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

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.

doi：10.3969/j.issn.1672⁃6731.2021.12.012