Phẫu thuật bóc lớp trong động mạch cảnh: kinh nghiệm 1200 trường hợp tại một trung tâm

Abstract

Backgrounds: The value of carotid endarterectomy (CEA) has been well established in patients with symptomatic and asymptom- atic carotid artery stenosis.The purpose of this study was review our experiences on carotid endarterectomy in Thongnhat hospital during 15 years with 1,200 cases. Methods: All of 1,200 CEA cases in our hospital during 15 year from 2004 to 2019 were prospectively collected. Eveluate the clinical characteristics of stenosis of the carotid. Carotid endarterectomy was performed with conventional carotid endarterectomy in 942 cases (78,5%) and Eversion carotid endarterectomy in 258 cases (21,5%). Primary outcomes are death and stroke in 30 day, 1 year and 5 years after operation. Secondary outcomes are restenosis over 70% at 1 years and 5 years after operation. Results: The mean age was 72.4 range 49 to 92, male:female was 2.6:1. Previous stroke in 628 patients (54.3%), TIA in 252 patients (21.0%) and asymptomatic in 320 patients (26.7%). Mean clamping time was 23.4 min. Perioperative mortality was 0.25% (3/1,200) with myocardial infarction being cause in 2 patients. Perioperative neurological morbidity was 0.83% (10/1,200) with 4 cases major and 6 minor strokes. In 16 cases (1.3%) had cervical hematoma, two cases need urgent operation for control bleeding. The recurrent laryngeal nerve involved in 5 cases (0.4%). The 1-year and 5-year mortality was 0.2% and 1.1%. Ipsilateral stroke after operation 30 days to 1-year and 5-year were 0.1% and 0.8%. The rates of restenosis >70% at 1 year and 5 year are 0.1% and 1.0%. Conclusions: Carotid endarterectomy has a reduced rate of perioperative complications when compared to those previously reported in literature. The low complication rate is related to improved preoperative patients evaluation, surgeons’ increasing experience and to surgical and anesthesiological techniques