Analysis Of Medium And Long-term Follow-up Results Of Cervical Segmencarotid Artery Stenting

Objective:Analyze the medium and long-term follow-up results after cervical segmental carotid artery stenting(CAS),and explore the long-term prognosis of patients after cervical segmental CAS and the related risk factors for ischemic cerebrovascular disease,and explore the correlation between different stent types and ischemic cerebrovascular disease after surgery.Method: Patients who underwent carotid stenting in the Affiliated Hospital of Qingdao University from July 2015 to June 2017 were selected.According to the different types of stent,Patients were divided into open-loop stent group,closed-loop stent group and mixed stent group.Clinical datas were collected,including age,gender,risk factors of vascular disease(hypertension,diabetes,hyperlipidemia,smoking),onset form(symptomatic stenosis,asymptomatic stenosis),modified Rankin score,target lesion,preoperative vascular stenosis rate,postoperative vascular residual stenosis rate,anesthesia mode(general anesthesia,local anesthesia),technical success rate,perioperative complication rate,etc.Observe the clinical follow-up of all patients for 5years after operation,and record the death and cerebral ischemia events.Collect the information of patients with in-stent restenosis who underwent color Doppler ultrasound or CTA or DSA within 5 years after operation,and analyze the baseline data,clinical and imaging results among the three groups.Results: 218 patients were included in this study.During the 5 year follow-up period,12 patients died,the mortality rate is 5.5%,including 7 patients with open-loop stents,3patients with closed-loop stents and 2 patients with mixed stents.206 patients who were able to complete the 5-year follow-up with complete follow-up data were divided into three groups according to the types of stent,127 patients in the open-loop stent group and42 patients in the closed-loop stent group and 37 patients in the mixed stent group.There was no significant difference among the three groups in general clinical data such as age,sex,hypertension,diabetes,hyperlipidemia,smoking,drinking,coronary heart disease,previous stroke history,and location of diseased blood vessels(P > 0.05).88 patients(42.3%)had the target lesion on the left side and 118 patients(57.7%)had the target lesion on the right side.There was no significant difference in the location of target lesion among the three groups(P > 0.05).There was no significant difference among the three groups in the preoperative stenosis rate,postoperative residual stenosis rate and in-stent restenosis rate.The technical success rate of the three groups was 100%.In the open-loop stent group,there were 12 perioperative complications,with an incidence of 9.4%;There were 5 perioperative complications in the closed-loop stent group,with an incidence of11.9%;There were 4 perioperative complications in the mixed stent group,with an incidence of 10.8%.There was no significant difference in perioperative complications among the three groups(P > 0.05).28 patients had ischemic cerebrovascular disease.14patients(11%)developed ischemic cerebrovascular disease during the follow-up of 5years in the open-loop stents group.8 patients(19%)developed ischemic cerebrovascular disease in the closed-loop stents group,6 patients(16%)developed ischemic cerebrovascular disease in the mixed stents group.There was no significant difference in the incidence of ischemic cerebrovascular disease among the three groups(P > 0.05).All the patients in the three groups had at least one color Doppler ultrasound or DSA / CTA reexamination five years after operation.Six patients(4.7%)in the open-loop stenst group had in stent restenosis,and three patients(7.1%)in the closed-loop stents group,2patients(5.4%)in the mixed stent group.There was no significant difference in the rate of in stent restenosis among the three groups(P > 0.05).Ischemic cerebrovascular disease occurred in 28 cases during the follow-up period,including 26 cases of cerebral infarction and 2 cases of transient ischemic attack.Among the patients with ischemic cerebrovascular disease after operation,smoking in 21 patients,post balloon dilatation in19 patients,and in-stent restenosis in 7 patients(P < 0.05).Univariate analysis showed that smoking,postoperative balloon dilatation,in-stent restenosis were related with ischemic cerebrovascular disease.Multivariate regression analysis showed that smoking and post stent balloon dilatation were independent predictors of postoperative ischemic cerebrovascular disease(P < 0.05).Conclusions: Smoking and post balloon dilatation during CAS are the risk factors for ischemic cerebrovascular disease after carotid angioplasty.There was no significant correlation between the types of stent and the incidence of postoperative ischemic cerebrovascular disease.