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Survey of prognostic factors of cerebral infarction due to internal carotid artery occlusion - 2


LIST OF TABLES

Table Name Page

Table 1.1 Frequency of main types of stroke (according to Framinham) 4

Table 1.2 Classification of causes of cerebral infarction according to TOAST 7

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Table 3.1 Stroke severity grouping according to NIHSS score at admission 59

Table 3.2 Results of paraclinical tests 61

Survey of prognostic factors of cerebral infarction due to internal carotid artery occlusion - 2

Table 3.3 Characteristics of cerebral infarction groups 68

Table 3.4 Collateral characteristics and M1 segment status in lesion groups 72

brain injury

Table 3.5 All-cause mortality outcomes by Kaplan-Meier estimates 75

Table 3.6 Univariate analysis for qualitative variables by functional outcome 77

(severe disability or death)

Table 3.7 Univariate analysis for quantitative variables by functional outcome 78

power

Table 3.8 Model 1 – multivariate logistic regression analysis with status 79

M1 ipsilateral

Table 3.9 Value of the 1-year functional outcome prediction formula 81

Table 3.10 Model 2 – multivariate logistic regression analysis with 82 variables

brain infarction image

Table 3.11 Model 3 – multivariate logistic regression analysis with score variable 82

ASPECTS

Table 3.12 Univariate Cox regression analysis with demographic and covariates 83

risk factor

Table 3.13 Results of univariate Cox regression analysis with clinical variables 84

Table 3.14 Results of univariate Cox regression analysis with the image variable 84

cerebral hemorrhage

Table 3.15 Results of univariate Cox regression analysis with segment status variable 85

M1 ipsilateral

Table 3.16 Model 1 – multivariate Cox regression analysis by mortality outcome 86

all causes, with ipsilateral M1 status variable

Table 3.17 Model 2 – multivariate Cox regression analysis by mortality outcome 87

all causes, with variable brain damage imaging

Table 3.18 Model 3 – multivariate Cox regression analysis by mortality outcome 87

all causes, with ASPECTS score variable

Table 3.19 Univariate analysis using Cox regression, demographic variables and 88

risk factors

Table 3.20 Univariate analysis by Cox regression, clinical variables 88

Table 3.21 Univariate analysis by Cox regression, paraclinical variables 89


Table 4.1 Gender and age characteristics of internal carotid artery occlusion studies

Table 4.2 Rehabilitation outcomes in patients with cerebral infarction and internal carotid artery occlusion

Table 4.3 Level of functional recovery compared with domestic studies on general cerebral infarction subjects

Table 4.4 Prognosis of outcome after internal carotid artery occlusion according to previous studies

Table 4.5 Mortality rate in patients with ischemic stroke according to domestic studies


90


106


107


110


111


Table 4.6 Rate of stroke recurrence in patients with internal carotid artery occlusion through studies

Table 4.7 Prediction of stroke recurrence by univariate analysis in the study of Grubb et al.

113


125


LIST OF FIGURES


Image Name Page

Figure 1.1 Arteries supplying blood to the brain 11

Figure 1.2 Cerebral arteries and their branches 11

Figure 1.3 Blood perfusion distribution of cerebral arteries on vertical slices 12

horizontal

Figure 1.4 Circle of Willis – connecting loop at the base of the brain 13

Figure 1.5 Collateral loops in cerebral perfusion 14

Figure 2.1 ASPECTS 44 scoring partitions

Figure 2.2 Lesions segmentation according to Bang et al. 45

Figure 3.1 Illustration of collateral blood supply to the anterior cerebral artery and the 64th artery

ipsilateral middle cerebral artery occlusion of internal carotid artery

Figure 3.2a Illustration of bilateral internal carotid artery occlusion – first case 66

Figure 3.2b Illustration of bilateral internal carotid artery occlusion – two remaining cases 67

Figure 3.3 Hemispheric injury after internal carotid artery occlusion 69

Figure 3.4 Large lesion of the entire perfusion area of ​​the internal carotid artery, 69

middle cerebral artery and anterior cerebral artery

Figure 3.5 Damage to the entire middle cerebral artery perfusion area 69

Figure 3.6 Damage to the majority of the middle cerebral artery perfusion area 70

