2. Functional recovery, mortality, and recurrence outcomes of patients with internal carotid artery occlusion
Mortality and functional recovery outcomes:
- The in-hospital mortality rate was 11.6%, cumulative at three months was 19.9%, 1 year was 25.1%, and by the end of the study (2.2 years) was 38.2%.
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- 55.4% of patients discharged with severe disabilities are bedridden
- The functional independence rate was 10.8% and 18.2%, respectively at 3 months and the end of the study (2.2 years).
Recurrence outcome:
The cumulative recurrence rate at 1 year was 8.4%, and at 2.2 years was 15.2%.
3. Factors predicting outcome in patients with internal carotid artery occlusion
Regarding functional recovery outcomes , factors that are significant in predicting functional outcomes include:
- Older age predicted poor outcome, with the risk more than doubling for every 10 years of age increase (HR 2.2 to 2.5).
- Hypertension reduces adverse outcomes by about 0.7 times compared to people without hypertension.
- Coronary artery disease increases the risk of poor outcomes by 9-10 times, compared with people without coronary artery disease.
- Stenosis of the ipsilateral middle cerebral artery M1 segment nearly doubled the risk of adverse outcome (HR 1.706).
- NIHSS score at admission and the extent of cerebral infarction on imaging (assessed by lesion segmentation or by ASPECTS score) strongly predicted the risk of poor functional outcome.
The formula for calculating the early prediction score for functional outcome is established as follows: G(x) = 0.08 * age – 0.28*THA + 2.2*BMV + 0.5*M1 + 0.15*NIHSSnv – 7.7
With a cutoff of 0, patients with a score <0 predicted a favorable outcome, and scores ≥
0 predicted poor outcome; preliminary assessment had a sensitivity of 77.2% and a specificity of 83.3%.
Regarding mortality outcomes, important predictive factors include:
- Age slightly increases the risk of death, adding about 4-9% for every additional 10 years of age.
- Atrial fibrillation nearly triples the risk of death (HR 2.14-2.82)
- High admission NIHSS and severe cerebral infarction on imaging both predicted increased risk of fatal outcome.
- If the ipsilateral middle cerebral artery has severe stenosis of the M1 segment, the risk of death will increase by nearly 1.2 times.
Regarding recurrence outcome , no predictive factors were noted in this study.
PROPOSAL
From the results of the study, we make the following recommendations:
1. Routine vascular examination is required in all patients with cerebral infarction, especially in the acute setting, to identify patients with large arterial occlusion, especially the carotid artery, so that timely revascularization can be performed because the consequences of infarction without intervention are often very severe.
2. In cases of established infarction, it is necessary to fully examine parenchymal and vascular images to assess damage and collaterals, especially actively treating patients with small infarctions and hemodynamic infarctions because these are the subjects that can benefit if treated with the right mechanism.
LIST OF AUTHOR'S RESEARCH WORKS
1. Nguyen Ba Thang, Le Van Thanh, (2014), “Clinical characteristics and 30-day outcomes of cerebral infarction due to internal carotid artery occlusion in 121 cases at Cho Ray Hospital”, Ho Chi Minh City Medical Journal; 18(5), pp. 130-136
2. Nguyen Ba Thang, Le Van Thanh, (2014), “Brain parenchymal imaging characteristics of 121 patients with cerebral infarction and internal carotid artery occlusion at Cho Ray Hospital”, Ho Chi Minh City Medical Journal , 18(4), pp.117-124.
3. Nguyen Ba Thang, Vu Anh Nhi, (2007), “Prediction of functional recovery in patients with middle cerebral artery infarction: prospective survey of 149 cases”. Ho Chi Minh City Medical Journal , volume 11 (supplement 1), pp.314-323.
4. Nguyen Ba Thang, Le Van Tuan, Vu Anh Nhi et al., (2006). “Survey of knowledge and attitude about stroke of stroke patients and relatives”. Ho Chi Minh City Medical Journal , volume 10 (supplement 1), pp.219-224.
5. Nguyen Ba Thang, (2003), “Validation of the clinical score scale for differential diagnosis of cerebral infarction and supratentorial cerebral hemorrhage”. Ho Chi Minh City Medical Journal , volume 7 (supplement 1), pp.63-69.
6. Nguyen Ba Thang, (2003), “Survey of atherosclerotic lesions distribution in patients with ischemic stroke”. Ho Chi Minh City Medical Journal , volume 7 (supplement 1), pp. 97-100.
7. Nguyen Ba Thang, Le Van Thanh, (2000), "Testing the establishment of a clinical score to differentiate between cerebral infarction and supratentorial cerebral hemorrhage". Journal of Science and Development , pp. 58-65.
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