The carotid stenosius progression evaluation in patients with ischemic stroke who underwent carotid endarterectomy
Journal Title: Український неврологічний журнал - Year 2019, Vol 0, Issue 2
Abstract
Objective — to evaluate the frequency incidence of carotid artery restenosis following carotid endarterectomy, the progression of atherosclerosis in patients with severe carotid stenosis and ischemic stroke, and to identify factors that influence its occurrence. Methods and subjects. 38 patients with atherothrombotic ischemic stroke were included in this study, 31 males and 7 females with a mean age of 58.4 years. Carotid endarterectomy was performed for 31 patients at the ipsilateral side, 7 patients had extra‑intracranial micro‑anastomosis due to the occlusion of the internal carotid artery. All patients underwent ultrasonography examination to indicate the stenosis according to ECST criteria. Restenosis was defined as recurrent luminal narrowing ≥ 50 % at the endarterectomy site. The mean postoperative follow‑up period was 35 months. Results. The main causes of risk factors were: smoking — 57.8 %, hypertension — 71.0 %, levels of total cholesterol greater than 5 mmol/L — 57.8 %, index body mass ≥ 25 — 57.8 %, diabetes mellitus — 5.7 %. The ipsilateral high‑grade stenosis 50 — 69 % was diagnosed for 15.8 %, 70 — 99 % stenosis — 65.8 %, occlusion — 18.4 % patients. Cases of contralateral carotid stenosis > 50 % were observed in 36.8 %. Two patients from the last group had a stroke in follow‑up period and underwent second carotid endarterectomy. Restenosis > 50 % after carotid endarterectomy developed in 44.7 %, progression of atherosclerosis in contralateral carotid artery — in 34.2 %. In 31.6 % restenosis and progression of atherosclerosis on ipsi‑ or contralateral side was absence. The incidences of current smoking, index body mass ≥ 25, diabetes mellitus were higher among patients with progression of atherosclerosis, but paytients with cholesterol > 5 mmol/L were in a group without stenosis progression. However, In the group without progression of restenosis and atherosclerotic process, patients received statins and antiplatelet drugs regularly (1.7 times) and more frequently. Conclusions. The incidence of restenosis in our study was 44.7 %. These findings support the need of regularly scheduled ultrasonography follow‑up examinations after carotid endarterectomy, improvement of cholesterol levels management in patients with carotid disease and the use of statins that could reduce the risk of carotid restenosis due to pleiotropic actions of statins.
Authors and Affiliations
O. Ye. Dubenko, O. V. Zubkov, V. Yu. Anysienkova, D. O. Krasiyk
Keywords
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- EP ID EP670580
- DOI 10.30978/UNJ2019-2-29
- Views 108
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