To the content
3 . 2022

Features of the postoperative period after carotid endarterectomy in patients with preserved or removed carotid glomus

Abstract

Background. Surgery continues to be the leading method of treating atherosclerotic lesions of the carotid arteries, which can lead to the development of an atherothrombotic ischemic stroke. The increasing number of surgical interventions leaves an important problem of preventing the most frequent postoperative complications.

Aim of this study is to compare postoperative hypertension in patients after carotid endarterectomy with preserved and removed carotid body.

Material and methods. Prospective analysis of 2 groups of patients. Group 1 (n=30) underwent carotid endarterectomy with carotid body removal, in group 2 (n=30) carotid endarterectomy with carotid body preservation was performed.

Results. After glomus-sparing carotid endarterectomy stable systolic blood pressure was 138.7± 7.8 mm Hg on the preoperative antihypertensive therapy. Patients who hadn’t undergone preservation of carotid body had systolic blood pressure more than 140 mm Hg, for the correction of which additional antihypertensive therapy was required.

Conclusion. Indicators of central hemodynamics significantly differ depending on the preservation or intersection of the carotid glomus. Preservation of carotid glomus contributes to a smoother, more controlled course of the postoperative period in patients with arterial hypertension.

Keywords:carotid glomus; carotid endarterectomy; glomus-saving carotid endarterectomy; carotid body

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Gavrilenko A.V., Al-Usef N.N., Bulatova L.R. Features of the postoperative period after carotid endarterectomy in patients with preserved or removed carotid glomus. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 23–7. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-23-27  (in Russian)

References

1.     Feigin V.L., Forounzanfar M.H., Krishnamurthi R., et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383: 245–55. DOI: https://doi.org/10.1016/s0140-6736(13)61953-4  

2.     Clinical guidelines for the management of patients with ischemic stroke and transient ischemic attacks. Moscow, 2017: 208 p. (in Russian)

3.     Piradov M.A., Maksimova M.Yu., Tanashyan M.M. Stroke step by step instructions. Moscow: GEOTAR-Media, 2019: 9–12. (in Russian)

4.     Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55: 3–81. DOI: https://doi.org/10.1016/j.ejvs.2017.06.021  

5.     Kuliha M., Roubec M., Prochazka V., Jonszta T., Hrba T., Havelka J., et al. Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting. Br J Surg. 2015; 102: 194–201. DOI: https://doi.org/10.1002/bjs.9677  

6.     Vincent S., Eberg M., Eisenberg M.J., Filion K.B. Meta-analysis of randomized controlled trials comparing the long-term outcomes of carotid artery stenting versus endarterectomy. Circ Cardiovasc Qual Outcomes. 2015; 8: S99–108. DOI: https://doi.org/10.1161/CIRCOUTCOMES.115.001933  

7.     Eckstein H.H., Ringleb P., Allenberg J.R., Berger J., Fraedrich G., Hacke W., et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008; 7: 893–902. DOI: https://doi.org/10.1016/S1474-4422(08)70196-0  

8.     Ederle J., Dobson J., Featherstone R.L., Bonati L.H., van der Worp H.B., de Borst G.J., et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010; 375: 985–97. DOI: https://doi.org/10.1016/S0140-6736(10)60239-5  

9.     Pokrovsky A.V., Beloyartsev D.F., Adyrkhaev Z.A. Does the method of carotid reconstruction affect the immediate results of the intervention? Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2012; 18 (3): 81–9. (in Russian)

10. Brott T.G., Hobson R.W. 2nd, Howard G., Roubin G.S., Clark W.M., Brooks W., et al.; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010; 363: 11–23. DOI: https://doi.org/10.1056/NEJMoa0912321  

11. Kukharchuk V.V. Arterial hypertension, lipid metabolism disorders and atherosclerosis. «Guidelines for arterial hypertension». Moscow: Media Medika, 2005: 289–99. (in Russian)

12. Clinical guidelines «Arterial hypertension in adults». Moscow, 2020: 136 p. (in Russian)

13. Uflacker R. Atlas of Vascular Anatomy: An Angiographic Approach. 2nd ed.  Lippincott Williams and Wilkins, 2006: 928 p.

14. Touyz R.M., Delles C. Textbook of Vascular Medicine. Springer, 2019: 18–22. DOI: https://doi.org/10.1007/978-3-030-16481-2  

15. Netter’s Clinical Anatomy. 3rd ed. Saunders, 2014: 568 p.

16. Fokin A.A., Borsuk D.A., Mironov V.A., Treiger G.A. Evaluation of the effect of sinus-sparing modifications of carotid endarterectomy on autonomic regulation and central hemodynamics. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2016; 20 (1): 19–24. (in Russian)

17. Kazantsev A.N., Chernykh K.P., Lider R.Yu., Zarkua N.E., Kubachev K.G., Bagdavadze G.Sh., et al. Glomus-sparing carotid endarterectomy according to A.N. Kazantsev. Hospital and mid-term outcomes. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2020; 24 (3): 70–9. DOI: http://dx.doi.org/10.21688/1681-3472-2020-3-70-79  (in Russian)

18. Gavrilenko A.V., Al’-Yusef N.N., Bulatova L.R., Wan Xiaochen, Li Zhui. The expediency of preserving the carotid glomus during surgical interventions on the carotid arteries. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2019; 12 (2): 95–9. DOI: https://doi.org/10.17116/kardio20191202195  (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

Journals of «GEOTAR-Media»