Efficacy And Safety Analysis Of Staged Angioplasty In Severe Carotid Artery Stenosis

Objective:To compare the effectiveness and safety of conventional carotid artery stenting(Carotid artery stenting,CAS)and staged angioplasty(SAP)in patients with severe carotid artery stenosis,so as to provide a theoretical basis for choosing appropriate surgical methods for such patients.Methods:From January 2017 to December 2022,the clinical data of 51 patients who were diagnosed with severe carotid artery stenosis and underwent carotid artery stenting in Jiangxi Provincial People’s Hospital were retrospectively analyzed.Patients with high perfusion risk were selected according to the degree of vascular stenosis determined by the preoperative evaluation,and were divided into the conventional CAS treatment group and the staged angioplasty group.By querying the patient’s inpatient and outpatient system,the patient’s general information,imaging examination,nursing situation and other related information can be obtained.The effectiveness of staging surgery in preventing hyperperfusion after severe carotid stenosis was evaluated by observing the main outcome indicators of postoperative patients,Hyperperfusion Intracerebral Haemorrhage(HICH),other manifestations of Hyperperfusion Syndrome(CHS),and m RS score.safety.Results:A total of 51 patients were included in this study,26 in the CAS group and 25 in the SAP group.Except for smoking(P=0.025)in the general data,there was no significant difference(P>0.05);in the perioperative data,there were differences in the degree of vascular stenosis before operation,the degree of stenosis after operation and the TCD flow rate index in the SAP group,there was no significant difference in other related indicators(P>0.05);the primary end point after operation was hyperperfusion cerebral hemorrhage,4 cases of cerebral hemorrhage occurred in the CAS group,and0 cases of SAP occurred,the difference was statistically significant(P=0.042),hyperperfusion Other manifestations of the syndrome occurred in 1 case in the SAP group,but not in the CAS group,and the difference was not statistically significant(P=0.303).There were 0 cases in the SAP group and 4 cases in the CAS group with m RS score ≥ 3 points,and 4 cases in the CAS group.Significance(P<0.05);the secondary end point(hyperperfusion phenomenon)also had a statistical difference between the two groups(P<0.01),and there was no significant difference in surgical operation-related complications between the two groups.Conclusion:Staged angioplasty can reduce the incidence of hyperperfusion cerebral hemorrhage after severe carotid stenosis and improve the neurological prognosis of patients;there is no significant difference in the incidence of other manifestations of hyperperfusion syndrome between the two groups,but SAP can significantly reduce the incidence of hyperperfusion syndrome.This phenomenon can reduce the risk of postoperative hyperperfusion in patients with severe carotid artery stenosis.