Comparison Of Modified Eversion And Conventional Eversion Carotid Endarterectomy In The Treatment Of Carotid Artery Stenosis

Background:Carotid Endarterectomy(CEA)is the first choice for surgical treatment of extracranial carotid artery stenosis.The destruction of carotid sinus receptor by conventional version technique often leads to postoperative hypertension,which leads to a high incidence of postoperative complications such as stroke,cerebral hyperperfusion syndrome and incisional hematoma.As a preventive operation,once the above complications occur,it will lead to death or disability,which will increase the patient and socio-economic burden.How to reduce the postoperative complications of CEA is particularly important,so there is an urgent need for a safe and effective operation that can reduce postoperative complications to replace the conventional eversion technique.Objective:Hemodynamic abnormalities after Conventional Eversion Carotid Endarterectomy(C-ECEA)have been confirmed to be related to the destruction of baroreceptor.Our center proposed a new improved eversion technique to protect the carotid sinus as much as possible during the operation,which can theoretically reduce the postoperative hemodynamic disorder.The purpose of this study was to determine the safety and efficacy of Modified Eversion Carotid Endarterectomy(M-ECEA)in the treatment of carotid artery stenosis,and to compare the hemodynamic effects of the two procedures on patients.Methods:Information of patients meeting surgical indications and CEA in our hospital from December 2021 to March 2023 was prospectively collected.The modified group received M-ECEA and the conventional group received C-ECEA.;General data of all CEA patients(gender,age,smoking history,hypertension,diabetes,coronary heart disease,BMI)were collected;Preoperative data(presence or absence of symptoms,degree of carotid stenosis);Intraoperative data(time of arterial occlusion,operation method,whether there is a patented tube);Postoperative data:complications(death,stroke,myocardial infarction,incisions hematoma,poor wound healing,cranial nerve injury),postoperative hemodynamic data,postoperative use of venous vasoactive drugs,length of hospitalization,hospitalization cost;Follow-up data(postoperative death,new stroke,myocardial infarction,postoperative restenosis,postoperative review impact data,etc.).Statistical software SPSS25.0 was used to analyze and compare the differences between the two groups of data collected.When P<0.05,the differences were considered to be statistically significant.Results:In this study,56 patients were eventually included,among which the modified group received M-ECEA(n=26 cases)and the conventional group received C-ECEA(n=30 cases).The operation was successfully implemented in both groups without perioperative death.1.The general data of the two groups were compared,and there were no significant differences in gender,age,smoking history,diabetes,hypertension,coronary heart disease and BMI between the modified group and the conventional group(P>0.05).2.No diversion tube was used in the two groups.The average time of intraoperative arterial occlusion was 18.58 minutes in the modified group(14-22)and 17.77 minutes in the conventional group(15-20).The average length of hospital stay in the modified group was 14.52±4.82 days,and the average length of hospital stay in the conventional group was 13.77±4.33 days.There was no significant difference in data between the two groups(P>0.05).Hospitalization cost:the average hospitalization cost of the modified group 31782.61±5970.28 yuan,the average hospitalization cost of the conventional group 32716.51±7257.54 yuan;There was no significant difference in data between the two groups(P>0.05).3.Postoperative adverse events(perioperative death,myocardial infarction,stroke,incisions hematoma,poor wound healing,cranial nerve damage):no above complications occurred in the modified group;In the conventional group,there was 1 case of incision hematoma,and there was no statistical significance between the two groups(P>0.05).In both the modified group and the conventional group,there was 1 patient with postoperative vomiting and discomfort reaction,which was considered to be related to anesthetic drugs and improved after gastric protection and other treatments.4.Venous vasoactive drug use:modified group:no use 13 cases,use one type of 10 cases,use two or more types of 3 cases;conventional group:7 cases were not used,12 cases were used one type,and 11 cases were used two or more types.There were statistically significant differences in the use of venous vasoactive drugs between the two groups(P<0.05).The average systolic blood pressure and diastolic blood pressure at 24 hours after operation between the two groups were lower in the modified group than in the conventional group,and the difference was statistically significant(P<0.05).Postoperative hemodynamic indexes(heart rate,respiration,systolic blood pressure,diastolic blood pressure):modified group:78.5,19.5,126.2,68.9,conventional group:85.2,19.6,130.7,75.6,the average value of the modified group was lower than that of the conventional group.Conclusion:1.Modified Eversion Carotid Endarterectomy is a safe and effective surgical method to treat carotid artery stenosis;2.Modified Eversion Carotid Endarterectomy has little effect on postoperative hemodynamics and can reduce the use of postoperative vasoactive drugs;3.Strict control of perioperative blood pressure can reduce postoperative complications after carotid endarterectomy.