| Objective: To investigate the c o rrelation between the risk factors of ischemic stroke and the establishment of the collateral circulation,to analyse The influence of different blood pressure ranges on the establishment of collateral circulation;By analysis the levels of serum TLR2 concentration in acut ischemic stroke patients with different statue of collateral circulation,To investigate the relationship between the level of expression of TLR2 and the the collateral circulation;and to investigate the correlation between the extent of collateral circulation and the prognosis of patients with CAS,to analyze the correlation between the extent of the collateral circulation,and the level of expression of TLR2 and the stent restenosis in patients after CAS.Methods: 314 patients with anterior circulation acute cerebral infarction were treated in neurology department of the First Affiliated Hospital of Xinjiang Medical University During the period of 2010.10 to 2016.12,The compensatory pathways and degree of opening of the cerebral circulation in patients with acute ischemic stroke were determined by DSA,Collateral circulation score were evaluated by the ASITN/SIR standard,ASITN/SIR0-1 is divided into collateral circulation poor group,ASITN/SIR2-4 is divided into collateral circulation good group;The ACoA-PCoA scoring criteria determined the extent of the ACoA and PCoA.The correlation between the risk factors of cerebrovascular disease and the establishment of collateral circulation and the influence of different blood pressure range on the opening of collateral circulation were analyzed.Blood samples were taken from 156 patients and serum TLR2 levels were measured and compared with blood samples taken from 208 normal subjects,The difference of serum TLR2 concentration between the two groups was observed,and the correlation between TLR2 concentration and the degree of collateral circulation openness.Serum VEGF concentration was also determined and the correlation between serum TLR2 concentration and serum VEGF concentration was investigated.Finally,107 patients with carotid stent implantation were followed up to record perioperative complications of carotid stenting and clinical end points during an average of 6~60 months follow-up,including ischemic stroke,to investigate the relationship between the degree of collateral circulation and the prognosis of patients undergoing carotid artery stenting,and to investigate the relationship between the degree of collateral circulation and the degree of stent restenosis.and investigate the influence of serum TLR2 expression on the prognosis of patients after carotid artery stenting.Results: 1)Of the Three hundred and fourteen patients,ASITN/SIR collateral grades 0,1,2,3 and 4 occurred inFifty-one,Seventy-eight,Eighty,Seventy-three and Thirty-seven patients,respectively.and 185 patients with circulation good group(collateral grades2-4),129 patients with circulation poor group(collateral grades0-1);Hypertension(54.6%VS 68.2%,P<0.05)and diabetes(27%VS 41.8%,P<0.05)were significantly lower in good the collateral circulation group;The NIHSS score in good collateral circulation was lower than that of the poor collateral circulation group(5.92±2.82 VS 7.53±2.43,P<0.05);Good collateralization will be more obviously with development of anterior communicating artery(ACoA),pial arteries And the number of more than two collateral pathways was more in good collateralization.Multivariate logistic regression analysis showed the development of Anterior communicating artery,pial arteries were independent factors for Formation of favorable collateral circulation.2)The mean systolic blood pressure(138.83+14.03 VS 142.97+12.27,P=0.011),mean diastolic blood pressure(75.48+8.34 VS 78.51+8.71,P=0.002)and the mean arterial pressure(92.92+9.08 VS 96.32+9.42,P=0.002)were lower in good collateral circulation group than the poor collateral circulation group.Median collateral scores was the highest when systolic blood pressure was between 120 and 130 mm Hg,diastolic pressure,mean arterial pressure,pulse pressure were not correlated with collateral circulation.3).Comparison of basic admission between 156 patients with acute ischemic stroke and control group,the age,BMI,hypertension,diabetes mellitus,smoking and drinking are the difference between the two groups,The concentration of TLR2 in the acute ischemic stroke group was significantly higher than that in the control group(6931.6+5912.9pg/ml VS,3299.1+1678.6pg/ml,P=0.003);and 92 patients with good collateral circulation group,64 patients with poor collateral circulation group,the concentration of TLR2 group was significantly higher than that of good collateral circulation group(8095.5+ 7264.3pg/ml VS 5258.4+2310.6pg/ml,P=0.036),When the collateral circulation score was 4,the serum TLR2 concentration(15324.2+8409.1pg/ml)was the highest,and there was a significant difference(P<0.05)when compared with the expression concentration of 0.1.2,and there was a correlation between TLR2 and the number of collateral circulation scores(r=0.442,P=0.001);There was a correlation between serum TLR2 concentration and serum VEGF concentration(r=0.65,P=0.001),TLR2 