Perioperative Risk And Prognosis Of Carotid Artery Stenosis Stent Angioplasty And Intravascular Treatment Of Chronic Carotid Artery Occlusion

Part 1 Perioperative risk and efficacy of stenting in patients with carotid artery stenosisObjective: With the increase of the degree of carotid stenosis,the difficulty of operation is increasing,and the risk of embolus shedding is increasing,To investigate the perioperative complications and prognosis of carotid artery stenting in patients with severe carotid artery stenosis.Methods: 55 patients of moderate carotid stenosis,69 patients of severe carotid stenosis who were hospitalized in Hebei general Hospital from October 2010 to October 2016 were retrospectively analyzed.All patients underwent carotid artery stenting.All patients were enrolled in this study by Doppler ultrasonography,MRI and CTA,DSA was diagnosed with atherosclerotic carotid artery stenosis.The patients were divided into two groups by the degree of stenosis,moderate carotid artery stenosis(50% ~ 90%),severe carotid artery stenosis(? 90%).The complication of stent angioplasty were observed in the perioperative period and ipsilateral stroke were follow-up.The primary composite end point was stroke,myocardial infarction,or death from any cause during the periprocedural period or any ipsilateral stroke during the follow-up period.Analysis of two groups freedom from the primary end point of the percentage.Result: In this study,a total of 124 patients were enrolled,of those,55 patients had moderate carotid stenosis,including 40 males,with mean age 65.07 ± 9.7;69 patients had severe carotid stenosis,including 60 males,with mean age 65.87 ± 8.9.the two groups have not significant difference in age,hypertension,diabetes,hyperlipidemia,coronary artery disease,atrial fibrillation,smoking,COPD,prior TIA/stroke,prior myocardial infarction(P >0.05).There was a significant difference in gender(P<0.05).There was no significant difference between the two groups before surgery(no symptoms,TIA,stroke).7.3% asymptomatic patients in moderate group,and 10.7% asymptomatic patients in severe group.Contralateral occlusion was no significant difference in two groups.Two group of patients underwent 126 CAS,two of those patients had severe bilateral carotid stenosis.No difference was observed between the groups relative to procedural duration,stent diameter or length,maximum balloon diameter or length,also perioperative complications(stroke,myocardial infarction,or death from any cause)and ipsilateral stroke in follow-up period(P > 0.05).While,hyperperfusion syndrome were significant differences between the two groups after operation(P<0.05).6 patients had primary composite end point in moderate group,and 10 in severe group,no differences had been observed between two groups.Conclusion: this study demonstrate that patients with moderate and severe stenosis are able to safely undergo CAS and achieve similar periprocedural outcomes and mid-term prognosis.Part 2 Feasibility of endovascular recanalization for chronic carotid artery occlusionObjective:Observe the feasibility of endovascular recanalization in patients with chronic symptomatic carotid occlusion with hemodynamic disorders.Method: A total of 4 patients with chronic carotid artery stenosis who were hospitalized in Hebei general Hospital from January 2015 to October 2016 were retrospectively analyzed.All patients underwent endovascular recanalization.Mean age 68 ± 2.45.All patients were male.Clinical manifestation:1 patient showed ischemic stroke,remaining were TIA.All patients underwent follow-up at 3 month after procedure.Result: 4 cases of chronic carotid artery occlusion patients,3 cases were successful recanalization,1 case was recanalization failure.3 patients with recanalization success,including 1 case of cerebral infarction did not appear symptoms increased,2 cases did not appear again TIA.3 months of telephone follow-up,3 patients were not significantly changed,no recanalization of 1 patients with ipsilateral ischemic stroke.Conclusion: Chronic symptomatic carotid occlusion with hemodynamic disorders in patients with intravascular intervention may be safe and effective,still need to choose a reasonable patient,comprehensive preoperative assessment and large sample experiments confirmed.