ObjectiveTo explore the short-term and long-term efficacy of carotid endarterectomy (CEA) in patients with carotid artery stenosis, and analyze the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after operation.MethodsThe clinical data of 326 patients with carotid artery stenosis who underwent CEA in the Second Department of General Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from January 2012 to December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to screen the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum homocysteine (Hcy) and modified Rankin scale (mRS) score.ResultsAll patients underwent successful surgery. Follow-up results showed that the incidence rate of cardiovascular and cerebrovascular events within 30 days after surgery was 6.7% (22/326), and the incidence rate of cardiovascular and cerebrovascular events within one year after surgery was 11.8% (38/323). Multivariate logistic regression analysis showed that smoking history (OR=2.373), contralateral carotid artery stenosis (OR=4.669), preoperative mRS score≥3 (OR=2.550), and preoperative serum Hcy≥20 μmmol/L (OR=1.335) were independent risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA (P<0.05). ROC curve analysis showed that the area under the curve of serum Hcy level was 0.834 in predicting cardiovascular and cerebrovascular events within 30 days after CEA [95%CI was (0.769, 0.899), P=0.003]. The area under the ROC curve of mRS score for predicting cardiovascular and cerebrovascular events within 30 days after CEA was 0.697 [95%CI was (0.552, 0.842), P=0.009].ConclusionsCEA is a safe and effective procedure for the treatment of carotid artery stenosis. The smoking history, contralateral carotid artery stenosis, preoperative severe neurological deficit, and elevated serum Hcy are independent risk factors for occurrence of cardiovascular and cerebrovascular events after CEA.
ObjectiveTo investigate the risk factors of carotid endarterectomy.MethodThe literatures about carotid artery stenosis in the past 30 years were screened through literature retrieval, and the study of surgical risk factors related to carotid artery stenosis were reviewed.ResultsThere were many risk factors associated with the carotid endarterectomy, including demographic, underlying disease, surgical factors, perioperative management, and so on. However, the risk factors analysis were not comprehensive enough in the current study, so there was still lack of effective methods to predict the surgical risk of carotid artery stenosis.ConclusionTo fully understand the risk factors of carotid endarterectomy and to establish a multi-factor prediction model is the direction of further research.
ObjectiveTo analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. MethodsWe reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). ConclusionStaged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.