| Objective:(1) To discuss the characteristics distribution of extracranial carotid stenosis and itsrisk factors, provide extracranial carotid stenosis with objective basis for the prevention, atthe same time help the secondary prevention of ischemic stroke.(2) To study the feasibility and technology advantage of CTA in the diagnosis ofcarotid stenosis.(3) The follow-up studies of the extracranial carotid stenosis intravascular stentangioplasty explore the safety and efficacy of the procedure through30cases of cerebralprotection device.Methods:(1) Collecting200cases of patients who are considered extracranial carotid stenosisin the department of neurosurgery and neurology of our hospital from June2011toDecember2012. All patients must be confirmed with PATE (head and neck) color Dopplerultrasound and PATE (head and neck) CTA or cerebral angiogram. In the same period,select200cases of patients as controls who are not considered extracranial carotid stenosisin this field.(2) Record all the patient’s general condition and past medical history, including thenationality (han, uygur), gender, age, history of diabetes, hypertension, smoking, drinking,etc, Patients in the hospital the next morning fasting venous blood was drawn, check bloodglucose (Glu), low density lipoprotein cholesterol (LDL-TC), high-density lipoproteincholesterol (HDL-TC), triglyceride (TG), glycosylated hemoglobin (HbA1c),homocysteine (Hcy), c-reactive protein (hs CRP).(3) Single factor measurement data is compared between groups using independent sample test, counting data by chi-square test, single factor Logistic regression analysis isapplied for14variables indicators, screen out meaningful indexes, Control theconfounding factors, combine with professional judgment and the single factor analysis ofmeaningful variables will be done by multiple factors Logistic regression analysis,stepwise method is put into use to choose extracranial carotid stenosis related indicators.(4) From June2011to December2012in our hospital,50cases of ischemiccerebrovascular disease in this field, all have done CTA and done DSA within two weeks;CTA and DSA images reviewed by two radiologists and neurosurgeons respectively,determine presence of artery stenosis, the narrow parts and degree; use DSA stenosis rateof average value as the gold standard, with medium and severe stenosis (stenosis rate was30%,70%) for the value, measuring the sensitivity of the CTA, specific degree, falsepositive rate and false negative rate, crude coincidence rate, positive predictive value,negative predictive value, positive likelihood ratio and negative likelihood ratio, diagnosis,Kappa coefficient, Youden index and its95%confidence interval.(5) A total of30cases of patients with carotid artery stenosis who will use a cerebralprotection device in the the CAS process are collected from June2012to December2012.All the patients with severe extracranial carotid stenosis are confirmed by preoperativeDSA, and meet the inclusion criteria for endovascular stent angioplasty, the property ofplaques are made clear for all patients by CTA examination preoperatively and conductpreoperative neurological function score (NIHSS) at the same time. Postoperative efficacy:①judging the degree of vasodilation and the stenosis rate of the residual vascular by theoutcome of the reviewed radiography;②improvement of clinical symptoms and nervefunction score (NIHSS) after extracranial carotid stenosis endovascular carotid stenting③Observe the detection rate of organization debris in different types of plaque ofextracranial carotid stenosis in patients after stenting..Result:(1) The general data in the case arm and control arm can be obtained by thechi-square test. Between the two groups,6observation indicators such as ethnic, gender,history of diabetes, hypertension disease history, smoking history and drinking histories,Only do the history of hypertension and diabetes have statistically significant value of P＜0.05.(2)Single factor Logistic regression statistical analysis after Variable assignment,among the14variabilities, age, diabetes, hypertension, GLU, LDL, HDL, CRP, HCY, HbA1c, the nine variabilities have statistically significance, the five independentvariabilities are not statistically significant.(3) Through stepwise logistic regression analysis, it can be drawn that history ofdiabetes, hypertension medical history, TG, LDL, HCY, HbA1c are independent riskfactors of extracranial carotid artery stenosis.(4)50cases of100carotid artery stenosis degree of DSA diagnosis without stenosisaccounted for31%(31/100), and occlusion was1.0%(1/100), mild stenosis was18.0%(18/100), moderate stenosis was25%(25/100), severe stenosis (25/100). CTA inspectionwith DSA in full compliance with as86, accounted for86%. Compared with the goldenstandard of DSA, the stenosis rate of30%or higher, the sensitivity of the CTA was88.2%,95%confidence interal,0.794-0.970, Its Specificity Was100%, false positive rate of0, thefalse negative rate was11.8%, positive predictive value100.0%, negative predictive valueof89.1%,95%confidence interal,0.803-0.979; Coincidence rate was94.0%,94.0%ci0.8940.987; Diagnostic index is188.2%, right (Youden index ’s index is0.882, the95%confidence interal,0.803-1.015; two diagnosis methods and the consistency of theKappa value ware0.880(Kappa acuity0.75it indicates that are very good consistency).Compared with the golden standard of DSA, the stenosis rate is70%or higher, thesensitivity of the CTA was92.3%,95%confidence interal,0.851-0.995;98.6%,98.6%ci0.9601.012; False positive rate was1.4%, false negative rate was7.7%, the positiveforecast of96.0%,95%confidence interal,0.884-1.036; negative predictive value of97.3%,97.3%ci0.8711.075; Coincidence rate was97.0%,97.0%ci0.8641.003;Diagnostic index is190.9%, right index (Youden ’sindex) is0.909, the95%confidenceinteral,0.803-1.015; Two diagnosis methods and the consistency of the Kappa value was0.921(Kappa acuity0.75it indicates that the very good consistency).(5) Preoperative, postoperative stricture rate difference of1d paired t test, P＜0.001,with statistical significance.(6)Through the exact probability method, P <0.05, we can conclude debris detectionrate difference of three different types of extracranial carotid artery stenosis(hard, soft andmixed plaque) in patients is statistically significant, the soft plaque up to90%, followedby mixed plaque and hard plaque.(7) Preoperative neurologic NIHSS score averages of4.47points, one month after sixmonths after nerve function NIHSS score was3.27and neural function NIHSS score was1.30points, using Friedman M rank and inspection (P＜0.001, statistically significant, thepreoperative and postoperative1month to the recovery of neural function in patients with half a year is getting better.(8) Recycle30umbrella by macroscopic observation18umbrella organization offragments,20patients in the course of balloon expansion a drop in heart rate (＜60times/min), drop in blood pressure (systolic blood pressure (90MMHG), given atropine,dopamine treatment1weeks in all.Conclusion:(1) History of diabetes, and hypertension, TG, LDL, HCY, HbA1c are theindependent risk factors of extracranial carotid stenosis, they play an important role in theoccurrence and development of extracranial carotid stenosis.(2) They can be used in the screening and diagnosis of routine inspection method ofcarotid artery stenosis.(3) Intravascular stent angioplasty for carotid stenosis under cerebral protectiondevice is a safe and effective mean of the treatment by which the vulnus is smaller, theperioperative complications are fewer, and lower incidences of postoperative ischemicstroke and death.(4) It is important to select specific therapy and prevent cerebral infarction bydetermining the plaque of preoperative head and neck CTA. |
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