Mathematical Model for the Choice of Tactics of Revascularization in Case of Combined Lesions of the Carotid and Coronary Arteries

Abstract

Based on the assessment of the long-term results of various surgical treatment strategies for patients with combined hemodynamically significant lesions of the coronary basin and internal carotid arteries, to develop a model for choosing the optimal revascularization strategy for patients with multifocal atherosclerosis. In 391 patients with combined hemodynamically significant atherosclerotic lesions of the coronary bed and internal carotid arteries, various options for reconstructive operations were performed. 1 - Staged surgery in the volume of coronary artery bypass grafting followed by carotid endarterectomy (n = 151, 38.6%); 2 - Combined coronary bypass surgery and carotid endarterectomy (n=141, 36%); 3 - Hybrid revascularization in the volume of percutaneous coronary intervention and carotidal endarterectomy (n = 28, 7.2%); 4 - Phased surgery in the volume of carotidal endarterectomyand subsequent coronary bypass surgery (n = 71, 18.2%). The study analyzed the frequency and structure of complications in the remote postoperative period (33.95±12.05 months - for of the total sample of patients). To select the optimal tactics of revascularization, the prognostic coefficients of all levels of risk factors for each tactic were evaluated and, on their basis, integral indicators characterizing a comprehensive assessment of risk factors for the corresponding surgical tactics were calculated. The developed model of personalized choice of the optimal surgical strategy, based on a comprehensive assessment of risk factors for an unfavorable outcome (clinical-demographic, coronary and cerebrovascular), makes it possible to predict the likelihood of developing unfavorable cardiovascular ones.