The Carotid Endarterectomy: A Study Of The Therapeutic Effect And Standardization Of The Treatment.

Background:The carotid endarterectomy has been performed for the treatment of carotid stenosis as a classical operation for half a century and with the development of the endovascular technique,it trends to be substituted of the casotid angioplasty and stenting(CAS) these years.However,the most recent study turned out that either operation has its advantage in the comparison of complications of 30 days and 1 year after sugery and the ratio of restenosis with the CEA demonstrates precedence. Therefore,CEA is still considered the "golden standard" therapy for carotid stenosis. Now that most domestic clinical centers are faced with the limited amount of the CEA operation,the treatment still need stardardization in some extent.Objective:To summarize the treatment of the CEA patients in recent years and study the normalization of CEA.Method:The clinical and radiological records of all patients undergoing CEA from 2004 to 2008 at our institution were reviewed retrospectively to assess outcomes at 30 days after surgery and the restenosis in the follow-up.The independent associations of clinical and radiological factors with the perioperative stroke and cranial nerve injury were assessed through multivariate logistic regression analysis.The associations of several factors with the restenosis were compared with the Kaplan-Meier curves.Outcomes:1,The clinical and radiological factors and perioperative outcomes were calculated with statistic tools and described in the charts.2,The association of the study factors with the stroke rate 30 days after the surgery:2-1 Selective versus routine shunting:(1) There were more perioperative stroke in the selective shunting group,but no statistic significance.(P=0.392)(2) There were more stroke history(P=0.037),pre-statin treatment(P=0.005) and less smoking history(P=0.001) in the selective shunting group.2-2 Stable and vulnerable plaques:(1) There were more perioperative stoke in the stable plaque group,but no statistic significance(P=0.319).(2) There were more ASO history in the stable group(P=0.024).2-3 Urgent and delayed surgery:(1) There were more perioperative stroke in the urgent surgery group,but no statistic significance(P=0.660).(2) There were more TIA history in the urgent surgery group(P=0.029).2-4 All three variables reaching a P value of 0.05 or less in the univariate analysis were included in a multivariate logistic regression model and the "ipsolateral stenosis rate" was found the independent predictor of perioperative stroke after CEA,which would increase the risk with its rise.3,No variables had a P value of 0.05 or less in the univariable analysis,so no variable was included in a multivariate logistic regression model.No variable was found a independent predictor of post-operative cranial nerve injury.4,The association of the study factors with post-operative restenosis:4-1 The non-angiography group turned up earlier restenosis with a P value of 0.008.The post-operative statin group turned up earlier restenosis with a P value of 0.011.4-2 No variable was found the independent predictor in the Cox regression analysis.