BACKGROUND: There is yet no evidence about whether internal carotid artery stenting with cerebral protection devices is beneficial to reducing neurological complications. OBJECTIVE: To explore the safety and efficacy of carotid angioplasty and stenting with cerebral protection devices for carotid stenosis. DESIGN, TIME AND SETTING: Non-randomized concurrent control trial was performed at Hospital Affiliated to Medical College of Chinese People’s Armed Police Force from June 2005 to January 2007. PARTICIPANTS: Seventy-four patients with carotid artery stenosis underwent stenting, including 21 with cerebral protection devices (16 males and 5 females; average age of 66.4 years, range 50-79 years), and 53 with no protection devices (36 males and 17 females; average age of 69.2 years, range 52-83 years). METHODS: Size of cerebral protection devices was confirmed according to the diameter of normal vessel at distal carotid artery stenosis. The guide wire was sent into distal stenosis under guidance of pathway picture followed by cerebral protection device release. The stent passed over the stenosis and released to appropriate site. The protection device was removed when the stenosis was relieved confirmed by routine angiography. MAIN OUTCOME MEASURES: Features of stenting process; frequency of stroke attack perioperatively and during 12-month follow-up. All of them took periprocedual anticoagulation treatment, cerebral vascular angiograpgy. RESULTS: Seventy-six self-expandable stents were delivered in 74 patients with carotid stenosis. Twenty-one cerebral protection devices were employed including 8 Angioguard and 13 Filterwire. The patients without cerebral protection devices were predilated 20 times (37.7%) with the balloons, and all were postdilated; 3 cases (5.6%) developed brief decreased heart rate and hypotension after stent release. The patients with cerebral protection devices were predilated 6 times (28.5%) with balloons, and all were postdilated; 2 cased (9.5%) developed brief decreased heart rate and hypotension after stent release and 2 (9.5%) developed angiospasm. One patient (4.7%) with cerebral protection devices had cerebral infarction (4.7%) perioperatively and another had cerebral infarction (4.7%) during the follow up. While four patients in the group without cerebral protection devices had cerebral infarction (7.5%) perioperatively, and five had cerebral infarction (9.4%) during the follow up. There were no significant differences between two groups. CONCLUSION: The results of the study show that cerebral protection devices are not helpful to reduce neurological complications in patients with carotid artery stenosis after stenting.

Objective To explore the influence of perioperative nursing for interventional open operation of patients with symptomatic internal carotid artery occlusion under the guidance of the Joint Commission International(JCI) concept. Methods The clinical data of 90 patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation from January 2016 to February 2018 were retrospectively analyzed, of which 40 patients receiving routine nursing from January 2016 to January 2017 were set as control group, of which 50 patients receiving nursing guided by JCI concept from February 2017 to February 2018 were set as observation group. The Hamilton Depression Scale (HAMD) was used to evaluate the anxiety of patients at preoperative 1 h and postoperative 48 h, and the extubation time and hospitalization time were compared, as well as the incidence of complications and the patient's coordination degree. Results The HAMD scores of preoperative 1 h and postoperative 48 h of the observation group respectively was (26.58 ± 5.79) and (17.41 ± 4.18) points, of which the control group respectively was (29.75 ± 5.21) points and (22.26 ± 4.64) points, and the HAMD scores between the postoperative 48 h and preoperative 1 h in the 2 groups were statistically significant differences (t=9.080, 6.790, all P < 0.01), of which between the 2 groups were statistically significant differences (t=2.697, 5.208, all P < 0.01). The extubation time and hospitalization time of the observation group respectively was (3.81 ± 0.62) and (12.97 ± 3.65) d, of which the control group respectively was (4.39 ± 0.71) and (16.18±3.54) d, with statistically significant differences (t=4.134, 4.201, all P<0.01). The total incidence rate of complications of the observation group was 18.00％(9/50), of which the control group was 40.00％(16/40), with statistically significant differences (χ2=5.361, P<0.05). The good rate of coordination of the observation group was 76.00％(38/50), of which the control group was 55.00％(22/40), with statistically significant differences (χ2=4.410, P < 0.05). Conclusions The perioperative nursing based on the JCI concept guidance can relieve the anxiety of patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation, shorten the postoperative recovery time, reduce the incidence of complications and improve the nursing coordination.

Objective To analyze the factors affecting the prognosis of elderly patients with severe craniocerebral injury.Methods Retrospective analysis of the clinical data of 1 047 elderly patients with severe craniocerebral injury admitted to the department of neurosurgery of Tianjin First Central Hospital from January 1997 to December 2021,including gender,Glasgow coma scale(GCS),injury factors and injury types,and treatment after admission.According to Glasgow outcome scale(GOS),good condition,mild disability,severe disability are considered as effective treatment,while persistent vegetative state and death are considered as ineffective treatment.Univariate and multivariate Logistic analysis of risk factors affecting the prognosis of patients with severe craniocerebral injury.Results Among the 1 047 patients,612(58.45%)were effectively treated,and 435(41.55%)were ineffective.The inefficiency of treatment in patients with intracranial hematoma was significantly higher than that of patients without intracranial hematoma[53.8%(342/636)vs.22.6%(93/411)],the treatment inefficiency of patients with complex injuries was significantly higher than that of patients with simple craniocerebral injury[62.4%(249/399)vs.28.7%(186/648)],the treatment inefficiency of patients with GCS scores of 3-5 was significantly higher than that of patients with GCS scores of 6-8[64.8%(243/375)vs.28.6%(192/672)],all differences were statistically significant(all P<0.05).There was no significant difference in the treatment inefficiency between males and females,or between patients with and without skull fractures[42.2%(294/696)vs.40.2%(141/351)and 37.9%(69/182)vs.42.3%(366/865),respectively,all P>0.05].Multivariate Logistic analysis showed that intracranial hematoma[odds ratio(OR)= 2.266,95%confidence interval(95%CI)was 1.656-3.103],type of injury(OR = 1.816,95%CI was 1.279-2.578)and GCS score(OR = 2.262,95%CI was 1.582-3.234)were independent prognostic factors for elderly patients with craniocerebral injury(all P<0.05).Conclusion To reduce the morbidity and mortality,it is crucial to address the factors that impact the prognosis of elderly patients with severe craniocerebral injury,by reducing the occurrence of intracranial hematoma and multiple injuries,as well as closely monitoring GCS scores,patient outcomes can be improved to a certain extent.