Internal Carotid Artery Occlusion: Its Vascular Risk Factors Of Stroke And Recurrent Stroke

Purpose: This study was aimed to investigate whether the different clinical presentations and the risk of recurrent ischemic stroke in patients with internal carotid artery occlusion(ICAO) are related to vascular risk factors, collateral circulation and cerebral hemodynamic management as well as improve the prognosis in patients with ICAO.Methods: 122 Patients with ICAO shown by MRA, CTA, or/and DSA at least were prospectively identified and followed between March 2013 and March 2016(mean 19.87±12.37 months) at Department of Neurosurgery, Tianjin Medical University General Hospital. The patients were classified according to their presenting symptoms(cerebral infarction and no cerebral infarction[including TIA, no symptom, retinal ischemia]) and according to recurrent ischemic stroke(patients with and without recurrent ischemic stroke). The vascular risk factors, collateral circulation and cerebral hemodynamic management were analyzed. Predictors for recurrent ischemic stroke were investigated by Logistic regression analysis.Results: 1、122 such patients were identified at our center. There were more male(98 cases) than female(24 cases) patients, with the male: female ratio 4.1:1. Although the incidence of male was higher than female incidence, there was no statistically significant change in the male/female incidence ratio: 3.9 in cerebral infarction group(83 cases, including 66 male and 17 female patients) and 4.6 in no cerebral infarction group(39 cases, including 32 male and 7 female patients), respectively. Furthermore, There were no significant differences in mean age between both patient groups(60.29±10.80 vs 61.51±12.00 years, P>0.05). 2、There were no significant differences in vascular risk factors, hospital days, anticoagulant days and collateral circulation between patients with and without cerebral infarction(P>0.05), except MRS Score(P<0.05). 3、Overall the recurrent ischemic stroke rate among all series is 29.5%(36/122). The patients were observed respectively for a mean of 8.65 months and 24.37 months between patients with and without recurrent ischemic stroke. 4(11.1%) patients had experienced a TIA and 32( 88.9%) had experienced an ischemic stroke. In this study 36.1% of patients(30/83) with stroke had a subsequent stroke, an incidence significantly higher than that observed in patients with no cerebral infarction(15.4%). There was no statistically significant change in the male/female incidence ratio: 6.2:1/3.5:1 between patients with and without cerebral infarction, respectively. The overall mortality rate was 4.1%(5 patients), and the stroke-related mortality rate was 1.6%. There were significantly higher mortality rate in those with recurrent ischemic stroke(P<0.05). 4、After Chi-square analysis, history of Hypertension, Diabetes mellitus, Stroke were associated with recurrent ischemic stroke(P<0.05). There were no significant differences in history of Heart disease, Hyperlipidemia, Smoking and Drinking in the two groups(P > 0.05). According to Logistic regression analysis, history of Hypertension, Stroke, MRS Score and collateral circulation were univariately associated with a recurrent ischemic stroke(OR=3.91, 3.16, 0.30, 0.46, P<0.05). 5、70 patients were defined by using DSA, including 22 and 48 patients with and without recurrent ischemic stroke. There were significantly difference in the pattern of collateral flow via the ACo A or PCo A(P<0.05). In contrast, there were no significant differences in presence of collateral flow via both the ACo A and PCo A, OA or leptomeningeal collaterals between patients with and without recurrent ischemic stroke(P>0.05). 6、The SPECT were obtained in 52 of 122 patients(60.00±11.03 years, including 46 male and 6 female patients). There were significantly difference in ipsilateral cerebral perfusion of the frontal lobe, temporal lobe and the thalamus between two groups(P<0.05). No differences in overall parietal lobe, basal ganglia and occipital lobe were observed between patients with and without recurrent ischemic stroke(P>0.05).Conclusions:The history of Hypertension, Stroke and collateral circulation were univariately associated with a recurrent ischemic stroke. Recurrent ischemic stroke in patients with ICAO is associated with the pattern of collateral flow via the PCo A.