The Effect Of Carotid Endarterectomy On Carotid Near Occlusion

Background:Carotid near occlusion is a variant of severe carotid artery stenosis,with a reduced distal internal carotid artery diameter compared with conventional carotid artery stenosis of ≥50%.The literature reported that eventually about 40% of near occlusions develop into complete occlusions.Depending on how much the distal internal carotid lumen is reduced,It can be subdivided into carotid near-occlusion with full collapse and carotid near-occlusion without full collapse.At present,the specific treatment plan of carotid artery occlusion is still controversial,and the mechanism of cerebral infarction has not been fully studied.We conducted a study to evaluate the specific efficacy of carotid endarterectomy for carotid near occlusion.Methods: A total of 86 patients who underwent carotid endarterectomy in the Department of Neurosurgery,Affiliated Hospital of Qingdao University from October 2020 to December 2022 were selected,and general clinical data of 86 patients were collected.According to relevant diagnostic criteria,patients with carotid artery stenosis were screened and divided into near-occlusion group and common stenosis group.The distal lumen diameter of the internal carotid artery near occlusion,the distal lumen diameter of the ipsilateral external carotid artery,and the distal lumen diameter of the contralateral internal carotid artery were measured at the axial level of CT angiography before and after surgery in patients with near occlusion.The collected data were statistically analyzed to evaluate the revascularization of patients with near occlusion after carotid endarterectomy.At the same time,magnetic resonance ASL perfusion imaging data of patients with near occlusion before and after surgery were collected and analyzed statistically,and the changes of Cerebral Blood Flow(CBF)in the temporal lobe of patients with stenosis and healthy side before and after surgery were evaluated.To evaluate the operative effect of carotid endarterectomy,a comprehensive comparison was made between the changes of proximal occlusive collapse vessel diameter and cerebral blood flow value after carotid endarterectomy.Results: A total of 30 patients with near occlusion were screened out from 86 patients who received carotid endarterectomy.These 30 patients were included in the near occlusion group,and the rest were included in the common stenosis group.After comparing the general clinical data of patients in the near occlusion group and the common stenosis group,we found that the proportion of patients with cerebral infarction history in the near occlusion group was higher than that in the common stenosis group(P<0.05),and the difference was statistically significant.There was no significant difference in other general clinical data between 2 groups(P>0.05).Paired sample t test was performed on distal internal carotid artery lumen after CEA surgery and distal internal carotid artery lumen before surgery in the near occlusion group,and the mean postoperative tube diameter was higher than the mean preoperative tube diameter,P=0.001<0.05,indicating a statistically significant difference,suggesting that the distal collapse vessel diameter of internal carotid artery in the near occlusion patients recovered after endarterectomy.Paired sample t test was performed on the preoperative and postoperative CBF values of the near occlusive side of the brain,and the difference was statistically significant(P<0.05),indicating that the cerebral perfusion of the near occlusive side of the patients after endarterectomy was significantly improved compared with that before surgery.Conclusions: Our study showed that carotid endarterectomy can significantly restore the distal internal carotid artery diameter and restore cerebral perfusion in patients with near occlusion.The specific pathophysiological process and cerebral infarction mechanism need to be further studied.