PLANNING A RECONSTRUCTION METHOD FOR DOLICHOARTERIOPATHIES OF THE INTERNAL CAROTID ARTERY BASED ON MULTISPIRAL COMPUTED TOMOGRAPHY
Introduction: The choice of the method of reconstruction on the carotid arteries (CA) depends on the type of dolichoarteriopathies of the internal carotid artery (DICA) and is selected based on the data of visual research methods. Recent advances in multispiral computed tomography (MSCT) and imaging techniques using the Software enable 3D images to be reconstructed for more accurate analysis. The purpose of this study is to optimize preoperative planning for DICA based on contrast-enhanced MSCT data. Methods: The study included 167 patients with clinical signs of cerebrovascular insufficiency (CVD) and hemodynamically significant DICA, who underwent contrast-enhanced MSCT. MSCT with contrast was performed on a Philips Brilliance iCT tomograph, the thickness of the resulting sections was not more than 0.6 mm. Three-dimensional images of CT scans were obtained using RadiAnt DICOM Viewer 2020.2.3 software. Based on the 3D image of MSCT with contrast, before surgical treatment, we compiled a protocol for assessing the state of the deformed area of the ICA. All patients were operated on, 30 patients had a bilateral lesion. They were operated on from the collateral side, as they had a clinic on both sides. Results: In 137 patients, unilateral DICA was identified, kinking prevailed - 64%, C- and S-shaped tortuosities were less common - 26%, and coiling - 10%; bilateral DICA was much less common than unilateral - in 30 patients. The location of the deformed segment of the ICA relative to the angle of the mandibular (at the level / above / below): at the level - 75 (38%); higher - 94 (48%); below - 28 (14%). In 69 out of 197 cases, the excess of the ICA after its conditional straightening was less than 2 cm, in other cases (162) it was more than 2 cm. Out of 197 reconstructions on the CA for DICA, 69 operations were performed by the 1st method, 105 by the 2nd method, 21 by the 3rd method, 2 by the 4th method. Conclusions: MSCT with contrasting allows obtaining information about the level of location of the pathologically altered ICA area, the type of deformation, and also allows calculating the excess of the artery after conditional straightening. All these data make it possible to correctly choose the method of reconstruction on the CA in DICA.
Yerbol K. Dogalbayev 1-3, https://orcid.org/0000-0001-8239-563X Alexander B. Fursov 1, https://orcid.org/0000-0002-6992-8646 Tokan A. Sultanaliev 2, https://orcid.org/0000-0003-1732-9489 Irlan N. Sagandykov 2, https://orcid.org/0000-0002-9597-198X Serik S. Suleimenov 2, https://orcid.org/0000-0002-4103-4130 1 NCJSC «Astana medical university», Nur-Sultan, Republic of Kazakhstan; 2 National research oncology center, Center for vascular surgery, Nur-Sultan, Republic of Kazakhstan; 3 Corporate Foundation University Medical Center, Intervention radiology unit, Nur-Sultan, Republic of Kazakhstan.
1. Виноградов Р.А., Закеряев А.Б. Современное состояние вопроса хирургического лечения патологической извитости внутренних сонных артерий // Клиническая физиология кровообращения. 2018. Т.15. №1. С. 12-17. https://doi.org/10.24022/1814-6910-2018-15-1-12-17 2. Вишнякова М.В. (мл.). Алгоритмы комплексной лучевой диагностики окклюзирующего поражения внутренней сонной артерии для определения тактики ведения пациентов // Вестник рентгенологии и радиологии. 2017. Т.98. №5. С. 231–237. doi: 10.20862/ 0042-4676-2017-98-5-231-237 3. Гавриленко А.В., Абрамян А.В. и др. Патологическая извитость внутренней сонной артерии: клиника, диагностика и хирургическое лечение // Кардиология и сердечно-сосудистая хирургия. 2016. Т.9. №1. С. 29-33. doi: 10.17116/kardio20169129-33 4. Гавриленко А.В., Абрамян А.