Clinical Effect Of Carotid Endarterectomy On Patients With Sympomatic Carotid Stenosis And Analysis Of Its Influencing Factors

This topic includes two parts:(1)clinical effect of carotid endarterectomy(CEA)in the treatment of patients with symptomatic carotid stenosis and its correlation with the timing of surgery;(2)study on the clinical effect of CEA on stroke patients and the characteristics of atheromatous plaque.Part?:clinical effect of CEA in the treatment of patients with symptomatic carotid stenosis and its correlation with the timing of surgeryObjectiveTo explore the clinical prognosis of carotid endarterectomy(CEA)on patients with symptomatic carotid stenosis and its correlation with the timing of surgery.Methods1.Clinical data:The clinical data of 146 patients with symptomatic carotid stenosis treated with CEA were retrospectively analyzed in neurosurgery of the First Affiliated Hospital of Suzhou University from September 2012 to May 2018.All patients underwent CT angiography(CTA)and computed tomography perfusion(CTP)to evaluate the patients' cerebral blood flow(CBF),cerebral blood volume(CBV),and the average passed Mean transit time(MTT)and time to peak(TTP);2.Transcranial doppler(TCD)examination was performed to evaluate the patients'cerebral hemodynamic changes.The evaluation indicators included the mean flow velocity of middle cerebral artery(MVMCA)and pulse index(PI).);Stroke patients were evaluated by the National Institutes of Health Stroke Scale(North American Symptomatic Carotid Endarterectomy Trial Collaborators,NIHSS).3-5 days after surgery,all patients underwent CTA,CTP,and TCD examinations,and NIHSS scores were obtained for stroke patients.All patients were followed up on an outpatient basis 12 months after discharge,including re-examination of CTP and TCD,NIHSS scores for stroke patients,and observation of surgical-side restenosis.3.Inclusion criteria:(1)unilateral CEA with moderate-severe stenosis of the carotid artery on the surgical side;(2)transient ischemic attack(TIA),slurred speech,decreased muscle strength on one side of the limbs,or even mobility disorders;(3)Temporal window sound penetration is good;(4)clinical data are complete and follow-up?1 year.Exclusion criteria:(1)severe stenosis or occlusion of intracranial arteries(such as middle cerebral artery,end of internal carotid artery,or siphon);(2)Carotid artery stenosis caused by non-atherosclerotic plaque;(3)Severe liver,Renal dysfunction.4.Research group:146 patients were divided into group A(?14 d,57 cases)and group B(>14 d,89 cases)according to the time from the first symptoms to CEA.CTP,TCD and NIHSS scores were used to compare postoperative cerebral perfusion and neurological recovery in the two groups.5.Statistical analysis:Statistical analysis was performed using SPSS 23.0 software.The Kolmogorov-Smirnov method is used for normality testing.Measurement data that conforms to the normal distribution are expressed as mean±standard deviation((?)).Paired sample t-tests are used for comparison within groups,and independent sample t-tests are used for comparison between groups.Repeated analysis of variance was used for comparison between groups;measurement data that did not meet the normality distribution was expressed as M(QR);Wilcoxon rank test was used for comparison within groups,and Mann-Whitney U test was used for comparison between groups.Count data were expressed as cases or percentages.Differences between groups were tested by ?2.The theoretical frequency was less than 5 using Fisher's exact test.The difference was statistically significant with P<0.05.Results1.Surgery results:Perioperative stroke occurred in 1(0.7%)of the 146 patients.Compared with preoperative 5 days after surgery,cerebral blood flow[the basal nucleus area was(56.9±9.2)ml/100ml·min vs(41.8±9.8)ml/100ml·min,and the temporal lobe was(58.6±10.0)ml/100ml·min vs(2.6±9.8)ml/100ml·min.]and cerebral blood volume[the basal nucleus areas was(3.3±0.5)ml/100 ml ml/100ml·min vs(2.6±0.8)ml/100ml,and the temporal lobe was(3.4·0.5)ml/100ml·min vs(2.7±0.6)ml/100ml·min.]were increased,and mean transit time(MTT)[the basal nucleus regions was(3.9±0.6)s vs(4.9±1.1)s,and the temporal lobes was(3.8±0.6)s vs(4.7±1.2)s]and time to peak(TTP)[the basal nucleus regions was(9.9±1.5)s vs(12.6±2.8)s,and the temporal lobe was(9.8±1.6)s vs(12.5±2.8)s]were shortened in the basal nucleus and temporal lobe of 146 patients(all P<0.05).The mean flow velocity of middle cerebral artery[(61.3±15.0)cm/s]and the pulsatility index(PI)value(1.0±0.2)were increased[respectively(47.8±15.1)cm/s,(0.8±0.2)](all P<0.01).88 patients with stroke had lower NIHSS scores than before surgery[respectively 1.0(0,2.0)minutes vs 3.0(2.0,5.8),P<0.001].2.Follow-up results:Up to the last follow-up,there was no significant difference between the above indicators and 5 days after surgery(all P>0.05).Six patients(4.1%)had restenosis on the surgical side.3.Comparison of two groups:There were no significant differences in age,gender,medical history,smoking history,onset symptoms,and degree of carotid stenosis between the two groups of patients(all P>0.05).The change rate of MVMCA in group A was higher than that in group B at 5 days and 12 months after operation[5 days after operation:41.0(16.7,78.1)%,18.9(4.9,44.3)%,12 months after operation:40.5(13.0,76.6)%?15.9(7.2,38.1)%,all P<0.05].The rate of change in NIHSS scores of stroke patients in group A was greater than that in group B[5 days after operation:-100(-100,-60)%,-66.7(-100,-50)%,12 months after operation:-100(-100,-58.6)%?