Fan Yi-Ling, Wan Jie-Qing, Zhou Zheng-Wen, Chen Lei, Wang Yong, Yao Qing, Jiang Ji-Yao
Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University Medical College, Shanghai, China.
Vasc Endovascular Surg. 2014 May;48(4):305-10. doi: 10.1177/1538574414525863. Epub 2014 Mar 18.
Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment remains a dismal disease when untreated. In this prospective, single-center, controlled study, we investigated the feasibility, safety, and long-term outcome of stenting by endovascular recanalization for patients with chronic ICA occlusion. Forty patients with symptomatic chronically occluded ICA were assigned to receive endovascular recanalization (group A, n = 18) or conservative management (group B, n = 22). The primary end point was 100% complete recanalization of the primary occlusion at 60 minutes, and secondary end points were improvement in neurologic function and cognitive function. Patients in the 2 groups were comparable in demographic and baseline characteristics. Successful recanalization was achieved in 88.9% (16 of 18) of patients with the restoration of Thrombolysis in Myocardial Ischemia/Thrombolysis in Cerebral Ischemia 2 or 3 flow. There was no procedural or new cerebral ischemic event. Improvement in brain perfusion was observed in 12 (12 of 18, 75%) patients on single-photon emission computed tomography. Improvement in neurologic function defined as a reduction of ≥4 points on the National Institutes of Health Stroke Scale (NIHSS) at 6 months was observed in group A (baseline, 6.83 ± 3.01 vs 6 months, 2.61 ± 1.20; P < .01) and group B (baseline, 6.05 ± 2.75 vs 6 months, 4.77 ± 1.69; P < .05). A significant difference in NIHSS scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Improvement in cognitive function defined as an increase of ≥8 on the Montreal Cognitive Assessment (MoCA) was observed in group A at 3 and 6 months (baseline, 14.67 ± 3.56 vs 3 months, 24.17 ± 3.55 and 6 months, 24.72 ± 2.85; P < .01). Significant improvement in MoCA was also observed in group B (P < .01). Furthermore, a significant difference in MoCA scores was noted between group A and B at 1, 3, and 6 months (P < .05 or .001). Endovascular recanalization is feasible and safe for patients with symptomatic chronic carotid artery occlusion. Successful carotid artery stenting can improve neurological function and global cognitive function than nonrevascularization.
有症状的伴有血流动力学损害的颈内动脉（ICA）闭塞若不治疗，仍然是一种预后很差的疾病。在这项前瞻性、单中心、对照研究中，我们调查了对慢性ICA闭塞患者进行血管内再通支架置入术的可行性、安全性及长期疗效。40例有症状的慢性ICA闭塞患者被分配接受血管内再通治疗（A组，n = 18）或保守治疗（B组，n = 22）。主要终点是60分钟时原发闭塞实现100%完全再通，次要终点是神经功能和认知功能的改善。两组患者在人口统计学和基线特征方面具有可比性。88.9%（18例中的16例）患者成功实现再通，心肌梗死溶栓/脑梗死溶栓2级或3级血流得以恢复。未发生手术相关或新的脑缺血事件。单光子发射计算机断层扫描显示12例（18例中的12例，75%）患者脑灌注得到改善。A组（基线时美国国立卫生研究院卒中量表[NIHSS]评分6.83±3.01，6个月时为2.61±1.20；P <.01）和B组（基线时6.05±2.75，6个月时4.77±1.69；P <.05）在6个月时观察到神经功能改善，定义为NIHSS评分降低≥4分。A组和B组在1、3和6个月时NIHSS评分存在显著差异（P <.05或.001）。A组在3个月和6个月时观察到认知功能改善，定义为蒙特利尔认知评估（MoCA）评分增加≥8分（基线时14.67±3.56，3个月时24.17±3.55，6个月时24.72±2.85；P <.01）。B组MoCA评分也有显著改善（P <.01）。此外，A组和B组在1、3和6个月时MoCA评分存在显著差异（P <.05或.001）。血管内再通对于有症状的慢性颈动脉闭塞患者是可行且安全的。成功的颈动脉支架置入术比未进行血运重建能更好地改善神经功能和整体认知功能。
