| ObjectiveTo explore the risk and benefit support by using the retrospective study comparing stenting with medical treatment for symptomatic intracranial atherosclerotic stenosis, and to analyse the evolution of syndrome before and after treatment of stenting. To provide the better decision for clinical treatment and the theoretical basis for using traditional Chinese medicine to reduce peri operation period complication and improve the long-term benefit.MethodsTo analyse the clinical follow-up data of 199 cases of symptomatic intracranial atherosclerotic stenosis with two different treatments using stent or medicine by retrospective study and survival analysis (Kaplan-Meier method), cox regression and other statistical methods with SPSS 17.0 software package, to compare the security and efficacy, and to preliminary explore the evolution of syndrome before and after the treatment of stenting.Results1. Phlegm and blood stasis make up the largest proportion in the syndrome of both medical group and stenting group before their treatment or operation, accounted for 82.9% and 81.9% in the whole of the two groups respectively, followed by wind (43.7%), Qi deficiency (22.1%), fire (11.5%) and hyperactivity of yang due to yin deficiency (4.5%).2. Wind, fire, phlegm and blood stasis are reduced after the treatment of stenting, while Qi deficiency increased (the proportion of wind, fire, phlegm, blood stasis and qi deficiency before operation is 38.7,15.1%,84.9%, 80.2%,18.9% respectively, and 15.1%,6.6%,67.9%,57.5% and 55.7% after operation respectively). Compared to the medical group Phlegm and blood stasis decreased more obviously, while Qi deficiency increased more obviously.3. Syndrome distributions between patients of restenosis and no restenosis are of no significance, and phlegm and blood stasis accounted for the largest proportion(38.1%,38.1% and 36.8%,37.7% respectively), followed by Qi deficiency, wind fire, and yin deficiency and yang hyperactivity.4. The success rate of stent placement is 98.3%, of which Wingspan stent is 97.4% and Solitaire stent is 98.5%. The influence on the success rate of type of stent, responsible vessels, learning curve and time from operation to the onset are of no significant difference(P>0.05).5. The rate of peri operation complications occurrence is 8.5%(9/106), and time from operation to the onset more than 14 days and a more mature stent technology are associate with less complications (P<0.05). Logistic regression correction shows that older age(≥65 years old), less mature stent technology and time from operation to the onset less than 14 days are positively correlated with complications(P<0.05).6. The primary endpoint between the two groups are of no significant difference (P>0.05), while the time distribution is of significant difference (P<0.05). There are 56.2%(9/16) of the primary endpoint in the stenting group occurs within 30 days while all in the medical group occurs beyond 30 days. The Cox proportional hazards model analysis shows that male and history of coronary heart disease are positively correlated with the primary endpoint (P<0.05).7. The secondary end point between the two groups are of no significant difference (P>0.05), while the incidence of recurrent ipsilateral stroke after 30 days in the stenting group is decreased more significantly than the medical group (P<0.05). The Cox proportional hazards model analysis shows that smoking and medical treatment are negatively correlated with the secondary endpoint (P<0.05), both Solitaire stent and Wingspan stent can decrease the incidence of recurrent ipsilateral stroke after 30 days(P<0.05).8. The rate and cumulative incidence of severe stenosis/restenosis and revascularization events ratio between the two proups is of no statistical significance (P>0.05). Solitaire stent has a lower restenosis incidence than Wingspan stent (17.6% VS 31.8%), but of no statistical significance (P>0.05). Stent restenosis often occurres in half a year around after stent implantation.Conclusion1. Phlegm and blood stasis are the main syndromes of symptomatic intracranial artery stenosis. Similarly to traditional Chinese medicine, the role of stent is like one promoting blood circulation for removing blood stasis and washing away the phlegm, but more strongly, impairing Qi simultaneously. Phlegm, blood stasis and Qi deficiency are the main syndromes of long-term follow-up.2. The implantation of intracranial stent has a high success rate. The incidence of restenosis or stenosis increase are of no difference between the stenting group and the medical group, also between Solitaire stent and Wingspan stent. Solitaire stent has a lower restenosis incidence than Wingspan stent, but of no statistical significance. Stent restenosis often occurres in half a year around after the operation.3. The primary endpoint and secondary end point between the two groups are of no significant difference, while the incidence of recurrent ipsilateral stroke after 30 days in the stenting group decreased more significantly than the medical group, showing that the longer after the operation the more benefit that stent treatment can bring, and the benefit is offset by the complications in the peri operation. Strengthen peri operation period management and to reduce the complications is the key to improve the whole benefit of the stent treatment.4. Combined with the evolution law of syndromes after the stent implantation, treatment of tonifying qi, invigorate the circulation of blood, reduce phlegm and vein relaxing may be of certain effect to improve peri operation complications and long-term outcome.5. Leading a healthier lifestyle and makeing a strict intervention of vascular risk factors and eliminating syndrome of phlegm and blood stasis are the fundamental measures to delay the progression of intracranial atherosclerosis and to reduce the recurrence rate of stroke. |
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