Figure 3.7 Injury to a superficial branch of the 70th artery.

midbrain

Figure 3.8 Large deep lesion, including basal ganglia and internal capsule 70

Figure 3.9 Cerebral infarction in the coronal region of ray 70

Figure 3.10 Borderline posterior cerebral infarction 71

Figure 3.11 Small focal cerebral infarction, infarction of a cortical branch 71


LIST OF CHARTS

Chart Name Page


Figure 2.1 Research diagram 51


Figure 3.1 Gender distribution in the study sample 55


Figure 3.2 Distribution of residence 56


Figure 3.3 Percentage of patients with hypertension 56


Figure 3.4 Prevalence of diabetes in the study sample 57


Figure 3.5 Prevalence of heart disease in the study sample of 57


Figure 3.6 Rate of smoking and drinking in the study sample 57


Figure 3.7 Rate of transient ischemic attacks 58


Figure 3.8 Glasgow Coma Score on Admission 58


Figure 3.9 Distribution of NIHSS scores at admission 59


Figure 3.10 Lesion hemisphere side 59


Figure 3.11 Distribution of causes according to TOAST 58 classification


Figure 3.12 Antithrombotic drug use in the first month 61


Chart 3.13 ASPECTS 62 score distribution


Figure 3.14 Cerebral infarction lesions by State 62 region


Figure 3.15 Distribution of types of cerebral infarction images 63


Figure 3.16 Status of the middle cerebral artery segment M1 on the same side as artery 65

traffic jam

Figure 3.17 Contralateral carotid artery status 66

Figure 3.18 Correlation of collateral blood supply and outcome of lesion groups 71

cerebral infarction

Figure 3.19 Distribution of functional status according to mRS over time 73

Evaluate

Figure 3.20 Mean difference in mRS scores between time points 74

Figure 3.21 Patient relapse-death outcomes at the end of the study 75

Figure 3.22 Kaplan-Meier equation for all-cause mortality outcome 75

core

Figure 3.23 Kaplan-Meier survival equation for sudden recurrence outcome 76

collapse

Figure 3.24 ROC curve for the 80-function outcome prediction equation

power

Figure 3.25 Box plot of prognostic scores of two groups of functional outcomes 81

power

Figure 3.26 Survival equation according to cerebral infarction image 85

Figure 3.27 Survival equation according to ipsilateral M1 segment status 85

Figure 3.28 Cox regression equation according to infarct lesion image 89

brain


PROBLEM STATEMENT


Cerebral ischemia is the most common form of stroke [97]. Although the mortality of this group is not as high as that of cerebral hemorrhage and subarachnoid hemorrhage, due to the highest incidence rate and a significant proportion of patients with severe functional and labor loss outcomes, this is a form of stroke that deserves special attention. Furthermore, compared with cerebral hemorrhage, cerebral ischemia is a form of stroke that is more likely to be treated, with many intervention methods, both emergency and delayed, both treatment and rehabilitation and prevention of recurrence, that have been studied and applied in practice, achieving many positive results.

Symptomatic internal carotid artery occlusion is a special type of cerebral infarction. The clinical picture of internal carotid artery occlusion can be very severe if the collateral system does not function well, leading to death or severe disability [54],[61],[128]. However, there are still many cases of only moderate or mild stroke, in the form of transient ischemic attack or even asymptomatic [109]. The first question is what is the specific outcome of patients with severe or mild internal carotid artery occlusion cerebral infarction? And what factors affect these outcomes?

An important factor affecting the outcome is the collateral perfusion. If the collateral is very good, the carotid artery occlusion may not have clinical symptoms. On the contrary, if the collateral is not adequate, the patient will have a very severe infarction. To improve collateral perfusion for patients with internal carotid artery occlusion, many interventional and surgical methods have been studied, such as endovascular recanalization and stent placement, external carotid artery-internal carotid artery bypass surgery, or contralateral internal carotid artery endarterectomy, etc. However, endovascular intervention has only shown initial signs of safety through small-sample studies [75],[123], while external carotid artery-internal carotid artery bypass surgery gave disappointing results through a large study, resulting in this surgery being

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