[Safety of carotid endarterectomy for the patiets with carotid artery stenosis and coronary artery disease under dual antiplatelet therapy].

Objective: To study the safety of dual antiplatelet therapy prior to carotid endarterectomy in the patients with carotid artery stenosis and Coronary Artery Accident. Methods: We review 86 patients with carotid artery stenosis and Coronary Artery Accidents who admitted in Peking University International Hospital between 2017 January and 2019 March. The 86 patients undergo carotid endarterectomy with dual antiplatelet therapy. We evaluate the safety of carotid endarterectomy dunring the dual antiplatelet thrapy by analyzing the incidence of acute coronary syndrome, ischemic cerebrovascular accident, intracranial hemorrhage, and regional hematoma. Results: From 2017 January to 2019 March, 86 patients with carotid artery stenosis and Coronary Artery Accident continued dual antiplatelet therapy prior to carotid endarterectomy. The incidence of main perioperative complications were as follows: acute coronary syndrome: 0; asymptomatic ischemia cerebrovascular accident: 8.1% (7/86); symptomatic ischemia cerebrovascular accident: 0; intracranial hemorrhage:0; neck hematoma:13.9%(13/86). All the patients were followed 30 days after the procedure. The modify Rakin Scale of the patients were all <3. The local hematoma were all recovered automatically without treatment and the perioperative mortality and morbidity was 0. Conclusion: For the patients with carotid artery stenosis and Coronary Artery Accidents, carotid endarterectomy under dual antiplatelet therapy was a safe choice.

[Immediate reconstruction of facial nerve defect using cable grafting of the greater auricualr nerve after parotid cancer resection].

Objective:To evaluate the feasibility of immediate reconstruction of facial nerve defect by using cable grafting of the greater auricular nerve after parotid cancer resection.Method:Clinical data of 11 patients suffering from parotid cancer was reviewed.9 cases were diagnosed as mucoepidermoid carcinoma and 2 cases were adenoid cystic carcinoma. Total parotidectomy and elective neck dissection were performed before cable grafting of the greater auricular nerve was interposed between stumps of facial nerve trunk and its branches. The facial nerve electromyogram and symmetry of mimetic musculature were evaluated. The House Brackmann (HB) grading system was used to assess the functional outcome of facial nerve rehabilitation. 8 patients received 50-65 Gy postoperative radiotherapy. The follow-up time ranged from 8 months to 36 months with the mean time of 12 months.Result:At all function oriented facial nerve reconstructed region, satisfactory orbicularis oculi muscle function in 7 patients was achieved (7/7); 5 patients obtained seeable and almost symmetric frowning (5/7); 9 patients obtained obvious nasolabial groove and satisfactory rest symmetry of the mouth corners (9/9); 4 patients got better facial nerve function restoration when it was 3 months after radiotherapy. Nine patients got HB grade Ⅱ, and 2 patients got HB grade Ⅲ facial nerve function restoration. Facial nerve electromyogram revealed weaker amplitude nerve conduction in 9 patients of HB grade Ⅱ than the conduction at its corresponding normal side.Conclusion:Cable grafting of the greater auricular nerve is a feasible candidate for the immediate reconstruction of facial nerve defect. Free nerve transplantation is probably not a contraindication for postoperative radiotherapy in the parotid region.