Clinical Effect Analysis Of Tongdu Tiaoshen Acupuncture Combined With CEA In The Treatment Of Carotid Artery Stenosis

1 Objective By comparing the patients diagnosed with carotid artery stenosis who underwent CEA combined with Tongdu Tiaoshen acupuncture and moxibustion,and those who under-went CEA alone.To investigate the effect of CEA combined with Tongdu Tiaoshen acupuncture in the treatment of carotid artery stenosis.To explore the effective intervention program of acupuncture and moxibustion to reduce the incidence of ischemic stroke.2.Methods The cases were collected from the Second Affiliated Hospital of Anhui University of Chinese Medicine,Huaibei People’s Hospital and Fuyang People’s Hospital.Sixty patients with carotid artery stenosis diagnosed and meeting CEA surgical criteria were admitted to the hospital from January 2018 to January 2019.Sixty patients who met the inclusion criteria were randomly divided into acupuncture group(30 cases)and control group(30 cases).Both groups received CEA surgery.Three weeks after the operation,the acupuncture group was combined with Tongdu Tiaoshen acupuncture treatment.The main acupoints were Yaoyangguan,Mingmen,Zhiyang,Shendao,Shenzhu,Dazhui,Yanmen,Fengfu,Baihui and Jingjiaji,with acupuncture once a day,and given Du Meridian moxibustion.The control group received CEA surgery only.Both groups were treated continuously for 3 weeks as a course of treatment.The scores of TCM syndromes before surgery,3 weeks after surgery,6 weeks after surgery and 6 months after surgery in 2 groups were observed.The changes of peak systolic flow rate(PSV),end-diastolic flow rate(EDV),operative middle cerebral artery(MCA)PSV and pulse index(PI)were observed before,3 weeks,6 weeks and 6 months after surgery in 2groups by carotid ultrasound and TCD combined evaluation.Clinical end points(restenosis or stroke)at 1 year after treatment were recorded in both groups.3.Results3.1 Comparison of clinical efficacy and TCM syndrome grading and scoring: after treatment,the clinical efficacy showed that the total effective rate of the acupuncture and moxibustion group was 90.0%,and the total effective rate of the control group was83.3%.There was a significant difference in the total effective rate between the two groups(P<0.05),the efficacy of the acupuncture and moxibustion group was better than the control group.Compared with pre-operation,TCM syndrome grading scores of patients in the two groups were significantly improved(P<0.05),while the comparison of TCM syndrome grading scores of patients in the two groups 6 weeks and 6 months after surgery was P<0.05,indicating that the improvement in the acupuncture group was better than that in the control group.It is suggested that the combination of acupuncture and moxibustion combined with CEA can better improve the clinical symptoms of patients with carotid artery stenosis than CEA operation alone.3.2 Comparison of pulse ultrasound and transcranial Doppler ultrasound indexes:compared with pre-operation,all aspects of carotid ultrasonography and transcranial Doppler ultrasonography were significantly improved in 2 groups(P<0.05);Compared with the control group,the peak systolic flow velocity(PSV),end-diastolic flow velocity(EDV),PSV and pulsatility index(PI)of the operative middle cerebral artery(MCA)in the acupuncture and moxibustion group were significantly improved 6 weeks and 6 months after surgery(P<0.05).It is suggested that both CEA combined with acupuncture and moxibustion therapy and CEA surgery can improve the parameters of carotid ultrasound and transcranial Doppler ultrasound in patients with carotid artery stenosis.However,the improvement of peak systolic flow velocity(PSV),end-diastolic flow velocity(EDV),operative middle cerebral artery(MCA)PSV and pulsatility index(PI)in acupuncture and moxibustion group was better than that in control group.3.3 Comparison of incidence of endpoint events: during the treatment period,there were no cases of restenosis and stroke in the two groups;no patients in the acupuncture and moxibustion group developed restenosis or stroke,while 2 patients in the control group developed mild stenosis and no patients suffered stroke.The chi-square test showed a P>0.05,indicating no significant difference in long-term efficacy between the two treatment methods.But the incidence of restenosis in acupuncture group was lower than that in control group.4.Conclusion4.1 CEA is an effective method for the treatment of carotid artery stenosis and the prevention of ischemic stroke.The combination of acupuncture and acupuncture combined with CEA is better than CEA operation alone in improving the clinical symptoms of carotid artery stenosis.4.2 Compared with CEA alone,CEA combined with Tongdu Tiaoshen acupuncture and moxibustion has more advantages in improving cerebral hemodynamics indexes such as PSV,EDV,PSV and PI of the operative side MCA,which is worthy of clinical promo-tion and application.4.3 There was no significant difference in the incidence of end events between the CEA combination of the Tongdu Tiaoshen acupuncture and moxibustion treatment and CEA surgery alone,but the incidence of postoperative restenosis in the acupuncture and moxibustion group was lower than that in the control group,which may have some errors,but it also suggested that acupuncture and moxibustion had certain advantages in the prevention of restenosis in patients after CEA.