Comparative Analysis Of The Efficacy Of Different Bypass Strategies In Carotid Endarterectomy

Objective: To investigate the safety of bypassing based on monitoring indexes of transcranial Doppler(TCD)and conventionally direct bypassing in carotid endar-terectomy(CEA).Methods: By a retrospective non-randomized controlled study,126 patients(age,44-78 years;96 males and 30 females)undergoing CEA with surgical indication(asymptomatic carotid artery stenosis > 70%,symptomatic carotid artery stenosis > 50%)in the Group of Vascular Diseases of the Department of Neurosurgery,China Medical University between July 2016 and 2017 March were selected.The patients were non-randomly divided into two groups: 88 patients with good temporal window,low rate of bypassing,recent cerebral infarction in magnetic resonance imaging(MRI)and high surgical risk were classified as experimental group A(bypassing based on TCD monitoring indexes in CEA);38 patients with poor temporal window,intracranial hemodynamics cannot monitored in TCD,poor contralateral compensation in preoperative TCD/CTA,high probability of excessive perfusion,high probability of using a bypass tube and no recent new cerebral infarction in MRI were classified as experimental group B(conventionally direct bypassing in CEA).Gender,age,history of smoking,diabetes and coronary heart disease(CHD)were compared between the 2 groups,showing no significant differences.Asymptomatic carotid artery stenosis and symptomatic carotid artery stenosis also showed no obvious difference,suggesting comparability.The incidence of postoperative complications including cardiac infarction,cerebral hyperperfusion syndrome(CHS),stroke and cerebral hemorrhage were compared between the 2 groups.Data were analyzed and processed using SPSS21.0,and enumeration data were expressed by percentage(%).Comparison between the groups was conducted by the x2 test,and P < 0.05 was considered as statistically significant.Results: A total of 126 patients were collected and divided into experimental group A(bypassing based on TCD monitoring indexes in CEA)and experimental group B(conventionally direct bypassing in CEA).The rate of bypassing in the experimental group A = 31/88 = 35.2%.No significant differences were found in gender,age,history of smoking,diabetes,CHD or asymptomatic/symptomatic carotid artery stenosis,suggesting comparability between the 2 groups.Comparison in postoperative complications showed that postoperative complications were found in 5 patients of the experimental group A,2 of whom presented postoperative CHS(incidence,2.27%)and recovered after active blood pressure control,and 3 of whom presented postoperative stroke(incidence,3.4%).In addition,in the experimental group B,7 patients showed postoperative complications,with CHS in 4 patients(incidence,10.5%)and stroke in 3 patients(incidence,2.6%).Postoperative CHS was compared using the x2 test(x2 = 3.519,P = 0.061 > 0.05),showing no statistical significance between the 2 groups.Postoperative ischemic stroke also presented no statistically significant difference between the 2 groups(x2 = 1.053,P = 0.305 > 0.05).The incidence of postoperative cerebral hemorrhage and cardiac infarction in the two groups was 0,without statistically significant difference.Safety was evaluated by comparing single complication between the 2 groups,which showed no statistical significance.Comparison of all possible complications(CHS,cardiac infarction,stroke,cerebral hemorrhage)after surgery between the two groups by the x2 test(x2 = 3.958,P = 0.047 < 0.05)suggested differences in the incidence of postoperative complications between the experimental group A and the experimental group B,with statistical significance.Conclusion: Bypassing based on intraoperative TCD monitoring indexes shows lower postoperative risk,high safety and effectiveness compared with conventionally direct bypassing in CEA.