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

Background:Ischemic cerebrovascular disease is a kind of disease due to the intracranial or extracranial vascular stenosisor thrombosis. Each year, nearly795000people experience a new or recurrent stroke in America, of which87%are ischemic stroke. Besides, nearly5000000people experience transient ischemic attack, the incidence of ischemic stroke of whom is much higher than normal. As to our country, cerebrovascular disease has become one of the most common cause of death.Extracranial carotid stenosis is one of the most common causes of ischemic cerebrovascular disease, of which carotid atherosclerotic stenosis is the most common.Carotid endarterectomy(CEA) andCarotid artery stenting(CAS) are two treatments of carotid atherosclerotic stenosis.Current clinical trials show thatthe risks of perioperative adverse events of the two treatments did not differ significantly,neither long-term follow-up results.Age may be one of the factors that influence the choice of treatments.Methods:A retrospective analysis of the symptomatic carotid stenosis patients who received CEA or CAS in The Second Affiliated Hospital Zhejiang University School Of Medicine during July2013to December2014.Collecting the basic informationprovided by the patients, including the gender, age, diseases, medical history, surgical history, smoking history, clinical symptoms, area and degree of stenosis, the perioperative adverse events and complications. We followed up each patients by clinic and telephonefor death, clinical outcomes and restenosis situations.Results:Our study included70CEA cases and41CAS cases. The basic information of both groups did not differ each other significantly. Both groups did not differ each other significantly either in the risk perioperative stroke (2.9%vs2.4%, OR=1.18,2.9%CI0.10-13.39), the risk of perioperative death (1.4%vs0%), or the risk of all perioperative complications (10.0%vs9.8%, OR=1.03,95%CI0.28-3.75).CEA patients spent more time in the hospital, but they spent less money. Long-term follow-up showed no significant differences between two groups either in the overall rate of adverse events orin the rate of restenosis. Age did not influence the outcome in both groups. For those who underwent carotid endarterectomy less than4weeks since the last symptomatic event to treatments, the risk of all perioperative complications was high (CEA group:delayed surgery vs early surgery=4.1%vs23.8%, P=0.022, OR=0.14,95%CI0.02-0.77), but both groups showed no significant differences neither in the perioperative adverse events norin the long-term follow-ups.Conclusion:The safety and efficacy of CEA and CAS are similar, but the treatment of CEA cost less. Stratified analysis of this study showno differences betweenelder people and the patients under the age of70. Early carotid endarterectomy may raise the risk of all perioperative complications, but time from the last symptomatic event to treatments did not influence the perioperative adverse events andlong-term follow-up.