Early changes of cerebral hemodynamics and perioperative events after carotid endarterectomy and carotid artery stenting in patients with unilateral symptomatic carotid artery stenosis

doi:10.3969/j.issn.1672-6731.2021.12.012

Abstract

Abstract: Objective To compare the cerebral blood flow (CBF) changes before and after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and perioperative events in patients with unilateral symptomatic carotid artery stenosis, so as to provide references for patients to choose surgical methods. Methods Forty-three patients with unilateral symptomatic moderate to severe carotid artery stenosis (>50%) were recruited from January 2018 to June 2020, including 19 cases in CEA group and 24 cases in CAS group. The dynamic changes of CBF values and perioperative events between 2 groups were compared. Results The hospitalization fee (t=-11.850, P=0.000) and the incidence of postoperative hypotension (χ²=3.634, P=0.022), bradycardia (χ²=3.634, P=0.022) and new DWI high signal (χ²=18.734, P=0.000) in CAS group were higher than those in CEA group. There were significant differences in heart rate (F=65.403, P=0.000), diastolic blood pressure (F=6.980, P=0.012), CBF values of the affected side and the healthy side (F=7.717, P=0.008; F=15.170, P=0.000) between 2 groups before and after operation. There were also significant differences in heart rate (F=2.452, P=0.048), systolic and diastolic blood pressure (F=13.296, P=0.001; F=5.814, P=0.020), CBF values of the affected side and the healthy side (F=48.959, P=0.000; F=57.758, P=0.000) between 2 groups at different observation time points. In CEA group the heart rate on the 1st to 3rd day after operation was higher than that before operation (P=0.000, 0.000, 0.003). The CBF values of the affected side on the 3rd and 7th day after operation (P=0.000, 0.001) and the CBF values of the healthy side on the 3rd day after operation (P=0.000) were higher than those before operation. In CAS group, the heart rate on the 1st and 2nd day after operation was lower than that before operation (P=0.000, 0.005). The CBF values of the affected side (P=0.000, 0.000) and healthy side (P=0.000, 0.000) on the 3rd and 7th day after operation were higher than those before operation. Conclusions The dynamic changes of CBF values, blood pressure and heart rate in the early stage after CEA and CAS were different, so we should choose the appropriate individualized treatment options for different patients to achieve better therapeutic effect.

Key words: Carotid stenosis, Endarterectomy, carotid, Stents, Cerebrovascular circulation, Heart rate, Blood pressure

摘要： 目的比较单侧症状性颈动脉狭窄患者行颈动脉内膜切除术（CEA）和颈动脉支架成形术（CAS）手术前后脑血流量（CBF）变化与围手术期事件，从而为患者选择合理手术方式提供参考。方法收集2018年1月至2020年6月收治的43例单侧症状性颈动脉中至重度狭窄（> 50%）患者，其中24例患者接受颈动脉支架成形术（CAS组），19例患者接受颈动脉内膜切除术（CEA组）。观察两组患者围手术期心率、血压，CBF值变化等围手术期事件，并对两组患者手术前后的血压、心率及CBF值变化进行比较。结果 CAS组住院费用（t=-11.850，P=0.000）以及术后低血压（χ²=3.634，P=0.022）、心动过缓（χ²=3.634，P=0.022）、新发DWI高信号（χ²=18.734，P=0.000）比例均高于CEA组。CEA组与CAS组患者手术前后心率（F=65.403，P=0.000）、舒张压（F=6.980，P=0.012）、患侧（F=7.717，P=0.008）和健侧（F=15.170，P=0.000）CBF值差异均有统计学意义，不同观察时间点两组患者心率（F=2.452，P=0.048）、收缩压（F=13.296，P=0.001）和舒张压（F=5.814，P=0.020）、患侧（F=48.959，P=0.000）和健侧（F=57.758，P=0.000）CBF值差异亦有统计学意义。其中，CEA组患者术后第1~3天心率高于术前（P=0.000，0.000，0.003），术后第3和7天患侧CBF值（P=0.000，0.001）以及术后第3天健侧CBF值（P=0.000）均高于术前；CAS组患者术后第1和2天心率低于术前（P=0.000，0.005），术后第3和7天患侧（P=0.000，0.000）和健侧（P=0.000，0.000）CBF值均高于术前。结论单侧症状性颈动脉狭窄患者行颈动脉内膜切除术和颈动脉支架成形术早期心率、血压和CBF值均发生改变，应针对不同人群选择适宜的个体化治疗方案，以达到较好的治疗效果。

关键词: 颈动脉狭窄, 颈动脉内膜切除术, 支架, 脑血管循环, 心率, 血压

WANG Wen-xin, WANG Ge-sheng, XUE Zhe, SUN Zheng-hui, MA Lin. Early changes of cerebral hemodynamics and perioperative events after carotid endarterectomy and carotid artery stenting in patients with unilateral symptomatic carotid artery stenosis[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(12): 1103-1110.

王文鑫, 王革生, 薛哲, 孙正辉, 马林. 单侧症状性颈动脉狭窄颈动脉内膜切除术或颈动脉支架成形术早期脑血流动力学变化及围手术期事件[J]. 中国现代神经疾病杂志, 2021, 21(12): 1103-1110.

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