Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19
A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymera...
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| Format: | Article |
| Language: | Russian |
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Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department
2021-11-01
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| Series: | Неотложная медицинская помощь |
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| Online Access: | https://www.jnmp.ru/jour/article/view/1210 |
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| author | A. N. Kazantsev S. V. Artyukhov K. P. Chernykh A. R. Shabaev G. Sh. Bagdavadze A. E. Chikin L. V. Roshkovskaya T. E. Zaitseva Yu. P. Linets |
| author_facet | A. N. Kazantsev S. V. Artyukhov K. P. Chernykh A. R. Shabaev G. Sh. Bagdavadze A. E. Chikin L. V. Roshkovskaya T. E. Zaitseva Yu. P. Linets |
| author_sort | A. N. Kazantsev |
| collection | DOAJ |
| description | A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition. |
| format | Article |
| id | doaj-art-b992aa670f2a481a9ba7679411944d7a |
| institution | Kabale University |
| issn | 2223-9022 2541-8017 |
| language | Russian |
| publishDate | 2021-11-01 |
| publisher | Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department |
| record_format | Article |
| series | Неотложная медицинская помощь |
| spelling | doaj-art-b992aa670f2a481a9ba7679411944d7a2025-08-20T03:43:21ZrusSklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare DepartmentНеотложная медицинская помощь2223-90222541-80172021-11-0110347748310.23934/2223-9022-2021-10-3-477-483706Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19A. N. Kazantsev0S. V. Artyukhov1K. P. Chernykh2A. R. Shabaev3G. Sh. Bagdavadze4A. E. Chikin5L. V. Roshkovskaya6T. E. Zaitseva7Yu. P. Linets8St. Petersburg City Alexandrovskaya HospitalSt. Petersburg City Alexandrovskaya Hospital; I.I. Mechnikov North-Western State Medical UniversitySt. Petersburg City Alexandrovskaya HospitalL.S. Barbarash Kuzbass Clinical Cardiological ClinicI.I. Mechnikov North-Western State Medical UniversitySt. Petersburg City Alexandrovskaya HospitalSt. Petersburg City Alexandrovskaya HospitalSt. Petersburg City Alexandrovskaya HospitalSt. Petersburg City Alexandrovskaya HospitalA case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition.https://www.jnmp.ru/jour/article/view/1210carotid endarterectomythrombosisinternal carotid artery thrombosisarterial thrombosisthrombectomycovid-19new coronavirusnew coronavirus infection |
| spellingShingle | A. N. Kazantsev S. V. Artyukhov K. P. Chernykh A. R. Shabaev G. Sh. Bagdavadze A. E. Chikin L. V. Roshkovskaya T. E. Zaitseva Yu. P. Linets Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 Неотложная медицинская помощь carotid endarterectomy thrombosis internal carotid artery thrombosis arterial thrombosis thrombectomy covid-19 new coronavirus new coronavirus infection |
| title | Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 |
| title_full | Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 |
| title_fullStr | Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 |
| title_full_unstemmed | Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 |
| title_short | Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19 |
| title_sort | emergency carotid endarterectomy for internal carotid artery thrombosis in the course of covid 19 |
| topic | carotid endarterectomy thrombosis internal carotid artery thrombosis arterial thrombosis thrombectomy covid-19 new coronavirus new coronavirus infection |
| url | https://www.jnmp.ru/jour/article/view/1210 |
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