FIGHT AGAINST HYPOAGREGATION AND HYPOCOAGULATION IN HYBRID REVASCULARIZATION (CAROTID ENDARTERECTOMY + PERCUTANEOUS CORONARY INTERVENTION) ACCORDING TO A.N. KAZANTSEV

Abstract

Purpose – to analyze hemorrhagic complications in patients after hybrid interventions, including percutaneous coronary intervention (PCI) and carotid endarterectomy (CEE). Demonstrate a new method of hemostasis and wound drainage after CEE according to A.N. Kazantsev. Materials and methods. Over the course of 5 years, 84 simultaneous PCI + CEE surgeries were performed. All patients were divided into two groups: group 1 (n = 38) – patients with the traditional method of hemostasis and wound drainage after CEE; Group 2 (n = 46) – patients, who received a new tactic (the use of local hemostatics with minimal electrocoagulation + the installation of two drains - in the paravasal and cellular space) according to A.N. Kazantsev. Coagulogram and aggregatogram indices were studied perioperatively. In the postoperative period, the incidence of hemorrhagic complications, the need for revision of the wound and, associated with high trauma, damage to the cranial nerves (CN) were assessed. Results. At the preoperative stage, the coagulogram indices were within normal limits, however, the aggregatogram showed hypoaggregation in two of the four inductors in both groups. After the completion of the second stage of revascularization in terms of coagulogram, the absolute partial thrombosed time among all patients was five to six times higher than the norm. According to the aggregation data, total hypoaggregation was noted. All acute hematomas after CEE requiring revision were formed in group 1 (p = 0.038), which was associated with more frequent damage to the PMN (p = 0.0002). Thus, the combined endpoint, including the rate of cranial nerve injury + acute hematoma in the first group, significantly exceeded the second (p <0.0001). There were no cases of wound complications in the CEE area. Conclusion. The results of the presented study demonstrated the preventive role of the new method of hemostasis and wound drainage after CEE according to A.N. Kazantsev against the background of hypoaggregation/hypocoagulation. This tactic is highly relevant for patients heading for hybrid revascularization of the heart and brain, when, against the background of the use of double antiplatelet therapy, the administration of protamine sulfate does not stop the development of hemorrhagic complications. The absence of cases of wound complications, a decrease in the number of acute hematomas and the need for repeated revision of the wound confirm the safety of the presented treatment tactics.

Keywords

• каротидная эндартерэктомия, чрескожное коронарное вмешательство, острая гематома, ревизия, геморрагические осложнения, невропатия, ишемический инсульт, гипоагрегация, гипокоагуляция