cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2022-3085cardiovascular-3085Research ArticleЭНДОВАСКУЛЯРНЫЕ ВМЕШАТЕЛЬСТВАENDOVASCULAR INTERVENTIONSВзаимосвязь медикаментозной терапии и частоты эмболических осложнений реконструктивных вмешательств на сонных артерияхRelationship of pharmacotherapy and the incidence of embolic complications of carotid reconstructive surgeryhttps://orcid.org/0000-0002-7418-3298ОсиповаО. С.OsipovaO. S.

Осипова Олеся Сергеевна  — врач сердечно-сосудистый хирург отделения сосудистой патологии и  гибридных технологий, аспирант

Новосибирск

Novosibirsk

O1esy0@yandex.ruhttps://orcid.org/0000-0002-6875-5122БугуровС. В.BugurovS. V.

Бугуров Савр Васильевич — врач рентгенэдоваскулярный хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

Novosibirsk

savr.doctor@mail.ruhttps://orcid.org/0000-0001-6547-6948СааяШ. Б.SaayaSh. B.

Саая Шораан Биче-оолович  — врач сердечно-сосудистый хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

Novosibirsk

s_saaya@meshalkin.ruhttps://orcid.org/0000-0002-6094-4607ЧебанА. В.ChebanA. V.

Чебан Александр Васильевич — врач сердечно-сосудистый хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

 

Novosibirsk

cheban_a@meshalkin.ruhttps://orcid.org/0000-0002-7806-7868ГостевА. А.GostevA. A.

Гостев Александр Александрович — врач сердечно-сосудистый хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

Novosibirsk

dr.gostev@gmail.ruhttps://orcid.org/0000-0003-2803-5937РабцунА. А.RabtsunA. A.

Рабцун Артем Александрович  — врач сердечно-сосудистый хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

Novosibirsk

a_rabtsun@meshalkin.ruhttps://orcid.org/0000-0001-8695-0848ИгнатенкоП. В.IgnatenkoP. V.

Игнатенко Павел Владимирович  — заведующий отделением, врач-сердечно-сосудистый хирург кардиохирургического отделения сосудистой патологии и  гибридных технологий

Новосибирск

Novosibirsk

p_ignatenko@meshalkin.ruhttps://orcid.org/0000-0001-6914-334XКарпенкоА. А.KarpenkoA. A.

Карпенко Андрей Анатольевич  — доктор медицинских наук, профессор, заведующий научно-исследовательским отделом сосудистой и  гибридной хирургии института патологии кровообращения, врач сердечно-сосудистый хирург

Новосибирск

Novosibirsk

a_karpenko@meshalkin.ruФГБУ “Национальный медицинский исследовательский центр им. Е.Н. Мешалкина”Meshalkin National Medical Research Center20222601202221230853085Copyright © Осипова О.С., Бугуров С.В., Саая Ш.Б., Чебан А.В., Гостев А.А., Рабцун А.А., Игнатенко П.В., Карпенко А.А., 20222022Осипова О.С., Бугуров С.В., Саая Ш.Б., Чебан А.В., Гостев А.А., Рабцун А.А., Игнатенко П.В., Карпенко А.А.Osipova O.S., Bugurov S.V., Saaya S.B., Cheban A.V., Gostev A.A., Rabtsun A.A., Ignatenko P.V., Karpenko A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/3085Цель

Цель. Оценка связи гиполипидемической и антиагрегантной терапии и  частоты церебральной сосудистой микроэмболии и  связанных с ней осложнений при открытой и эндоваскулярной реваскуляризации сонных артерий (СА).

Материал и  методы

Материал и  методы. Проведено одноцентровое исследование с участием пациентов со стенозами внутренних СА. Пациенты были разделены на 2 группы в зависимости от типа выполняемой операции: в группу каротидной эндартерэктомии (КЭ) включено 163 пациента, в группу стентирования СА (ССА) — 71 пациент. Для регистрации эмболии сосудов головного мозга во время ССА и КЭ всем пациентам была выполнена интраоперационная транскраниальная допплерография.

Результаты

Результаты. У  66,2% пациентов во время процедуры ССА наблюдались эпизоды микроэмболии vs 22,1% пациентов в  группе КЭ (p=0,04), наибольшее количество которых зарегистрировано на этапах катетеризации внутренней СА и  установки противоэмболического фильтра (p=0,000). По частоте инсультов группы статистически значимо не различались между собой. У  8 пациентов в группе ССА и 1 пациента в группе КЭ наблюдалась транзиторная ишемическая атака в  течение 30 сут. после операции (p=4×10-4 ). Интраоперационная эмболия была предиктором неврологического события в  раннем послеоперационном периоде  — отношение шансов (ОШ) 33,08; 95% доверительный интервал (ДИ): 3,49-56,37 (p6 мес. до операции снижает шанс развития эмболии в 4 раза — ОШ 0,25; 95% ДИ: 0,11-0,58 (p=0,001), а комбинированный прием гиполипидемической и антиагрегантной терапии в 12,5 раз — ОШ 0,08; 95% ДИ: 0,01-0,40 (p=0,001).

Заключение

Заключение. Предоперационный прием антиагрегантов и  статинов снижает шансы развития эмболии во время процедуры реваскуляризации СА.

Aim

Aim. To evaluate the relationship between lipid-lowering and antiplatelet therapy and the incidence of cerebral microembolism and related complications in open and endovascular revascularization of the carotid arteries (CA).

Material and methods

Material and methods. This single-center study involved patients with internal CA stenosis. The patients were divided into 2 groups depending on the surgery type performed: carotid endarterectomy (CEA)  — 163 patients; CA stenting (CAS)  — 71 patients. All patients underwent intraoperative transcranial Doppler monitoring to register cerebral embolism during CAS and CE.

Results

Results. In CAS, microembolism episodes were observed in 66,2% vs 22,1% of patients in the CEA group (p=0,04), the largest number of which was recorded during catheterization of the internal CA and embolic filter installation (p=0,000). There were no significant differences between the groups in terms of the stroke incidence. In 8 patients in the CAS group and 1 patient in the CEA group, a transient ischemic attack was observed within 30 days after surgery (p=4x10-4 ). Intraoperative embolism was a predictor of a neurological event in the early postoperative period (odds ratio (OR), 33,08; 95% confidence interval (CI): 3,49-56,37 (p6 months before surgery reduces the likelihood of embolism by 4 times (OR 0,25; 95% CI: 0,11-0,58 (p=0,001), while lipid-lowering and antiplatelet therapy combination — by 12,5 times (OR, 0,08; 95% CI: 0,01-0,40 (p=0,001)).

Conclusion

Conclusion. Preoperative antiplatelet and statin therapy reduces the likelihood of embolism during the CA revascularization procedure.

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The authors declare that there are no conflicts of interest present.