Analysis Of The Effect Of Modified Carotid Endarterectomy On Severe Carotid Stenosis

Background:In the treatment of carotid artery stenosis,carotid endarterectomy is commonly used clinically.However,the traditional surgical method is more likely to cause lumen stenosis of internal carotid artery by suture,which increases the risk of postoperative restenosis.Therefore,on the basis of the traditional carotid endarterectomy,the surgical method was improved to ensure the integrity of the internal carotid artery lumen without the use of the patch and without the need for eversion.A retrospective study was conducted to evaluate the feasibility and efficacy of this new surgical procedure.Objective:Clinical data and data were collected and compared between patients who received modified carotid endarterectomy(MCEA)treatment and those who received traditional CEA treatment to evaluate the feasibility,efficacy and early outcome of MCEA treatment for symptomatic severe carotid artery stenosis.Method:The clinical data of 10 patients treated with modified carotid endarterectomy for carotid stenosis and 6 patients treated with traditional carotid endarterectomy for carotid stenosis in the department of vascular surgery of vascular surgery,Nanfang hospital of southern medical university from February 2016 to April 2019 were retrospectively analyzed.The patient's basic information,complications and perioperative data were recorded.All cases underwent computed tomography angiography(CTA)or doppler ultrasound or digital subtraction angiography(DSA),and were clearly in line with the American heart association/American stroke association(AHA/ASA)recommended surgical indications:symptomatic and the degree of stenosis are ?70%.No shunt or patch was used during the operation.Before the end of the operation,2mm caliber endoscopy was used to observe the patency of internal carotid artery before closing the carotid incision.After closing the carotid incision,ultrasound or DSA was used to detect the surgical effect.All patients were given dual antiplatelet agents preoperatively,were discontinued one day preoperatively,and continued to take dual antiplatelet agents for at least 3 months postoperatively.The preoperative and postoperative modified rankin scale of the above patients was compared,and the occurrence of postoperative complications was evaluated,and the feasibility and efficacy were analyzed.Result:All patients completed the operation successfully,with 10 patients receiving 10 modified carotid endarterectomy and 6 patients receiving 6 traditional carotid endarterectomy.Among them,the average operation time of modified carotid endarterectomy group was 89.0±22.6 minutes,and the average clamping time of carotid artery was 15.3±4.5 minutes.There was one case of perioperative stroke and the symptoms were significantly relieved after treatment.No myocardial infarction,cerebral hyperperfusion syndrome,incision hematoma,etc.The mean operation time of traditional carotid endarterectomy group was 107.0±17.6 minutes,and the average clamping time of carotid artery was 23±9.0 minutes,and no postoperative complications.Through statistical analysis,both surgical methods significantly improved the postoperative symptoms of patients,and the modified carotid endarterectomy could achieve similar therapeutic effect as the traditional carotid endarterectomy,and there was no significant difference in postoperative complications.Conclusion:MCEA has a clear curative effect,which can guarantee the postoperative patency rate,and at the same time,there is no significant increase in the incidence of major adverse events during the perioperative period and the follow-up period,which can be used as a surgical method for patients with symptomatic severe carotid artery stenosis.