-50(-100,-33.3)%,all P<0.05].Conclusion:Carotid endarterectomy can significantly improve cerebral perfusion,cerebral hemodynamics,and some neurological functions in patients with symptomatic carotid stenosis,and the early surgical prognosis is better.Part ?:Study on the clinical effect of CEA on stroke patients and the characteristics of atheromatous plaque.ObjectiveTo study the clinical effect of carotid endarterectomy(CEA)for stroke patients and its relationship with atheromatous plaque characteristicsMethods1.Clinical data:Sixty-one stroke patients who underwent CEA in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University from August 2015 to October 2018 were retrospectively included.All patients were diagnosed with moderate to severe carotid stenosis by multimodal imaging based on carotid doppler ultrasonography(CDU).Patients routinely underwent CT angiography(CTA)and CDU examinations 3 to 5 days after surgery,followed by CDU examinations at 1,3,6,and 12 months after surgery,and observed whether recurrent stroke,restenosis,and death occurred.2.Inclusion criteria:(1)moderate carotid artery stenosis(50%to 69%stenosis)and severe stenosis(70%to 99%stenosis);(2)insufficient speech,weakness of one limb,even mobility disorders,sensory disorders,etc.(3)CDU examinations were performed;(4)clinical data were complete.Exclusion criteria:(1)carotid artery stenosis caused by carotid dissection or aorta inflammation;(2)those who have been followed up for less than 12 months;(3)severe stenosis of the contralateral carotid artery(stenosis of 70%to 99%);(4)patients with severe hypertension and abnormal liver and kidney function cannot tolerate surgery.3.Research group:According to the change of NIHSS score at 30 days after surgery,they were divided into symptom improvement group(42 patients,NIHSS decreased)and unimproved symptoms group(19 patients,NIHSS score unchanged or increased).The clinical data and plaque characteristics of carotid artery stenosis in the two groups were analyzed to evaluate their clinical efficacy,and the safety and effectiveness of CEA in stroke patients were assessed.4.Statistical analysis:SPSS 23.0 was used for statistical analysis,and the Kolmogorov-Smirnov method was used for normality testing.Unpaired measurement data that conformed to normality distribution were tested using independent sample t test,expressed as(?);The measurement data were analyzed by Mann-Whitney rank sum test and expressed by M(QR).Count data were tested by ?2 test or Fisher exact test(prediction frequency<5).Multivariate logistic regression analysis was used to compare the influencing factors of clinical efficacy.Results1.Surgical results:All 61 stroke patients were successfully operated.1.64%of the patients(1/61)developed cerebral hyperperfusion syndrome without cerebral hemorrhage during the perioperative period.2.Clinical data:The difference between the symptom improvement group and the non-symptom improvement group was that the average speed of the middle cerebral artery after the internal carotid artery was opened(51.14±14.69 vs 41.21±15.21)and the time from the symptom to the operation[14.5(10.0,95.5)vs 45(25,16)]were statistically significant(P<0.05).There were no significant differences in risk factors related to cerebrovascular disease and other clinical data between the two groups of patients(all P>0.05).3.Plaque characteristics:The proportion of low-echo atheromatous plaque and ulcerative plaques in the group with no improvement in symptoms[63.2%(12/19),47.4%(9/19)]was significantly higher than that in the group with improvement of symptoms[28.6%(12/42),11.9%(5/42)],the difference was statistically significant(P<0.05).4.Multi-factor analysis:Low-echo atheromatous plaque(OR=6.131,95%CI:1.355-27.737,P=0.019)and ulcerative plaque(OR=7.158,95%CI:1.468-34.912,P=0.015)were closely related to the clinical efficacy of the patients.5.Follow-up:Until the last follow-up,all patients had no recurrence of stroke or death.In the symptom-improving group,2.4%(1/42)of patients with moderate symptomatic carotid artery stenosis occurred 1 year after surgery;in the non-improved group,10.5%(2/19)of patients had moderate-degree carotid artery stenosis and Severe stenosis.Conclusion:1.Low-echo atheromatous plaque and ulcerative plaques are important factors affecting the clinical efficacy of stroke patients.2.CEA can both improve the symptoms of stroke and prevent recurrent strokes.Early surgery can improve the clinical prognosis of patients.