Carotid endarterectomy for severe symptomatic carotid artery stenosis

Abstract

Objective To investigate the clinical efficacy of carotid endarterectomy (CEA) in the treatment of extremely severe symptomatic carotid artery stenosis (stenosis rate 95%-99%). Methods The clinical data of 30 patients with extremely severe symptomatic carotid artery stenosis were analyzed retrospectively. Those patients were admitted to Department of Neurosurgery, the First Affiliated Hospital of Soochow University between January 2013 and December 2016. Among them, 14 cases underwent conventional CEA, 11 cases received patch CEA and 5 cases underwent eversion CEA. Cerebral hemisphere perfusion was evaluated with CT Perfusion (CTP) and cerebrovascular collateral circulation was evaluated with DSA or CTA. Results All 30 cases of CEA were performed successfully. CTP was reviewed at 1 week post surgery and all patients had a higher CBF (cerebral blood flow) compared with presurgical states (65.1±8.9 ml·100 g-1·min-1vs. 48.5±5.1 ml·100 g-1·min-1,P<0.05), and the TTP (time-to-peak) was significantly shorter than that prior to surgery (9.8±2.8 s vs. 13.4±1.6 s, P<0.05). After operation, 3 cases suffered from hyperperfusion syndrome. There was no perioperative stroke or death. The duration of follow-up was 3-48 months (mean: 20±12 months). No patient developed a new stroke.No reocclusion was detected. Conclusion CEA seems to be a safe and effective treatment for extremely severe symptomatic carotid artery stenosis. Key words: Carotid stenosis; Atherosclerosis; Endarterectomy, carotid; Treatment outcome