| BackgroundIschemic cerebrovascular disease has the characteristics of high morbidity,disability,mortality,recurrence and medical expenses,which seriously affects the health and quality of life of Chinese people.The internal carotid artery occlusion is one of the important causes of ischemic cerebrovascular disease.At present,internal carotid occlusion for more than 4 weeks is generally considered to be chronic occlusion.As for patients with chronic internal carotid artery occlusion,a number of centers have carried out studies on endovascular interventional recanalization therapy,which were satisfactory.Recanalization in patients with chronic internal carotid occlusion has been shown to improve cognitive function and reduce the risk of recurrence of stroke.There are often remodeling or bridging collateral circulation at the distal end of chronic internal carotid occlusion.Conventional cerebral angiography evaluation before endovascular treatment lacks visual path to the occlusion segment.In recent years,as a new non-invasive technique,high resolution magnetic resonance imaging has been developed to visualize the intracranial arterial wall.At the same time,high resolution magnetic resonance can be used to analyze the components of arterial plaques and find unstable atheromatous plaques that do not cause lumen stenosis but may lead to stroke,as well as the presence of luminal thrombosis.Some studies have reported that the application of high resolution magnetic resonance to evaluate the nature and length of occlusive artery wall lesions in patients with symptomatic chronic internal carotid artery occlusion before endovascular interventional therapy can be a great imaging guidance for the feasibility and safety of interventional treatment.Compared with high resolution magnetic resonance imaging,three dimensional sampling perfection with application optimized contrasts using different flip angle evolutions mode has a higher image resolution,wider imaging range,and can be used for curved surface reconstruction to obtain the full picture of the occluded vessels,thus accurately measuring the length of the lesion occlusion.ObjectiveTo study the curative effect of endovascular treatment for chronic internal carotid artery occlusion from the success rate and safety evaluated by cerebral angiography and 3D-SPACE examination.Through the multi-mode imaging technology,we explore the predictive value of interventional recanalization of chronic internal carotid artery occlusion by showing the lumen,wall morphology andplaque properties of the occlusive artery for more precise clinical treatment guidance.MethodsRetrospective analysis was performed on patients with chronic internal carotid artery occlusion treated in the Department of Neurointervention in the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2020.They were divided into examination group and control group according to whether they had received 3D-SPACE examination before endovascular treatment or not.The preoperative examination characteristic data of patients in the examination group and the control group were analyzed and evaluated.The success rate,intraoperative complications and residual stenosis rate were recorded.Subgroup analysis was performed in the 3D-SPACE examination group to explore its predictive value for interventional recanalization of chronic internal carotid artery occlusion.The improvement of disability function,new ipsilateral ischemic events and restenosis rate of the patients were recorded in 3-month and 6-month follow up period after recanalization.SPSS 25.0 statistical software was used for data processing and analysis.The independent sample t test was used for numerical variables,and χ2 test,Fisher’s exact test,Wilcoxon rank sum test and ordered Logistic regression analysis were used for categorical variables.P<0.05 was considered statistically significant.ResultsA total of 86 patients who met the screening criteria were included in this study,including 60 patients who received 3D-SPACE examination group and 26 patients who did not receive 3D-SPACE examination group.There were no significant differences in baseline data such as age and gender between the two groups.Fifty-one patients in the examination group and 17 in the control group were recanalized.There was a statistical difference in the success rate of recanalization between the two groups(P=0.040).In the examination group,there were 2(3.3%)cases of perioperative complications,including 1 case of vascular dissection and 1 case of hemorrhage.In the control group,there were 5(19.2%)cases of complications,including 3 cases of vascular dissection,1 case of hemorrhage,and 1 case of carotid cavernous sinus fistula.Also,there was a significant difference in the incidence of complications between the two groups(P=0.024),but no significant difference in the incidence of residual stenosis in stents.In the multi-mode imaging evaluation of the examination group,there were statistically significant differences between the occlusion length,atrophy of the distal occlusion segment,the distal occlusion involved the ophthalmic artery and Ti high signal after 3D-SPACE examination of the occlusion segment.There was no death in both groups during the 6-month follow up period.In the examination group,there was no new ipsilateral ischemic events during the 3-month and 6-month follow up period.The control group had 1 case of new neurological impairment during the 3-month follow up period.The control group had no new ipsilateral ischemic events during the 6-month follow up period.A total of 0 patients were found to have restenosis after 3 months of angiographic follow-up.One patient was found to have restenosis 6 months after recanalization in the patients who achieved vascular imaging examination.There were no significant differences between the two groups in the mRS score during the follow up period,as well as new ipsilateral ischemic events,and the occurrence of restenosis.In the examination group,there was statistically significant difference between the mRS score in 3-month and 6-month follow up period after recanalization.In the control group,there was no statistical difference in the mRS score in 3-month and 6-month follow up period.For all the patients who received endovascular interventional recanalization treatment,the mRS score in 3-month and 6-month follow up period after recanalization were both statistically different from those before recanalization.ConclusionRetrospective study of our center indicated that:patients with 3D-SPACE showed no atrophy in the distal wall of internal carotid artery occlusion and no high signal of T1-SPACE in the lumen had a high success rate of endovascular interventional recanalization,fewer operation-related complications,and patients’symptoms improved significantly during short-term follow up period compared with preoperative ones.It indicates that preoperative multi-modal imaging evaluation is helpful to improve the success rate of internal carotid artery occlusion and reduce the incidence of complications.The conclusion need to be further studied prospectively by multiple centers. |
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