Short-term Efficacy Of Carotid Endarterectomy For Treatment Of Carotid Stenosis

Object：Discuss the efficacy and safety of carotid endarterectomy according tocomparison with drug therapy of14、23cases carotid stenosis, separately.Methods：Analysis the clinical characteristic of14carotid stenosis patients whoundergo treatment of CEA in Dalian Medical University between August2013toJanuary2014,2cases with lateral occlusion in one side and lateral narrow in the otherside,3cases with lateral narrow in both sides,9cases with lateral narrow in one side.All cases were consistent recommended indications from the American HeartAssociation/American Stroke Association (AHA/ASA) for surgery: the stenosisexceeded70%in lateral, with clinical symptoms (I level recommended, A level ofevidence). The less serious one was chosen to udergo surgery when it came to caseswith lateral narrow in both sides.2patients take intraoperative vascular patch shaping.Transiting flow was undergoing in5patients lateral occlusion in one side and lateralnarrow in the other. Analysis the improvement compare with preoperation. Compare theradiographic characteristics with pre-and after operation: carotid artery blood flowvelocity was assessed by carotid ultrasound contrast, carotid stenosis rectify thesituation was conducted by CTA and ultrasound evaluation. Compare another23patients in the same period who take drug therapy alone, record the postoperativecomplications, analysis the security of different therapies, Single lateral stenosis andbilateral stenosis was analyzed in different group.Results：14patients were successfully operated without intraoperative bloodtransfusion, the average operative time was125±35min, the surgical results are all in line with standard surgery AHA proposed. All patients was relieved after operation,symptoms improved in13cases, one case no significant improvement. Postoperativelateral cervical carotid artery intravascular ultrasound show that that the surgerycompletely corrected the lateral narrow, postoperative neck vessels CTA show that2cases of routine patch repair local vascular slightly swollen, and the remaining12casesof stenosis completely removed. There have no complete remission in23cases whotake drug therapy. we recorded local complications and brain complications aspostoperative complications.2cases of local complications incision, wound hematomain1case, no tracheal compression symptoms. hypoglossal nerve irritation take placein1case, and end by self-healing. Cerebral complications of cerebral hyperperfusioncame up in one case, nerve recovery by controlling of blood pressure, dehydration andnutrition. no neurological sequelae occured. Low complication rate, no serioussequelae, safe and reliable. Through statistical analysis. We found the significantimprovement in symptoms compared pre-and after surgery in patients with statisticalsignificance (P <0.05). Comparison with medical therapy alone, the effect wasstatistically significant (P <0.05). Bilateral stenosis compared with unilateral stenosis,symptoms improved slightly worse, the difference was statistically significant (P<0.05),but still significantly better than drug therapy alone.Conclusion：CEA can improve the symptomatic of carotid stenosis patientssignificantly. Compared with drug therapy alone, CEA can improve symptoms moresignificantly, and removes plaque stenosis, can greatly reduce the incidence of cerebralinfarction. This surgery is safe and reliable, having no serious neurologicalcomplications except for the lower partial complications. Surgery at the lighter side inpatients with bilateral carotid stenosis have the same good clinical efficacy. Thus we canconclude: CEA have significant effect to symptomatic carotid stenosis, this researchshows its safey and reliability, and it’s suite cases with both bilateral carotid stenosis.