Influencing Factors Of Recanalization Of Intramural Hematoma Type With Internal Carotid Artery Dissection

Objective:We set out to investigate the Influencing Factors that might affect the recanalization of intramural hematoma in patients with internal carotid artery dissection.Methods:We retrospectively analysed 45 patients during from September 2014 to August2017 with acute stroke that caused by intramural hematoma type with internal carotid artery dissection(ICAD).These patients were treated by the neurology department of the first hospital of Shanxi Medical University.The medical records collected includes age,sex,NIHSS score for admission and discharge,treatment,blood pressure,glucose,lipid,homocysteine,stroke history,smoking,drinking,body mass index and the opening between the collateral circulation.Through the CDU in combination with TCD,the information was collected including ultrasound imaging for admission,discharge and follow-up.The endpoint event was ending up in one year or the recanalization happened.According to the follow-up,patients were divided into recanalization group and non-recanalization group.SPSS22.0 was used for statistical analysis.The mean value comparison between multiple data sets of data was performed using a completely randomized design analysis of variance.For continuous variables,the results were expressed as the mean±standard deviation.For discrete variables,they were expressed in the form of frequency(ratio)and used between risks factors.Chi-square test was used for the analysis of risk factors.A multivariate logistic regression analysis includingvariables that showed statistical difference P < 0.05 on univariate comparison was performed.The adjusted OR of the model was compared with the results of univariate comparison.Paired t-test were used to compared the NIHSS scores of the same group for admission and discharge.The NIHSS scores of the two groups were compared using independent sample t-test.The test level was 0.05,and P<0.05 represents a statistically significant difference.Results:1.A total of 45 eligible patients were enrolled in the study.According to the results of the follow-up,patients have been divided into with recanalization group of 15 patients and without recanalization group of 30 patients.Recanalization was observed in33.3%.None of these patients turned on the occurrence of recurrent stroke or dissections.2.Among the 45 patients,11 patients(11/15)were hypertension in the recanalization group and 9 patients(9/30)were in the non-recanalization group.The rate difference between the two groups was statistically significant(P=0.006).The OR value was 6.417 indicating that hypertension was a positive correlation between hypertension and recanalization.3 patients(3/15)with hyperhomocysteinemia in the recanalization group and the other 20 patients(20/30)were in the non-recanalization group.The difference between the two groups was statistically significant(P=0.03).According to the OR value being 0.125,suggesting the hyperhomocysteinemia was negatively correlated with the recanalization 4 cases(4/15)of collateral circulation were opened in the recanalization group and 25 cases(25/30)were in the non-recanalization group.There was a statistically significant difference between the two groups(P <0.05).As the OR value being 0.073,the collateral circulation was negatively correlated with the recanalization.Multivariate logistic regression analysis of the three related factors from the univariate analysis also led to the same conclusion.3.The discharged NIHSS scores of the two groups were significantly lower than the NIHSS scores admitted.The difference was statistically significant.There was nosignificant statistical difference in the discharged NIHSS between the two groups.4.In addition to hypertension,hyperhomocysteinemia and the opening of collateral circulation might be related to the recanalization,there was no significant statistical difference in the analysis of other related factors.Conclusion:1.Intramural hematoma type with carotid artery dissection could be recanalized.The recanalization may be lower.It is not prone to recurrent stroke or dissection events.2.The recanalization may be associated with hypertension,hyperhomocysteinemia and collateral circulation.But it is not associated with anticoagulation or antiplatelet therapy.A certain degree of hypertension may promote the recanalization.Hyperhomocysteinemia may be an negative predictor of recanalization.The clinical symptoms of the opening collateral circulation are mild and the NIHSS scores is low,but it seems less likely to be recanaliazed.A multivariate logistic regression analysis of the three risk factors also led to the same conclusion.3.The prognosis of the nerve function turns favourable.There is no significant correlation between recanalization and the functional outcome.4.CDU combined with TCD as a non-invasive and simple examination method should encourage regular follow-up of ICAD patients.