SURGICAL TREATMENT OF MULTIFOCAL ATHEROSCLEROSIS: CORONARY AND BRACHIOCEPHALIC PATHOLOGY AND PREDICTORS OF EARLY ADVERSE EVENTS DEVELOPMENT

Abstract

Aim. Analysis of clinical and demographic, anatomic and angiographic, instrumental and perioperational factors of adverse prognosis in inpatient period for various surgical managing strategies in patients with multifocal atherosclerosis.Material and methods. The analysis is done, of surgical treatment results in 391 patient with combination lesion of coronary and brachocephalic arteries under the frame work of single center prospective registry. According to the presence of in-hospital complications (HC) all patients were selected to 2 groups: I — patients with HC (n=84); II — patients with no HC (n=307). In this selection, 4 revasculariztion tactics were realized: staged surgery within the procedures of coronary bypass and carotid endarterectomy (CEE) with various sequence (n=222, 56,8%); combinational operation of coronary bypass and CEE (n=141; 36%); hybrid revascularization within percutaneous coronary intervention and CEE (n=28; 7,2%).Results. The wide spectrum of prognostically significant factors was analized in details, including clinical and instrumental, anatomic and angiographic, perioperational factors. Adverse prognosis factors were found, and protecting parameters defined that decrease the risk of adverse cardiovascular events occurence. Predictors of adverse prognosis in post-operation period were found: clinical and demographic — older age; high surgical risk by EuroScore II ≥3; chronic renal failure; cerebrovascular — chronic cerebral ischemia III grade; the unclosed Willis circle; unstable atherosclerotic plaque or subtotal stenosis of the internal carotid arteria unilateral with operation; subtotal stenosis or occlusion of internal carotid artery contralateral.Conclusion. The results can be applied in algorithms development for selection of surgical tactics in multifocal atherosclerosis patients.

Keywords

• multifocal atherosclerosis
• carotid endarterectomy
• coronary shunting
• simultaneous lesion
• adverse outcomes predictors