Clinical interference and follow-up studies in patients with symptomatic carotid artery totalocclusion

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Author:
YANG Hua(Department of Neurology, Liaocheng Third People′s Hospital of Shandong Province, Liaocheng 252000, China)
XIA Zhang-yong()
ZHANG Min()
REN Zeng-guang(Department of Neurology, Liaocheng Third People′s Hospital of Shandong Province, Liaocheng 252000, China)
YIN Qin()
XU Ge-lin()
QU Huai-qian()
WANG Li()
Journal Title:
Chinese Journal of Neuromedicine
Issue:
Volume 10, Issue 11, 2011
DOI:
10.3760/cma.j.issn.1671-8925.2011.11.004
Key Word:
Internal carotid;Vascular occlusion;Stent;Follow-up study

Abstract: Objective To evaluate the effects of artery-interventional therapy and drug treatment on patients with symptomatic carotid artery total occlusion,and observe the follow-up results of cerebrovascular events after clinical interference.Methods According to patient′s intention,62patients with symptomatic carotid artery total occlusion,admitted to our hospitals from February 2004 to January 2009,were divided into artery-interventional therapy group(n=21)and drug treatment group (n=41).In the artery-interventional therapy group,patients were given revascularization of internal carotid by endovascular intervention.In the drug treatment group,patients were given aspirin,clopidogrel and statins.The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Scale(mRS),and Rank sum test was employed to compare the differences of mean rank of the 2 groups; the minor end-point outcome was the cardiovascular events,and Kaplan-Meier method and multivariate Cox regression were employed to analyze the median time and independent risk factors.Results During the 3,6 and 9 months,1 and 2 years of follow-up,mRS average ranks in the artery-interventional therapy group were statistically lower than those in the drug treatment group(P<0.05).The median times of recurrence of cardio-cerebrovascular events in the artery-interventional therapy group and drug treatment group were(17.42±1.20)months(95%CI:15.07-19.76)and(19.43±1.51)months(95%CI:16.48-22.38),respectively,and Kaplan-Meier analysis showed no significant difference(P>0.05).Survival Cox regression analysis showed that independent factors of cardio-cerebrovascular events were smoking(RR=3.189,95%CI:1.020-9.968,P=0.046),diabetes(RR=2.717,95%CI:1.113-6.631,P=0.028),and baseline NIHSS scores(RR=2.984,95%CI:1.049-8.485,P=0.040),but treatment methods(artery-interventional therapy and drug treatment)were not independent factors(RR=1.191,95%CI:0.430-3.296,P=0.737).Conclusion Artery-interventional therapy is superior to drug therapy in achieving better functional prognosis; however,the 2-year-follow-up shows that the artery-interventional therapy can not reduce the occurrence of cardio-eerebrovascular events.Smoking,diabetes and baseline NIHSS scores are independent factors of recurrence of cardio-cerebrovascular events.

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