| Objective: To compare and analyze the postoperative short-term efficacy of carotid endarterectomy with patch(p CEA)and standard carotid endarterectomy(s CEA),investigate the surgical characteristics,optimize selections,and improve the quality of clinical surgery.Methods: A retrospective analysis was conducted for the patients treated with the above two surgeries at Neurosurgery Department of First Hospital of China Medical University from January 2016 to November 2018;the patients with carotid artery stenosis were usually treated with p CEA;if the patients could not take oral dual antiplatelet drugs due to peptic ulcer,gout,recent need of surgery,they were treated with s CEA.Through respective statistical analysis of the preoperative baseline indexes of the two groups such as age,sex and disease risk factors,the primary endpoint events and secondary endpoint events were further compared between the two groups of patients after the operation;the primary endpoint events included hemorrhagic stroke,ischemic stroke,postoperative myocardial ischemia and death;the secondary endpoint events included the occurrence of postoperative luxury perfusion syndrome and postoperative restenosis;the main methods for the follow-up of 1-12 months after discharge were as follows: Records of adverse events during treatment in hospital,after discharge from hospital,in the outpatient visit and subsequent visit of the center,and in relevant departments,and telephone follow-up.The preoperative baseline data and postoperative endpoint events data in the above two groups were collected;the independent sample t test was used for the data in normal distribution,the rank sum test was used for the data not in normal distribution,and the ?2was used for qualitative data.Results: No significant statistical difference was found between pCEA group and s CEA group in smoking,preoperative age,sex,complications,symptomatic status,and other preoperative baseline indexes,as well as postoperative short-term complications.The patients were followed up for 6.8 months after operation.Details are as follows:Observation: Observation group(p CEA): a total of 226 cases,including 185 males(185/226,81.8%)and 41 females(41/226,18.1%),aged 43-87 years,with an average age of 64.24±6.51 years.Baseline indicators: smoking 131(131/226,57.9%),hypertension 91(91/226,40.26%),coronary heart disease 18(18/226,7.96%),diabetes 50(50/226,22.12%),hyperlipidemia 4(4/226,1.77%),symptomatic stenosis 184(184/226,81.41%),moderate stenosis 4(4/226,1.77%),severe stenosis 222(222/226,98.23%).Control group(s CEA): 101 cases,including 86 males(86/101,81.15%)and 15 females(15/101,14.85%),aged 43-82 years,with an average age of 63.77±7.51 years.Baseline indicators:smoking 60(60/101,59.40%),hypertension 31(31/101,30.69%),coronary heart disease 5(5/101,4.95%),diabetes 21(21/101,20.79%),hyperlipidemia 1(1/101,0.99%),symptomatic 83(83/101,82.18%),moderate stenosis 2(2/101,1.98%),and severe stenosis 99(99/101,98.02%).There was no statistically significant difference in baseline indicators between the two groups.Details of the primary endpoint events of the two groups are as follows: 1.Postoperative hemorrhagic stroke: p CEA 1(1/226,0.44%),s CEA 1(1/101,0.99%),(?2 =0.01,P=0.93>0.05),the difference was not statistically significant.2.Postoperative myocardial ischemia : p CEA 1(1/226,0.44%),s CEA 0,(?2=0.45,P=0.50>0.05),the difference was not statistically significant.3.Postoperative death : p CEA 1(1/226,0.44%),s CEA0,(?2=0.45,P=0.50>0.05),the difference was not statistically significant.Conclusion:1.The postoperative short-term(6 months)efficacy of p CEA and s CEA in the treatment of moderate and severe carotid artery stenosis is the same.2.In view of the fact that p CEA has a lower rate of carotid artery restenosis and better long-term benefits than s CEA,the p CEA is recommended for patients who can take double antiplatelet drugs in the perioperative period. |
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