nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2025-14-4-803-811nmp-2291Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSВыбор метода обезболивания при каротидной эндартерэктомии в остром периоде ишемического инсультаСhoice of Anaesthesia for Carotid Endarterectomy in the Acute Period of Ischemic Strokehttps://orcid.org/0000-0003-0928-9392ЧисловаA. П.ChislovaA. P.

Числова Анна Павловна, кандидат медицинских наук, врач анестезиолог-реаниматолог 

115516, Москва, ул. Бакинская, д. 26

 

Anna P. Chislova, Candidate of Medical Sciences, Anesthesiologist-Resuscitator

Bakinskaya Str. 26, Moscow, 115516

 

4-ap@mail.ruhttps://orcid.org/0000-0002-4202-7549ПрямиковA. Д.PryamikovA. D.

Прямиков Александр Дмитриевич, доктор медицинских наук, заведующий отделением сосудистой хирургии ГБУЗ «ГКБ им. В.М. Буянова» ДЗМ; доцент кафедры хирургии и эндоскопии ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» МЗ РФ

115516, Москва, ул. Бакинская, д. 26,

117997, Москва, ул. Островитянова, д. 1

Aleksander D. Pryamikov, Doctor of Medical Sciences, Head, Department of Vascular Surgery, V.M. Buyanov City Clinical Hospital; Associate Professor, Department of Surgery and Endoscopy, N.I. Pirogov Russian National Research Medical University

Bakinskaya Str. 26, Moscow, 115516,

Ostrovityanova Str. 1, Moscow, 117997

pryamikov80@rambler.ruhttps://orcid.org/0000-0002-9844-857XЛолуевР. Ю.LoluevR. Yu.

Лолуев Руслан Юнусович, кандидат медицинских наук, сердечно-сосудистый хирург отделения сосудистой хирургии ГБУЗ «ГКБ им. В.М. Буянова» ДЗМ; ассистент кафедры хирургии и эндоскопии ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» МЗ РФ

115516, Москва, ул. Бакинская, д. 26,

117997, Москва, ул. Островитянова, д. 1

Ruslan Yu. Loluev, Candidate of Medical Sciences, Cardiovascular Surgeon, Department of Vascular Surgery, V.M. Buyanov City Clinical Hospital; Assistant Professor, Department of Surgery and Endoscopy, N.I. Pirogov Russian National Research Medical University

Bakinskaya Str. 26, Moscow, 115516,

Ostrovityanova Str. 1, Moscow, 117997

rus07-91@mail.ruhttps://orcid.org/0000-0001-8472-4249АсратянС. А.AsratyanS. A.

Асратян Саркис Альбертович, кандидат медицинских наук, врач-нейрохирург, заместитель главного врача по хирургии 

115516, Москва, ул. Бакинская, д. 26

 

Sarkis A. Asratyan, Candidate of Medical Sciences, Neurosurgeon, Deputy Chief Physician for Surgery

Bakinskaya Str. 26, Moscow, 115516

 

dr.sako1970@mail.ruhttps://orcid.org/0000-0003-2770-2857ШолинИ. Ю.SholinI. Yu.

Шолин Иван Юрьевич, кандидат медицинских наук, врач анестезиолог-реаниматолог 

115516, Москва, ул. Бакинская, д. 26

 

Ivan Yu. Sholin, Candidate of Medical Sciences, Anesthesiologist-Resuscitator

Bakinskaya Str. 26, Moscow, 115516

 

scholin.i@mail.ruhttps://orcid.org/0000-0001-9651-4759СуряхинВ. С.SuryakhinV. S.

Суряхин Виктор Станиславович, кандидат медицинских наук, заместитель главного врача по анестезиологии и реанимации 

115516, Москва, ул. Бакинская, д. 26

 

Viktor S. Suryakhin, Candidate of Medical Sciences, Deputy Chief Physician for Anesthesiology and Intensive Care

Bakinskaya Str. 26, Moscow, 115516

 

surjakhin@mail.ruhttps://orcid.org/0000-0001-9782-6893ЕсиповП. С.EsipovP. S.

Есипов Павел Сергеевич, заведующий отделением нейрохирургической реанимацией 

115516, Москва, ул. Бакинская, д. 26

 

Pavel S. Esipov, Head, Neurosurgical Intensive Care Department

Bakinskaya Str. 26, Moscow, 115516

 

ventriculus@bk.ruhttps://orcid.org/0000-0003-0951-908XМиронковА. Б.MironkovA. B.

Миронков Алексей Борисович, доктор медицинских наук, заведующий отделением рентгенохирургических методов диагностики и лечения ГБУЗ «ГКБ им. В.М. Буянова» ДЗМ; доцент кафедры хирургии и эндоскопии ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» МЗ РФ

115516, Москва, ул. Бакинская, д. 26,

117997, Москва, ул. Островитянова, д. 1

Aleksey B. Mironkov, Doctor of Medical Sciences, Head, Department of X-ray Surgical Diagnostic and Treatment Methods, V.M. Buyanov City Clinical Hospital; Associate Professor, Department of Surgery and Endoscopy, N.I. Pirogov Russian National Research Medical University

Bakinskaya Str. 26, Moscow, 115516,

Ostrovityanova Str. 1, Moscow, 117997

medax@mail.ruhttps://orcid.org/0000-0001-7669-0835ХрипунА. И.KhripunA. I.

