| Objective:1.By analyzing the four main traditional risk factors and vascular morphological characteristics of occlusive ICA in patients with symptomatic CICAO,the relationship between traditional cerebrovascular disease risk factors and symptomatic ICAO and its vascular morphological characteristics was investigated;to explore the independent predictors of internal borderzone(IBZ)cerebral infarcts in patients with chronic internal carotid artery occlusion(CICAO);2.The clinical data of patients with symptomatic CICAO were analyzed retrospectively to study the predictors of successful endovascular recanalization in patients with CICAO;3.To investigate the feasibility,efficacy and safety of endov(?)r recanalization of chronic internal carotid artery(ICA)occlusion with proximal protection technique.Methods:1.From January 2011 to May 2019,the clinical data of 185 patients in the Second Affiliated Hospital of Soochow University and Suzhou Ninth Hospital affiliated to Soochow University were analyzed retrospectively.At the same time,102 patients with atherosclerotic ischemic cerebrovascular disease were included.These patients were divided into carotid atherosclerosis group(102 cases)and internal carotid artery occlusion group(185 cases).The clinical data between the two groups were compared.The frequency of four common risk factors of cerebrovascular diseases:age,hypertension,diabetes and smoking history were used to analyze.To describe the vascular morphological factors of occluded ICA,including stump morphology,collateral compensation(ASTIN/SIR)score,collateral compensation pathway,distal ICA reconstitution,degree of contralateral carotid artery stenosis and calcification at the beginning of occlusion,and analyze the frequency and characteristic vascular morphology of four risk factors in these ICAO lesions.They were divided into "with IBZ group"(n=64)and "without IBZ group"(n=121).Univariate analysis was used to analyze the general clinical data of the two groups.Binary logistic regression analysis was used to identify the independent risk factors of internal borderzone(IBZ)cerebral infarcts in patients with chronic internal carotid artery occlusion.2.Our study included 73 symptomatic patients with CICAO who underwent endovascular recanalization in the Second Affiliated Hospital of Soochow University and Suzhou Ninth Hospital affiliated to Soochow University from January 2011 to May 2019.They were divided into recanalization group(49cases)and non recanalization group(24 cases).Proximal protection technology and distal protection technology were used during operation.Some patients did not use protection devices due to special circumstances.The clinical data(baseline data,preoperative evaluation,detailed operation process,postoperative management,surgical complications and postoperative follow-up)and imaging data of these patients were recorded and analyzed retrospectively.The data between the two groups were compared.The related factors of endovascular recanalization patency in patients with symptomatic CICAO were investigated by univariate analysis and multivariate logistic regression analysis.3.From March 2012 to May 2019,the clinical data of 27 patients in the Second Affiliated Hospital of Soochow University and Suzhou Ninth Hospital affiliated to Soochow University with symptomatic chronic internal carotid artery occlusion who were successfully recanalized in the Second Affiliated Hospital of Soochow University and Suzhou Ninth Hospital affiliated to Soochow University were analyzed retrospectively.The proximal protection technology was used to ensure the safety of the recanalization.The vascular patency and neurological function were followed up regularly for successful patients after operation.Results:1.In our study,compared with atherosclerosis group,history of cerebral infarction and Fg were risk factors for patients with chronic internal carotid artery occlusion;HDL is a protective factor in patients with chronic internal carotid artery occlusion.Four main risk factors of CICAO patients were analyzed in our study.Single risk factor analysis:age>60 years 91.9%,hypertension 73%,smoking 42.2%,and diabetes 24.9%;the analysis of two combined risk factors showed that age>60 years and hypertension accounted for 71.4%,followed by age>60 years and smoking 38.9%,hypertension and smoking 31.4%;the analysis of three combined risk factors showed that age>60 years,hypertension and smoking accounted for the highest proportion(31.4%);four combined risk factors analysis showed that age>60 years,hypertension,diabetes and smoking accounted for 7.6%.The four main risk factors in the distribution of blood vessel morphology in CICAO patients showed that the age>60 years accounted for the highest proportion,followed by hypertension,smoking,and diabetes.The patients with OA reflux in IBZ group were significantly more than those