| Objective(s):Cervical artery dissection(CAD)is a relatively uncommon cerebrovascular disease but is thought to be an important cause of stroke in young people.With advances in imaging technology,more and more patients with CAD are being diagnosed and treated by clinicians.There is no uniform standard of care for the disease and the traditional treatment of CAD has been mainly pharmacological conservative(anticoagulation and antiplatelet).In recent years,with advances in interventional techniques,endovascular therapy has been gradually applied to the treatment of the disease.Endovascular treatment can be effective in relieving stenosis as well as recanalising occluded vessels and restoring cerebral blood flow,but endovascular treatment is an invasive procedure and there are no random controlled studies to assess the efficacy and safety of endovascular treatment for CAD.There is still debate as to which treatment modality is more advantageous and beneficial to patients.The aim of this study was to investigate the clinical efficacy of endovascular treatment of acute ischemic stroke due to CAD.Methods:A total of 77 patients(58 males and 19 females)diagnosed with acute ischemic stroke due to CAD in the Department of Neurology,First People’s Hospital of Yunnan Province from October 2019 to October 2022 were collected.All patients included in the study were confirmed to have carotid artery entrapment by imaging data.Patients were divided into endovascular treatment group and drug conservative treatment group according to whether they underwent endovascular treatment or not.Corresponding clinical data,blood sampling and laboratory indexes were collected,and patients were followed up after 3 months of discharge to record the effectiveness and safety outcomes.Effective outcomes included: National Institutes of Health Stroke Scale(NIHSS)scores at discharge to assess short-term neurological recovery,modified Rankin scale(m RS)scores at 90 days to assess prognosis,and 90-day stroke recurrence rate.The NIHSS score was used to assess short-term neurological recovery,the 90-day modified Rankin scale(m RS)score to assess prognosis and the 90-day stroke recurrence rate.Safety outcomes included: intracranial hemorrhage rate during hospitalization and 90-day mortality.The effectiveness and safety outcomes of endovascular treatment and conservative drug treatment were compared between the two groups of CAD patients to evaluate the effectiveness and safety of endovascular treatment.CAD patients were classified as having mild stroke(NIHSS score 1-4)and moderate or more stroke(NIHSS ≥5)according to the NIHSS score at admission,and the effectiveness and safety outcomes of CAD patients with different severity of stroke treated with endovascular therapy and pharmacological conservative therapy were compared separately.Patients with CAD included in the study were divided into a good prognosis group(m RS ≤ 2)and a poor prognosis group(m RS > 2)according to the 90-day m RS score.The clinical data,phlebotomists and treatment modalities of the two groups were compared to analyse the risk factors affecting the prognosis of patients with CAD.Results:(1)Seventy-seven patients with acute ischemic stroke due to CAD were included in the study,28 in the endovascular treatment group and 49 in the conservative drug treatment group.A higher proportion of patients with internal carotid artery system entrapment occurred in the endovascular treatment group(82.15% vs 55.1%,P=0.017)and a higher proportion of patients with moderate or higher stroke in the endovascular treatment group(71.4% vs 42.9%,P=0.016).(2)In CAD patients with mild stroke(NIHSS score 1-4),the NIHSS score1(0,1)at discharge was lower in the endovascular treatment group than the NIHSS score1(1,2)at discharge in the medically conservative treatment group,with a statistically significant difference(P=0.015).(3)For CAD patients with moderate or greater stroke(NIHSS ≥5),the proportion of patients with a good 90-day prognosis(m RS ≤2)was higher in the endovascular treatment group than in the pharmacological treatment group(65% vs19%),with a statistically significant difference(P=0.003);the proportion of patients with intracranial hemorrhage during hospitalization was 15% vs.9.5% in the drug conservative treatment group for intracranial hemorrhage during hospitalization,a statistically insignificant difference(P=0.954);10% in the endovascular treatment group vs.0% in the drug conservative treatment group for 90-day death,a statistically insignificant difference(P=0.232).(4)Based on the 90-day m RS score,CAD patients were divided into 49 cases in the good prognosis group(m RS ≤ 2 points)and 28 cases in the poor prognosis group(m RS > 2 points).Univariate analysis showed that the poor prognosis group had more men(67.3% vs 89.3%,P=0.032),a higher proportion of alcohol consumption(22.4% vs 50.0%,P=0.013),a higher incidence of responsible vessel occlusion(16.3%vs 57.1%,P<0.001),and a higher NIHSS score on admission(2.0 vs 9.0,P< 0.001).Binary logistic regression analysis showed that responsible vessel occlusion(OR=0.194,95% CI 0.054-0.694,P=0.012)was associated with poor prognosis in patients with CAD.NIHSS score at admission(OR=0.890,95% CI 0.808-0.982,P=0.020)was associated with poor prognosis in patients with CAD.Conclusion(s):1.In CAD patients with mild stroke,the endovascular treatment group had a more significant improvement in NIHSS scores at discharge than the conservative drug treatment group,which improved the patient’s immediate neurological recovery.In patients with CAD with moderate stroke or more,more patients in the endovascular group had a good prognosis and improved their immediate prognosis.Endovascular treatment may be more effective than pharmacological treatment.2.Endovascular treatment is relatively safe compared to conservative drug treatment as it does not increase the rate of intracranial hemorrhage and 90-day mortality in CAD patients during hospitalization.3.The prognosis of patients with acute ischemic stroke due to CAD correlates with the patient’s NIHSS score on admission and with occlusion of the responsible vessel. |
