Clinical Study For Stenting Of Extracranial Carotid Stenosis

ObjectiveTo explore risk factors of CAS for the treatment of carotid artery stenosis. To analyze the efficacy,safety and technical feasibility. To summarize CAS on the indication of choice between different populations and the prevention of complications.Data and Methods1. Retrospective analysis of 379 side of the CAS in patients with extracranial carotid stenosis on population characteristics, clinical features and vascular data.2. To summarize the prognosis of CAS according to criteria of efficacy, the incidence of early postoperative,30-days adverse events and the follow-up status.3. Statistical analyses were performed using the CHISS package.All the basic characteristics of selected groups of patients, clinical characteristics, vascular data and complications entered into the database after assignment by the acquisition. Univariate analysis was performed to evaluate the impact of every variable on early postoperative adverse events, Logistic regression was used to reveal the relationship between a variety of factors and the 30-day stroke,MI(myocardial infarctions) and death rates.Results1. Technical success rate of 100% from preoperative stenosis (81±17)% to reduce the postoperative (18±9)%. Patients with NIHSS score:median preoperative 5 points and postoperative 3 points.2. Early postoperative complications occurred 72 times,15 cases of CAS occurred two or more. The 30-day stroke,MI and death occurred 27 cases of times, the overall incidence rate was 7.12%, includingmajor stroke in 5 cases (1.32%), minor stroke in the 12 cases (3.17%), myocardial infarction (myocardial infarction, subendocardial infarction in 2 cases respectively) 4 cases (1.05%),6 deaths (1.58%).3.3 month to 3 year follow-up results showed that no procedure-related death occurred, ipsilateral stroke occured in 3 cases(0.79%), restenosis (≥50%) occurred in 10patients(2.63%).4. Univariate analysis showed age, diabetes and heart failure on the incidence of early postoperative complications had a respectively significant impact(p<0.05). Multivariate Logistic regression analysis revealed that asymptomatic stenosis (odds ratio[OR]= 0.39, p=0.0426)and diabetes([OR]= 3.38, p=0.0099) were significant predictors of the composite 30-days end point of MI,stroke and all-cause mortality.Conclusion1. In terms of CAS efficacy, CAS can be effective in restoring carotid artery stenosis, increased cerebral blood flow and prevent the occurrence of stroke according to technical success rate, stenosis remedy, improvement of symptoms, and postoperative follow-up results,2. In terms of CAS safety, elderly patients because of its anatomical characteristics, may increase the difficulty of precedure; elderly patients are more likely to have hemodynamic disorders to increase the risk of adverse events. Risk of symptomatic carotid artery stenosis in patients with carotid artery stenosis is asymptomatic of 2.56 times, the concept of vulnerable plaque and the importance of lipid-lowering therapy must be stressed. Very severe carotid artery stenosis does not increase the incidence of adverse events. As an independent risk factor, not clear whether the blood glucose levels in diabetic patients for CAS perioperative period, thus, the diabetic increases the risk of postoperative complications,especially for stroke patients. To confirm infarction lesions were completely repaired effectively, to adjust perioperative cardiac and renal function to a certain level, can reduce the surgical risk to some extent, but further proof are needed.3. In terms of technical feasibility of CAS, Including dual protection technology, the key technology of CAS in elder, the special part of CAS technology, the recognition technology of vulnerable plaque, the key control technology of high-reperfusion injury, all can effectively reduce complications and expand the scope of CAS.