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Marchenko A.V.¹

and 6 more

Objective: To study the surgical treatment’s immediate and long-term results of patients with the coronary and carotid arteries’ combined atherosclerotic lesions when choosing treatment tactics according to the developed a differentiated approach’s algorithm. Methods: During the period from 01.07.2014 – 01.01.2021, 243 patients with the coronary and carotid arteries’ combined atherosclerotic lesions were included in the study. Patients underwent revascularization operations on the previously developed algorithm’s basis for choosing the surgical intervention’s volume and stage. 104 patients (42.8%) underwent simultaneous combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), 139 (57.2%) patients received phased revascularization, of which 102 (73.4%) patients underwent CABG, 37 (26.6%) underwent CEA in the first stage. The endpoints both when comparing immediate and long-term results were: death from all causes, acute cerebrovascular accident (ACVA), transient ischemic attack (TIA), acute myocardial infarction (MI), as well as a combined endpoint that includes all of these events. Average follow-up time: 41.1±21.8 months. Results: In the early postoperative period, there weren’t fatal cases in any groups. At the hospital stage, 5 (2.1%) ACVA cases, 1 (0.4%) TIA case and 3 (1.2%) acute MI cases were recorded. Long-term results were evaluated in 225 patients (92.3%). The overall survival rate was 93.8%. During the follow-up, 5 (2.4%) MI cases, 11 (4.9%) ACVA cases , 1 (1.0%) TIA case were recorded. There weren’t identified significant differences between the groups stage and combined interventions for any endpoints as when comparing the immediate outcomes (acute IM p=0,680, TIA – p=0,500, ACVA – p=0,567, combined indicator, p=0,940) and remote results (mortality – 0,860, acute MI – p=0,906, TIA – p=0,528, ACVA – p=0,378, combined indicator, p=0,669). Conclusion: The treatment’s results of patients with the coronary and brachycephalic arteries’ combined atherosclerosis on the developed algorithm’s basis, allows you to safely perform correction in both arterial basins and achieve satisfactory results in the hospital and long-term period.