В. и др. Сравнительный анализ эффективности реконструктивных операций и консервативного лечения у больных с патологической извитостью внутренней сонной артерии на основании динамики неврологического и офтальмологического статусов // Кардиология и сердечно-сосудистая хирургия. 2017. Т.10. №1. С. 51-55. doi: 10.17116/kardio201710151-55 5. Гавриленко А.В., Кочетков В.А., др. Качество жизни пациентов после реконструктивных операций при патологической извитости внутренней сонной артерии // Клин. и эксперимент. хир. журн. им. акад. Б.В. Петровского. 2020. Т.8. №2. С. 32–36. doi: 10.33029/2308-1198-2020-8-2-32-36 6. Данилова М.А., Байдина Т.В., Каракулова Ю.В., Трушникова Т.Н. Патологическая извитость сонных артерии // Пермский медицинский журнал. 2018. Т.35. №6. С. 82-88. doi: 10.17816/pmj35682%88 7. Дуванов Д.А., Куликова А.Н., Чехонацкая М.Л., Илясова Е.Б. Патологические деформации внутренней сонной артерии: современные аспекты этиологии, патогенеза, диагностики и хирургического лечения // Клиническая медицина. 2017. Т.95. №7. С. 599-606. http://dx.doi.org/10.18821/0023-2149-2017-95-7-599-606 8. Дуданов И.П., Ордынец С.В., Лукинский И.А., и др. Экстракраниальная неатеросклеротическая патология сонной артерии в причинах развития острого ишемического инсульта // Исследования и практика в медицине. 2017. Т.4. №4. С. 35-49. https://doi.org/10.17709/2409-2231-2017-4-4-4 9. Зербино Д.Д., Кузык Ю.И. Патологические деформации сонных артерий (обзор литературы) // Журнал неврологии и психиатрии им. С.С. Корсакова. 2015. Т.115. №1. С. 118-123. doi: 10.17116/jnevro201511511118­123. 10. Симонов О.В., Тюрин И.Н., Прямиков А.Д., Миронков А.Б. Выбор метода анестезии при каротидной эндартерэктомии (обзор) // Общая реаниматология. 2018. №14. С. 95-113. doi:10.15360/1813-9779-2018-6-95-113 11. Hye R.J., Voeks J.H., Malas M.B. et al. Anesthetic type and risk of myocardial infarction after carotid endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) // Journal of vascular surgery. 2016. N.64. P. 3-8. https://doi.org/10.1016/j.jvs.2016.01.047 12. Ji-heng Hao, Li-yong Zhang et al. Surgical Revascularization of Symptomatic Kinking of the Internal Carotid Artery // Vascular and Endovascular Surgery. 2016. V.50. N.7. P. 470-474. doi: 10.1177/1538574416671246 13. Jinlu Yu, Lai Qu, Baofeng Xu, et al. Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review // International Journal of Medical Sciences. 2017. N.14. P. 772-784. doi: 10.7150/ijms.19229 14. Kfoury E. et al. Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: an analysis of national surgical quality improvement program database // Vascular. 2015. N.23. Р. 113-119. https://doi.org/10.1177/1708538114537489 15. Nagata T., Masumoto K., Hayashi Yu. et al. Three-dimensional computed tomographic analysis of variations of the carotid artery // Journal of Cranio-Maxillo-Facial Surgery. 2016. N.44. Р. 734-742. https://doi.org/10.1016/j.jcms.2016.02.011 16. Sang-Mi Noh, Hyun Goo Kang. Clinical signifcance of the internal carotid artery angle in ischemic stroke // Scientific Reports. 2019. N.9. P. 1-5. https://doi.org/10.1038/s41598-018-37783-1 17. Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. Etiology and radiographic anatomy // Neurology (Minneap). 1965. N15. Р. 7-18. References [1-10]: 1. Vinogradov R.A., Zakeryaev A.B. Sovremennoe sostoyanie voprosa khirurgicheskogo lecheniya patologicheskoy izvitosti vnutrennikh sonnykh arteriy [State of the art surgical treatment of pathological kinking of the internal carotid arteries]. Klinicheskaya fiziologiya krovoobrashcheniya [Clinical Physiology of Circulation]. 2018. T.15. №1. pp. 12-17 [in Russian]. https://doi.org/10.24022/1814-6910-2018-15-1-12-17 2. Vishnyakova M.V. (ml.). Algoritmy kompleksnoy luchevoy diagnostiki okklyuziruyushchego porazheniya vnutrenney sonnoy arterii dlya opredeleniya taktiki vedeniya patsientov [Imaging algorithms for occlusive carotid disease in treatment strategy]. Vestnik rentgenologii i radiologii [Journal of radiology and nuclear medicine]. 