| Part ?ClINICAL STUDY OF CAROTID ARTERY STENOSIS IN THE TREATMENT OF CAROTID ARTERY STENOSIS ObjectiveTo explore the safety and curative effect of carotid endarterectomy in patients with the treatment of carotid artery stenosis,Analysis of postoperative complications and prevention and treatment of carotid artery intima media.Methods412 cases from May 2008 to July 2015 in Liaocheng Brain Hospital of CEA in patients with extracranial segment of carotid artery stenosis were selected,of which 18 cases of patients with bilateral extracranial segment of carotid artery stenosis and staging of bilateral operation,each case in 2 cases of individual cases statistics,a total of 430 cases.Retrospective analysis of the clinical data of patients before the,including patients admitted to hospital with basic information: age,sex,associated chronic disease,smoking history,the main clinical symptoms,radiographic vascular lesions,side,plaques,the degree of stenosis of the observed within 30 days after operation the complication occurrence and long-term follow-up,the symptoms to improve the situation,restenosis.1.To investigate the safety of operation: the occurrence of various complications within 30 days after the operation statistics.Complications were classified as major complications and secondary complications,major complications including cerebral infarction,cerebral hemorrhage,myocardial infarction,death,minor complications including incision tension hematoma,incision healing bad,nerve injury,cerebral hyperperfusion syndrome(CHS),pulmonary infection.The relationship between using univariate analysis,the basic characteristics of patients,the clinical characteristics andsurgical treatment every variable and postoperative complications were analyzed using logistic regression analysis to assess the independent factors between patients with a variety of factors influencing and clarify the effects of postoperative major complications occurred.According to the operation time was divided into early experience group(2008 ~2011)and the recent experience group(2012 to 2015),and analysis of the different time period of patients with the complications of the trend.2.Discussion on the curative effect: after surgery,all patients were greater than or equal to 12 months of follow-up,an average of 18.9 months,long-term follow-up observation of clinical symptoms of the patients improved and image improvements,evaluation of CEA in the treatment of extracranial segment of carotid artery stenosis in patients with curative effect.Results1.430 cases of CEA operations were successful.The success rate of the operation was100%,the stenosis after the termination of the feasible transcranial Doppler(TCD)determination of ipsilateral middle cerebral artery peak velocity(SPV),pulsatility index(PI)is before operation were significantly improved(P < 0.05).2.Within 30 days after operation,the main complications in 12 cases(2.7%),of which one died(0.2%),cerebral hemorrhage in 1(0.2%),6 cases of cerebral infarction(1.3%),myocardial infarction in 4 cases(0.9%);minor complications in 70 cases(16.3%),which tension incision hematoma formation in 6 cases(1.3%),incision poor healing in 4cases(0.9%),nerve injury in 18 cases(4.2%),CHS38 cases(8.8%),pulmonary infection in4 cases(0.9%).Single factor analysis of variance showed that age is more than or equal to70 years old,modified Rankin Scale(MRS)is more than or equal to 3 points,unstable plaque,within 30 days after the operation of patients with previous history of heart disease is a major complication incidence rate increased significantly,the difference is statistically significant(P < 0.05).Multivariate logistic regression analysis results: unstable plaque,used is larger than or equal to three in two factors is independent factors of postoperative30 day major complications.Tension tension of 52 cases in 5 cases in 13 cases,early experience of group a total of 184 cases,the occurrence of major complications,including death in 1 cases,cerebral hemorrhage in 1 case,cerebral infarction and myocardial infarction in 3 cases,minor complications,including incision hematoma in 4 cases,incision poor healing in 3 cases,nerve injury in 12 cases,CHS in 29 cases,pulmonary infection in 3 cases,recent experience of group a total of 246 cases,the occurrence of major complications in 3 cases,including 1 death cases,cerebral hemorrhage cases,cerebral infarction in 1 case,myocardial