| Part Ⅰ Comparison the Methods of Unilateral Artery SurgicalReconstruction for Carotid Artery Stenosis DiseaseObjective:The aim of this study was to compare early and long-term outcomes of eversion carotid endarterectomy(eCEA)and carotid endarterectomy with path(pCEA).Methods:In a retrospective study,we collected data on 441 patients who underwent CEA(eCEA=211 vs.pCEA=230)between October 2009 and October 2015 at our team.Economic costs,postoperative hospital days,use of shunts and antibiotics.early(30-day)complications,long-term restenosis,and mortality rates were compared between groups during 4 to 76 months of follow-up.Results:Patients in the pCEA group had a significantly higher percentage of antibiotic use(58.3%vs.27%,respectively;P<0001)and shunt use(86.6%vs.16.1%,respectively;P<.0001),longer postoperative hospital stay(7.23±0.25 days vs.6.38±0.20 days,respectively;P<.009)and a higher medical cost(24110± 1058 ￥ vs.17257±747.6 ￥,respectively;P<.0001).The perioperative complications including stroke or transient ischemic attack,cranial nerve injury,and infection/bleeding showed no difference between the 2 groups(all P>0.05).Long-term complication,including stroke or heart attack,recurrent stenosis rate,and mortality rate,showed no difference between the 2 groups(all P>0.05).Kaplan-Meier analysis shows that the recurrent stenosis-free and survival rates were not significantly different between the 2 groups(P=0.867,P=0.177,respectively).Conclusions:The adverse event rates of perioperative and long-term follow-up showed no significant difference between the eCEA and pCEA groups.Both eCEA and pCEA are effective for carotid artery stenosisPart II Exploration of Simultaneous Multi-Supra-Aortic Arteries Surgical Reconstruction for Carotid Artery Stenosis DiseaseObjective:To evaluate the safety and efficacy of simultaneous multi-supra-aortic arteries reconstruction(SMSAAR)in patients with a specific type of carotid stenosis,type I Takayasu Arteritis.Methods:Seventeen patients with Takayasu arteritis who received SMSAAR from June 2012 to March 2016 were included in this analysis.Demographic features and basic information were recorded.Follow up results,including major complications,patency rates,and survival rates,were also obtained.The EQ-5D questionnaire was also administered to evaluate the quality of life of patients.Results:Among these 17 patients,there were 77 supra-aortic arteries affected by TA and 37 arteries were reconstructed,10 with great saphenous vein and 27 with artificial blood vessels.All the operations were technical successes and the mean operation time was 396.6 ± 93.4 min.The patients were followed for a mean of 25.22±12.3 months.Two graft restenosis were found,and both were successfully recanalized by balloon dilatation.One patient suffered a minor stroke but was free from obvious sequelae.No major complications,recurrent symptoms,or deaths occurred during the follow up period.The EQ-5D questionnaire scores were significantly improved after the operation compared with the pre-operative scores(87.14±8.25 vs.58.93±14.4,P<.01),and all the patients enjoyed a satisfactory quality of life.Conclusion:SMS AAR in type I Takayasu arteritis can be effectively and safely performed with rigorous perioperative management.Maintaining the patency of the bypass graft relieves the symptoms of cerebral ischemia and helps sustain patients’ quality of lifePart Ⅲ Establishment a Risk Prediction Model for Surgical Reconstruction of Carotid Artery Stenosis DiseaseObjective:To develop a surgical reconstruction risk nomogram in patient with carotid artery stenosis disease.Methods:The 79486 patients were collected from American Vascular Quality Initiative database between 2003 and 2019.All patients were randomly divided into training dataset(70%)and verification dataset(30%).The optimal feature variables were selected through the least absolute shrinkage and selection operator(Lasso)regression in the training dataset,and the surgical reconstruction risk nomogram was built by multivariable logistic regression.Calibration,discrimination,and clinical usefulness of the predicting model were assessed using the calibration plot,C-index,and decision curve analysis.Results:Fifteen predictors were selected from 44 variables and incorporated in the prediction nomogram.In the training dataset,the model displayed good discrimination with a C-index of 0.746(95%confidence interval:0.731-0.761),ROC curve was 0.746 and good calibration.Decision curve analysis showed that the nomogram was clinically useful when intervention was decided at the risk possibility of 1%-24%.High C-index value of 0.741 could still be reached in the verification dataset.Conclusion:This novel nonadherence nomogram incorporating 15 feature variables could be conveniently used to facilitate the individual surgical reconstruction risk prediction within 1%-24%in carotid artery stenosis patients. |
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