An Observation And Analysis Of The Risk Factors For Acute Cerebral Infarction In Patients With Internal Carotid Artery Stenosis

Objective Atherosclerotic internal carotid stenosis is one of the most common causes of cerebral infarction in anterior circulation.We aimed to investigate the risk factors of acute cerebral infarction in patients with unilateral internal carotid stenosis.Methods We consecutively enrolled patients with unilateral internal carotid artery stenosis ≥50% of atherosclerotic origin,who admitted to our hospital from November2018 to October 2019.According to the presence of cerebral infarction in the area supplied by internal carotid stenosis,the enrolled patients were divided into two groups:infarction and non-infarction groups.Clinical data,risk factors of cerebrovascular disease,the degree of internal carotid artery stenosis,internal carotid artery tandem stenosis,the plaque characteristics of internal carotid artery,posterior circulation vascular stenosis,fetal posterior cerebral artery,WMH score and old lacunar infarction were compared between the infarction group and non-infarction group.According to the presence of tandem stenosis in internal carotid artery,the patients with cerebral infarction were divided into two groups: tandem stenosis group and single stenosis group.The above data was compared between two groups.Results 1.We enrolled 236 patients with unilateral internal carotid stenosis of atherosclerotic origin,with mean age of 68.21±9.76 years old,69.92%(165/236)being male patients,and 30.08%(71/236)female.There were 82 patients(34.75%)had cerebral infarction and 154(66.25%)patients did not have cerebral infarction in the area supplied by internal carotid stenosis.Compared with the non-infarction patients,the infarction patients had lower admission systolic blood pressure(148 mm Hg vs156 mm Hg,p= 0.011),higher proportion of internal carotid artery tandem stenosis(37.8%vs 16.2%,p<0.001),more serious degree of internal carotid artery stenosis(p=0.020).There were no significant differences between infarction patients and non-infarction patients in the WMH score on both sides of cerebral,the number of old lacunar infarction,intimal-medial thickness in carotid common arteries ipsilateral to the stenosed ICA artery,plaque thickness at the stenosed location,the proportion of incomplete Willis circle,the presence of fetal posterior cerebral artery stenosis,the presence of vertebral artery stenosis and basilar artery stenosis.Multivariate logistic regression analysis showed that the admission systolic blood pressure in the cerebral infarction patients was lower than that in the non-infarction patients(OR=0.985,95%CI 0.972-0.997,p=0.019).Tandem stenosis of internal carotid artery was an independent risk factor for cerebral infarction(OR=3.139,95% CI 1.173-8.396,p=0.023).2.There were 82 patients who had infarction in the area supplied by internal carotid artery,among whom 31 patients(37.80%)had tandem stenosis and 51patients(62.20%)had single stenosis of internal carotid artery.Compared with the single stenosis patients,the patients with tandem stenosis were younger(63 vs 70,p= 0.001),had a lower proportion of fetal posterior cerebral artery(9.7 vs 33.3,p= 0.016),a higher proportion of vertebral artery and basilar artery stenosis(2.71 vs 3.74,p=0.003)and a more serious degree of internal carotid artery stenosis(p< 0.001).There was an significant difference in plaque morphology of internal carotid artery stenosis between patients of tandem stenosis and single stenosis(p=0.006).Multivariate logistic regression analysis showed that the tandem stenosis patients had a higher proportion of vertebral artery and basilar artery stenosis(OR=7.849,95%CI 1.338-46.042,p=0.022),and a higher proportion of internal carotid stenosis occlusion(OR=64.793,95%CI2.459-11707.183,p=0.012).Conclusion Tandem stenosis of internal carotid artery was an independent risk factor for acute cerebral infarction in patients with unilateral internal carotid artery stenosis of atherosclerotic origin.This might contribute to a higher proportion of stenosis in posterior circulation and internal carotid artery occlusion in the patients with tandem stenosis.