CAS和CEA治疗颈内动脉重度狭窄疗效及对脑血流量、血清miR-145、IGF1R的影响.

Objective: To study the effects of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cerebral blood flow, serum miR-145 and insulin-like growth factor 1 receptor (IGF1R) in treatment of severe internal carotid artery stenosis. Methods: The clinical data of 100 patients with severe carotid stenosis admitted to our hospital from January 2018 to December 2019 were retrospectively analyzed, they were divided into A group and B group according to different operative methods, 50 cases in each group, the A group was given CAS treatment, and the B group received CEA treatment. The perioperative conditions, cerebral blood flow, serum miR-145, IGF1R, Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were compared between the two groups, and the postoperative complications, restenosis rate and mortality rate were compared. Results:There was no significant difference in operation time, intraoperative blood loss, postoperative mechanical ventilation time, ICU stay time and hospitalization time between the two groups(P＞0.05); at postoperative 30 days, there were no significant differences in the relative time to peak (RTTP), relative mean transit time (rmtt), relative cerebral blood volume (rCBV), relative cerebral blood flow (rcbe), serum miR-145, IGF1R, MMSE scale and MOCA scale scores between the two groups(P＞0.05); within postoperative 30 days, there was no significant difference in bradycardia, myocardial enzyme spectrum increased, hyperperfusion syndrome, local hematoma and acute carotid artery occlusion between the two groups(P＞0.05); the incidence of stroke and hypotension in A group were significantly higher than that in B group, the incidence of hypertension in the B group was significantly higher than that in A group (P＜0.05); at postoperative1 year, there was no significant difference in mortality and restenosis rate between the two groups (P＞0.05). Conclusion: CAS and CEA have similar effects in the treatment of patients with severe internal carotid artery stenosis, they are can effectively improve cerebral blood flow, regulate the expression of serum miR-145 and IGF1R, and promote the recovery of cognitive function. However, the incidence of stroke and hypotension after CAS is higher, and the incidence of hypertension after CEA is higher. [ABSTRACT FROM AUTHOR]