impact on the autonomic regulation of vascular tone and arterial hemodynamics with a tendency to hypertension.

Objective: In our work we propose to use a modification of eversion CEA is associated with preservation of the nerves of the carotid sinus and to evaluate its effectiveness by comparing the immediate results with a control group of patients with standard scheme surgery.

Materials and methods:the study included 412 patients operated on carotid arteries to the Chelyabinsk regional clinical hospital from 2010 to 2017. The first group included 237 patients with standard methods of the eversion technique - the intersection of the nerves of the carotid sinus. The second group consisted of 175 patients who were applied sinus-saving modification. Technically it was a change of direction cut when clipping of the ICA from the bifurcation of the common carotid artery, thus the area of the carotid sinus was left intact. In addition to the permanent monitoring of hemodynamic parameters was carried out prospective evaluation of peripheral autonomic regulation by analysis of heart rate variability.

Results: In the group of patients who used the sinus-saving modification in the 1st day after operation was lower hemodynamic parameters: systolic, diastolic, pulse blood pressure and heart rate compared with the control group and a more significant decrease in sympathetic pressor impact on the rhythm.

Conclusions: the practical application of the sinus-saving modification of eversion carotid endarterectomy allows to reduce the risk of postoperative hemodynamic complications associated with the instability of arterial hypertension.