Study On The Effect Of Collateral Circulation On Chronic Symptomatic Internal Carotid Artery Occlusion Combined With Hybrid Surgery

Research Background:Internal carotid artery occlusion is one of the main causes of ischemic stroke.Strengthening the diagnosis and treatment of internal carotid artery occlusion is important for the prevention and treatment of stroke.Among them,hybrid surgery is one of the important surgical procedures for the treatment of chronic symptomatic internal carotid artery occlusion disease.hybrid surgery has a certain rate of surgical failure.Not all patients can successfully achieve vascular revascularization,thus restoring blood supply to brain tissue.Understanding the factors affecting the success rate of combined hybrid surgery is of great significance for the treatment of chronic symptomatic internal carotid artery occlusive disease.Objective:Digital subtraction angiography(DSA)and magnetic resonance perfusion imaging were used to evaluate the collateral circulation and total compensatory results of patients with unilateral chronic symptomatic internal carotid artery occlusion,and to observe the collateral circulation and total generation.Then explore the relationship between these factors and the success rate of hybrid surgery.Method:Retrospective continuous enrollment analysis from January 2016 to January2019,Department of Neurovascular Surgery,First Hospital of Jilin University,confirmed by DSA,CTA or carotid artery ultrasound for chronic internal carotid artery occlusion Symptomatic patients,then underwent hybrid surgery,a total of 43 patients with clinical data after inclusion and exclusion.According to whether the successful revascularization is successful,it is divided into failed the group of recanalization,and the successful group of recanalization.Statistical analysis was used to analyze the gender,age,hypertension,hyperlipidemia,diabetes,smoking history,Drinking history,time of complaint,homocysteine,fibrinogen,and uric acid in the two groups.DSA was used to assess the openness of the primary collateral circulation(anterior and posterior communicating arteries),the opening of the secondary collateral circulation(the ophthalmic artery,the soft-membrane anastomosis),and analysis and comparison.The centrum semiovale was obtained by magnetic resonance perfusion imaging.Calculate the ratio of the four parameters of TTP,MTT,CBV and CBF in the bilateral centrum semiovale(surgical side/non-surgical side),and analyze and compare.Data entry and statistical analysis were performed using SPSS19.0 software.The t test(normal distribution)and Wilcoxon rank sum test(non-normal distribution)were used for comparison of measurement data between the two groups,while chi-square test or Fisher exact test was used for comparison of counting data between the two groups.The differencesbetween the two groups were compared,with P < 0.05 being considered statistically significant.Results:Among them,there were 16 cases(50%)of ophthalmic artery reflux in the successful group of recanalization,and 10 cases(90.9%)of ophthalmic artery opening in the failed group of recanalization,P=0.042<0.05.The difference between the two groups was statistically significant.In this study,the chief complaint time of the successful group was 2.09±1.92 months,and that of the failed group was 4.45±3.14 months,P=0.005<0.05,and the difference between the two groups was statistically significant.The number of collateral circulation opening in the successful group was2.19±0.998,and that in the failed group was 3±1.00,P=0.025<0.05.The difference between the two groups was statistically significant.After the ophthalmic artery reflux,number of collateral circulation opening and chief complaint time were included in the binary Logistic regression analysis,the difference of chief complaint time between the two groups was still statistically significant.In this study,15 patients without magnetic resonance perfusion imaging were excluded.The TPP ratio and MTT ratio of the 21 patients who were successfully recanalized were 1.175±0.77 and 1.589±0.41,respectively,which were smaller than the TPP ratio and MTT ratio of 1.23±0.76 and 2.104±0.37 of the 7 patients who were successfully recanalized,and the difference between the two groups was statisticallysignificant(P<0.05).Conclusion:The compensation of intracranial collateral circulation is correlated with the success rate of hybrid surgery of chronic symptomatic internal carotid artery occlusion.Understanding the condition of the cranial medial branch circulation is helpful for the preoperative evaluation of the operation.Long duration of chief complaint,large number of collateral circulation opening and ophthalmic arterial reflux are not conducive to the success of hybrid surgery of chronic symptomatic internal carotid artery occlusion,and long duration of chief complaint is an independent risk factor for the failure of this operation.Cerebral perfusion is poor and severe ischemia is not conducive to the success of hybrid surgery of chronic symptomatic internal carotid artery occlusion.