Clinical Article
Relationship between surgical timing and clinical outcomes of carotid endarterectomy for symptomatic carotid stenosis
Pan Xiangjun, Hui Pinjing, Ding Yafang, Yan Yanhong, Zhang Bai, Wang Runchuan, Zhang Yi, Huang Yabo, Hu Chunhong, Fang Qi
Published 2020-01-28
Cite as Chin J Neurosurg, 2020,36(01): 32-37. DOI: 10.3760/cma.j.issn.1001-2346.2020.01.009
Abstract
ObjectiveTo explore the clinical outcomes of carotid endarterectomy (CEA) on patients with symptomatic carotid stenosis and its correlation with the timing of surgery.
MethodsA 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.
ResultsPerioperative 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). The mean flow velocity of MCA and pulsatility index (PI) value were increased (both P<0.001). Eighty-eight patients with stroke had lower NIHSS scores than before surgery [1.0(0, 2.0) points vs. 3.0(2.0, 5.8) points, P<0.001]. Up to the last follow-up, there was no significant difference between the above indicators and 5 days after surgery (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].
ConclusionsCarotid 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
Contributor Information
Pan Xiangjun
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Hui Pinjing
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Ding Yafang
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Yan Yanhong
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Zhang Bai
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Wang Runchuan
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Zhang Yi
Department of Cerebrovascular Ultrasound, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Huang Yabo
Department of Neurosugery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Hu Chunhong
Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Fang Qi
Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China