ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ HẸP ĐỘNG MẠCH CẢNH TRONG BẰNG PHƯƠNG PHÁP BÓC NỘI MẠC Ở BỆNH NHÂN CÓ NGUY CƠ PHẪU THUẬT CAO

Abstract

Research objective:  To evaluate the results of early and mid-term treatment of internal carotid artery stenosis by endarterectomy in patients at high surgical risk. Methods: Using hospital medical records, collect clinical and paraclinical data, surgical methods, pathology, information on treatment and monitoring from the time the patient is admitted. hospital for surgery until the patient is discharged. Contact relatives and patients by phone to collect data according to the form after follow-up examination. Result: The average postoperative hospital stay in the study was 3.5 ± 1.1 days. The shortest hospital stay after surgery is 2 days, the longest is 7 days. In the study, there was 1 case of cerebrovascular accident during the postoperative period, accounting for 3.3%, no cases of postoperative bleeding, surgical wound hematoma, or surgical wound infection were recorded damage to cranial nerves, myocardial infarction or death. Successful surgical results accounted for 96.7%, with 1 case of unsuccessful surgery accounting for 3.3% due to stroke. There were 26 patients with medium-term follow-up, 4 patients were lost to follow-up. The longest follow-up period was 44 months, the shortest was 10 months. By the end of September 2023, the median follow-up was 29 months. In 26 cases with medium-term follow-up, no case required re-surgery due to narrowing of the carotid artery on the same side that had been previously operated on. Follow-up cases were evaluated by carotid ultrasound, recording: 21 cases (80.8%) did not see carotid artery stenosis, 5 cases (19.2%) had carotid artery stenosis. On the surgical side, all were narrowed less than 50%. In 26 cases with medium-term follow-up, no patient died from stroke or myocardial infarction. Conclude: Contralateral internal carotid artery occlusion accounts for the majority of patients at high surgical risk, the remaining are age ≥ 80, severe chronic obstructive pulmonary disease. No patient had severe cardiovascular disease, neck radiation therapy, or a history of internal carotid artery endarterectomy on the same side of surgery. Most patients have symptoms of carotid artery stenosis upon admission and have severe carotid artery stenosis on CTA. There was only 1 case of stroke, no case of infarction myocardial infarction or death after surgery. High surgical success rate.  No cases of complications were recorded during the medium-term follow-up period.