may induce the expression of VEGF and promote the establishment of collateral circulation;Patients with high expression of TLR2 had higher rates of vulnerable plaque and surface ulceration plaques.4).In CAS group,51 patients with circulation good group,56 patients with circulation poor group;the proportion of diabetes in patients with poor collateral circulation was higher than in patients with good collateral circulation(50%,VS,29.4%,P=0.03).the proportion of severe stenosis of internal carotid artery(66.7%VS 44.6%,P=0.022),ACoA score(1.73+0.53 VS 0.63+0.75,P=0.001),PCoA score(0.88+0.81 VS 0.59+0.56,P=0.042)and ACoA-PCoA score(2.61+0.85 VS 1.14+0.91,P=0.001)were significantly higher in good collateral circulation group than that in poor collateral circulation group.The number of pial arteries(56.9%VS 23.2%,P=0.001)and the number of greater than or equal to 2 of collateral pathways(76.5%VS 36.7%,P=0.001)were also higher than that of poor collateral circulation group.5).Perioperative complications in CAS patients did not differ between the good collateral circulation group and poor collateral circulation group,CAS patients were followed up for 25.84±14.23 months(6-60 months),there were 14 cases of ischemic cerebral infarction,2 cases occurred in the collateral circulation group,12 cases occurred in the collateral circulation group,there were significant differences between the two groups(3.9%VS 21.4%,P=0.007).COX regression analysis revealed that,good collaterals were the independent protective factors of cerebral infarction(HR 0.194,95%CI 0.017-0.531,P=0.017),and diabetes were independent risk factors of cerebral infarction(HR 9.438,95%CI 2.084-42.746,P=0.004),The Kaplan-Meier survival curve of the two groups showed a good prognosis in the collateral circulation group(Log-Rank,test=3.97,P=0.046).There was no significant difference in the concentration of TLR2 between the recurrent group and the non recurrent group(7794.4+4693.9,VS 5270.5+2555.3,P=0.058).6).There were 3 cases of stent restenosis in the good collateral circulation group.and 4 cases of stent restenosis in the poor collateral circulation group.There were no significant differences between the two groups,COX regression analysis of in-stent restenosis revealed that diabetes was an independent risk factor for in-stent restenosis(HR 4.706,95%CI 1.526-14.511,P=0.007),The ASITN/SIR score(2.14+0.69 VS,1.46+1.21,P=0.042),PCoA score(1.57±0.53 VS 0.7±0.74,P=0.003)and ACoA-PCoA score(3.29±0.75 VS 1.77±1.11,P=0.001)in the restenosis group was significantly higher than that in the non stenosis group,However,there was no significant difference in ACoA score between the two groups(1.71+0.48 VS,1.11+0.86,P=0.071).Comparison between stent restenosis and restenosis,The ACoA score in the restenosis group was significantly lower than that in the non stenosis group(1.09+0.71 VS,1.56+0.0.69,P=0.039),and the PCoA score in the restenosis group was slightly higher than that in the non stenosis group(1.45+0.52 VS,0.95+0.83,P=0.053);In the restenosis group,the peak systolic flow velocity(90.14+14.34 VS,104.49+17.64,P=0.048)and the end diastolic velocity(32.29+4.95 VS,40.32+10.25,P=0.049)were lower than those in the stenosis group;The concentration of TLR2 was not significantly different between the two groups(7245.9+4557.3 VS,5459.7+3060.3,P=0.181).Conclusions: Among the risk factors of cerebrovascular disease,hypertension and diabetes were different in different collateral circulation state,The anterior communicating artery open,pial arteries open and a plurality of collateral pathways open is the decisive factor for good collateral circulation statue,posterior communicating artery and ophthalmic artery was not found in the relationship;The mean systolic blood pressure,mean diastolic pressure and mean arterial pressure in the group with good collateral circulation were lower than those of the poor collateral circulation group.The extent of collateral circulation is different in different blood pressure ranges,Median collateral scores was the highest when systolic blood pressure was between 120 and 140 mm Hg.The levels of serum TLR2 in patients with acute ischemic stroke were significantly higher than those in the normal control group;The serum concentrations of TLR2 in the patients with good collateral circulation were significantly higher than those in the poor collateral circulation group;The expression of serum TLR2 is related to the statue of collateral circulation,and There is a correlation between TLR2 and VEGF.The higher the TLR2 concentration,the higher the concentration of VEGF,TLR2 may induce the expression of VEGF,and then promote the establishment of collateral circulation,The increased expression of serum TLR2 can promote the vulnerability of carotid plaque,The good collateral circulation can improve the prognosis of patients after CAS,and is a protective factor of cerebral infarction after long-term follow-up;The insufficiency of anterior communicating artery can promote the formation of stent restenosis after CAS,The expression of TLR2 was not correlated with the prognosis of patients with CAS. |
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