Relationship Between Collateral Circulation And 1-year Clinical Prognosis In Patients With Severe Stenosis Or Occlusion Of Unilateral Internal Carotid Artery

Objective:The purpose of this study was to investigate the relationship between collateral circulation and one-year clinical prognosis in patients with severe stenosis or occlusion of unilateral internal carotid artery,so as to provide theoretical basis for prevention,treatment and prognosis of patients with severe stenosis or occlusion of unilateral internal carotid artery.Methods:A total of 152 patients with severe unilateral internal carotid artery stenosis(≥ 70%)or occlusion confirmed by DSA in the intervention Department of Xianyang Hospital of Yan’an University from November 2017 to August 2018 were included.After admission,all patients should determine whether they suffer from basic diseases such as coronary atherosclerotic heart disease,diabetes,hypertension and hyperlipidemia,and targeted control and treatment.Anticoagulant or antiplatelet therapy should be taken for at least 2 weeks after admission.After discharge,the patients were followed up for at least one year.During the follow-up period,4 patients lost follow-up and the remaining 148 cases.There were 108 male patients and 40 female patients.After excluding the confounding factors such as sex,age,hypertension,hyperlipidemia and smoking: 1.One hundred and forty-eight patients were divided into unilateral internal carotid artery occlusion group and severe internal carotid artery stenosis group according to the degree of internal carotid artery stenosis.The formation of collateral circulation on DSA was compared between the two groups.two 。.The patients with collateral circulation establishment on DSA were divided into unilateral internal carotid artery severe stenosis group and occlusion group.The compensatory conditions of primary collateral circulation and secondary collateral circulation were compared between the two groups.3.On the basis of DSA,148 patients were divided into two groups: no collateral circulation compensation group and collateral circulation compensation group.The NHISS score and modified Rankin score in different periods of the two groups were recorded,and the differences of NHISS score and modified Rankin score in different periods of the two groups were compared.4.One hundred and forty-eight patients were followed up for one year to record whether they had new cerebral infarction.According to the follow-up results,the patients were divided into two groups: new cerebral infarction group and no new cerebral infarction group.The establishment of superior collateral circulation in DSA was compared between the two groups.Results:1.On the basis of DSA,there were 77 patients with severe unilateral internal carotid artery stenosis,including 44 patients with collateral circulation(57.14%)and 33 patients without collateral circulation(42.86%).There were 71 patients in the occlusive group,63 patients with collateral circulation establishment,accounting for88.73%,and 8 patients without collateral circulation establishment,accounting for11.27%.The release rate of collateral circulation in unilateral internal carotid artery occlusion group was significantly higher than that in unilateral internal carotid artery severe stenosis group.Chi-square test showed that the results were statistically significant(P < 0.05).2.On the basis of DSA,107 patients with collateral circulation were divided into primary collateral compensatory group and secondary collateral compensatory group.There were 44 patients with severe unilateral internal carotid artery stenosis,including 37 patients with primary collateral circulation compensation,accounting for 84.09%,and 7patients with secondary collateral circulation compensation,accounting for 15.91%.The compensation ratio of primary collateral circulation was significantly higher than that of secondary collateral circulation,which was statistically significant by chi-square test(P< 0.05).There were 63 patients with unilateral internal carotid artery occlusion,including 33 patients with primary collateral circulation compensation(52.38%)and 30 patients with secondary collateral circulation compensation(47.62%).The results were not statistically significant(P >0.05).3.One hundred and forty-eight patients with severe stenosis or occlusion of unilateral internal carotid artery were divided into collateral circulation group and non-collateral circulation group according to the opening of collateral circulation on DSA.Among them,there were 107 patients in collateral circulation group and 41 patients innon-collateral circulation group.The difference of NIHSS score between the two groups was recorded at admission,during the third month of follow-up and when the NIHSS score was minus the third month at admission.On admission,the NIHSS score of the group without collateral circulation was 7.35 ±3.64,and that of the group with collateral circulation was 2.23 ±1.76.At 3 months,the NIHSS score of the group without collateral circulation was 6.47 ±4.03,and the NIHSS score of the group with collateral circulation was 0.68 ±1.24.The NIHSS score at admission minus the difference of NIHSS score at the third month was 0.62 ±0.53 in the group without collateral circulation and 1.53 ±1.01 in the group with collateral circulation.The difference between the two groups was compared.The results were statistically significant(P<0.05).4.One hundred and forty-eight patients with severe stenosis or occlusion of unilateral internal carotid artery were divided into collateral circulation group and non-collateral circulation group according to the opening of collateral circulation on DSA.There were 107 patients in collateral circulation group and 41 patients in non-collateral circulation group.The modified Rankin score at admission,the modified Rankin score at1 year follow-up and the modified Rankin score at admission minus the difference of modified Rankin score at 1 year follow-up were recorded in the two groups.At admission,the modified Rankin score was 2.13 ±0.72 in the non-collateral circulation group and1.72 ±1.18 in the collateral circulation group.The modified Rankoin score was 1.75±0.71 in the non-collateral circulation group and 0.38 ±1.74 in the collateral circulation group at 1 year follow-up.The modified Rankin score at admission reduced the difference of the modified Rankin score at 1-year follow-up,0.63 ±0.49 in the non-collateral circulation group and 1.34 ±0.74 in the collateral circulation group,and the difference of the modified Rankin score at admission was 0.63 ±0.49 in the non-collateral circulation group and 1.34 ±0.74 in the collateral circulation group.The difference between the two groups was statistically significant(P <0.05).5.According to the results of 1-year follow-up,148 patients were divided into two groups: the group with new cerebral infarction and the group without new cerebral infarction.The establishment of collateral circulation on DSA was compared between the two groups.There were 66 cases of new cerebral infarction and 82 cases of no new cerebral infarction.In the new cerebral infarction group,there were 34 patients withoutcollateral circulation,accounting for about 51.52%,and 82 cases without new cerebral infarction,of which 7 cases were without collateral circulation,accounting for about8.53%.The rate of patients without collateral circulation in the new cerebral infarction group was much higher than that in the non-new cerebral infarction group,and the results were statistically significant(P < 0.05).There were 63 cases of primary collateral circulation in the new cerebral infarction group,accounting for 31.82%,and 63 cases in the non-new cerebral infarction group,accounting for 76.83%.Compared with patients without new cerebral infarction,the opening of primary collateral circulation in patients with new cerebral infarction was lower,and the results were statistically significant(P<0.05).There was no significant difference in the opening of secondary collateral circulation between the two groups(P>0.05).Conclusion:1.In the case of severe stenosis or occlusion of internal carotid artery,the higher the degree of stenosis,the higher the opening rate of collateral circulation.2.When the internal carotid artery is severely stenosed,the primary collateral circulation may be the main mode of intracranial compensation.3.On the basis of DSA,when the internal carotid artery was severely stenosed or occluded,the decrease of NHISS score and modified Rankin score in the group with collateral circulation establishment was better than that in the group without collateral circulation,and the probability of new cerebral infarction within one year in the group with collateral circulation establishment was significantly lower than that in the group without collateral circulation.