| Objective: To evaluate the efficacy and safety of carotid endarterectomy and carotid stenting,as well as the improvement of cerebral blood flow after operation,in patients with unilateral internal carotid artery stenosis and contralateral carotid occlusion.Methods: A retrospective analysis was conducted using t he clinical data of 614 patients with unilateral internal carotid artery stenosis and underwent surgical treatment in the fifth department of neurosurgery,Huanhu Hospital from January 2016 to January 2019.All the patients were divided into CAS group and CEA group according to the presence or absence of contralateral carotid occusion,and each group was subdivided into CCO and Non-CCO subgroups.Univariate analysis was carried out on the relevant risk factors th at may affect postoperative complications,and the independent risk factors were determined by multi variate regression analysis after excluding irrelevant factors.The peak systolic velocity of bilateral middle cerebral artery were monitored by TCD before,1 day and 3 months after operation.Compared the data between groups to evaluate the improvement of cerebral blood flow in patients with CCO after operation.Results: 55 patients with CCO were enrolled,including 42 CAS and 13 CEA,with an average age of 6 4.27±4.59 years.The proportion of such patients with hypertension,diabetes and hyperlipidemia is relatively high,but there is no statistical difference compared wit h patients without CCO.There was no significant difference in the incidence of early major complications after CAS and CEA in patients with CCO.Univariate analysis showed that CCO was a related risk factor for postoperative stroke(P =0.033),further regr ession analysis confirm that CCO was an independent risk factor for stroke(OR 3.934,95%CI 1.185-13.065,P 0.025).In patients with CCO,the peak systolic velocity of bilateral middle cerebral artery increased significantly at 1 day and 3 months after CAS and CEA(P values of all subgroups are less than 0.001).The blood flow velocity of middle cerebral artery on the ipsilateral side improved more significantly at 1 day after CEA than CAS(the average growth rate of CAS and CEA was 28% and 34% respective ly,P=0.002).Conclusion: CCO is an independent risk factor for postoperative stroke,and there was no significant difference in the incidence of early postoperative complications between CEA and CAS in patients with CCO.Both CEA and CAS can effectively im prove cerebral blood flow of bilateral cerebral hemispheres in patients with CCO,and the improvement of blood flow of middle cerebral artery on the ipsilateral side is more obvious in CEA than CAS at 1 day after procedure. |
