Xiao Chao, Chen Xiuen, Lu Lizhi, Ye Ziming, Chen Xiangren, Dong Meiyu, Qin Chao
Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China.
Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
Neuropsychiatr Dis Treat. 2023 May 3;19:1103-1115. doi: 10.2147/NDT.S400496. eCollection 2023.
This study aimed to investigate the feasibility and clinical efficacy of endovascular recanalization in patients with chronic internal carotid artery occlusion (CICAO) and explore the application value of computed tomography perfusion (CTP) in endovascular recanalization.
This non-randomized controlled study included 41 patients with CICAO. All patients received active medical treatment. In this study, patients with successful endovascular recanalization and those who refused endovascular recanalization were included in the recanalization and medication groups, respectively. Before and 90 days after treatment, cognitive function was evaluated using the Montreal Cognitive Function Assessment, and neurological function was evaluated using the National Institutes of Health Stroke Scale and modified Rankin scale. For patients with successful endovascular recanalization, brain CTP imaging was performed to evaluate hemodynamic changes in patients with CICAO before and three days after treatment.
Overall, 41 symptomatic patients with CICAO were included, and 20 patients received endovascular recanalization therapy, with a success rate of 60% (12/20). The perioperative complication rate was 15% (3/20); there were no events such as hyperperfusion, distal embolism, vascular rupture, or cerebral hemorrhage, and no stroke-related or death-related events. Patients were divided into a medication group (n=21) and recanalization group (n=12). After 90 days of follow-up, patients in the recanalization group showed greater improvement in overall cognitive and neurological function. In addition, successful endovascular recanalization significantly improved cerebral blood perfusion on the occluded side of patients with CICAO.
Successful recanalization can effectively improve the overall cognitive and neurological functions of patients in the short term. CTP can be used to quantitatively evaluate not only the cerebral hemodynamic changes after internal carotid artery occlusion but also the improvement of cerebral blood perfusion after successful endovascular recanalization, which provides a reliable method for postoperative follow-up.
本研究旨在探讨慢性颈内动脉闭塞（CICAO）患者血管内再通的可行性和临床疗效，并探索计算机断层扫描灌注（CTP）在血管内再通中的应用价值。
本非随机对照研究纳入了41例CICAO患者。所有患者均接受积极的药物治疗。在本研究中，血管内再通成功的患者和拒绝血管内再通的患者分别纳入再通组和药物治疗组。治疗前及治疗90天后，采用蒙特利尔认知功能评估量表评估认知功能，采用美国国立卫生研究院卒中量表和改良Rankin量表评估神经功能。对于血管内再通成功的患者，进行脑CTP成像，以评估CICAO患者治疗前及治疗后3天的血流动力学变化。
总体而言，纳入了41例有症状的CICAO患者，20例患者接受了血管内再通治疗，成功率为60%（12/20）。围手术期并发症发生率为15%（3/20）；未发生高灌注、远端栓塞、血管破裂或脑出血等事件，也未发生与卒中相关或与死亡相关的事件。患者分为药物治疗组（n=21）和再通组（n=12）。随访90天后，再通组患者的整体认知和神经功能改善更为明显。此外，血管内再通成功显著改善了CICAO患者闭塞侧的脑血流灌注。
成功再通可在短期内有效改善患者的整体认知和神经功能。CTP不仅可用于定量评估颈内动脉闭塞后脑血流动力学变化，还可用于评估血管内再通成功后脑血流灌注的改善情况，为术后随访提供了可靠的方法。
