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CarotidSCORE

Risk stratification of postoperative complications (death, stroke, myocardial infarction) of carotid endarterectomy during the hospital follow-up period.

This interactive calculator was created based on the analysis of a multicenter outcome register of 25812 carotid endarterectomies performed from 01/01/2010 to 04/01/2022. The following types of carotid endarterectomy were implemented: 6814 classic ones with patch repair of the reconstruction zone; 18998 eversion endarterectomies. In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14% - myocardial infarction, 0.35% - ischemic stroke. The combined end point was 0.68%.

For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was understood as a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. The total contribution of these factors was displayed in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. Based on the calculations obtained, the CarotidSCORE program was created.

CarotidSCORE allows you to calculate the likelihood of postoperative complications (death, myocardial infarction, ischemic stroke) in patients after carotid endarterectomy.

CarotidSCORE also calculates the risk of postoperative complications in the implementation of combined, hybrid and staged strategies for brain and myocardial revascularization.


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Neurological characteristics
1 Past medical history of stroke
2 Past medical history of transient ischemic attack
3 Acutest period of stroke1
4 Acute period of stroke2
5 Chronic cerebral ischemia stage 13
6 Chronic cerebral ischemia stage 24
7 Chronic cerebral ischemia stage 35

1 - Acutest period of stroke includes 1 - 3 days after the development of neurological deficit [1]

2 - Acute period of ischemic stroke includes up to 4 - 28 days after the development of neurological deficit [1]

3 - Chronic cerebral ischemia stage 1. Anisoreflexia, non-rough reflexes of oral automatism. There may be slight changes in gait (slowness of walking, small steps), a decrease in stability and uncertainty when performing coordinating tests. Often noted emotional and personality disorders (irritability, emotional lability, anxiety and depressive traits). Already at this stage, mild cognitive disorders of the neurodynamic type occur: exhaustion, fluctuating attention, slowing down and inertia of intellectual activity. Patients cope with neuropsychological tests and jobs that do not require time tracking. The vital activity of patients is not limited [2].

4 - Chronic ischemia of the brain stage 2. It is characterized by an increase in neurological symptoms with the possible formation of a mild, but dominant syndrome. Separate extrapyramidal disorders, incomplete pseudobulbar syndrome, ataxia, CN dysfunction of the central type (proso- and glossoparesis) are revealed. Complaints become less pronounced and not so significant for the patient. Emotional disorders worsen. Cognitive function increases to a moderate degree, neurodynamic disorders are supplemented by dysregulatory ones (frontosubcortical syndrome). The ability to plan and control one's actions is deteriorating. The performance of tasks that are unlimited in time is disrupted, but the ability to compensate remains (the ability to use hints remains). It is possible to show signs of a decrease in social and professional adaptation [2].

5 - Chronic cerebral ischemia stage 3. It is characterized by a vivid manifestation of several neurological syndromes. Impaired walking and balance (frequent falls), urinary incontinence, Parkinson's syndrome. In connection with the decrease in criticism of one's condition, the volume of complaints decreases. Behavioral and personality disorders manifest as explosiveness, disinhibition, apathicoabolic syndrome, and psychotic disorders [2].

References:
  1. БЛИЖАЙШИЕ И ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ В РАЗНЫЕ ПЕРИОДЫ ИШЕМИЧЕСКОГО ИНСУЛЬТА
    Казанцев А.Н., Черных К.П., Заркуа Н.Э., Лидер Р.Ю., Буркова Е.А., Багдавадзе Г.Ш., Калинин Е.Ю., Зайцева Т.Е., Чикин А.Е., Линец Ю.П., Кубачев К.Г. Российский медико-биологический вестник имени академика И.П. Павлова. 2020. Т. 28. № 3. С. 312-322. DOI: 10.23888/PAVLOVJ2020283312-322
  2. ХРОНИЧЕСКАЯ ИШЕМИЯ ГОЛОВНОГО МОЗГА
    Данияр Ж., Бхат Н.А., Раимкулова К.Б., Раимкулова Х.Б., Раимкулов Б.Н. Вестник Казахского национального медицинского университета. 2012. № 4. С. 100-102.
Cardiac pathology
8 Past medical history of myocardial infarction
9 Past medical history of percutaneous coronary intervention
10 Past medical history of coronary artery bypass grafting
11 NYHA functional class I
12 NYHA functional class II
13 NYHA functional class III
14 Aneurysm of the left ventricle1
15 Left ventricular ejection fraction less than 50% (according to Simpson)2

1 - according to the results of echocardiography

2 - according to the results of echocardiography
Coronary angiography
16 Low level (≤22 points) of coronary lesions according to the SYNTAX Score scale (www.syntaxscore.com)
17 Intermediate level (23 - 32 points) of coronary lesions according to the SYNTAX Score scale (www.syntaxscore.com)
18 Severe level (≥33 points) of coronary lesions according to the SYNTAX Score scale (www.syntaxscore.com)
19 Intact coronary arteries

Visualization of extracranial and intracranial arteries
20 Unclosed circle of Willis1
21 Stenosis of the internal carotid arteries on both sides more than 60%2
22 Occlusion of the contralateral internal carotid artery
23 Unstable atherosclerotic plaque in the ipsilateral internal carotid artery3
24 Unstable atherosclerotic plaque in both internal carotid arteries3
25 High level of bifurcation of the common carotid artery4
26 Calcification of the ipsilateral internal carotid artery
27 Extended atherosclerotic lesion of the internal carotid artery (more than 3 centimeter)5

1 - The circle of Willis is an important network of collaterals of the intracranial basin, capable of compensatory redistribution of the hemodynamic load, including when clamping the carotid arteries during carotid endarterectomy. A number of studies have shown that in approximately 50-90% of cases, the VC is open, and the number of missing segments correlates with low tolerance to cerebral ischemia caused by clamping of the internal carotid arteries [1,2].

