Surgical or endovascular treatment for large-artery atherosclerosis-related ischemic cerebrovascular disease:analysis of 56 cases

Objective To evaluate the efficacy of neurosurgical and endovascular treatment for large-artery atherosclerosis-related ischemic cerebrovascular disease, and explore a reasonable and effective surgical and endovascular treatment protocol. Methods Clinical data of 56 patients with large-artery atherosclerosis-related ischemic cerebrovascular disease were analyzed retrospectively, including 36 cases presented with recurrent TIA, 6 with dizziness or vertigo, 14 with untypical symptoms of cerebral ischemia. Surgical or endovascular treatment was performed according to their clinical symptoms. Based on the improvement of postoperative clinical symptoms and the changes of the postoperative imaging features, the efficacy of operation or intervention was assessed. Results Surgical treatments were performed in 24 patients, including 7 carotid endarterectomies (CEA) and 17 intracranial-extracranial bypasses. The percutaneous transluminal angioplasty and stenting (PTAS) was carried out for the carotid artery stenosis and cranial artery stenosis in 32 cases, of which carotid artery and vertebrobasilar artery stenoses were seen in 26 cases and subclavian artery and brachiocephalic trunk in 6. Of the 36 patients with TIA, there was no TIA or stroke event happened in the follow-up period, except 1 patient with complete stroke after CEA and another death as a result of heart failure in the CEA group. The symptoms of dizziness or vertigo were relieved obviously. In the patients with atypical symptoms, the satisfactory imaging features after treatment were observed in the follow-up. Conclusion Surgical or endovascular treatment should be performed early for the patients with large-artery atherosclerosis-related ischemic cerebrovascular disease, and maybe both the two approaches are beneficial in the prevention and treatment of this disease.