Objective To investigate the effect of clopidogrel on platelet function and inflammation factor in treatment of severe carotid artery stenosis after stent-assisted angioplasty.Methods Patients (120 cases) with severe carotid artery stenosis after stent-assisted angioplasty were chosen and divided into two groups,the control group were given atorvastatin combined with aspirin,and the observation group were given atorvastatin combined with chlorine.The serum coagulants DD level,FIB level,inflammation factor P-chosen element level and restenosis event incidence of two groups were observed.Results D-double polymer of two groups had no significant difference;After surgery,the D-double polymer and FIB level of two groups were all higher (P ＜ 0.05).After surgery for 24 h,the D-double polymer and FIB level of observation group were higher,after 3 months of surgery,the D-double polymer and FIB level had no significant differences compared with before surgery,which were all in normal level.After 24 h,1 month,3 months of surgery,the D-double polymer and FIB level of observation group were all lower than control group (P ＜ 0.05).Before treatment,the P-chosen selectin of two groups had no significant differences,which were all decreased after surgery,and the observation group was lower than control group (P ＜ 0.05);The restenosis event of observation group was lower than control group (P ＜ 0.05).Conclusion Clopidogrel could control the platelet aggregation of severe carotid stenosis after surgery to prevent the thrombogenesis and decrease the restriction incidence,while control the inflammation factor expression to prevent the atherosclerosis.

OBJECTIVETo analyze risk factors for cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA).

METHODSFrom September 2010 to September 2012, 183 consecutive patients with carotid artery stenosis who had indications for CEA entered the study. There were 149 male and 34 female patients, aged from 38 to 83 years with an average of (66 ± 9) years. Intracranial blood flow changes were monitored through transcranial Doppler routinely. Pre- and post-operative middle cerebral artery velocity (VMCA) were recorded. CHS was diagnosed by the combination of hyperperfusion syndrome and 100% increase of VMCA after operation compared with pre-operative baseline values. The patients who had CHS during hospitalization were recorded. Pre-operative and operative related factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of CHS.

RESULTSOverall, CHS occurred in 15 patients (8.2%) after CEA. The average onset time was (2.6 ± 0.2) days after surgery. By decreasing blood pressure and using dehydration medicine, all the patients with CHS recovered before discharge. None of them developed to intracranial hemorrhage. On univariate analysis, significant risk factors for CHS were history of stoke, symptomatic carotid artery stenosis and shunting during operation. On Logistic regression model, independent risk factor was symptomatic carotid artery stenosis (OR = 6.733, 95%CI: 1.455-31.155, P = 0.015), while shunting during operation (OR = 0.252, 95%CI: 0.067-0.945, P = 0.041) was a protective factor.

CONCLUSIONSSymptomatic carotid artery stenosis is an independent risk factor for CHS after CEA and shunting during operation is a protective factor. Using shunt may be an effective method of preventing CHS after CEA.

Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Middle Cerebral Artery ; Risk Assessment ; Risk Factors