Comparative Analysis Of Carotid Endarterectomy And Carotid Artery Stenting For Treatment Of Carotid Stenosis

Objective: Through the comparative analysis of the clinical case information of Neurosurgery implementation of carotid endarterectomy(CEA)and neurology implementation of carotid artery stenting(CAS)in our hospital,we objectively evaluate the therapeutic effect of CEA and CAS for treatment of carotid stenosis.Methods: Retrospective analysis of Clinical cases of carotid artery stenosis patients treated with carotid endarterectomy(CEA)and carotid artery stenting(CAS)were performed in Dalian Medical University between June 2013 to October 2015.Follow up through outpatient or telephone until February 2016.The actual operation of CEA was 51 cases,2 cases were lost and 49 cases were grouped into the case.The actual operation of CAS was 38 cases,1 cases were lost and 37 cases were grouped into the case.All patients underwent preoperative examination of neck vascular ultrasound,DSA or CTA.All of these patients have reached the recommended surgical guidelines for the American Heart Association.Preoperative general conditions of the two groups were compared.(Sex,age,smoking and drinking history,hypertension,diabetes,hyperlipidemia,coronary heart disease,cerebral infarction history,carotid stenosis,Contralateral blood vessel).To compare the blood vessel of after operation(Stenosis and blood flow),Surgical Complications,hospital stay,hospitalization Costs were analyzed statistically.Result : There was no significant difference in the general data between the 49 groups in CEA and 37 patients in CAS.CEA: There was 1 case of incision skin swelling which was eliminated subcutaneous aematomas by color Doppler ultrasonography,and improved after local ice deposition.we consided Visceral Traction during the course of operation.CEA had 2cases of Local nerve injury,1 case of cerebral apoplexy after postoperative half year,1case of myocardial infarction.We examined the medical history that the patient has ahistory of coronary artery disease.No patient died.There was no case of carotid artery restenosis in 1 years.The average hospitalization expenses of CEA was about 31125±3014.36 yuan.The average length of stay was about 10.45±2.34 days.There were 3cases of Cerebral hyperperfusion syndrome and 3 cases of Carotid sinus syndrome.CAS: No local hematoma and local nerve injury occurred in CAS.Postoperative half year 2 cases of cerebral apoplexy.There was no myocardial infarction.No patient died.CAS had 5 cases of carotid artery restenosis in 1 years.The average hospitalization expenses of CAS was about 78451.± 3715.4 yuan.The average length of stay was about 8.89±3.25 days.There were 5 cases of Cerebral hyperperfusion syndrome and 4cases of Carotid sinus syndrome.CEA was more than CAS in postoperative local complications.There was no significant difference in stroke,myocardial infarction,and mortality.The mid-term follow-up showed that the rate of restenosis in CAS was higher than CEA in 1 years,and the difference was statistically significant(P < 0.05).Although CEA long time in hospital,the hospital cost difference was statistically significant(P< 0.05).Conclusion : CEA and CAS can improve the symptomatic of carotid stenosis patients significantly.CEA removes plaque stenosis,can greatly reduce the incidence of cerebral infarction.CAS can support the carotid artery hemodynamics in normal.Postoperative patients need to take anti-platelet and stable plaque drug.There are some flaws on the problem of restenosis after CAS.Through the improvement of the material in the operation and the improvement of the surgical technique and the regular use of medicine can reduce the incidence of this complication.CAS hospitalization costs are higher than CEA,the difference was statistically significant.