CTP Was Used To Study The Cerebral Perfusion Recovery Of T2DM Complicated With Carotid Artery Stenosis After CEA

Background:To investigate the difference of cerebral perfusion recovery after carotid endarterectomy in type 2 diabetes mellitus and non-diabetes mellitus patients with unilateral carotid artery stenosis.Methods:The subjects were 88 patients with unilateral carotid artery stenosis(stenosis ≥60%)who were admitted to the Department of Neurovascular Surgery of the Affiliated Hospital of Jilin University from May 2018 to December 2020 and underwent carotid endarterectomy.Gender,age,smoking history and alcohol consumption history were collected,and BMI,heart rate,blood pressure,fasting blood glucose,glycated hemoglobin,blood lipid(TG,HDL,TC,LDL,Apo A-I,Apo B,LPA),serum uric acid,serum creatinine and homocysteine values were recorded.Cervical vascular color ultrasound was used to evaluate the degree of carotid stenosis.Perfusion parameters before and one week after carotid endarterectomy(CEA)were obtained by computed tomography Perfusion(CTP)to evaluate cerebral Perfusion recovery.Results:1.After CEA,the patient’s perfusion status was significantly improved compared with that before surgery,mainly manifested in the increased CBF affected side(26.24±10.40vs38.59±19.84,P < 0.001);Postoperative MTT(10.30±3.0vs8.15±3.22,P < 0.001)and TTP(23.21±3.45 vs 20.28±3.67,P < 0.001)were decreased,and the differences were statistically significant(P < 0.05).2.The cerebral perfusion status of T2 DM group was worse after CEA,mainly manifested in the decrease of MTT on the affected side(9.37±3.94vs7.52±2.60,P=0.010)compared with that of non-DM group,with statistical significance(P < 0.05).3.Spearman correlation analysis was used to analyze the parameters of different HbA1c classification and cerebral perfusion recovery,and the classification of HbA1 c in two groups(well controlled: HbA1 c < 8;Poor control: correlation between HbA1c≥8)and cerebral perfusion recovery parameters.The results were shown in the table below: there was a negative correlation between HbA1 c and CBF affected side after cerebral perfusion recovery parameters(r=-0.213,P =0.046)in the two groups.In other words,the worse the control of HbA1c(the greater the value),the worse the postoperative CBF affected side parameters of cerebral perfusion recovery(the smaller the value).4.Univariate linear regression analysis was conducted with the affected side of postoperative CBF as the representative parameter.The results showed that heart rate and systolic blood pressure were related to the affected side of CBF(P < 0.05),and the standardized coefficients were0.292 and-0.213,respectively.The results showed that heart rate and systolic blood pressure were independently correlated with the affected side of CBF(P < 0.05),with regression coefficients of 0.296 and-0.297(P< 0.05),respectively.Heart rate was positively correlated with the affected side of CBF,while systolic blood pressure was negatively correlated with the affected side of CBF.Conclusion:1.Compared with non-diabetic patients,postoperative perfusion recovery of type 2 diabetic patients was poor.2.The worse the blood glucose control in T2 DM patients,the worse the recovery of cerebral perfusion.