A Clinical Study Of Surgical Treatment Of Carotid Stenosis To Improve Cognitive Dysfunction

Background:Carotid artery stenos is not only plays an important role in the occurrence and development of the ischemic cerebrovascular disease,and also is considered to be an independent risk factor for vascular cognitive dysfunction. Carotid endarterectomy(carotid endarterectomy, CEA) and the endovascular treatment of carotid artery stenting(carotid, arterystenting, CAS) has been widely used in the treatment of carotid artery stenosis at present. The treatment of carotid artery stenosis, on the one hand to prevent the occurrence of ischemic stroke, but also will have a certain impact on cognitive function.In this study,the clinical characteristics of patients with carotid artery stenosis and the cognitive function of patients with different stenosis were evaluated, and the surgical treatment of carotid stenosis in improving the effect of patients with cognitive dysfunction was analyzed and to compare CEA and CAS surgery after the occurrence of restenosis in patients.Objective:To evaluate the clinical characteristics and cognitive function of the patients with stenosis of carotid artery stenosis, surgical treatment of carotid artery stenosis improve patients with cognitive dysfunction, and compare CEA and CAS postoperative restenosis incidence.Methods:From 2011 January to 2013 December, we were selected 212 cases of carotid artery in the Department of Neurosurgery of General Hospital Affiliated to Tianjin Medical University which were narrow as the research object.The research object:male 166 cases, female 46 cases, average age was 62.8, and all cases were confirmed by imaging(CTA or DSA) was confirmed by carotid artery stenosis, 110 cases underwent surgical treatment, among them male 96 cases, female 14 cases, CEA:49cases, CAS:61 cases. This study assesses the different patients by the clinical characteristics and cognitive function of carotid artery stenosis, and observes the effect of surgical treatment of carotid artery stenosis on patients with cognitive dysfunction, and compares CEA and CAS postoperative restenosis incidence.Part oneSelect treated 212 cases of carotid stenosis as the research object,according to the degree of carotid stenosis is divided into three groups: mild stenosis refers to the degree of stenosis<30%, moderate stenosis refers to the degree of stenosis in30-69%, severe stenosis refers to the degree of stenosis in 70-99%. Analysis of the clinical characteristics of different stenosis, and the application of Montreal cognitive assessment scale(MoCA), Mini Mental State Examination(MMSE) for patients in the table of cognitive function assessment, compare different carotid stenosis degree of the change of cognitive function,using the statistical methods for data analysis.Part twoWe choose the surgical treatment of 110 cases of carotid stenosis patients as the research object,the team in 96 cases of male, 14 cases of female,of which the CEA was 49 cases and CAS was 61 cases,preoperative and postoperative 6 months、12months after improving the effect of cognitive dysfunction in Montreal cognitive assessment scale(MoCA), Mini Mental State Examination(MMSE) statistical method should be adopted for data analysis, which were evaluation of surgical treatment of carotid artery stenosis to improve patients with cognitive dysfunction.And the 2 groups of patients are in control group, with statistical methods for data analysis, two different methods of surgical treatment of carotid artery stenosis patients, 6 months after surgery, 12 months after the operation of restenosis were compared.Results:1, The results show that 3 different groups of patients with carotid artery stenosis patients(baseline), in terms of age, gender and risk factors of cerebrovascular disease(diabetes, hypertension, smoking, dyslipidemia) was no significant difference(P>0.05). Comparison of different degree of carotid artery stenosis in 3 groups of patients MoCA score, MMSE score, with the aggravation of carotid artery stenosis, cognitive dysfunction is more obvious, and the upper level of mild stenosis, MoCA score and MMSE score was lower, the difference was statistically significant(P < 0.05).2, By compared with preoperative MoCA score, MMSE score increasedsignificantly, CEA and CAS operation has the difference statistically significant after6 months, 12 months after surgery,(P < 0.05). Comparison of CEA and CAS operation 6 months after surgery, postoperative 12 month restenosis rate, CAS has high restenosis rate, the difference was statistically significant(P < 0.05).Conclusions1,Comparison of general patients with carotid artery stenosis in different degrees,in terms of age, gender and risk factors of cerebrovascular disease(diabetes,hypertension, smoking, dyslipidemia) they are no significant difference. The degree of carotid stenosis and cognitive impairment is positively correlated, with the increasing of the degree of carotid artery stenosis, cognitive dysfunction was aggravated.2, CEA and CAS is an effective way in the treatment of carotid stenosis, each has its characteristics, after surgical treatment of carotid stenosis, the cognitive function of carotid stenosis patients significantly improved. Comparison of CEA and CAS operation 6 months after surgery, postoperative 12 month restenosis rate, CAS has high restenosis rate.