The Analysis Of The Effect Of Surgical Treatment On Cerebral Autoregulation In Carotid Artery Occlusive Disease:Single Center's Experience

Background: A large number of studies have confirmed impairment of dynamic cerebral autoregulation(dCA)in patients with internal carotid artery stenosis.Damaged dCA is associated with stroke.At present,there are few continuous studies on the effect of surgical treatment on cerebral autoregulation in patients with carotid artery occlusive disease in China.The purpose of this study is to collect patients with unilateral carotid artery stenosis or occlusion who underwent surgical treatment in our center.The ability of cerebral blood flow autoregulation was monitored at different time points before and after surgery,and to explore the surgical effect on the change process of cerebral autoregulation in patients with carotid artery occlusive disease.Objective: To retrospectively analyze 33 patients with severe unilateral carotid stenosis or occlusion diagnosed by CTA or DSA who underwent carotid endarterectomy or hybrid surgery from January 2017 to December 2018 in the Department of Neurovascular Surgery,The First Hospital of Jilin University.The change of dynamic cerebral autoregulation ability in patients with carotid artery occlusive disease after surgical treatment which can guide the treatment and prognosis.Methods: From January 2017 to December 2018,33 patients with unilateral severe stenosis or occlusion of carotid artery diagnosed by CTA or DSA in neurovascular surgerydepartment of the First Hospital of Jilin University were retrospectively analyzed.The ability of dynamic cerebral autoregulation was measured before and after operation,and the effect of surgical treatment on dynamic cerebral autoregulation was discussed.All patients were confirmed to be unilateral carotid artery stenosis or occlusion by imaging examination.Postoperative recanalization was confirmed by DSA or CTA.The ability of dynamic cerebral autoregulation was tested before operation,3 days after operation and 1 month after operation.The transfer function analyses was used to analyze the blood flow and blood pressure signals,and the parameters were obtained: phase difference,gain and coherence.The values of each parameter after operation were compared with those before operation and analyzed statistically.Results: There was significant difference in the phase difference of 1 month after operation compared with that before operation in the operative side(P=0.002).There was no significant difference in the phase difference of 3 days after operation compared with that before operation(P=0.215).There was no significant difference in the phase difference of the non-operative side after operation compared with that before operation(P>0.05).There was significant difference in the phase difference compared with the operative side and non-operative side before operation and 3 days after operation(P<0.001?p=0.004).There was no significant difference in the phase difference of 1 month after operation compared with that before operation(P=0.749).Conclusion: 1.The ability of dynamic cerebral autoregulation can be improved in patients with severe unilateral carotid artery stenosis or occlusion after successful surgical treatment,but it needs to be restored to the level of healthy side about 1 month after operation.2.Carotid endarterectomy and carotid artery recanalization are effective methods for the treatment of carotid artery occlusive diseases.3.Autoregulation of cerebral blood flow in the affected side of carotid artery occlusive disease is impaired.