| Purpose: This study was aimed to retrospect and analyze the outcomes of carotid artery stenting(CAS)with cerebral protection device(CPD)or carotid endarterectomy(CEA)with primary closure in 305 unilateral and bilateral carotid artery severe stenosis cases.Methods: 305 Patients with Severe carotid artery stenosis shown by at least one imageological examination were prospectively analyzed and followed between January 2008 and January 2016 at Department of Neurosurgery,Tianjin General Hospital(average follow-up time:16.47±11.34 months).Information including clinical characteristics,therapeutic method,prognosis and outcome was collected and evaluated.Unilateral carotid artery stenosis of patients were divided to two groups:A group were treated with CEA(121),and B group were treated with CAS(146).38 patients with bilateral carotid artery stenosis were divided to three subgroups: C1 group were treated with bilateral CEA(17),C2 group were treated with CEA on one side and CAS on the other side(12),C3 group were treated with bilateral CAS(9).The results of major adverse events and prognosis were analyzed statistically.Results: 1?305 patients were analyzed at our hospital.The number of male is 252,while the number of female is 53.Although the differences of the incidence between male and female,there was no statistically different in the incidence ratio in A group,B group and C group,respectively.In addition,There were significant differences in average age between the three groups(62.3±18.7 vs 71.5±4.6 vs 67.5±7.8 years,P<0.05).2?The incidence of main adverse events for A group was 7.4%,similar to B group(5.5%),while the C1 group,C2 group and C3 group were respectively 2.9%,4.2%,5.6%,which were similar.There was no statistically significant different of incidence of main local complications in A group(7.4%)and in B group(5.5%),while the C1 group(5.9%),C2 group(4.2%)and C3 group(11.1%)were respectively similar.3?Good neurologic condition rate:there were better neurologic status in A group compared with B group(P<0.05)during preoperation.And the good neurologic condition rate of A group compared with B group during postoperation was similar.4?The incidence of main adverse events and local complications of patients above the age of 70 in A group was similar to B group(P>0.05).There was no statistically different of incidence main adverse events and local complications of patients under the age of 70 between A group(16.4%)and B group(10.2%)(P>0.05).5?The incidence of main adverse events and long-term prognosis: there were no statistically differences between early treatment group(time window < 3weeks)(15.0%,6/40)and delayed treatment group(time window?3weeks)(14.8%,12/81)in A group,while the early treatment group(10.4%,5/48)and delayed treatment group(11.2%,11/98)in B group were are similar.The early treatment group was 25.0%(3/12),similar to delayed treatment group(19.2%,5/26)in C group.6?The C3 group have a higher rate of hypertension syndrome compared with other group when time-interval<3weeks,but not in statistical significance.There are higher rate of cranial nerve injury in C1 group and lower rate of perioperative adverse events in C3 group when the time-interval?3weeks,but still not in statistical significance.7?There was statistically different about hospital stay between A group(15.19±6.49 days)and B group(10.88±4.36 days).Moreover,there were statistically differences in the average hospitalization expenses between A group and B group(28023.62±19177.94 RMB vs 64824.83±12110.15 RMB,P<0.001).There were not significant differences in average mean operation time between the two groups.Conclusions: 1?There ware no differences between the efficacy and safety of CEA and CAS in the treatment of unilateral and bilateral carotid artery stenosis.2?There was no significant difference in treatment effect and safety between above 70 years of age and under the age of 70.3?There was no significant difference in treatment effect and safety in sub-groups when bilateral severe carotid stenosis underwent CEA and CAS staging treatment,but it tend to be a higher rate of hypertension syndrome when the operation time-interval is less than 3 weeks,but not in statistical significance.4?CEA has some advantages in health economics compared with CAS. |
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