Xрипун Алексей Иванович, доктор медицинских наук, профессор, заведующий кафедрой хирургии и эндоскопии 

117997, Москва, ул. Островитянова, д. 1

Aleksey I. Khripun, Doctor of Medical Sciences, Professor, Head, Department of Surgery and Endoscopy

Ostrovityanova Str. 1, Moscow, 117997

surgery_fuv@inbox.ruГБУЗ «Городская клиническая больница им. В.М. Буянова» ДЗМРоссияV.M. Buyanov City Clinical HospitalRussian FederationГБУЗ «Городская клиническая больница им. В.М. Буянова» ДЗМ; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» МЗ РФРоссияV.M. Buyanov City Clinical Hospital; N.I. Pirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» МЗ РФРоссияN.I. Pirogov Russian National Research Medical UniversityRussian Federation202530012026144803811Copyright © Числова A.П., Прямиков A.Д., Лолуев Р.Ю., Асратян С.А., Шолин И.Ю., Суряхин В.С., Есипов П.С., Миронков А.Б., Хрипун А.И., 20262026Числова A.П., Прямиков A.Д., Лолуев Р.Ю., Асратян С.А., Шолин И.Ю., Суряхин В.С., Есипов П.С., Миронков А.Б., Хрипун А.И.Chislova A.P., Pryamikov A.D., Loluev R.Y., Asratyan S.A., Sholin I.Y., Suryakhin V.S., Esipov P.S., Mironkov A.B., Khripun A.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/2291

Презентация зарегистрированного одноцентрового проспективного рандомизированного клинического исследования «Регионарная или общая анестезия при каротидной эндартерэктомии у пациентов в острой стадии ишемического инсульта».

Цель

Цель. Определить роль регионарной анестезии (РА) при каротидной эндартерэктомии (КЭЭ) в остром периоде ишемического инсульта.

Материал и методы

Материал и методы. Изучена и проанализирована мировая литература, посвящённая сравнению РА и общей анестезии (ОА) при КЭЭ. В анализ также вошли основные рандомизированные клинические исследования и метаанализы по этой тематике за последние 16 лет. Однако большинство статей носят ретроспективный и одноцентровой характер.

Результаты

Результаты. Установлено, что все работы были посвящены сравнению этих двух методов обезболивания при плановой КЭЭ. Крупные метаанализы, включавшие рандомизированные работы, не выявили достоверных различий этих двух видов анестезий по основным результатам (транзиторная ишемическая атака, инсульт, инфаркт миокарда и летальность). Рандомизированных клинических исследований, сравнивающих РА и ОА при КЭЭ в остром периоде ишемического инсульта (28 суток), мы не встретили. В связи с этим спланировано и зарегистрировано в реестре ClinicalTrials. gov (Unique protocol ID: NCT06175715) одноцентровое проспективное рандомизированное клиническое исследование «Регионарная или общая анестезия при каротидной эндартерэктомии у пациентов в острой стадии ишемического инсульта». Под ОА подразумевается тотальная внутривенная анестезия. Работа одобрена локальным этическим комитетом (ЛЭК) ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России (выписка из протокола заседания ЛЭК РНИМУ им. Н.И. Пирогова № 223 от 23 октября 2023 года). Основные конечные точки исследования: повторный ишемический инсульт на стороне операции, любой другой инсульт, раневые геморрагические осложнения, потребовавшие хирургической ревизии операционной раны или переливания компонентов крови, смертельный исход и совокупность больших неблагоприятных сердечно-сосудистых событий (инсульт + инфаркт миокарда + смертельный исход). Предварительный срок завершения исследования — декабрь 2026 года.

The aim of the study To determine the role of regional anesthesia in carotid endarterectomy in the acute period of ischemic stroke.

Material and methods

Material and methods. The world literature on the comparison of regional and general anesthesia in carotid endarterectomy has been studied and analyzed. The analysis also included the main randomized clinical trials and meta-analyses on this topic over the past 16 years. However, most of the articles are retrospective and from a single center.

Results

Results. It was found that all the researches were devoted to comparing these two methods of anesthesia for planned carotid endarterectomy. Large meta-analyses, which included randomized trials, did not reveal significant differences between these two types of anesthesia according to the main results (transient ischemic attack, stroke, myocardial infarction and mortality). We have not found randomized clinical trials comparing regional and general anesthesia for carotid endarterectomy in the acute period of ischemic stroke (28 days). In this regard, a single-center prospective randomized clinical trial “Regional or general anesthesia for carotid endarterectomy in patients in the acute stage of ischemic stroke” was planned and registered in The ClinicalTrials.gov (Unique protocol ID: NCT06175715). General anesthesia means total intravenous anesthesia. The research was approved by the local ethics committee of the Federal State Budgetary Educational Institution of the Russian National Research University named after N.I. Pirogov of the Ministry of Health of the Russian Federation (extract from the minutes of the meeting of the LEK of the Russian National Research University named after N.I. Pirogov No. 223 dated October 23, 2023). The main endpoints of the study are: repeated ipsilateral stroke, any other stroke, big hemorrhagic complications that required surgical revision of the surgical wound or transfusion of blood components, fatal outcome and a combination of major adverse cardiovascular events (stroke + myocardial infarction + fatal outcome). The preliminary deadline for completing the study is December 2026.

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The authors declare that there are no conflicts of interest present.