A Study Of Complications And Influencing Factors After Carotid Endarterectomy And Literature Review

BackgroundStroke is an important factor leading to human death and long-term disability,and most of them are Ischemic stroke.With the improvement of living standard and the aggravation of population aging,the incidence of carotid artery stenosis increased year by year.Stenosis and occlusion caused by carotid atherosclerotic plaques is one of the most common causes ot ischemic stroke.DeBakey performed the world's first carotid endarterectomy for carotid stenosis in 1953.In the 1980s,carotid endarterectomy(CEA)has become the traditional treatment for extracranial carotid artery stenosis in North America and Europe.In the past 20 years,with THE NASCET and European carotid surgery trial(ECST)and THE ACAS and Asymptomatic carotid artery surgery trial study(ACST),The results of large scale,multicenter,randomized,controlled clinical trials were published one after another,further establishing the gold standard status of CEA in the treatment and prevention of stroke from the perspective of evidence-based medicine,and gradually being accepted by the medical community and patients.As we all known,as a traditional treatment for this disease,It can completely eradicate the lesion.But CEA is a traumatic surgery,and the surgery is carried out lately in China,postoperative complications are more dangerous,and some of the complications can lead to fatal consequences.Therefore,the problems of exploring the efficacy of carotid artery internal membrane stripping,reducing the occurrence of complications,and strengthening medical norms,especially the prevention and treatment of postoperative complications,need to be further solvedObjectiveTo Summarize clinical data of-the patients with carotid endarterectomy in the treatment of carotid stenosis in department of neurosurgery of qilu hospital in July,2016-December 2018.And to carries on the statistical analysis.And to analysis the patient's clinical complications and postoperative complications of possible factors,in order to further reduce the postoperative complications risk,to explore management methods to provide certain reference basis in the treatment of carotid stenosis.MethodsTo summarize the clinical data of 170 patients who underwent carotid endarterectomy in qilu hospital of-shan dong university from July 2016 to December 2018.Information including:preoperative information:including demographic data,physical examination and Clinical symptoms,hypertension,diabetes,history of myocardial infarction,history of stroke,history of cerebrovascular disease surgery),a history of bad habits(drinking,smoking),medical history(mainly including anticoagulant antiplatelet drug name,dose),a series of hospital laboratory examination(excluding surgery taboo),Imaging examination(carotid ultrasound,head and neck CTA/MRI/CT,cerebral DSA,etc.),preoperative status and function of score(mRS score).Intraoperative information:including the time of surgery,whether the intraoperative transit flow,whether there is subcutaneous drainage,etc.Postoperative information records:including postoperative blood sample reexamination,The area of surgery secretion culture,postoperative imaging(head and neck CTA/MRI/CT,etc.),concomitant medication(mainly anticoagulant and antiplatelet therapy),mRS score,etc.Finally,all the data were summarized into EXCEL tables.We analyzed the possible factors of complications after CEA with the Univariate and multifactor analysis.ResultsA total of 170 cases were included in this study,all of which underwent carotid endarterectomy on one side.For those who underwent the second carotid endarterectomy,the operative interval was more than half a year.In all cases,the age of patients were between 48 and 79 years.In terms of sex ratio,there were 132 males and 38 females.Among the selected patients,127 had a history of hypertension,92 had a history of cerebral infarction,56 had a history of diabetes,41 had coronary heart disease,and.There were 88 smokers and 56 drinkers.159 of them had clinical symptoms,3 had non-neurological symptoms,and 8 had no clinical symptoms.In terms of stenosis degree,only 4 patients had moderate stenosis and 166 patients had severe stenosis.Among them,95 had unilateral stenosis and 75 had bilateral stenosis.Among the 170 enrolled patients,128 received preoperative antiplatelet therapy,78 of them received aspirin 100mg,50 of them received aspirin 100mg and clopidogrel 75mg.There were 42 patients without antiplatelet before operation.Overall complications after CEA surgery were 8.9%Within 30 days.there were 4 patients with ischemic stroke,6 patients with the area of surgery hematoma,2 patients with incision infection,1 patients with cranial nerve injury,2 patients had cardiac events.Conclusions1.Within 30 days after CEA surgery,4 patients(2.4%)had ischemic stroke,6 patients(3.5%)had wound hematoma,2 patients(1.2%)had incision infection,1 patients(0.6%)had cranial nerve injury,2 patients(1.2%)had cardiac events,No patients died.2.Operative time is the influencing factor of postoperative stroke.3.There was no correlation between postoperative incision infection and intraoperative hematoma of the factors considered.