infarction in 1 case;minor complications occurred in 18 cases,and the incision of hematoma in 2 cases,incision healing bad 1 cases,nerve injury in 6 cases,CHS in 9 cases,pulmonary infection in 1 case.3.for long-term follow-up,excluding deaths,5 cases of patients after 1 year by cerebral angiography(DSA)and CT angiography(CTA)inspection confirmed that postoperative restenosis,of which 3 patients appeared transient ischemic attack(TIA),conservative treatment after symptoms improved.Increased significantly improve the former than and more than 424 patients postoperative 1 week,6 months,1 year review the carotid artery color Doppler ultrasonography(CDUS)showed the stenosis vascular diameter,peak systolic velocity(PSV),end diastolic velocity(EDV)were all improved significantly(P < 0.05);postoperative 1 week,6 months,1 year follow-up TCD MSPV PI operation were(P < 0.05);a total of 43 cases of patients after 1 year follow-up CT perfusion showed preoperative ischemic cerebral blood flow(CBF)and cerebral blood volume(CBV)decreased,mean through time(MTT)and peak time(TTP)decreased(P <0.05);424 patients postoperative 1 year or so DSA or CTA showed the narrow lifted,smooth flow.392 cases(92.2%)of patients with cerebral ischemia symptoms improved after surgery.ConclusionCarotid endarterectomy for treatment of patients with extracranial carotid artery stenosis can effectively relieve the stenosis of the artery lumen,Gai Shannao flow,prevent the occurrence of ischemic stroke.Unstable plaque patients,preoperative neurological function defect in patients with severe carotid endarterectomy in early postoperative complication rate increase.With carotid artery intima resection surgery volume will continue to increase,constantly sum up lessons of operation,to strengthen the training of micro operation,preoperative evaluation and postoperative management based on the importance and carotid artery intima resection operation safety will continue to improve.Part ?THE RELATIONSHIP BETWEEN P4H?1?MMP-9?TYPE1 COLLAGEN AND THE STABILITY OF CAROTID ATHERO-SCLEROTIC PIAQUE ObjectiveBy on carotid arterial intima resection in the clinical study of the safety and efficacy of surgery for the treatment of carotid artery stenosis and multivariate logistic regression analysis showed that the unstable plaque this factor is independent factors of major complications occurred within 30 days after surgery.To further explore the effect of plaque of carotid artery stenosis in patients with unstable,monitoring of P4 H alpha 1,MMP-9,type I collagen in stable carotid artery plaques and unstable plaques in the expression of,of P4 H alpha L,MMP-9,type I collagen expression of correlation and lead to the possible mechanism of plaque vulnerability.MethodsFrom the carotid endarterectomy carotid atherosclerotic plaque(atherosclerotic plaque,AP)30 cases as experimental group.According to the preoperative color Doppler ultrasound examination of carotid artery to determine plaque,experimental group was divided into the stable plaque group(stable plaques,SP)and unstable plaque group(unstable plaques and up).The normal isolated mesenteric arteries from 16 patients with carotid atherosclerosis were excluded from the control group.Western(blotting)was used to detect the protein expression level of P4 H alpha 1,MMP-9,type I collagen in the three groups of specimens ResultsThe experimental group P4 H alpha 1,MMP-9,type I collagen was significantly higher than that of control group(P < 0.05)and MMP-9 in the unstable plaque group expression was significantly higher than that in stable plaque group(P < 0.05),P4 H alpha1,type I collagen expression in stable plaque group was significantly higher than that of unstable plaque group(P < 0.05)ConclusionType ? collagen are involved in the formation and stability of carotid atherosclerotic plaque.Collagen metabolism is mainly regulated by the synthesis and degradation of collagen.The decrease of collagen metabolism and the increase of collagen synthesis and /or degradation of collagen can lead to the thinning of the fibrous cap on the surface of theplaque and the instability of the plaque.P4 H alpha 1 is an important rate limiting enzyme in collagen synthesis,and the degradation of collagen is mainly involved in MMP-9.The content of P4 H alpha 1,MMP-9,type I collagen in plaque can reflect the stability of atherosclerotic plaque. |
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