Carotid Enadrterectomy for Thrombosis of the Internal Carotid Artery in Patients With COVID-19.

Autor: Kazantsev AN; Alexander Hospital, St. Petersburg, Russian Federation. Electronic address: dr.antonio.kazantsev@mail.ru., Karkayeva MR; St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation., Tritenko AP; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Korotkikh AV; Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation., Zharova AS; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Chernykh KP; Alexander Hospital, St. Petersburg, Russian Federation., Bagdavadze GS; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Lider RY; Kemerovo State Medical University, Kemerovo, Russian Federation., Kazantseva YG; Kemerovo State Medical University, Kemerovo, Russian Federation., Zakharova KL; Alexander Hospital, St. Petersburg, Russian Federation., Shmatov DV; St. Petersburg State University, St. Petersburg, Russian Federation., Kravchuk VN; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Peshekhonov KS; Alexander Hospital, St. Petersburg, Russian Federation., Zarkua NE; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Lutsenko VA; Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation., Sultanov RV; Kemerovo Regional Clinical Hospital named after S.V. Belyaeva, Kemerovo, Russian Federation., Artyukhov SV; Alexander Hospital, St. Petersburg, Russian Federation., Kharchilava EU; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Solotenkova KN; North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation., Zakeryayev AB; Research Institute - Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky.
Jazyk: angličtina
Zdroj: Current problems in cardiology [Curr Probl Cardiol] 2023 Aug; Vol. 48 (8), pp. 101252. Date of Electronic Publication: 2022 May 13.
DOI: 10.1016/j.cpcardiol.2022.101252
Abstrakt: Analysis of the results of emergency carotid endarterectomy (CEE) against the background of internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVA) in patients with COVID-19. During the COVID-19 pandemic (April 1, 2020-May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019-March 1, 2020). According to laboratory parameters, patients with COVID-19 had severe coagulopathy (with an increase in D-dimer: 3832 ± 627.2 ng/mL, fibrinogen: 12.6 ± 3.1 g/L, prothrombin: 155.7 ± 10, 2%), inflammatory syndrome (increased ferritin: 646.2 ± 56.1 ng/mL, C-reactive protein: 161.3 ± 17.2 mg/L, interleukin-6: 183.3 ± 51.7 pg/mL, leukocytosis: 27.3 ± 1.7 10E9/L). In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n = 1; group 2: 1.1%, n = 1; P= 0.81; OR=2.09; 95 % CI = 0.12-34.3) myocardial infarction (group 1: 2.3%, n = 1; group 2: 0%; P= 0.7; OR = 6.3; 95% CI = 0.25-158.5), CVA (group 1: 2.3%, n = 1; group 2: 2.2%, n = 2; P= 0.55; OR = 1.03; 95% CI = 0,.09-11.7). ICA thrombosis and hemorrhagic transformations were not recorded. However, due to severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n = 5; group 2: 1.1%, n = 1; P= 0.02; OR = 11.5; 95% CI = 1.3-102.5). In all cases, the flow of hemorrhagic discharge came from the drainage localized in the subcutaneous fat. This made it possible to remove skin sutures in a dressing room, suturing the source of bleeding and applying secondary sutures under local anesthesia. Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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