ObjectiveTo summarize our experience in treating highrisk carotid stenosis. MethodsWe retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with highrisk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. ResultsAll patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. ConclusionSelective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with highrisk carotid stenosis.
Objective To investigate the effect of combined carotid endarterectomy (CEA) and offpump coronary artery bypass grafting (OPCAB) on patients with carotid arteriostenosis and coronary heart diseases. Methods A total of 121 consecutive patients with carotid arteriostenosis and coronary artery diseases underwent CEA and OPCAB between January 2003 and December 2009 in Nanjing First Hospital of Nanjing Medical University. There were 81 males and 40 females, with their ages ranged from 62 to 72 years (67.2±4.5 years). All patients had 3vessel coronary artery lesions, and there were 3 cases of left main coronary artery lesion. Unilateral carotid arteriostenosis (≥50%) occurred in 95 patients, and bilateral (≥50%) in 26 patients. The occurrence of stroke, myocardial infarction, angina pectoris and other complications after operation was observed, and followup was carried out. Results All patients underwent unilateral CEA including 50 on the right side and 71 left. The mean block time of carotid artery in CEA was 20.5±7.0 minutes. The average number of distal grafts per patient in OPCAB was 2.9±0.3. None of the patients had stroke or myocardial infarction and no perioperative death occurred. Eightyseven patients felt well in terms of their neuropsycho symptoms; 32 felt no change; and 2 worsened. Follow-up was done for all the patients with a follow-up rate of 100%. The mean time of the follow-up was 67.5±12.5 months. During this period, none of the patients manifested stroke, myocardial infarction or neuropsycho symptoms. Conclusion Concomitant OPCAB and CEA is a safe and effective procedure in patients with carotid arteriostenosis and coronary artery diseases. It can reduce the rate of postoperative stroke significantly. However, longterm outcome of the procedure needs operative experience accumulation, longterm follow-up and observation, and serious research and illumination.
Objective To compare the early compl ications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the rightside in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major cl inical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local compl ications were compared between 2 groups within 7 days after operation. Results In CEA group, encephalon compl ications occurred in 3 cases (8.3%), heart compl ications in 2 cases (5.6%), and local compl ications in 5 cases (13.9%); while in CAS group, encephalon compl ications occurred in 8 cases (29.6%), heart compl ications in 1 case (3.7%), and local compl ications in 3 cases (11.1%). The encephalon compl ication ratio of CAS group was significantly higher than that of CEA group (χ2=4.855, P=0.028); and there was no significant difference in other compl ications ratios between 2 groups (P gt; 0.05). Conclusion CEA is the first choice to treat carotid artery stenosis.
Objective To summarize cl inical experience of carotid endarterectomy (CEA) in treating severe carotid stenosis. Methods Between October 1998 and January 2010, 215 patients with carotid stenosis were treated with CEA. There were 140 males and 75 females with an average age of 66 years (range, 51-88 years). Transient ischemic attack (TIA) occurred in127 cases, and 31 cases had history of cerebral infarction. All cases were diagnosed definitely by selective angiography and/or CT angiography, and stenosis degree was more than 80%; contralateral carotid artery was also involved in 45 cases. Ninty-six cases were found to have coronary artery stenosis by coronary angiography. CEA and coronary artery bypass grafting were performed simultaneously in 25 cases. Peripheral arterial disease was found in 43 cases and treated at the same time. Results A total of 155 patients were followed up 6-72 months. The cl inical symptom significantly alleviated in 148 cases postoperatively. Two cases had compl ication of cerebral hemorrhage within 1 week postoperatively; one died and the other was resumed after the conservative treatment. One case had hypoglossal nerve injury. Four cases had injuring marginal mandibular branch of the facial nerve, and no special treatment was given. Restenosis was found in 25 patients, and the stenosis degree was less than 25%; moreover, the patients had no TIA. One case died of heart attack at 3 years of follow-up period. Conclusion CEA is an effective and safe method for treating severe carotid stenosis.
Objective To observe the ocular hemodynamic changes and flow direction of ophthalmic artery of patients with severe internal carotid stenosis (ICAS) and investigate the relationship between flow direction of ophthalmic artery and degree of stenosis. Methods Forty eyes of 40 patients with unilateral highgrade ICAS (29 eyes, 72.5%) and internal carotid artery occlusion (11 eyes, 27.5%) diagnosed by color Doppler flow imaging (CDFI) were enrolled in this study. There were 14 eyes (35.0%) with obvious ocular signs of ischemia, 26 eyes (65.0%) without obvious signs of ocular ischemia. The peak systolic velocity (PSV) of central retinal artery (CRA) was measured. The flow direction of the ophthalmic artery was observed by digital subtraction angiography (DSA). The PSV of CRA in eyes with different flow directions in the ophthalmic artery was comparatively analyzed. The relationship between flow direction of the ophthalmic artery and degree of stenosis was also analyzed. Results The PSV of CRA in ICAS eyes was (6.59plusmn;1.49) cm/s, which was decreased compared to fellow eye (8.95plusmn;1.35) cm/s, the difference was statistically significant (t=-7.24,P＜0.01). The PSV of CRA in eyes with signs of obvious ocular ischemia was (5.84plusmn;1.42) cm/s, which was decreased compared to eyes without signs of obvious ocular ischemia (7.00plusmn;1.39) cm/s, the difference was statistically significant (t=-2.49,P＜0.05). There were 15 eyes (37.5%) with retrograde flow in the ophthalmic artery, 25 eyes (62.5%) with forward flow of ophthalmic artery. The PSV of CRA in eyes with retrograde flow and forward flow of ophthalmic artery were (6.96plusmn;2.09), (7.01plusmn;1.42) cm/s, the difference was not statistically significant (t=-0.09，P＞0.05). Among 15 eyes with retrograde flow of ophthalmic artery, there were five eyes (33.3%) with unilateral high-grade ICAS, 10 eyes (66.7%) with internal carotid artery occlusion. The incidence rate of retrograde flow in the ophthalmic artery in eyes with internal carotid artery occlusion was higher than that in eyes with unilateral high-grade ICAS (P＜0.01). Conclusions The PSV of CRA in eyes with severe ICAS decreased compared to fellow eyes. The PSV of CRA in eyes with signs of obvious ocular ischemia also decreased compared to eyes without obvious signs of ocular ischemia. With the increase of the degree of the internal carotid artery stenosis, the incidence of retrograde flow of ophthalmic artery increased.
Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
More and more people suffered from the car otid artery obstruction. It is reported that it's around 69% of these patients the first clinical manifes tation of carotid occlusive disease is the ocular ischemic syndrome. Owing to th e most symptoms of the ocular ischemic syndrome are very obscure, so there are a lways overlook or made a misdiagnosis of this entity in clinical. Fundus fluores cein angiography (FFA) is the best procedure to find this entity. We should pay close attention to notice the early phase of FFA. It is the most specific FFA si gn in ocular ischemic syndrome, and it is a distinctly unusual finding to find t he ocular ischemic syndrome. (Chin J Ocul Fundus Dis, 2008, 24: 79-81)