| Objective:To evaluate the safety and efficacy of staged surgery for bilateral carotid atherosclerotic stenosis,explore the risk factors that affect major complications after CEA.Methods:Retrospective analysis of 214 patients with vascular surgery in the Fifth Affiliated Hospital of Zhengzhou University from January 2013 to January2017.According to the operation,the patients were divided into unilateral operation group(185 cases)and staged surgery.The patients(29 cases)were enrolled in the perioperative period of local complications and adverse events.Postoperative follow-up was performed to evaluate the target vascular patency by imaging examination,and the target vascular patency rate and adverse events were recorded.Results:1.214 patients underwent CEA carotid revascularization,cumulative CEA 243times,and all patients with occlusion were successful;185 patients with unilateral surgery,29 patients with bilateral surgery,staging interval 1~28 months(average 3.1±4.6 months).In the unilateral operation group,the CEA(185 times)intraoperative block time was 10-28 min(mean 13.5±8.1 min),and the CEA(58 times)in the staging group was 11-27 min(mean 14.2±6.9 min).No statistical significance(P>0.05);2.Perioperative local complications:1)8 cases(3.3%)had neck incision hematoma,including 6 cases in the unilateral group and 2 cases in the staging group;(2)19 cases(7.8%)had symptoms of cranial nerve injury,including 14 cases in the unilateral group and 5 cases in the staging group.There was no statistical difference(X~2=1.42,P=0.258).The main adverse events were:(1)13 patients(5.3%)had high perfusion after operation,8 patients in unilateral group,5 patients in staging group,the difference between the groups was statistically significant(X~2=14.16,P<0.001);(2)4 Case(2.3%)had cardiac events:2 patients with myocardial infarction(MI)were unilateral;2 patients had unstable angina,including 1 in the unilateral group and 1 in the staging group;(3)3 patients(1.6%)There were 2 strokes in the unilateral operation group and 1 in the staged surgery group.All stroke events occurred on the surgical side.The overall incidence of stroke,cardiac events and death within 30 days after surgery was 2.88%(7/243);3.During the follow-up period,the follow-up rate was 94.4%in the long-term follow-up period.202 patients were followed up.In the patients who were lost to follow-up,11 patients(2.8%)were lost to follow-up.The remaining follow-up time was 6 to 47 months(mean 27.6±9.4 months);patients with staged surgery were lost to follow-up(2.3%,bilateral CEA patients),and the remaining follow-up period was7 to 56 months(mean 24.1±10.2 months).Adverse events occurred:(1)5 patients(2.2%)had new cardiac events,4 patients had myocardial infarction,1 patient had unstable angina pectoris,and 1 patient in the staging surgery group died of acute large-area myocardial infarction.2 cases were improved after coronary artery bypass grafting or intracoronary treatment,and the remaining patients were relieved after conservative treatment;(2)3 patients(1.3%)developed stroke,2 of which were hemorrhagic major strokes,and unilateral surgery group One patient died;(3)3patients(1.3%)died,except for one patient who died of myocardial infarction and one patient who died of hemorrhagic stroke.The other cause of death was unknown.The overall incidence of stroke,cardiac events,and death in 230 patients in the mid-and long-term follow-up was 4.78%(11/230);4.Logistic multivariate analysis showed that the risk ratio(HR)of previous myocardial infarction,severe stenosis/occlusion of the contralateral carotid artery,age?65 years,and smoking were 2.18,2.61,2.51,and 5.96,respectively.Conclusions:Carotid endarterectomy is one of the effective surgical methods for the safe treatment of carotid atherosclerotic stenosis;staged surgery for the treatment of severe bilateral carotid stenosis is safe and effective.For patients with bilateral carotid stenosis,patients need to be treated individually.Medical treatment;Age?65years,smoking,surgical contralateral carotid artery stenosis,and previous myocardial infarction are risk factors for medium and long-term outcomes after carotid endarterectomy. |
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