Relationship between surgical timing and clinical outcomes of carotid endarterectomy for symptomatic carotid stenosis

Q4 Medicine

中华神经外科杂志 Pub Date : 2020-01-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2020.01.009

Xiangjun Pan, P. Hui, Ya-suo Ding, Yanhong Yan, Bai Zhang, Runchuan Wang, Yi Zhang, Yabo Huang, Chunhong Hu, Q. Fang

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引用次数: 0

Abstract

Objective To explore the clinical outcomes of carotid endarterectomy (CEA) on patients with symptomatic carotid stenosis and its correlation with the timing of surgery. Methods A retrospective analysis was conducted on the clinical data of 146 patients with symptomatic carotid stenosis treated with CEA at Neurosurgery Department of the First Affiliated Hospital of Soochow University from September 2012 to May 2018. All 146 patients were divided into group A (≤14 d, 57 cases) and group B (> 14 d, 89 cases) according to the time from the initial symptoms to CEA. All patients underwent CT computed tomography perfusion (CTP) and transcranial doppler (TCD), and stroke patients were evaluated by the National Institutes of Health stroke scale (NIHSS) at 5 days after surgery. All patients were followed up on an outpatient basis 12 months after discharge, including re-examination of CTP and TCD, NIHSS scores for stroke patients, and observation of surgical-side restenosis. Results Perioperative stroke occurred in 1 (0.7%) of the 146 patients. Compared with preoperative 5 days after surgery, cerebral blood flow and cerebral blood volume were increased, and mean transit time (MTT) and time to peak (TTP) were shortened in the basal ganglia and temporal lobe of 146 patients (all P 0.05). Six patients (4.1%, 6/146) had restenosis on the surgical side. There were no significant differences in age, gender, medical history, smoking history, onset symptoms, or degree of carotid stenosis between the two groups of patients (all P>0.05). The change rate of MVMCA in group A was higher than that in group B at 5 days and 12 months after operation [5 days after operation: 41.0(16.7, 78.1)%, 18.9(4.9, 44.3)%, 12 months after operation: 40.5(13.0, 76.6)%, 15.9(7.2, 38.1)%, both P<0.05]. The rate of change in NIHSS scores of stroke patients in group A was greater than that in group B [5 days after operation: -100.0(-100.0, -60.0)%, -66.7(-100.0, -50.0)%, 12 months after operation: -100.0(-100.0, -58.6)%, -50.0(-100.0, -33.3)%, both P<0.05]. Conclusions Carotid endarterectomy could significantly improve cerebral perfusion, cerebral hemodynamics, and some neurological functions in patients with symptomatic carotid stenosis, and the early surgical prognosis seems better. Key words: Carotid stenosis; Treatment outcome; Carotid endarterectomy; Surgical timing

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颈动脉内膜切除术治疗症状性颈动脉狭窄手术时机与临床结果的关系

目的探讨颈动脉内膜切除术(CEA)治疗症状性颈动脉狭窄的临床效果及其与手术时机的关系。方法回顾性分析2012年9月至2018年5月苏州大学第一附属医院神经外科应用CEA治疗的146例症状性颈动脉狭窄患者的临床资料。将146例患者按出现症状至CEA的时间分为A组(≤14 d, 57例)和B组(≤14 d, 89例)。所有患者均行CT计算机断层扫描灌注(CTP)和经颅多普勒(TCD)检查，并于术后5天采用美国国立卫生研究院卒中量表(NIHSS)对卒中患者进行评估。所有患者出院后12个月门诊随访，复查CTP和TCD，脑卒中患者NIHSS评分，观察手术侧再狭窄情况。结果146例患者围手术期发生卒中1例(0.7%)。146例患者术后5 d与术前比较，基底节区和颞叶区脑血流量、脑血容量增加，平均传递时间(MTT)和到达峰值时间(TTP)缩短(P均为0.05)。手术侧再狭窄6例(4.1%，6/146)。两组患者在年龄、性别、病史、吸烟史、发病症状、颈动脉狭窄程度等方面差异均无统计学意义(P < 0.05)。A组术后5天、12个月MVMCA变化率均高于B组[术后5天:41.0(16.7,78.1)%，18.9(4.9,44.3)%，术后12个月:40.5(13.0,76.6)%，15.9(7.2,38.1)%，P均<0.05]。A组脑卒中患者NIHSS评分变化率大于B组[术后5 d: -100.0(-100.0， -60.0)%， -66.7(-100.0， -50.0)%，术后12个月:-100.0(-100.0，-58.6)%，-50.0(-100.0，-33.3)%，P均<0.05]。结论颈动脉内膜切除术可显著改善症状性颈动脉狭窄患者的脑灌注、脑血流动力学及部分神经功能，手术早期预后较好。关键词:颈动脉狭窄;治疗效果;颈动脉内膜切除手术;手术时机

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.