Follow-up Observation Of Patient With Carotid Stenosis In The Initial Segment After Stent Angioplasty In Chifeng Region

Background:Chifeng City is located in southeastern Inner Mongolia, is thejunction of Inner Mongolia, Hebei Province and Liao Ning Province, is one of primaryMongolian neighborhoods in Inner Mongolia, and belongs to the semi-arid continentalmonsoon climate in the temperate zone. Because it is cold, droughty and windy,unhealthy habits such as high salt and fat diet, smoking, and sot lead to the highincidence of cerebral stroke. The ischemic cerebrovascular disease was chronic diseasewhich hurt acutely the population health, was the first dead cause of urban and ruralresidents’ diseases in Chifeng region after2001, according to the statistics of HanZhongyi and etc.[30]Relevant studies have shown the cerebral stroke towards theincreasing tendency year by year, patients’ age are gradually getting younger andyounger[31], patients who suffer from the ischemic stroke have been high morbidity,mortality and recurrence rates, so our hospital combined with other two hospitals inChifeng City found that the atherosclerotic carotid stenosis was the focus of highincidence of cerebral stroke in the local by the screening measures of carotid ultrasound,head and neck CTA, and so forth. As for the mechanism of ischemic stroke caused bythe carotid stenosis, there are two kinds of accepted arguments: one is that thedesquamation of atherosclerotic plaque in the site of carotid stenosis causes the distalcerebrovascular embolization; the other is that the hemodynamic embolization is causedby lack of blood-stream in the perfusion area, results in the hypoperfusion response,appearing in the transient cerebral ischemic attack or ischemic cerebral infarction[32]after the carotid stenosis. At present, there are a lot of therapies for carotid stenosis,such as drug treatment, carotid endarterectomy angioplasty (CEA), carotid atherectomy,carotid-stenosis coronary angioplasty, carotid-stenosis angioplasty by stent (CAS) andso forth. Now carotid endarterectomy angioplasty (CEA) and carotid-stenosisangioplasty by stent (CAS) have more certain and roughly equal postoperative effects in the prevention of cerebral stroke, what’s more, some of studies have demonstrated thatthe latter has unique advantage[33], since the late1980s, carotid-stenosis angioplasty bystent (CAS) has been used the clinical treatment, today it is very mature, in comparisonwith carotid endarterectomy angioplasty (CEA)(CEA), CAS is being accepted by moreand more patients due to without the general anesthesia, smaller trauma, shorter surgicaltime, and similar postoperative effect with CEA. The main complication of CAS wasthe postoperative restenosis, in which the incidence reached5.0%～16.0%by thecomprehensive-literature analysis, but there were no a mass of reports in the literature.The pathological process of this restenosis is the smooth fibrous intimal hyperplasia, itis difficult to produce emboli, and CAS can be repeated after restenosis. AdditionallyCAS complications included also TIA, cerebral stroke, cerebral hemorrhage, thevascular injury in the operative site such as vasospasm, intimal avulsion, arterialdissection, subcutaneous hematoma or forming pseudoaneurysm, arteriovenous fistula,hyperperfusion response, and hypoperfusion response caused by the desquamatedemboli, although these complications are closely related to the surgeon’s proficiency, itis still unavoidable for some postoperative complications in CAS, such as the ratio ofaverage desquamated emboli of1%-3%. In terms of the prevention in the incidence ofischemic cerebral stroke and postoperative restenosis, this research analyzed the resultsof follow-up observation in long-term from patients with the carotid stenosis in theinitial segment who were treated by CAS in the Chifeng region, which are reportedpresently as follows.Objective:It is to evaluate the long-term efficacy of carotid-stenosis angioplasty bystent (CAS) in Chifeng Inner Mongolia, to analyze the correlation between theincidences of restenosis and restroke in stent, and the related perilous factors inpostoperative patients.Methodology:The follow-up observations were carried on3months,6months,1year,2years and3years after their operation respectively, from103patients withcarotid stenosis in the initial segment, who were treated by the self-expandable stent.They were evaluated by the clinical follow-up, imaging follow-up, and biochemicaltests follow-up logs; patients who accepted the treatment of carotid-stenosis angioplastyby stent (CAS) were analyzed the incidences of restenosis and restroke in stent within1year,2years,3years upon their operations, with reference to the follow-up patients’carotid-color ultrasonography and transcranial Doppler ultrasound, the CTA and DSAresults in head and neck, blood glucose, lipid, blood pressure levels, and age; the