The Clinical Study Of Carotid Artery Stenosis Treated With Carotid Endarterectomy And Carotid Artery Stenting

Background:Carotid artery stenosis is one of the most important causes of ischemic stroke, accounting for approximately20%. Carotid artery endarterectomy (CEA) and Carotid artery stenting (CAS), as surgical and interventional option respectively, has been world-wide applied to patients with carotid stenosis. However, the choice of CEA or CAS has been controversial for decades, especially for asymptomatic patients with carotid stenosis. Recent studies have shown that age might be an important predictor of clinical outcome for patients who undergo CEA or CAS.For patients undergo CEA, perioperative carotid stenosis and long-term restenosis are common complications. The best option of repairing the carotid artery wall during the procedure to reduce the risk of restenosis is controversial. Therefore, many neurosurgeon advocate a selective application of primary closure. One of the major indications is the diameter of the impaired carotid artery. For patients with ICA<5mm, patch angioplasty can significantly reduce the risk of perioperative and long-term stroke, as well as long-term carotid restenosis. A Class D recommendation claims primary closure is safe for patients with ICA>6mm. However, Class I evidence for supporting either of options is absent. Materials and methods:A retrospective analysis of38patients who undergo CEA with primary closure in our hospital since2008is conducted. The incidence of perioperative complication and long-term restenosis in patients with ICA>5mm and ICA<5mm has been compared. In addtion,36patients who undergo carotid artery stenting is included, divided by age70years old as two subgroup.Results:There were a total of38CEA cases in our hospital from2008to2013, all of which were conducted with primary closure.20cases were bilateral stenosis. There were36CAS cases from2010to2013, of which21cases were bilateral stenosis. The hospital stay were longer for endarterectomy group over stenting group(15.39±4.73d vs10.91±4.48d, P<0.001), with an approximately2/3reduction of hospital costs (￥23686.21±7267.03vs￥60855.34±13512.30, P<0.001). The overall incidence of perioperative complications in endarterectomy goup was7.9%, with no statically significant difference in ICA≥5mm group and ICA<5mm group (9.1%vs6.3%, P=0.75). No restenosis occurred in either of subgroups during the follow up. In patients>70years old, the perioperative complications was0%in CEA and10.53%in CAS (P=0.42); The long-term restenosis was0%in CEA and5.26%in CAS(P=0.67). In patients<70years old, the perioperative complications was11.5%in CEA and23.53%in CAS (P=0.31); The long-term restenosis was0%in CEA and0%in CAS(P>0.01).Conclusion:There were no significant difference in perioperative complications or restenosis rate between CAS group and CEA group. Even stratified by age70years old, the study shows both CEA and CAS were equally effective in preventing stroke. However, the cost of CEA treatment was about1/3of the cost of CAS treatment. For all patients undergo CEA with primary closure, there was no significant difference in perioperative complications or restenosis rate between ICA≥5mm group and ICA<5mm group. The indication of primary closure for CEA may not be associated with the diameter of impared carotid artery.