I.P. Pavlov Russian Medical Biological HeraldI.P. Pavlov Russian Medical Biological Herald0204-34752500-2546Eco-Vector7612510.17816/PAVLOVJ76125Research ArticleGlomus-Saving Autografting of the Internal Carotid Artery in the Peracute Period of Ischemic Stroke with Underlying COVID-19AltymukhamedovaLeyli D.lilialtlolo@gmail.comhttps://orcid.org/0000-0002-7660-2871RotanovaAnna I.rotanova-anna@rambler.ruhttps://orcid.org/0000-0002-1926-663XKatykhinaValentina V.vkatyhina16@mail.ruhttps://orcid.org/0000-0002-3839-5226ChesnokovaAnna A.a.chesnockova22@yandex.ruhttps://orcid.org/0000-0003-1732-0978KorotkikhAleksandr V.ssemioo@rambler.ruhttps://orcid.org/0000-0002-9709-1097ZharovaAlina S.zharova.alina2018@yandex.ruhttps://orcid.org/0000-0001-9474-4972PivovarovAleksandr A.a.a.pivovarov@bk.ruhttps://orcid.org/0000-0001-9461-4908BuksayevDmitriy S.buksaev00@mail.ruhttps://orcid.org/0000-0003-4251-7238KazantsevAnton N.dr.antonio.kazantsev@mail.ruhttps://orcid.org/0000-0002-1115-609XNorth-Western State Medical University named after I. I. MechnikovClinic of Cardiac Surgery of Amur State Medical AcademyKemerovo State Medical UniversityAlexander City Hospital290620223022332421707202119052022Copyright © 2022,2022<p><strong><em>INTRODUCTION</em></strong><em>: </em>The severe acute respiratory syndrome coronavirus 2 is associated with the development of arterial thromboses of different locations. This pathology is common in patients with multifocal atherosclerosis. The overwhelming majority of published reports are devoted to the surgical treatment of patients with thrombosis of lower limb arteries. Thus far, no studies of revascularization in the case of extended atherosclerotic lesion and thrombosis of the internal carotid artery (ICA) in patients with COVID-19, have been published.</p>
<p><strong><em>AIM</em></strong><em>:</em> To analyze the immediate results of glomus-saving autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ischemic stroke in patients with COVID-19.</p>
<p><strong><em>MATERIALS AND METHODS</em></strong><em>: </em>The retrospective study (inclusion period 01.01.201701.03.2020) involved 49 patients with hemodynamically significant extended atherosclerotic lesion of the ICA in the peracute period of acute cerebrovascular accident (ACVA). From April 1, 2020, to May 15, 2021, 26 patients with hemodynamically significant extended atherosclerotic lesion and floating thrombus in the ICA and a positive result of polymerase chain reaction to SARS-CoV-2 were included. In all cases, brain revascularization was performed in the peracute period of ACVA in the volume of glomus-saving autografting of the ICA.</p>
<p><strong><em>RESULTS</em></strong><em>: </em>No adverse cardiovascular events were noted throughout the postoperative follow-up period in both groups. In the examination of the reconstruction zone using color duplex ultrasonography, no data for restenosis/thrombosis were recorded. On day 7 after surgery, in both cohorts of patients, significant regression of neurological deficit on the National Institute of Health Stroke Scale was noted: in the first group, the values during admission and day 7 after revascularization were10.5 3.5 and 6.5 1.5, respectively (р = 0.001); in the second group, the values were 12.5 2.5 and 5.5 1.5, respectively (р = 0.001). In both groups, no cases of unstable difficult-to-control arterial hypertension were noted, and no changes were introduced to the antihypertensive therapy.</p>
