Prophylaxis of complications in postoperative period in patients, suffering stenosis of carotid arteries
Objective. To analyze the surgical treatment results in patients, suffering carotid arteries stenosis, using endarterectomy in combination with conservative therapy.
Materials and methods. Results of treatment were analyzed in 58 patients, suffering hemodynamically significant stenosis of carotid arteries and/or presence of embologenic pluck, in whom from 2017 to 2019 yrs in V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkov intraoperative supportive conservative therapy, taking into account the risk for development of the cerebral ischemia and the reperfusion syndrome, was conducted.
There were 52 (89.7%) men and 6 (10.3%) women. Middle age of the patients operated on have constituted (65 ± 15) yrs.
Results. Basing on the literature data analyzed as well as on investigation of the thrombocytes aggregation in patients in perioperative period the algorithm of supportive conservative therapy was elaborated: injection of 5000 IU heparin 5 min before the internal carotid artery clamping under the ICT control; injection of Citicoline 1000 mg 5 min before the internal carotid artery clamping to the patients with neurological deficiency in accordance to the neurological test data and with application of a temporary by-pass. In all the patients in postoperative period the complications were absent. Control of the carotid arteries passability and the ischemia zone state on the 14th day was conducted, the carotid arteries stenosis was not revealed. Nonsignificant complications, such as the stressed hematoma, demanding postoperative wound revision and hemostasis performance, were observed in 4 patients. In 2 patients postoperative period was complicated by the hypoglossal nerve paresis because of its squeezing by hematoma.
Conclusion. Citicoline injection before the carotid artery clamping in the carotid endarterectomy with a temporary by-pass permits to lower the risk for development of neurological complications, and while development of postoperative reperfusion syndrome –to reduce its signs.
Suslinoy ZA, Piradova MA, editors. Insult: diagnostika, lechenie i profilaktika. - Moskva: MEDpress-inform; 2008. 288 s.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: The Brain Attack Study. Stroke. 2006;37(3):769-75. doi: 10.1161/01.str.0000204041.13466.4c.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Trombolysis with alteplase 3 to 4,5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29. doi: 10.1016/j.jvs.2008.10.047.
Qureshi AI, Kirmani JF, Sayed MA, Safdar A, Ahmed S, Ferguson R, et al. Buffalo Metropolitan Area and Erie County Stroke Study Group. Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke. Neurology. 2005;64(12):2115-20. doi: 10.1212/01.WNL.0000165951.03373.25.
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-7. doi: 10.1097/00008506-199604000-00018.
Haley C.E, Lyden PD, Johnston KC, Hemmen TM, TNK in Stroke Investigators. A pilot doseescalation safety study of tenecteplase in acute ischemic stroke. Stroke. 2005;36(3):607-12. doi: 10.1161/01.str.0000154872.73240.e9.
Tytgat SHAJ, Laman DM, Rijken AM, Klicks R, Voorwinde A, Ultee JM, et al. Emboli Rate During and Early after Carotid Endarterectomy after a Single Preoperative Dose of 120mg Acetylsalicylic Acid-A Prospective Double-Blind Placebo Controlled Randomised Trial. Eur J Vasc Endovasc Surg. 2005; 29(2):156-62. doi: 10.1016/j.ejvs.2004.11.009.
De Borst GJ, Hilgevoord AAJ, de Vries JPPM, van der Mee M, Moll FL, van de Pavoordt HDWM, et al. Influence of Antiplatelet Therapy on Cerebral Micro-Emboli after Carotid Endarterectomy using Postoperative Transcranial Doppler Monitoring. Eur J Vasc Endovasc Surgery. 2007;34(2):143-5. doi: 10.1016/j.ejvs.2007.05.004.
Fisher M, Paganini-Hill A, Martin A, Cosgrove M, Toole JF, Barnett HJ, et al. Carotid Plaque Pathology: Thrombosis, Ulceration, and Stroke Pathogenesis. Stroke. 2005; 36:253-8. doi: 10.1161/01.STR.0000152336.71224.21.
Hayes PD, Box H, Tull S, Bell PRF, Goodall A, Naylor AR. Patients' thromboembolic potential after carotid endarterectomy is related to the platelets' sensitivity to adenosine diphosphate. J Vasc Surg. 2003;38(6):1226-31. doi: 10.1016/j.jvs.2003.05.001.
This work is licensed under a Creative Commons Attribution 4.0 International License.