A Retrospective Control Study On Selection Of Carotid Endarterectomy Types Based On Antiplatelet Strength

Objective:At present,different types and dosages of antiplatelet drugs are used in different surgical procedures of carotid endarterectomy（CEA）,and the sensitivity of antiplatelet drugs in each patient is also different.There is no unified standard of antiplatelet drug treatment in perioperative period of carotid endarterectomy.The purpose of this study is to explore how to choose the surgical procedure of CEA according to the antiplatelet strength.Methods:From May 2019 to December 2020,80 patients who underwent patch CEA or eversion CEA in neurosurgery department of the First Affiliated Hospital of China Medical University were retrospectively analyzed.Platelet aggregation(AR_AA)≤20%was regarded as the standard of aspirin antiplatelet strength,adenosine diphosphate induced platelet aggregation(AR_ADP)≤50%is considered as the standard of clopidogrel antiplatelet strength.According to the platelet aggregation function and CEA operation method,all patients are divided into 6 groups:（1）double standard group（2）single standard group（3）double standard group and PCEA group（P double group）（4）double standard group and ECEA group（E double group）（5）single standard group and PCEA group（P single group）（6）single standard group and ECEA group（E single group）.Baseline data,laboratory and imaging examinations,treatment methods,perioperative complications,postoperative subcutaneous drainage were collected.All measurement and counting data were grouped for comparative statistical analysis.Result:1.Aspirin resistance and clopidogrel resistance:12 patients（12/74,16.2%）who took aspirin 100 mg once a day had aspirin resistance,and 19 patients（19/77,26.7%）who took clopidogrel 75 mg once a day had clopidogrel resistance.2.Comparative analysis of perioperative bleeding risk between double standard group and single standard group:in double standard group,3 patients（3/45,6.7%）used protamine during operation,1 patient（1/45,2.2%）used blood transfusion during operation,single standard group had no intraoperative bleeding event（P=0.252>0.05,P=1>0.05）,and there was no significant difference in postoperative 48 h drainage between the two groups（P=0.252>0.05,P=1>0.05）.There were 2 cases（2/45,4.4%）in the double standard group and 1 case（1/35,2.9%）in the single standard group（P=1>0.05）.3.The effect of PCEA and ECEA on bleeding in operation area in double standard group:3 cases（3/37,8.1%）in P double group were treated with protamine during operation,8cases in E double group were not treated with protamine during operation（P=1>0.05）;1 case（1/37,2.7%）in P double group were treated with blood transfusion during operation,and no patients in E double group were treated with blood transfusion during operation（P=1>0.05）;The time of heparin metabolism in E double group was shorter than that in P double group（P=0.106>0.05）;the drainage volume 48 hours after operation in E double group was significantly higher than that in P double group（P=0.042<0.05）.4.Effect of double standard and single standard on perioperative ischemic events of PCEA:36 patients（36/37,97.3%）in the P double group had good patency of internal carotid artery,while 20 patients（20/20,100%）in the P single group had good patency of internal carotid artery（P=1>0.05）.7（18.9%）of 37 patients in the P double group completed carotid ultrasound reexamination one week after CEA,of which 2（2/7,28.6%）had mural thrombus,and 8（40%）of 20 patients in the P single group completed carotid ultrasound reexamination one week after operation,and no mural thrombus was found（P=0.2>0.05）.5.Effect of double standard and single standard on perioperative ischemic risk and subcutaneous drainage volume of ECEA:there was no ischemic event in E double group and E single group.And no significant difference in drainage volume 48 hours after operation between E double group and E single group（P=0.079>0.05）.Conclusion:1.Compared with the patients with single standard antiplatelet strength,the patients with double standard antiplatelet strength did not increase the risk of perioperative bleeding.2.Compared with PCEA,ECEA has more subcutaneous drainage in patients with double standard antiplatelet strength.3.There was no increase in the risk of perioperative ischemia in PCEA when the antiplatelet strength reached the single standard compared with the double standard.