<p><strong><em>CONCLUSIONS</em></strong><em>:</em> Emergency autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ACVA is an effective and safe method of brain revascularization in patients with COVID-19.</p>carotid endarterectomyautografting of the internal carotid arterycarotid glomusacute period of ischemic strokeemergency carotid endarterectomyкаротидная эндартерэктомияаутотрансплантация внутренней сонной артериикаротидный гломусострый период ишемического инсультаэкстренная каротидная эндартерэктомия[Kazantsev AN, Chernykh KP, Lider RYu, et al. Emergency Glomus-Sparing Carotid Endarterectomy According to A.N. Kazantsev. Russian Sklifosovsky Journal “Emergency Medical Care”. 2020;9(4):494–503. (In Russ). doi: 10.23934/2223-9022-2020-9-4-494-503][Kazantsev AN, Shabayev AR, Medvedeva EA, et al. Emergency Extra–Intracranial Microanastomosis After Carotid Endarterectomy Complicated With Thrombosis of the Internal Carotid Artery. Russian Sklifosovsky Journal “Emergency Medical Care”. 2020;9(3):452–8. (In Russ). doi: 10.23934/2223-9022-2020-9-3-452-458][Kazantsev AN, Porkhanov VA, Khubulava GG, et al. Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results. Russian Sklifosovsky Journal “Emergency Medical Care”. 2021;10(1):33–47. (In Russ). doi: 10.23934/2223-9022-2021-10-1-33-47][Natsional’nyye rekomendatsii po vedeniyu patsiyentov s zabolevaniyami brakhiotsefal’nykh arteriy. Moscow; 2013. Available at: https://www.angiolsurgery.org/recommendations/2013/recommendations _brachiocephalic.pdf. Accessed: 2021 July 17. (In Russ).][Kazantsev AN, Chernykh KP, Zarkua NE, et al. Eversion carotid endarterectomy with transposition of the internal carotid artery according to A.N. Kazantsev. Hospital and long-term results. I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):73–88. (In Russ). doi: 10.23888/PAVLOVJ202129173-88][Rosseykin EV, Voyevodin AB, Bazylev VV. Autotransplantatsiya vnutrenney sonnoy arterii: novyy vzglyad na tekhniku eversionnoy karotidnoy endarter·ektomii. Byulleten' NTSSSKH im. A.N. Bakuleva RAMN “Serdechno-Sosudistyye Zabolevaniya”. 2015;16(S6):98. (In Russ).][Vinogradov RA, Matusevich VV. Use of glomus-sparing techniques in surgery of carotid arteries. Angiology and Vascular Surgery. 2018;24(2):201–5. (In Russ).][Fokin AA, Borsuk DA. The influence of preserved carotid sinus nerves on vegetation regulation and central hemodynamic after carotid reconstructions. Clinical and Experimental Surgery. Petrovsky Journal. 2014;(4):42–6. (In Russ).][Kazantsev AN, Burkov NN, Borisov VG, et al. Computer–assisted simulation of haemodynamic parameters of carotid artery bifurcation after carotid endarterectomy. Angiology and Vascular Surgery. 2019;25(3):107–12. (In Russ). doi: 10.33529/ANGIO2019311][Kazantsev AN, Burkov NN, Zakharov YuN, et al. Personalized brain revascularization: computer modeling of the reconstruction zone for carotid endarterectomy. Pirogov Russian Journal of Surgery. 2020;(6):71–5. (In Russ). doi: 10.17116/hirurgia202006171][Cancer–Perez S, Alfayate–García J, Vicente–Jiménez S, et al. Symptomatic Common Carotid Free–Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review. Annals of Vascular Surgery. 2021;73:122–8. doi: 10.1016/j.avsg.2021.02.008][Vertkin AL, Avdeev SN, Roitman EV, et al. Treatment of COVID-19 from the perspective of endotheliopathy correction and prevention of thrombotic complications. The agreed position of the experts. Profilakticheskaya Meditsina. 2021;24(4):45–51. (In Russ). doi: 10.17116/profmed20212404145][Linets YuP, Artyukhov SV, Kazantcev AN, et al. Thrombosis in the structure of surgical complications COVID-19. Emergency Medical Care. 2020;21(4):24–9. (In Russ). doi: 10.24884/2072-6716-2020-21-4-24-29][Lal A, Mishra AK, Akhtar J, et al. Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome. Monaldi Archives for Chest Disease. 2021;91:1608.]