2 - According to the North American Symptomatic Carotid Endarterectomy Trial.

3 - Unstable atherosclerotic plaque - an atherosclerotic plaque with one or more signs according to duplex scanning or angiography: ulceration, hemorrhage into the plaque, intimal flotation, parietal thrombus [3].

4 - From the upper edge of the body of the II cervical vertebra to the lower edge of the intervertebral disc located between the III and IV cervical vertebrae.

5 - Atherosclerotic lesion of the internal carotid artery from the mouth in the distal direction.

References:
  1. МНОГОЦЕНТРОВОЕ ИССЛЕДОВАНИЕ: ИСХОДЫ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ В ЗАВИСИМОСТИ ОТ КОНФИГУРАЦИИ ВИЛЛИЗИЕВА КРУГА
    Казанцев А.Н., Черных К.П., Виноградов Р.А., Чернявский М.А., Кравчук В.Н., Шматов Д.В., Сорокин А.А., Ерофеев А.А., Луценко В.А., Султанов Р.В., Шабаев А.Р., Раджабов И.М., Багдавадзе Г.Ш., Заркуа Н.Э., Матусевич В.В., Вайман Е.Ф., Солобуев А.И., Лидер Р.Ю., Шукуров И.Х.У., Барышев А.Г. и др. Российский медико-биологический вестник имени академика И.П. Павлова. 2021. Т. 29. № 3. С. 397-409. DOI: 10.17816/PAVLOVJ61088
  2. ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ МУЛЬТИФОКАЛЬНОГО АТЕРОСКЛЕРОЗА: ПАТОЛОГИЯ КОРОНАРНОГО И БРАХИОЦЕФАЛЬНОГО БАССЕЙНОВ И ПРЕДИКТОРЫ РАЗВИТИЯ РАННИХ НЕБЛАГОПРИЯТНЫХ СОБЫТИЙ
    Тарасов Р.С., Казанцев А.Н., Иванов С.В., Бурков Н.Н., Ануфриев А.И., Барбараш Л.С. Кардиоваскулярная терапия и профилактика. 2017. Т. 16. № 4. С. 37-44. DOI: 10.15829/1728-8800-2017-4-37-44
  3. НАЦИОНАЛЬНЫЕ РЕКОМЕНДАЦИИ ПО ВЕДЕНИЮ ПАЦИЕНТОВ С ЗАБОЛЕВАНИЯМИ БРАХИОЦЕФАЛЬНЫХ АРТЕРИЙ
Concomitant pathology
28 Diabetes mellitus
29 Chronic obstructive pulmonary disease
30 Chronic kidney disease
31 Hemodynamically significant lesion of the coronary arteries, carotid arteries, arteries of the lower extremities
32 Obesity
33 Chronic lower limb ischemia - threatening ischemia1
34 Had COVID-19 within the last 6 months
35 Hypertension grade III
36 Pulmonary arteries hypertension2
37 Atrial fibrillation

1 - I – III degree according to Fontaine, A.V. Pokrovsky (page 14: NATIONAL RECOMMENDATIONS FOR THE DIAGNOSIS AND TREATMENT OF DISEASES OF THE LOWER LIMB ARTERIES )

2 - according to the results of echocardiography
Tactics of revascularization
38 Next stage myocardial revascularization
39 Simultaneous operation (carotid endarterectomy + coronary bypass grafting)
40 Hybrid operation (carotid endarterectomy + percutaneous coronary intervention)
41 Classic carotid endarterectomy (with patch)
42 Eversion carotid endarterectomy planned
43 Glomus-sparing carotid endarterectomy1
44 'Chik-chirik' carotid endarterectomy2
45 Use of a temporary intraluminal shunt

1 - Glomus-sparing carotid endarterectomy is a type of eversion carotid endarterectomy, which includes cutting off the internal carotid artery from the orifice without traumatizing or cutting the carotid glomus [1].

2 - 'Chik-chirik' carotid endarterectomy is a type of glomus-sparing carotid endarterectomy, in which, after cutting off the internal carotid artery from the bifurcation, it is transposed above the hypoglossal nerve [2].

References:
  1. ГЛОМУС-СБЕРЕГАЮЩАЯ КАРОТИДНАЯ ЭНДАРТЕРЭКТОМИЯ ПО А.Н. КАЗАНЦЕВУ. ГОСПИТАЛЬНЫЕ И СРЕДНЕОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ
    Казанцев А.Н., Черных К.П., Лидер Р.Ю., Заркуа Н.Э., Кубачев К.Г., Багдавадзе Г.Ш., Калинин Е.Ю., Зайцева Т.Е., Чикин А.Е., Линец Ю.П. Патология кровообращения и кардиохирургия. 2020. Т. 24. № 3. С. 70-79. DOI: 10.21688/1681-3472-2020-3-70-79
  2. "ЧИК-ЧИРИК" КАРОТИДНАЯ ЭНДАРТЕРЭКТОМИЯ
    Казанцев А.Н., Черных К.П., Заркуа Н.Э., Лидер Р.Ю., Кубачев К.Г., Багдавадзе Г.Ш., Калинин Е.Ю., Волков А.Н., Шабаев А.Р., Бурков Н.Н. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2020. Т. 21. № 4. С. 414-428. DOI: 10.24022/1810-0694-2020-21-4-414-428
Probability of complications: 0.000%
Risk level of complications: Low

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