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Mullakhmetov R.M., Plotnikov M.V., Fomina E.E., Maksimov A.V.
Ultrasound Findings in the Early and Long-Term Period after Carotids Endarterectomy
Keywords: atherosclerosis, intimal hyperplasia, restenosis, floating intimal flap, carotid endarterectomy, ultrasonography, carotid arteries
Carotid endarterectomy is an effective method of primary and secondary prevention of acute cerebrovascular accident. However, surgical intervention is associated with a risk of acute cerebrovascular accident of up to 3% in asymptomatic and up to 6% in symptomatic patients, and in the long-term period after surgical treatment, there are risks of developing repeated stenoses in the reconstruction area. Object. To identify pathological ultrasound phenomena in the reconstruction area in the early and long-term period after carotid endarterectomy. Materials and methods. A retrospective analysis of the data of 52 patients after carotid endarterectomy, in the environment of the Republican Clinical Hospital of Kazan for 2023, was carried out. The results of the surgical intervention were evaluated by color ultrasound duplex scanning on the MINDRAY Resona 7 device after 1-3 days, then 1, 3 and 6 months after the operation. Research results. 52 patients were enrolled in the study. Of these, 40 men (average age 66.9±1.3 years) and 12 women (average age 67.5±2.3 years). There were 26 (50%) symptomatic patients (who had suffered a transient ischemic attack or acute cerebrovascular accident less than 6 months ago). Complications in the form of transient ischemic attack or acute cerebrovascular accident in the perioperative, early postoperative and long-term periods were not recorded in any of the patients. Ultrasound examination revealed pathological phenomena in the reconstruction area in 22 (42.3%) patients. In the early postoperative period, detachment of the intima – media complex in the internal carotid artery was detected in 4 (7.7%) patients; in 6 (11.5%) patients, detachment of intima – media complex in the common carotid artery was recorded; in 7 (13.5%) patients the detachment of intima – media complex in the external carotid artery was recorded, in 6 (11.5%) cases the occlusion of external carotid artery was recorded. Floating hyperechoic structures in the reconstruction zone after 1–3 days were recorded in 8 patients (15.4%). In the long-term period, intimal hyperplasia of more than 2 mm was visualized in 18 (34.6%) patients. Conclusions. Ultrasound examination of the brachiocephalic arteries in the early postoperative period is necessary to identify pathological changes and floating structures as potential predictors of impaired cerebral circulation. Pathological ultrasound phenomena (detachment of the intima – media complex in the reconstruction zone, floating hyperechoic structures, occlusion of the external carotid artery) are recorded in 42.3% in the early postoperative period, and in the long-term period they can spontaneously regress. Their frequency for a period of 6 months is 15.4%. Improving the technique of surgical intervention, as well as the selection of drug therapy aimed at relieving the processes of hyperplasia, will help improve the results of treatment of patients with atherosclerotic lesions of the carotid arteries.
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About authors
- Mullakhmetov Rafael M.
- Vascular Surgeon, Department of Vascular Surgery, Republican Clinical Hospital, Russia, Kazan (corvina422@rambler.ru; ORCID: https://orcid.org/0009-0002-6869-9084)
- Plotnikov Mikhail V.
- Candidate of Medical Sciences, Vascular Surgeon, Department of Vascular Surgery, Republican Clinical Hospital; Associate Professor, Department of Cardiology, X-ray Endovascular and Cardiovascular Surgery, Kazan State Medical Academy – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Russia, Kazan (plotnikov_mv@bk.ru; ORCID: https://orcid.org/0000-0002-3733-0789)
- Fomina Elena E.
- Doctor of Medical Sciences, Associate Professor, Department of Ultrasound Diagnostics, Kazan State Medical Academy – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Russia, Kazan (efomina@mail.ru; ORCID: https://orcid.org/0000-0003-0667-6127)
- Maksimov Aleksandr V.
- Doctor of Medical Sciences, Professor, Department of Surgical Diseases of Postgraduate Education, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University; Chief Researcher, Research Department, Republican Clinical Hospital, Russia, Kazan (maks.av@mail.ru; ORCID: https://orcid.org/0000-0003-2803-4010)
Article link
Mullakhmetov R.M., Plotnikov M.V., Fomina E.E., Maksimov A.V. Ultrasound Findings in the Early and Long-Term Period after Carotids Endarterectomy [Electronic resource] // Acta medica Eurasica. – 2024. – №2. P. 19-26. – URL: https://acta-medica-eurasica.ru/en/single/2024/2/3/. DOI: 10.47026/2413-4864-2024-2-19-26.