Experience In Surgical Treatment Of Severe Carotid Artery Stenosis And Analysis Of Interfering Factors And Countermeasures

Objective:Based on the prognosis of patients with severe carotid artery stenosis treated by our center and the selection of surgical methods by patients followed up by telephone or their family members,the interfering factors of surgical intervention methods for patients with severe carotid artery stenosis in primary hospitals were analyzed,and countermeasures were discussed to help patients choose the most suitable surgical methods.Methods:A total of 86 patients with severe carotid artery stenosis who underwent surgical treatment in our hospital from August 2018 to October 2020 were recruited.The reasons for each patient or family member to choose the surgical method were collected during follow-up by telephone,and the clinical and imaging data of the patients were used to determine the surgical method through the MDT team of the neurosurgery department for carotid artery stenosis by blind method.Compare the differences between the two surgical methods.Results:There were no statistically significant differences in age,gender,underlying diseases(including hypertension,diabetes,coronary heart disease and cerebral infarction),stenosis side(including unilateral and bilateral)and symptom severity between the two groups(P>0.05).In CEA group,postoperative restenosis occurred in 1case and peripheral nerve injury in 2 cases.In CAS group,there were 2 cases of restenosis and 2 cases of hyperperfusion injury.There was no statistical significance in postoperative adverse events and postoperative ADL score between 2 groups(P>0.05),but there were statistical significance in postoperative NIHSS score,preoperative and postoperative NIHSS and ADL score,hospitalization cost and length of stay between 2groups(P<0.05).After telephone follow-up,40 cases of CEA group and 46 cases of CAS group were selected.The number of cases selected by MDT physicians in neurosurgery group was 50 cases in CEA group and 36 cases in CAS group.The two selection methods had differences in the number of cases in different surgical groups and individual surgical methods.Through the follow-up analysis of the causes of these differences,for these reasons to explore solutions.Conclusion:Combined with the differences between the reasons for patients to choose surgery during follow-up and the MDT group,the cost and length of stay in hospital,patients’ underlying diseases,their family members’ cognition of the two surgeries,patients’ psychological state,anesthesia methods,family background and education level were the interfering factors affecting patients’ choice of surgical procedures for carotid artery stenosis.The countermeasures are as follows: to improve the people’s understanding of surgical methods and significance through certain means of education and publicity,to popularize the benefits of early operation to prevent ischemic stroke,and to make more people realize the importance of cerebrovascular disease prevention.However,this study belongs to the single-center small-sample study of primary hospitals,which has some limitations.The sample size can be expanded or multi-center combination can be used for further study.