非急性期症状性颈内动脉闭塞患者的血管内再通治疗及患者分类研究

Endovascular recanalization of symptomatic non-acute internal carotid artery occlusion: a new patient classification proposal

目的:针对非急性期症状性颈内动脉闭塞(ICAO)血管内再通治疗的单中心临床结果提出一种新的患者分类方法,明确最适合血管内再通治疗的ICAO患者类型。方法:选择河南省人民医院脑血管介入科自2019年1月至2021年12月行血管内再通治疗的140例非急性期症状性ICAO患者进入研究。根据患者病变血管闭塞节段、闭塞时间、斑块性质、闭塞部位是否钙化及闭塞节段成角将患者分为低风险组(57例)、中风险组(54例)及高风险组(29例)3组,比较3组患者血管再通率、围手术期并发症发生率、死亡率及90 d预后(改良Rankin量表评分<2分为预后良好)。结果:术后即刻血管再通率为82.9%(114/140),围手术期并发症的发生率为11.4%(16/140),围手术期内死亡率为0.7%(1/140)。低风险组、中风险组至高风险组患者再通成功率依次为100%、85.2%和37.9%,围手术期总体并发症发生率依次为0%、11.1%和34.5%,差异均有统计学意义(P<0.05)。术后90 d时109例患者预后良好,27例患者预后不良。低风险组、中风险组至高风险组患者预后良好率分别为98.2%、79.6%、34.5%,差异有统计学意义(P<0.05)。低风险组、中风险组至高风险组患者术后90 d血管再狭窄率分别为0%、8.7%和18.2%、再闭塞率分别为0%、6.5%和27.2%,差异均有统计学意义(P<0.05)。结论:血管内再通治疗非急性期症状性ICAO技术上可行,满足本研究分组方法中低风险组要求的患者获益更大。

Objective Based on single-center clinical results of endovascular recanalization for symptomatic non-acute internal carotid artery occlusion(ICAO),a new patient classification method is proposed to distinguish the most suitable ICAO patient subgroups for endovascular recanalization.Methods A total of 140 patients with symptomatic non-acute ICAO accepted endovascular recanalization in Department of Cerebrovascular Intervention,He'nan Provincial People's Hospital from January 2019 to December 2021 were selected.These patients were divided into low risk group(n=57),medium risk group(n=54)and high risk group(n=29)according to the occlusion segments,occlusion times,plaque features,calcification at the occlusion site and occlusion segment angulation.The immediate postoperative recanalization rate,perioperative complications,perioperative death,and prognoses 90 d after endovascular recanalization(modified Rankin scale scores of 0-2 as good prognosis)were evaluated in the 3 groups.Results The immediate postoperative recanalization rate was 82.9%(114/140),perioperative complication rate was 11.4%(16/140),and perioperative mortality was 0.7%(1/140).The success recanalization rate decreased gradually from the low risk group to the high risk group(100%,85.2%,and 37.9%),while the perioperative complication rate was the opposite(0%,11.1%,and 34.5%),with significant differences(P<0.05).Ninety d after endovascular recanalization,109 patients had good prognosis and 27 had poor prognosis;the good prognosis rate in low risk group,medium risk group and high risk group was 98.2%,79.6%and 34.5%,respectively,with significant differences(P<0.05).The vascular restenosis rate in low risk group,medium risk group and high risk group was 0%,8.7%and 18.2%,and re-occlusion rate was 0%,6.5%and 27.2%,respectively,90 d after endovascular recanalization,with significant differences(P<0.05).Conclusion Endovascular recanalization is technically feasible for patients with symptomatic non-acute ICAO,especially those met the criterions of low and medium risk groups in our study.