The Clinical Efficacy Study Of Carotid Endarterectomy In The Treat-ment Of Carotid Artry Stenosis

Objective:By retrospectively analyzing data from patients who underwent carotid endarterectomy(CEA),this study aims to investigate the effectiveness and prognosis of CEA in order to provide insights into the treatment of carotid artery stenosis.Methods:A retrospective analysis was conducted on 192 patients who underwent carotid endarterectomy(CEA)for carotid artery stenosis at the Department of Vascular Surgery,Second Affiliated Hospital of Nanchang University,from May 2017 to December 2022.A total of 200 sides were analyzed(each side was treated as a separate case).General information on the patients was collected,including gender,age,neurological symptoms,past medical history(coronary heart disease,atrial fibrillation,diabetes,peripheral vascular disease,hypertension,smoking and alcohol history),imaging findings(degree and location of carotid artery stenosis,and characteristics of plaque and preoperative transcranial Doppler ultrasound evaluation),perioperative data,postoperative complications,and follow-up status.The data were preliminarily processed and recorded in an Excel spreadsheet.According to the literature,factors possibly related to complications were selected,such as clinical symptoms,contralateral stenosis,unstable plaque,and advanced age,etc.Group differences in clinical factors and postoperative complications were tested.Multivariate regression analysis was performed to explore the related influencing factors of postoperative complications and adverse events during follow-up after CEA.Results:A total of 230 patients who were diagnosed with carotid stenosis by cervical-toskull CT angiography and three-dimensional reconstruction and underwent CEA treatment at our hospital between May 2017 and December 2022 were included in this study.After excluding those who did not meet the inclusion criteria,a total of 200 cases were included in the analysis.This study included 47 female and 153 male patients with a mean age of 66.84 ± 7.71 years(range: 41-90 years).Among them,87 patients had clinical symptoms of carotid stenosis,including 5 with moderate stenosis,190 with severe stenosis,and 5 with near-total occlusion.Six patients had atrial fibrillation,59 had diabetes,115 had dyslipidemia,39 had coronary heart disease,24 had peripheral vascular disease,104 had a history of cerebral infarction,157 had hypertension,100 had a long-term smoking history,and 23 had a history of alcohol consumption.Adverse events during the perioperative period included postoperative wound bleeding or hematoma in 15 cases,cranial nerve injury in 2 cases,cerebral infarction in 2 cases,and 3 deaths.The modified Rankin Scale(MRS)score was used to evaluate the patients’ conditions before surgery,during the perioperative period,and at 1 month after surgery.Nonparametric rank-sum tests showed that the MRS score of patients during the perioperative period and at 1 month after surgery was significantly improved compared to before surgery(P<0.05 and P=0.01<0.05,respectively).Among the 89 patients with clinical symptoms of carotid stenosis,72 patients showed improvement in their clinical symptoms during outpatient follow-up,with a symptom improvement rate of 80.9%.There was no significant difference in the incidence of postoperative complications between patients with different plaque characteristics(P=1.000>0.05),or between symptomatic and asymptomatic patients with carotid stenosis(P=0.925>0.05).There was also no significant difference in the incidence of postoperative complications between patients with and without contralateral stenosis(P=1.000>0.05),or between elderly and non-elderly patients(P=0.179>0.05).The study found that gender was a significant risk factor for postoperative complications,but further binary logistic regression analysis did not find it to be an independent risk factor.The study also found that the presence of coronary heart disease and clinical symptoms were independent risk factors for adverse events during follow-up and prognosis.In summary,the study found that carotid endarterectomy was effective in improving MRS scores in patients with carotid artery stenosis and had a high rate of symptom improvement.Conclusion:Carotid endarterectomy(CEA)is a classic surgical treatment for carotid artery stenosis that is safe and effective.It not only improves cerebral blood flow but also has a low incidence of complications.Qualitative plaque characterization,transcranial Doppler(TCD)intracranial evaluation,and intraoperative neurophysiological monitoring before surgery can reduce the Modified Rankin Scale(MRS)score and minimize postoperative complications,thereby improving the efficacy and safety of CEA.In this study,there was no statistically significant difference in the incidence of postoperative complications between elderly and younger patients undergoing CEA treatment.However,it is still necessary to fully prepare before surgery,evaluate and clarify the patient’s cerebral perfusion status,and develop individualized diagnosis and treatment plans based on the specific clinical symptoms of the patient.The influencing factors for the occurrence of adverse events in the mid-to longterm after carotid endarterectomy in this study were coronary heart disease and clinical manifestations.Therefore,preoperative examinations such as echocardiography,left ventricular function determination,and electrocardiography should be performed,and if necessary,coronary artery computed tomography angiography(CTA)should be conducted.