The Surgical Techniques Of Carotid Endarterectomy And The Clinical Effect

Objective:1. To investigate the surgical techniques of carotid endarterectomy, reduce adverse events intraoperative and complications after operation.2. To observe the surgical techniques clinical efficacy.Materials and Method:Retrospective analysis surgical datas of53cases from October2010to October2013that undergone carotid endarterectomy in the department of neurosurgery in TianJin HuanHu Hospital. There were39males and14females, aged from40to78years old, mean age(60.34±8.92); Course of disease two days to four years. The right carotid stenosis26cases,15cases on the left, double-sided12cases(were unilateral surgery), mild stenosis (<30%)0case, moderate stenosis (30%-69%)35cases, severe stenosis (70%-99%)16cases,2cases were complete occlusion. The clinical expression is transient amaurosis (8cases), unilateral limb paralysis or weakness (34cases), transient aphasia (16cases), dizziness (22cases),completely asymptomatic (2cases); at the same time accompanied by lacunar infarction or old cerebral infarction (37cases), diabetes (16cases), hypertension (43cases) and hyperlipidemia (39cases). Patients with bilateral stenosis should be based on clinical symptoms of decision operation in which one side, the complete occlusion cases were depended on DSA (digital subtraction angiography) to determine whether the vascular distal flow is smooth, the distal vascular patency were treated with operation. This group contains53cases,50cases undergone CEA,2cases undergone CEA+aneurysm clipping,1case undergone stent removal surgery by CEA because this stent restenosis. All patients underwent unilateral operation,2cases of complete occlusion of the left internal carotid artery given DSA examination,the distal blood was flow, then underwent left CEA operation.All patients were followed up for3to24months, According to this datas preoperative and postoperative, to design and analysis by SAS software.Results:1.1case dead of myocardial infarction,2cases appeared skin numbness in the side of the neck,1case appeared hoarseness after the operation, maybe caused by the damage of intubation when considering general anesthesia, the symptom disappeared after the therapy of budesonide inhalation;3cases still had mild transient ischemic attack(TIA), but no stroke or cerebral infarction, postoperative neck CT angiography (computed tomography angiography, CTA) and functional magnetic resonance perfusion imaging (functional magnetic resonance imaging, fMRI) examination.Showed the blood flow of carotid artery was good, cerebral blood flow perfusion had different degrees of improvement.2. All patients were followed up for3to24months, preoperative symptoms were improved after the operation, TIA symptoms disappeared.2cases appeared skin numbness in the side of the neck and the symptom disappeared3months later,9cases were still have the symptoms of unresponsive, memory loss, chronic cerebral ischemia, but improved significantly compared with the preoperative degree;3patients showed a short period of TIA patients, disappeared after2months.Conclusion:1. Statistical conclusion:t=-13.740, P<0.0001, according to the alpha=0.05level, thought to have statistics difference, after CEA patients symptoms improved significantly;2. Carotid endarterectomy is a safe and effective surgical approach to treat of carotid stenosis;3. Correct and reasonable choices of the surgical indications and surgeon’s surgical technique are the key to ensure the success of the operation and to improve the efficacy of the therapy; 4. Carotid endarterectomy is the remedial treatment after the operation of in-stent restenosis.