Analysis Of Natural History And Treatment Of Patients With Internal Carotid Artery Occlusion

Purpose: This study aims to evaluate the natural history of patients with internal carotid artery occlusion,assess the establishment of collateral circulation,explore the relationship between the compensation of collateral circulation and the patient’s clinical performance and prognosis,and explore the impact of drug therapy or surgery on recurrent stroke,provide a reliable basis for the choice of treatment methods,the judgment of prognosis,and effective prevention.Methods: We retrospectively analyzed the clinical data of 106 patients with unilateral internal carotid artery occlusion in our hospital from June 2015 to September 2017.All patients were diagnosed with the imaging examinations.Patients’ clinical information,risk factors,blood examination,imaging data,and treatment were collected for subsequent analysis.The patients were devided into cerebral infarction group(68 cases)and no cerebral infarction group(38 cases)including TIA(19 cases),no symptom(19 cases)according to presenting symptoms,and they were also confirmed with the outcomes divided into recurrent ischemic stroke(30 cases)and no recurrent ischemic stroke(76 cases).The risk factors,collateral circulation compensation,cerebral hemodynamic changes and treatment methods were analyzed.Results: 1.Our center collected 106 patients.There were 84 males(79.2%)and 22 females(20.8%).Males are more vulnerable to ICAO than females.The average age is(60.53±10.14)years old.In the risk factors in patients with ICAO,hypertension was 75(70.7%),diabetes mellitus was 59(55.7%),coronary arety heart disease was 37(34.9%),hyperlipemia was 27(25.5%),stroke history was 24(22.6%),smoking history was 65(61.3%),drinking history was 41(38.7%).In all the 197 collateral circulation cases,there were 53 ACo A,49 PCo A,34 OA,32 leptomeningeal anastomosis,11 new artery.2.Among 106 patients,cerebral infarction was 68(64.2%),no cerebral infarction was 38(35.8%),TIA was19(17.9%),no symptom was19(17.9%).Compared with the risk factor,there were significant differences in ESRS score,hypertension,and stroke history(P<0.05),except age,gender,diabetes,coronary heart disease,hyperlipidemia, smoking history,drinking history(P>0.05).Compared with the collateral circulation,the first-grade collateral circulation was significant difference(P<0.05),the second-and third-grade collateral circulation were not significant differencet(P>0.05).ACo A in the first-grade collatera was significant difference(P=0.043).3.Among 106 patients,30cases(28.3%)underwent new cerebral infarction,4 patients(3.7%)died during the follow-up period.In the cerebral infarction group,25(36.8%)underwent new cerebral infarction,3(1.5%)patients died during the follow-up period.In TIA group,3 cases(15.8%)underwent new cerebral infarction,and no patients died during the follow-up period.In no symptom group,2 cases(10.5%)underwent new cerebral infarction,1 patients(5.2%)died during the follow-up period.Compared with patients with no cerebral infarction,patients with cerebral infarction had a higher risk of new cerebral infarction.4.Comparing the collateral circulation between new cerebral infarction and no new cerebral infarction,second-and third-grade collateral circulation were not significant differencet(P>0.05).ACo A in the first-grade collatera was significant difference(P=0.01).5.Among 106 patients,11 cases were superficial temporal artery-middle cerebral artery anastomosis,2 cases of ischemic events;18 cases were CEA or CAS for the combined stenosis,3 cases of ischemic events,15 cases were in good condition;77 cases of conventional drug therapy,no surgical treatment,25 cases of ischemic events.Compared with the treatment,it was found that there was no statistical difference between the two surgical treatments and drug treatment(P>0.05).Conclusions:Hypertension and stroke history are high risk factors for cerebral infarction in patients with ICAO.ICAO patients with cerebral infarction are more likely to have recurrence of cerebral infarction.The first-grader collateral circulation,especially ACo A,is beneficial to reduce the cerebral infarction of ICAO patients.Compared with drug therapy,bypass therapy and treatment of combined stenosis cannot reduce the incidence of ischemic stroke.