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  • 92 -12 (74) 2024 - A.A. Abdurakhmanov, F.A.Mamataliev - COMPARATIVE ANALYSIS OF THE RESULTS OF INTERVENTIONAL AND SURGICAL TREATMENT FOR STENOTIC ATHEROSCLEROSIS OF THE CAROTID ARTERIES

92 -12 (74) 2024 - A.A. Abdurakhmanov, F.A.Mamataliev - COMPARATIVE ANALYSIS OF THE RESULTS OF INTERVENTIONAL AND SURGICAL TREATMENT FOR STENOTIC ATHEROSCLEROSIS OF THE CAROTID ARTERIES

COMPARATIVE ANALYSIS OF THE RESULTS OF INTERVENTIONAL AND SURGICAL TREATMENT FOR STENOTIC ATHEROSCLEROSIS OF THE CAROTID ARTERIES

A.A. Abdurakhmanov - Republican Scientific Center for Emergency Medical Care Uzbekistan

F.A.Mamataliev - Republican Scientific Center for Emergency Medical Care Uzbekistan

O.A.Mashrapov - Republican Scientific Center for Emergency Medical Care Uzbekistan

S.A.Tursunov - Republican Scientific Center for Emergency Medical Care Uzbekistan

Sh.U. Buronov - Republican Scientific Center for Emergency Medical Care Uzbekistan

Resume

Aim. Improving the short- and long-term outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in patients with significant carotid stenosis by optimizing diagnostic methods to select the most appropriate treatment modality. Material and methods. This prospective, non-randomized, observational clinical trial included 100 patients with severe carotid artery stenosis (stenosis ≥70%) confirmed by Doppler ultrasonography and CT angiography. Patients were allocated to either carotid stenting (CAS) (n=50) or carotid endarterectomy (CEA) (n=50) using a decision-making algorithm proposed by the authors based on diagnostic ultrasonography and CT angiography data. Results. At 1-year follow-up, CAS and CEA demonstrated comparable rates of restenosis, stroke freedom, and reintervention. This supports the idea that both CAS and CEA are effective treatment options for preventing cerebrovascular events in patients with carotid artery stenosis. Conclusions. CAS and CEA demonstrate similar short-term safety profiles, with no significant differences in major adverse events, including stroke, myocardial infarction, or death within 30 days. Although these injuries were transient and resolved within six months, these results highlight a key procedural risk of CEA that should be considered in patient selection, particularly in patients with predisposing cranial nerve vulnerabilities. Myocardial infarction rates are comparable and indicate that both CAS and CEA are relatively safe in terms of major adverse cardiovascular events within 30 days of the procedure.

Key words: hemodynamically significant stenosis, occlusion, restenosis, stroke, CT angiography, Doppler sonography, carotid endarterectomy, carotid artery stenting.

First page

478

Last page

485

For citation:A.A. Abdurakhmanov, F.A.Mamataliev, O.A.Mashrapov, S.A.Tursunov, Sh.U. Buronov - COMPARATIVE ANALYSIS OF THE RESULTS OF INTERVENTIONAL AND SURGICAL TREATMENT FOR STENOTIC ATHEROSCLEROSIS OF THE CAROTID ARTERIES//New Day in Medicine 12(74)2024 478-485 https://https://newdayworldmedicine.com/en/new_day_medicine/12-74-2024

List of References

  1. Brott T.G., Hobson R.W., Howard G., Roubin G.S., Clark W.M., Mackey A., Phillips H.R. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis. //New Engl J Med 2010;363(2):11-23. doi:10.1056/NEJMoa.0912321.
  2. Ringleb P.A., Allenberg J.R., Brückmann H., Conzelmann M., Eckstein H.H., Fraedrich G., Zeller T. Safety and Efficacy of Stenting Versus Endarterectomy for Treatment of Carotid Artery Stenosis: A Randomised Controlled Trial with Long-term Follow-up (SPACE). //Lancet 2008;372(9652):1239-1247. doi:10.1016/S0.140673608617037.
  3. Ederle J., Dobson J., Featherstone R.L., Holmes M., Davies H., Torgerson D.J. Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (International Carotid Stenting Study): //An Interim Analysis of a Randomised Control Trial Lancet 2010;375(9719):985-997. doi:10.1016/S0.140673610602395.
  4. Bonati L. H., Ederle J., Dobson J. Long-Term Outcomes after Stenting versus Endarterectomy for Treatment of Symptomatic Carotid Stenosis: The International Carotid Stenting Study (ICSS) Randomized Trial. //Lancet 2015;385(9967):529-538. doi:10.1016/S0.140673614611843.
  5. Mas J.L., Chatellier G., Beyssen B., Branchereau A. Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis. //New Engl J Med 2006;355(16):1660-1671. doi:10.1056/NEJMoa.061752.
  6. Chaturvedi S., Malik A. Outcomes after Carotid Artery Stenting Versus Carotid Endarterectomy in Patients with Symptomatic Carotid Stenosis: A Meta analysis. Stroke 2015;46(12):3437-444. doi:10.1161/STROKEAHA.115011671.
  7. Gurm H.S., Yadav J.S., Fayad P. Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients. //New Engl J Med 2008;358(15):1572-1579. doi:10.1056/NEJMoa.0708020.
  8. Naylor A.R., Ricco J.B., de Borst G.J. Carotid Artery Stenting versus Carotid Endarterectomy: Endovascular Versus Surgical Treatment. //Europ J Vasc Endovasc Surg 2018;55(1):12-22. doi:10.1016/ jejvs. 201708008.
  9. De Rango P., Cao P. The Role of Carotid Artery Stenting and Endarterectomy in Asymptomatic Carotid Artery Stenosis. JACC: Cardiovasc Interv. 2014;7(10):1167-1174. doi:10.1016/jjcin.201406015.
  10. Rothwell P.M., Warlow C. P. Analysis of Pooled Data from the Randomised Controlled Trials of Endarterectomy for Symptomatic Carotid Stenosis. //Lancet 2004;363(9413):915-924. doi :10.1016/S.0140673604157854.
  11. Hobson R.W., Weiss D.G., Clark W. M. Carotid Endarterectomy vs. Carotid Artery Stenting: Which One is Better for Patients with Severe Carotid Stenosis? //JAMA 2004;291(11):1356-1362. doi:10.1001/jama.291.11.1356.
  12. Manninen H.I., Lehto T. Carotid Artery Stenting vs. Endarterectomy: A Meta-Analysis of Randomized Controlled Trials. //Europ J Vasc Endovasc Surg 2011;42(5):581-586. doi:10.1016/jejvs.201107014.
  13. Naylor A. R., Sayers R. D. Carotid Artery Stenting Versus Endarterectomy: The Evidence in 2012. //Ann Vasc Surg 2012;26(7):969-977. doi:10.1016/j.avsg.201202004.
  14. Sacco R.L., Adams R. D. Guidelines for Carotid Endarterectomy: A Review of the Current Evidence. Stroke 2009;40(1):225-235.doi:10.1161/STROKEAHA. 108531188.
  15. Tzeng S.K., Tsai Y.H. Carotid Artery Stenting versus Endarterectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. //J Vasc Surg 2013;57(6):1755-1764. doi:10.1016/jjvs.201211091.

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