correlation was analyzed between eld, hypertension, diabetes, blood glucose control,lipid levels of hyperlipidemia of patients with restenosis in the carotid stent, and therelated perilous factors such as smoking and drinking.Results:Under the surgeon’s guidance,50-76patients in103patients were carriedthrough the postoperative clinical follow-up observation of CAS in long-term, thefollow-up period for12-36months (mean for24months).76patients accepted thefollow-up observation within3months after surgery, among them,2patients occurredin the disabled symptoms of persistent physical activity in line with the lesion in theblood supply area of side vascular in the treatment;69patients accepted the follow-upobservation within6months after surgery, among them,1patient appeared in thestent-related side transient cerebral ischemic attack in6months,1patient occurred inthe stent-related side cerebral infarction, showing the side disabled physical activity,dysarthria,1patient belonged to the asymptomatic cerebral infarction.39patients withpreoperative dizziness and headache,35patients accepted the follow-up observation inpostoperative, their symptoms were improved obviously or disappeared;64patientsaccepted the follow-up observation within1year in postoperative,4cases occurred inthe ischemic stroke attack, showing the transient cerebral ischemic attack in1case, thesymptomatic cerebral infarction of persistent side-limb incapable anaesthesia in2cases,the asymptomatic cerebral infarction in1case, in which6cases fit to the side ischemicstroke by the stent treatment,57patients accepted the follow-up observation within2years after surgery,3cases occurred in the ischemic stroke, showing the transientcerebral ischemic attack in1case, the symptomatic cerebral infarction of persistent sidelimb incapable anaesthesia in4cases, the non-stent-related side asymptomatic cerebralinfarction in1case, all of which got well markedly by the intensive medicine therapy;50patients accepted the follow-up observation within3years after surgery,1caseoccurred in the symptomatic cerebral infarction, showing the inflexibility of sidephysical activity, dysarthria, finding the side cerebral infarction by the stent therapy inhead CT reexamination, which improved after treatment.1case occurred in thenon-stroke death during the course of follow-up observation. In Clinical follow-up for12-36months,15cases occurred again stroke, showing the transient cerebral ischemicattack and lacunar cerebral infarction;76patients accepted the follow-up observation bythe means of neck vascular ultrasound within3months after surgery,2case occurred inthe mild stenosis, kept on the oral clopidogrel tablets of75mg, Aspirin tablets of100mg and atorvastatin of20mg per day.69patients accepted the follow-up observation by the means of head and neck CTA within6months after surgery, showing the mildstenosis in3cases, the moderate stenosis in2cases, the incidence of restenosis was2.9%;69patients accepted the follow-up observation by the means of outpatient’s headand neck CTA within1year after surgery, it was found that5patients occurred inrestenosis, showing the mild restenosis in2cases, the moderate restenosis in1case, thesevere restenosis in2cases, who were hospitalized and operated again in the stentangioplasty, the incidence of restenosis was4.7%in postoperative;57patients acceptedthe follow-up observation by the reexamination of head and neck CTA within24months upon surgery, showing2patients with restenosis,1patient with mild stenosis,1patient with moderate stenosis, so the incidence of restenosis was3.5%;50patientsparticipated in the follow-up observation by the reexamination of head and neck CTAwithin36months upon surgery, it was found that2patient occurred in-stent restenosis,1cases with mild stenosis,1case with moderate stenosis, so the incidence of restenosiswas2.0%, they kept on the oral drug according to the surgeon’s order; in comparisonwith the follow-up observations at the first, second or third years in postoperative, thehigh restenosis rate occurred in6-12months, in which the highest restenosis rateappeared in stent for1year after CAS, after that, the restenosis rate shown in thedeclining trend.Conclusion:1. Carotid stent angioplasty is a safe and effective therapy to thecarotid atherosclerotic stenosis.2. Carotid stent angioplasty can reduce effectively theincidence of stroke, the stroke incidences occurred in again within the first, second orthird years after CAS that were6.3%,5.3%,2.0%separately in Chifeng region.3. Therestenosis rates of carotid stent angioplasty in postoperative were4.7%,3.5%,2.0%separately within the first, second or third years after operation, which excepted thecorrelation with perilous factors such as eld, hypertension, diabetes, smoking anddrinking, may also be related closely to a unique high-salt, high-fat diet habits, the coldclimates in Chifeng Inner Mongolia.