Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization

Chao Xiao; Xiuen Chen; Lizhi Lu; Ziming Ye; Xiangren Chen; Meiyu Dong; Chao Qin

doi:10.2147/NDT.S400496

Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization

Neuropsychiatr Dis Treat. 2023 May 3:19:1103-1115. doi: 10.2147/NDT.S400496. eCollection 2023.

Authors

Chao Xiao^#^{1

2}, Xiuen Chen^#¹, Lizhi Lu³, Ziming Ye², Xiangren Chen², Meiyu Dong⁴, Chao Qin²

Affiliations

¹ Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China.
² Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
³ Department of Neurology, Forsea Life Insurance Nanning Hospital, Nanning, People's Republic of China.
⁴ The First Clinical Medical College of Guangxi Medical University, Nanning, People's Republic of China.

^# Contributed equally.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: chronic internal carotid artery occlusion; clinical effect; endovascular recanalization; hemodynamics.

Grants and funding

This study was funded by the National Natural Science Foundation of China (Grant No.81960220, No.82260240, No.82060226, No.81860222), Natural Science Foundation of Guangxi Province (Grant No.2019GXNSFAA185029, No.2019GXNSFDA185008), “Medical Excellence Award” Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University (Grant No.201907), and The Scientific Research Project of Guangxi Health and Family Planning Commission (Grant No. Z20170571).