Feng Ling-Xiao, Gao Huili, Zhang Jinlong, Gu Jianjun, Wang Yongfeng, Li Tianxiao, Gao Bulang
Henan Provincial People's Hospital, Zhengzhou University, China.
Eur J Radiol. 2025 Feb;183:111885. doi: 10.1016/j.ejrad.2024.111885. Epub 2024 Dec 12.
To investigate the safety and effect of endovascular recanalization for subacute or chronic occlusion of the internal carotid artery (ICA) ophthalmic segment and risk factors for the prognosis.
135 patients with subacute or chronic occlusion of the ICA ophthalmic segment were retrospectively enrolled to undergo endovascular recanalization, with the clinical, imaging and follow-up data being analyzed.
Among 135 patients with ICA ophthalmic segment occlusion, hypertension was presented in 72 (53.3 %) patients, diabetes mellitus in 44 (32.6 %), coronary heart disease in 12 (8.9 %), smoking in 51 (37.8 %), and alcohol abuse in 38 (28.1 %). Endovascular recanalization was performed in all patients, and recanalization was successful in 130 (96.3 %). Five patients (3.7 %) were not recanalized because of intraprocedural complications. Periprocedural complications occurred in 16 patients, resulting in a total complication rate of 11.9 %. The mRS (modified Rankin Scale score) was 1.45 ± 0.03 after recanalization, significantly (P < 0.001) better than that (2.25 ± 0.12) before recanalization. The NIHSS (National Institute of Health Stroke Scale) was 11.91 ± 0.67, significantly (P < 0.0001) better than that (18.45 ± 1.33) before recanalization. Eighty-nine (65.9 %) patients underwent angiography at follow-up 6-86 (mean 48) months after recanalization, which demonstrated good prognosis in 72 (80.9 %) patients and poor prognosis in the other 17 (19.1 %) with instent restenosis > 50 %. Telephone follow-up was conducted in 46 (34.1 %) patients 6-38 (mean 27) months after recanalization, which revealed good prognosis in 38 (82.6 %) patients and poor prognosis in 8 (17.4 %). In total, good prognosis was present in 110 (81.5 %) patients while poor prognosis in 25 (18.5 %). In angiographic follow-up, instent restenosis > 50 % was present in nine (10.1 %) patients. Univariate analysis showed age (OR = 1.82), hypertension (OR = 2.38), diabetes mellitus (OR = 1.84), and alcohol abuse (OR = 1.49) were significant (P < 0.05) risk factors, whereas multivariate analysis demonstrated that only hypertension (OR = 1.54) and diabetes mellitus (OR = 2.67) were significant (P < 0.05) independent risk factors to affect the prognosis of recanalization.
Subacute or chronic occlusion of the internal carotid artery ophthalmic segment can be safely and efficiently recanalized using endovascular skills, and hypertension and diabetes mellitus are the independent risk factors for the prognosis of endovascular recanalization.
探讨颈内动脉眼段亚急性或慢性闭塞血管内再通治疗的安全性、疗效及预后危险因素。
回顾性纳入135例颈内动脉眼段亚急性或慢性闭塞患者行血管内再通治疗，并对其临床、影像学及随访资料进行分析。
135例颈内动脉眼段闭塞患者中，72例（53.3%）有高血压，44例（32.6%）有糖尿病，12例（8.9%）有冠心病，51例（37.8%）吸烟，38例（28.1%）有酗酒史。所有患者均行血管内再通治疗，130例（96.3%）再通成功。5例（3.7%）因术中并发症未再通。围手术期并发症发生16例，总并发症发生率为11.9%。再通后改良Rankin量表（mRS）评分为1.45±0.03，显著优于再通前（2.25±0.12，P<0.001）。美国国立卫生研究院卒中量表（NIHSS）评分为11.91±0.67，显著优于再通前（18.45±1.33，P<0.0001）。89例（65.9%）患者在再通后686个月（平均48个月）行血管造影随访，其中72例（80.9%）预后良好，17例（19.1%）因支架内再狭窄>50%预后不良。46例（34.1%）患者在再通后638个月（平均27个月）进行电话随访，其中38例（82.6%）预后良好，8例（17.4%）预后不良。总体上，110例（81.5%）患者预后良好，25例（18.5%）患者预后不良。血管造影随访中，9例（10.1%）患者支架内再狭窄>50%。单因素分析显示年龄（OR=1.82）、高血压（OR=2.38）、糖尿病（OR=1.84）和酗酒（OR=1.49）是显著（P<0.05）的危险因素，而多因素分析表明只有高血压（OR=1.54）和糖尿病（OR=2.67）是影响再通预后的显著（P<0.05）独立危险因素。
应用血管内技术可安全、有效地实现颈内动脉眼段亚急性或慢性闭塞再通，高血压和糖尿病是血管内再通预后的独立危险因素。
