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Aim. This study provides an analysis of the results of eversion carotid endarterectomy (CEE) with transposition of the internal carotid artery (ICA) over the hypoglossal nerve, according to A.N. Kazantsev. Materials and Methods. The given prospective open study covering the period from January 2017 to May 2020 involved 311 patients who underwent eversion CEE with transposition of ICA over the hypoglossal nerve, according to A.N. Kazantsev. Transposition was performed in the following way: after standard isolation of the carotid arteries, their compression, arteriosection, and removal of atherosclerotic plaque, ICA was extracted in the area above the hypoglossal nerve and was implanted to the same position. The condition of the patient was controlled on repeated visits to the clinic every six months. Hemodynamics in the reconstruction zone were studied using multispiral computed tomography with angiography of carotid bifurcation with 0.6 mm steps and processing the obtained results in Sim Vascular and Open Foam programs in DICON format. The follow-up period was 18.37.1 months. In case of development of restenosis, reCEE was performed with patch plasty of the reconstruction zone. For histologic examination, the restenosis area was stained by the van Gieson method. Results. In the hospital follow-up period, one case of myocardial infarction was noted that developed due to the stents thrombosis in the anterior descending artery deployed two years before. When studying the hemodynamic properties of carotid bifurcation in the postoperative period using computer modeling, in all cases, no changes or obstacles to blood flow were formed in the ICA in the area above the hypoglossal nerve. In the long-term follow-up period, two cases of lethal outcome were recorded connected with the onset of an oncological disease. In one case, due to recurrence of the pulmonary artery thromboembolism. In two cases, the cause of myocardial infarction was thrombosis/occlusion of venous anastomoses (in one patient to the circumflex artery, in the other to the right coronary artery). In four cases, repeated acute cerebrovascular accidents developed due to restenosis after CEE. In cases of significant restenosis (n=8), reCEE was performed with plasty of the reconstruction zone with a patch. The average restenosis period was 8.23.6 months. No cardiovascular complications and cases of hypoglossal nerve traumatization were identified. Intraoperatively, it was confirmed that restenosis was formed in the bifurcation zone, in front of the perimeter of the primary arteriosection. According to the results of histological examination, the main cause of all restenoses was hyperplasia of the neointima. Conclusion. The eversion CEE with the transposition of the ICA, according to A.N.Kazantsev, creates conditions for additional maneuvers in case of restenosis and implementation of reCEE. The ICAs placement over the hypoglossal nerve during primary CEE allows more confident isolation of carotid artery bifurcation from scar tissues with a zero risk of damage to the hypoglossal nerve. Such a course of the operation makes it possible to apply a clamp on the ICA and perform arteriotomy in any location without the threat of injury to the nerve structures.

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.