Clinical Analysis Of The Short-term Prognosis Of Two Surgical Methods For Chronic Internal Carotid Artery Occlusion

Objective:To compare the effectiveness,safety and economy of carotid hybrid surgery and cerebral revascularization in the treatment of chronic carotid artery occlusion,summarize the possible complications during the perioperative period,and put forward the corresponding preventive measures,in order to optimize the health economics on the premise of effective and accurate treatment,and further provide more reliable evidence for the surgical treatment of chronic carotid artery occlusion.Methods:The clinical data of 30 patients with chronic carotid artery occlusion who were admitted to the Department of Neurosurgery,Dalian Municipal Central Hospital from July 2020 to June 2022 and planned to undergo carotid hybrid surgery or cerebral revascularization were collected.Smoking history,coronary heart disease history,hypertension history,diabetes history,stroke history,operation information,hospitalization information and follow-up information after discharge were collected for retrospective analysis.According to the different surgical methods,they were divided into group A: 15 cases in hybrid operation group and group B: 15 cases in cerebral revascularization group.Inclusion criteria: age 45-75 years old;The patients who have chronic symptomatic carotid artery occlusion for more than 4 weeks(m RS ≤ 4);All patients underwent CTA and DSA imaging examination before operation to confirm the complete occlusion of carotid artery,and the length of vascular occlusion was at least5 mm,with no obvious stump at the proximal end of occlusion and no positive blood flow at the distal end of occlusion.Patients who consented to undergo hybrid surgery or cerebral revascularization for chronic carotid artery occlusion and underwent postoperative follow-up;Those who were informed of the study and signed the informed consent form.Exclusion criteria: asymptomatic carotid artery occlusion;Patients with severe stroke within 4 weeks;Intracranial concomitant aneurysm or arteriovenous malformation and other serious intracranial vascular diseases requiring treatment;Severe calcification of the lesion;Contraindications to anticoagulant or antiplatelet drugs,or allergy to contrast agents;Patients with severe diseases who could not tolerate surgery.SPSS22.6 software was used to analyze the data.Results:A total of 30 patients in the two groups were compared in terms of safety,efficacy,cerebral blood flow improvement evaluation and health economic evaluation.There was no significant difference in the improvement of symptoms between the two groups after operation(P > 0.05).There were significant differences in the incidence of hyperperfusion syndrome,postoperative infection and carotid sinus reaction between the two groups(P < 0.05),and there were no significant differences in the incidence of other perioperative complications between the two groups(P > 0.05).The regional cerebral blood flow and regional cerebral blood flow velocity of the two groups after operation were significantly higher than those before operation,and the mean transit time was significantly shorter than that before operation,with statistically significant differences(P < 0.05).At the same time,there was no statistically significant difference between the two groups(P > 0.05).The data showed that hybrid surgery and cerebral revascularization had a good improvement effect on cerebral blood supply in patients with chronic carotid artery occlusion.The m RS scores of the patients in the two groups decreased at 1 week and 6 months after operation compared with those at the time of admission,and there was a downward trend in each time period,with statistical significance(P < 0.05).At the same time,there was no statistically significant difference between the two groups.The data showed that hybrid surgery and cerebral revascularization had significant effects on the recovery of neurological function and the improvement of cerebral ischemia symptoms in patients with chronic carotid artery occlusion.The operation time and hospital stay of hybrid surgery were significantly lower than those of cerebral revascularization,and the total hospital cost of cerebral revascularization was significantly lower than that of hybrid surgery.There were statistically significant between the two groups(P < 0.05).Conclusion:Hybrid surgery and cerebral revascularization in the treatment of chronic carotid artery occlusion have high efficacy and safety in improving symptoms,restoring cerebral blood supply and the recovery of neurological function.In terms of perioperative complications,the risk of perioperative carotid sinus reaction in the hybrid operation was considerably above that in the cerebral revascularization,and the risk of postoperative hyperperfusion syndrome and postoperative infection in the cerebral revascularization group was also significantly higher than that in the hybrid operation group.Finally,in terms of health economics,the operation time and hospitalization time of hybrid operation group were shorter than those of cerebral revascularization group,but the total hospitalization cost was much higher than that of cerebral revascularization group.Therefore,while considering the effectiveness and safety of the two operations,the appropriate surgical method should also be selected according to the patient’s condition,economic condition and hospitalization time.