2017. T.98. №5. pp. 231–237 doi: 10.20862/ 0042-4676-2017-98-5-231-237 [in Russian]. 3. Gavrilenko A.V., Abramyan A.V. i dr. Patologicheskaya izvitost' vnutrennei sonnoi arterii: klinika, diagnostika i khirurgicheskoe lechenie [Pathological tortuosity of the internal carotid artery: clinical picture, diagnosis and surgical treatment]. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2016. T.9. №1. pp. 29-33 doi: 10.17116/kardio20169129-33 [in Russian]. 4. Gavrilenko A.V., Abramyan i dr. Sravnitel'nyi analiz effektivnosti rekonstruktivnykh operatsii i konservativnogo lecheniya u bol'nykh s patologicheskoi izvitost'yu vnutrennei sonnoi arterii na osnovanii dinamiki nevrologicheskogo i oftal'mologicheskogo statusov [Comparative analysis of the effectiveness of reconstructive operations and conservative treatment in patients with pathological tortuosity of the internal carotid artery based on the dynamics of neurological and ophthalmological status]. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2017. T.10. №1. pp. 51-55 doi: 10.17116/kardio201710151-55 [in Russian]. 5. Gavrilenko A.V., Kochetkov V.A. i dr. Kachestvo zhizni patsientov posle rekonstruktivnykh operatsiy pri patologicheskoy izvitosti vnutrenney sonnoy arterii [Quality of life of patients after reconstructive surgery with pathological tortuosity of the internal carotid artery]. Klin. i eksperiment. khir. Zhurn. im. akad. B.V. Petrovskogo [Clinical and experimental surgery. Petrovsky journal]. 2020. T.8. №2. pp. 32-36. doi: 10.33029/2308-1198-2020-8-2-32-36 [in Russian]. 6. Danilova M.A., Baydina T.V., Karakulova Yu.V., Trushnikova T.N. Patologicheskaya izvitost' sonnykh arterii [Pathologic carotid arteries tortuosity]. Permskiy meditsinskiy zhurnal [Perm medical journal]. 2018. Т35. №6. pp. 82-88. doi: 10.17816/pmj35682%88[in Russian]. 7. Duvanov D.A., Kulikova A.N. i dr. Patologicheskie deformatsii vnutrennei sonnoi arterii: sovremennye aspekty etiologii, patogeneza, diagnostiki i khirurgicheskogo lecheniya [Pathological deformities of the internal carotid artery: modern aspects of etiology, pathogenesis, diagnosis and surgical treatment]. Klinicheskaya meditsina [Clinical medicine]. 2017. T.95. №7. pp. 599-606 http://dx.doi.org/10.18821/0023-2149-2017-95-7-599-606 [in Russian]. 8. Dudanov I.P., Ordynets S.V., Lukinskiy I.A., i dr. Ekstrakranial'naya neateroskleroticheskaya patologiya sonnoy arterii v prichinakh razvitiya ostrogo ishemicheskogo insul'ta [Extracranial non-atherosclerotic pathology of the carotid artery in the causes of acute ischemic stroke]. Issledovaniya i praktika v meditsine [Research'n practical medicine journal]. 2017. T.4. №4. pp. 35-49. https://doi.org/10.17709/2409-2231-2017-4-4-4 [in Russian]. 9. Zerbino D.D., Kuzyk Yu.I. Patologicheskie deformatsii sonnykh arterii (obzor literatury) [Pathological deformities of the carotid arteries (literature review)]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova [Journal of Neurology and Psychiatry named after S.S. Korsakov]. 2015. T.115. №1. pp. 118-123 doi: 10.17116/jnevro201511511118­123. [in Russian]. 10. Simonov O.V., Tyurin I.N., Pryamikov A.D., Mironkov A.B. Vybor metoda anestezii pri karotidnoy endarterektomii (obzor) [The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)]. Obshchaya reanimatologiya [General reanimatology]. 2018. №14. pp. 95-113 doi:10.15360/1813-9779-2018-6-95-113 [in Russian].
Number of Views: 43

Key words:

Bibliography link

Dogalbayev Ye.K., Fursov A.B., Sultanaliev T.A., Sagandykov I.N., Suleimenov S.S. Planning a reconstruction method for dolichoarteriopathies of the internal carotid artery based on multispiral computed tomography // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 2, pp. 24-31. doi 10.34689/SH.2022.24.2.003