Study About The Relationship Between The Stump Pressure And The Degree Of Contralateral Carotid Artery Stenosis

Carotid artery atherosclerosis is one of the most important causes and risk factor of cerebral infarction, it plays a critical role in the occurrence and development of cerebral infarction. Nowadays CEA has been used widely to therapy carotid artery stenosis patients who had a carotid artery TIA or little stroke, the propose of this operation is to remove the resource of arterial thrombus and prevent the recurrent stroke. CEA is efficiency for symptomatic carotid artery stenosis patients, but the high rate of complications occured perioperation had restricted the widely used of this operation. Block the blood flow intraoperation can develop the ipsilateral cerebral ischemia, and cause to stroke. Repellently how to decrease the perioperative complications is impotent in clinical research. Doctors usually use SP measurements to determined the ability of collateral flow compensation .The propose of study is to determined the impact on the ability of collateral flow compensation when the contralateral Carotid Artery or vertebral basilar artery has been stenosis, so we can evaluated the ability of collateral flow compensation before operation by noninvasive or mini invasive mesuremnts, and promote the successful rate of the operation, decrease the complications perioperation.SubjectsFrom 1 , 2002 to 1, 2005, 60 cases were selected random from patients who has symptomatic carotid arterial stenosis, and undergo CEA in our vascular department of People Hospital.All the cases underwent the examination of carotid artery color-flow Doppler scan, cerebrovascular angiography, cerebral CT and MRA (magnetic resonance aogiography) preoperation.Methods1. According to classification standard of TOAST and the degree of contralateral Carotid Artery stenosis, the subjects were divided into 3 groups: minor stenosis group(30%-~~49%) ,moderate stenosis group(50%-~~ 69%), severe stenosis group(70%~99%)), and then According to the vertebral basilar artery stenosis, the every group were divided into 2 subgroups, the total is 6 group.2. General anesthesia, exposed the common carotid artery, external carotid artery and internal carotid artery, clamp the intra carotid artery then measure the stump pressure, select using of shunt according to stump pressure measurement.Result1 .In this research, 50 case SP>40mmhg after internal carotid was clamped , performed CEA directly ,no complication perioperation was occurred, 10 case SP<40mmhg after internal carotid was clamped , performed CEA with shunt, 1 case has occurred ipsilateral stroke postoperation. No one died after operation , follow up 2~48 months, average 26 months, no postoperative ipsilateral stroke was recurrent. 2 The sp in minor stenosis group is higher than that in moderate stenosis group and severe stenosis group (P<0. 01) , The sp in moderate stenosis group is higher than that in severe stenosis group (P<0. 01) 3. Among the subgroup of the carotid stenosis, The sp has no different when the vertebral basilar artery stenosis was existed, in minor stenosis group and moderate stenosis group, but in severe stenosis group, The sp would decrease when vertebral basilar artery stenosis was existed(P<0. 05) .Discussion1 . Extra cranial carotid stenosis is major cause of TIA, CEA could remove the resource of arterial thrombus and prevent the recurrent stroke. Strict adaptation and complete guiding is the best way to prompt clinical effect and diminish complication .2 Select using of shunt according to stump pressure measurement, avoid not only the perioperative stroke but also the complication about the improper use shunt.3 The degree of carotid stenosis is higher , the ability of collateral flow compensation is lower, in moderate stenosis group when the vertebral basilar artery stenosis was existed, the use rate of shunt was particularly increased. In severe stenosis group .whether the vertebral basilar artery stenosis was existed is a major cause to impact the ability of collateral flow compensation.ConclusionWe can determined the degree of contralateral Carotid Artery or vertebral basilar artery stenosis , via noninvasive or mini invasive measurements before operation, and then evaluated the ability of collateral flow compensation, by this way we can promote the successful rate of the operation, and decrease the complications perioperation.