in non IBZ group(P<0.05);The number of patients with collateral compensation(ASTIN/SIR 3～4 级)in non IBZ group was significantly higher than that in IBZ group(P<0.05).Multivariate logistic regression analysis showed that history of cerebral infarction,occlusion time ≤3 months,low density lipoprotein(LDL)and OA reflux were independent risk factors for internal borderzone cerebral infarcts in patients with symptomatic CICAO(P<0.05);Prothrombin international normalized ratio(INR)and collateral compensation(ASTIN/SIR 3～4 级)were protective factors for internal borderzone cerebral infarcts inpatients with symptomatic CICAO(P<0.05).2.Seventy-three patients with symptomatic CICAO underwent endovascular recanalization,and 49 cases were successful(67.1%).The results of univariate analysis showed that the HDL level in the non recanalization group was higher than that in the recanalization group,the difference was statistically significant(P<0.05).The number of patients with tapered stump,distal ICA reconstitution at the clinoid segment and the occlusion position of ICA C1 in in the recanalization group was higher than that in the non recanalization group,the difference was statistically significant(P<0.05);The variables with P<0.25 were included in multivariate logistic regression analysis.The results showed that distal ICA reconstitution at the clinoid segment and tapered stump were independent predictors of the success of ICA revascularization in patients with CICAO(P<0.05);calcification at the beginning of ICA occlusion was an adverse factor for successful revascularization in patients with CICAO(P<0.05).No fatal complications occurred.The proportion of patients with smoking history in this study was significantly higher than that in Chen’s study(P<0.05);In Chen’s study,the ratios of occlusion point C1,reflux below C5 and tapered stump were higher than those in this study(P<0.05);The calcification rate of occluded segment in this study was significantly higher than that in Chen’s study(P<0.05).All patients were followed up for an average of 17.8(12～24)months.In the recanalization group,there was 1 case of myocardial infarction(2.0%,1/49)and 1(2.0%,1/49)case of ischemic stroke(contralateral ICA);there were 3 cases of ischemic stroke(12.5%,3/24)and 1 case of myocardial infarction(4.2%,1/24)in the non recanalization group.35 patients were evaluated by neck color Doppler ultrasound,CTA or DSA imaging.Two patients had ICA reocclusion,3 patients had ICA stent restenosis,and the patency of ICA was determined in other patients.3.Twenty-seven patients underwent endovascular recanalization of internal carotid artery occlusion with proximal protection technique,22 of whom were successful(81.5%),the average operation time was 148.9(116～180)minute.The complications related to the operation included:2 cases of gastrointestinal hemorrhage,1 case of carotid dissection,2 cases of cerebral hyperperfusion syndrome,1 case of asymptomatic ischemic event,1 case of subarachnoid hemorrhage,and 1 case of TIAs.There were no fatal complications.The 3 months mRS of 18 successful patients after operation was ≤2(81.8%,18/22),and the mRS of the other 4 successful patients was 3(18.2%,4/22);22 successful patients were followed up 18.1(12～24)months,there were no adverse events such as ischemic stroke,myocardial infarction and death during the follow-up period.Fifteen patients underwent neck ultrasound,CTA or DSA evaluation.The blood flow in the stent was normal,2 patients had hyperplasia of stent intima,the residual stenosis rate was 60%,the residual stenosis rate in 13 patients was less than 30%.Conclusions:1.History of cerebral infarction and Fg were risk factors for patients with chronic internal carotid artery occlusion;HDL is a protective factor in patients with chronic internal carotid artery occlusion.Among the patients with symptomatic CICAO,age>60 years,hypertension,smoking and diabetes are four main traditional risk factors.Age>60 years and hypertension were the most important risk factors,followed by smoking history and diabetes history.OA reflux,LDL,occlusion time ≤3 months and history of cerebral infarction were independent risk factors for internal borderzone cerebral infarcts in patients with symptomatic CICAO;INR and collateral compensation scores(ASTIN/SIR 3～4 级)are the protective factors of internal borderzone cerebral infarcts in patients with symptomatic CICAO.2.The independent predictors of successful ICA revascularization in patients with symptomatic CICAO mainly include tarepered stump and distal ICA reconstitution at the clinoid segment.Calcification at the beginning of ICA occlusion is an adverse factor.Compared with the research results of Chen,some predictors have high consistency.3.Endovascular recanalization of chronic internal carotid artery occlusion under proximal protection technique has been proved safe and effective. |
