Analysis Of The Neurological And Cognitive Outcome Of Non-acute Interventional Opening Of Internal Carotid Ophthalmic Segment Occlusion

Background and ObjectiveStroke has become the first killer of Chinese residents' health.The number of deaths caused by stroke each year is far higher than other causes,accounting for about one third of the global stroke mortality.As a country with the largest population and a rapid aging rate in the world,China is facing more and more challenges in the treatment of stroke.Ischemic stroke is the most common subtype of stroke in China,accounting for 69.6% of all strokes.Chronic internal carotid artery occlusion is one of the important causes of ischemic stroke.Opening the internal carotid artery occlusion can significantly improve the state of cerebral hypoperfusion,relieve ischemic symptoms,and reduce the incidence of long-term ischemic stroke.This study retrospectively analyzed the data of patients with internal carotid ophthalmic segment occlusion in the non-acute phase who received intravascular interventional therapy and drug conservative treatment,and discussed the changes of nerve and cognitive functions after vascular recanalization,so as to provide a basis for the treatment of patients with internal carotid ophthalmic segment occlusion in the non-acute phase.MethodsA retrospective analysis was performed on the data of 45 patients(study group)who received interventional open stenting and 27 patients(control group)who received drug treatment(non-acute phase)of internal carotid ophthalmic segment occlusion from January 2014 to December 2017.The incidence of cerebrovascular adverse events and neurological and cognitive functions of all included patients at 3,12 and 24 months before and after treatment were compared during the follow-up period.It included mini mental state examination(MMSE),Montreal cognitive assessment(Mo CA),m RS and national institute of health stroke scale(NIHSS).ResultsPatients in the two groups were followed up for 24 months.The number of patients who lost follow-up at 3,12 and 24 months after treatment in the study group was 3,2 and 3,respectively,with 0,1 and 2 patients with adverse cerebrovascular events.In the control group,3,3 and 6 patients were lost to follow-up at 3,12 and 24 months after treatment,and 2,3 and 3 patients had adverse cerebrovascular events(recurrent stroke or transient ischemic attack).Compared with the control group,the incidence of adverse cerebrovascular events in the study group decreased at 12 and 24 months after treatment(P < 0.05).During follow-up,there were significant differences in neurological function between the study group and the control group at 3 and 12 months after treatment: NHISS at 3 months [study group(4.46�0.43)vs control group(5.29�0.37),P < 0.05],m RS[study group(1.74�0.23)vs control group(1.95�0.35),P < 0.05].At 12 months,NHISS [study group(2.51�0.37)vs control group(4.68�0.43),P < 0.05],m RS[study group(1.43�0.34)vs control group(1.73�0.41),P < 0.05].At 12 and 24 months after treatment,there were significant differences in cognitive function between the study group and the control group: at 12 months,MMSE [study group(25.42�2.57)vs control group(23.49�3.59),P < 0.05],Mo CA [study group(19.56�2.94)vs control group(18.14�2.58),P < 0.05].At 24 months,MMSE [study group(27.28�2.13)vs control group(24.61�1.79),P < 0.05],Mo CA [study group(20.45�1.83)vs control group(17.93�1.78),P < 0.05].ConclusionsThe results of this study showed that occlusion of the internal carotid artery in the ophthalmic segment would lead to neurological and cognitive impairment in patients,and endovascular interventional recanalization could significantly improve neurological impairment and long-term cognitive function in patients with symptomatic internal carotid occlusion,and effectively reduce the risk of recurrent stroke or TIA in patients with symptomatic internal carotid artery occlusion.