Carotid stenosis can significantly increase the incidence of cerebral ischemia episodes and cerebral infarction and should be treated promptly. There are currently two treatment options for carotid stenosis: carotid endarterectomy and carotid stenting. In the past decade, many large retrospective studies have shown that carotid stenting has a higher success rate in treating carotid stenosis and is less invasive, free of anesthetic accidents, and more suitable for high-risk groups, and has the potential to further replace carotid endarterectomy in treating carotid stenosis.
Aetiology and principle
Carotid artery stenosis can be caused by atherosclerosis, polyarteritis, surgery and radiation injury, and most commonly by atherosclerosis. Stent placement acts on the stenosis, the sclerotic plaque is squeezed, the vessel is reshaped, the lumen is enlarged, and the distal blood supply is improved, thus preventing the occurrence of stroke.
Which patients should be highly suspected of carotid artery stenosis
1, recurrent TIA: recurrent weakness of one limb or facial numbness and slurred speech, usually recovering within 24 hours.
2, Dizziness, except for those with insufficient blood supply to the vertebral basilar artery.
3.History of hypertension for many years, history of diabetes mellitus.
4.Patients with head CT or MRI suggesting cerebral infarction.
What tests should be performed in patients with carotid artery stenosis?
1.Carotid vascular ultrasound and TCD examination, because they are non-invasive, can be used as the first choice for this disease, and can understand the presence or absence of stenosis, degree of stenosis and blood flow velocity of the extracranial segment of the carotid vertebral artery and intracranial vessels, and their accuracy is high.
2.Cranial CT or MRA examination to understand the presence of fresh infarct foci and decide the time of treatment for the next part.
3.Cerebral angiography is the only reliable basis for diagnosing this disease. The presence or absence of stenosis, length of stenosis, stenosis rate and size of vessel diameter of the carotid artery can be understood by imaging the common carotid artery bilaterally, and the length and diameter of stent can be selected by these. See Fig.
4. ECT can measure the blood flow in ischemic tissue semi-quantitatively to decide whether surgery or stenting is needed.
Indications and contraindications
1.Indications
(1) Extracranial carotid stenosis >60% with or without symptoms, where drug therapy is ineffective.
(2) Restenosis after balloon dilatation angioplasty, generation of entrapment and non-functional occlusion.
(3) With occlusion of the contralateral internal carotid artery, vertebrobasilar artery lesion, unstable angina pectoris, myocardial infarction, congestive heart failure, or advanced age who are not suitable for surgery.
(4) The lesion site is not suitable for surgery.
2. Contraindications
(1) Severe stroke with severe neurological dysfunction.
(2) Patients who have had a recent stroke (1 month).
(3) Chronic complete occlusion greater than 6 months.
V Preoperative preparation: Oral aspirin 300mg and Polivyx 75mg daily for at least 3 days before surgery, the rest of the preparation is the same as the preoperative preparation for cerebral angiography.
VI Postoperative management: Oral aspirin 300mg and Polivivir 75mg daily for at least 6-8 weeks postoperatively, and aspirin for life.
Comparison before and after stenting treatment