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УДК: 616.8-009 DOI:10.33920/med-01-2102-02

Postoperative cognitive dysfunction after carotid endarterectomy — current preventive strategy

Ivolgin Aleksandr Fedorovich head of the Neurological Center — chief neurologist of the FSBI 3rd Central Military Clinical Hospital named after A.A. Vishnevsky of the Ministry of Defense of the Russian Federation, Novy, Krasnogorsk district, 143420, Moscow Region; E-mail: aivolgin@mail.ru, ORCID 0000-0002-8849-680X
Litvinenko I. V. FSBMEI HE Military Medical Academy named after S.M. Kirov of the Ministry of Defense of Russia, Saint-Petersburg, ORCID 0000-0001-8988-3011
Tsygan N. V. FSBMEI HE Military Medical Academy named after S.M. Kirov of the Ministry of Defense of Russia, Saint-Petersburg; NRC Kurchatov Institute, Moscow; NRC Kurchatov Institute — PNPI, Gatchina, Leningrad Region, ORCID 0000-0002-5881-2242
Samushiya M. A. SBI FPE Central State Medical Academy of the Presidential Administration of Russia, Moscow, ORCID 0000-0003-3681-9977
Ragimova A. A. SBI FPE Central State Medical Academy of the Presidential Administration of Russia, Moscow; Higher School of Economics — National Research University, Moscow, ORCID 0000-0002-4370-4249

Forty-nine foreign and domestic publications on prevention of postoperative cognitive dysfunction (POCD) developing after reconstructive operations on the carotid arteries were reviewed. Conclusions Reconstructive operations on carotid arteries (the internal carotid artery primarily) which are prioritized for the prevention of ischemic strokes in the atherosclerotic stenotic lesion ofthe brachiocephalic arteries, can cause the development of POCD. The current strategy forreducing postoperative cognitive impairment risks is far from perfect and requires further research.

Литература:

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We selected scientific publications and studies from the main medical databases PubMed, UpToDate, E-library using the keywords «postoperative brain dysfunction», «postoperative cognitive dysfunction», «postoperative delirium», «early postoperative delirium», «delayed cognitive impairment», «perioperative stroke», «carotid endarterectomy». The search results were 1775 articles. When some publications excluded due to irrelevance, the unavailable full text of the article, as well as oft-recurring similar articles or ones with a poor-quality material presentation, 49 articles remained.

Among the studied literature, 3 Russian and 46 foreign sources were selected. Half of the sources (24) were published from 2002 to 2014, and the second half — from 2015 to 2020. 31 articles are devoted to features of cognitive functioning (7 of them are devoted to cognitive decline after carotid surgery (14.7 %), 20 are devoted to features of cognitive functioning after other operations (42 %), including cardiac surgery and orthopaedic surgery, the other three articles cover fundamental aspects of human cognitive functioning, and one deals with delirium after vascular surgery (2.1 %). Eight articles (16.8 %) are devoted to pharmacological treatment for maintaining a certain level of cognitive abilities after surgery. Five articles (10.5 %) are focused on aspects of surgical intervention, and other 5 articles are devoted to Theoretical Neurobiology. Five articles (10.5 %) are meta-analyses, 34 (71.4 %) are original studies, 9 articles (18.9 %) are reviews, and one paper is presented in the form of abstracts.

Of the 12 original articles on carotid surgery, 5 articles had more than 1,000 included patients (1,045 to 21,624 patients, average –10,184 patients), 7 articles had 42 to 279 patients (average — 160 patients). The number of references in the reviews ranges from 31 to 149 sources (average — 59 sources), in metaanalyses — from 14 to 61 sources (average — 42 sources), in original studies — from 12 to 56 sources (average — 30 sources). In 6 studies, the follow-up time after surgery was a month, in one study — after three months, in two studies, the treatment results were reviewed repeatedly (after 1 and 6 months), in one study, treatment control was carried out 2.5 years after treatment, in the other studies, the patient’s condition was assessed only after surgery.

Для Цитирования:
Ivolgin Aleksandr Fedorovich, Litvinenko I. V., Tsygan N. V., Samushiya M. A., Ragimova A. A., Postoperative cognitive dysfunction after carotid endarterectomy — current preventive strategy. Вестник неврологии, психиатрии и нейрохирургии. 2021;2.
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