Novel method for glomus-saving carotid endarterectomy sensu A. N. Kazantsev: cutting the internal carotid artery on the site from external and common carotid artery

Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness