Endovascular treatment for symptomatic non-acute long-segment occlusion of the internal carotid artery: comparison with drug therapy
10.3760/cma.j.issn.1673-4165.2024.08.003
- VernacularTitle:非急性期有症状颈内动脉长节段闭塞患者的血管内治疗：与药物治疗的比较
- Author:
Yue ZHU
1
;
Chao HOU
;
Shuxian HUO
;
Qin YIN
;
Xianjun HUANG
;
Wen SUN
;
Guodong XIAO
;
Yong YANG
;
Hongbing CHEN
;
Min LI
;
Mingyang DU
;
Ruidong YE
Author Information
1. 南京医科大学金陵临床医学院神经内科，南京 210002
- Keywords:
Carotid stenosis;
Carotid artery, internal;
Endovascular procedures;
Stents;
Stroke;
Mortality;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2024;32(8):576-584
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical outcome of endovascular treatment vs. drug treatment in patients with symptomatic non-acute long-segment occlusion of the internal carotid artery. Methods:Based on prospective cohort registration research data, patients with symptomatic non-acute long-segment occlusion of internal carotid artery were retrospectively included. They were divided into a drug treatment group and an endovascular treatment group according to the actual treatment received. The latter was further divided into a successful recanalization group and an unsuccessful recanalization group. The endpoint events included ipsilateral ischemic stroke, any stroke, and all-cause death. Multivariate logistic regression analysis was used to compare the endpoint events between groups during the perioprocedural period (within 30 days), and multivariate Cox proportional hazards model was use to compare the endpoint events between the groups during the long-term follow-up. Results:A total of 684 patients were included, of which 570 (83.33%) were male, median aged 63 years (interquartile range, 56-70 years). Three hundred and fifty-three patients (51.6%) received drug treatment; 331 (48.4%) received endovascular treatment, of which 161 (48.6%) had successful recanalization. The median follow-up time was 1 223 days (interquartile range, 646.5-2 082 days), with 109 patients (15.9%) experiencing stroke recurrence events (including 87 ipsilateral ischemic stroke) and 78 (11.4%) experiencing all-cause mortality. The risk of any stroke during the perioprocedural period in the successful recanalization group was significantly higher than that in the drug treatment group (odds ratio 3.679, 95% confidence interval 1.038-13.036; P=0.044), but the risk of ipsilateral ischemic stroke recurrence (risk ratio 0.347, 95% confidence interval 0.152-0.791; P=0.012) and all-cause mortality (risk ratio 0.239, 95% confidence interval 0.093-0.618; P=0.003) during the long-term follow-up were significantly lower than those in the drug treatment group. Conclusions:In patients with symptomatic non-acute long-segment occlusion of the internal carotid artery, endovascular treatment can increase the risk of stroke recurrence within 30 days, but successful recanalization can reduce the risks of long-term ipsilateral ischemic stroke recurrence and all-cause mortality.
