Natural history of atherosclerotic lesions of the innominate artery

OBJECTIVE: to study the natural history of atherosclerotic lesions of the innominate artery (IA) and to identify factors influencing the disease progression. MATERIAL AND METHODS: The study included 82 patients with atherosclerotic lesions of the IA observed for various diseases in A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2010 to 2022. All patients were divided into 4 groups depending on the initial degree of IA stenosis: less than 50% - 35 (42.7%) patients, 50-69% - 29 (35.4%), 70-99% - 14 (17.1%), and occlusion - 4 (4.8%). RESULTS: The incidence of increasing grade of IA stenosis in the groups with initial stenosis less than 50% and 50-69% was statistically significant (p=0.001 and p=0.000, respectively). Significantly more often there was an increase in the degree of IA stenosis, and hence migration to groups with a more severe degree of stenosis, in persons not taking statins (p=0.000), in smokers (p=0.005), and in patients suffering from diabetes (p=0.015). In the groups with 50-69% and 70-99% stenosis, differences between the number of asymptomatic and symptomatic patients at the beginning and end of the follow-up period were significant (p=0.000). In the groups with less than 50% stenosis and occlusions the dynamics of initial cerebrovascular insufficiency was insignificant (p=0.643). It is worth noting that in 1 (25%) case of initial asymptomatic occlusion, a stroke developed. History of arterial hypertension (p=0.007), smoking (p=0.03), as well as hemodynamically significant stenosis of IA (p=0.000) had statistically significant effect on the dynamics of initial cerebrovascular insufficiency. Patients with initial or developed hemodynamically significant IA lesions had the development of strokes in half of the cases (53.5%) (p=0.000), and every third case was fatal (p=0.009). The incidence of myocardial infarction and mortality due to myocardial infarction, as well as the overall mortality in patients with hemodynamically significant (initial or developed) and insignificant lesions did not differ significantly (p>0.05). Cumulative freedom from stroke by year 10 in hemodynamically significant lesions of the IA fell to 0, and in stenoses 50-69% and up to 50% it was 38% and 100%, respectively. The 10-year cumulative survival rate for hemodynamically significant IA lesions was 34%, whereas for stenoses 50-69% and up to 50% was 54% and 88%, respectively. CONCLUSION: At the initial degree of IA stenosis up to 50% and 50-69%, patients should be recommended to correct any risk factors (primarily diabetes, smoking, hypercholesterolemia, arterial hypertension), and to undergo duplex scanning of the brachiocephalic arteries with a frequency of 1-2 times a year. In hemodynamically significant lesions surgical intervention is absolutely indicated regardless of the initial degree of cerebrovascular insufficiency, followed by optimal drug therapy and correction of risk factors.