The Analysis Of Cerebral Vascular Screening And Prognosis For Posterior Circulation Infarction In Patients

Though the posterior circulation infarction (PCI) accounted for 20% of ischemic stroke, base on high mortality and morbidity, the study on the posterior circulation infarction risk factors, treatment, evaluation and other aspects of efficacy are more and more in recent years. Since cerebrovascular disease was the basis of the incidence of PCI, we discussed the cerebral vascular screening result of PCI patients and analyzed the affecting factors on the prognosis.The analysis was performed by 106 patients (75 men and 31 women, age range 39-89 years, average age 61.9±11.5 years) underwent therapy for the PCI patients in our institution between December 2009 and December 2010. There were 82 patients in the first group (mild group) and 24 patients in the second group (severe group). In the first group,18 patients underwent interventional therapy and 64 patients underwent conservative treatment. In the second group,4 patients underwent interventional therapy and 20 patients underwent conservative treatment. The outcome was categorized using the modified Rankin grade (mRS) score:independent (mRS 0-2 points), dependent (mRS 3 points), bad (mRS≥4 points, including death).As shown in the results, the cases of patients with a poor prognosis were increasing with the increasing admission NIHSS score. Atrial fibrillation, the distribution and the number of lesions were related with the prognosis. when P <0.05, the relation was considered statistically significant base on the single analysis. Base on P<0.05, hypertension, atrial fibrillation and admission NIHSS score were also related with the prognosis during the multivariate analysis.74 cases (69.81%) patients had one or more of vascular screening between TCD, MRA, DSA. Between 74 cases, there were 43 cases in severe stenosis group (mRS 0～2,18 cases; mRS 3,6 cases; mRS≥4,19 cases). There were 31 cases in no severe stenosis group (mRS 0～2,16 cases; mRS 3, 9 cases; mRS≥4,6 cases). In 43 cases in severe stenosis group, intervention may be more efficient than the medical treatment. While P> 0.05, the comparison wasn't considered statistically significant. Between 19 patients with progress infarction, the average mRS≥4 in 1 month (3 cases died). In this group,10 patients were found severe vertebrobasilar artery stenosis or occlusion when 11 patients had vascular screening. In addition,20 (24.39%) patients in mild group and 12 cases (50%) patients in severe group did not receive any form of vascular screening. In this study, there were 10 cases died (9.43%),2 cases in interventional therapy,8 cases in conservative treatment. The most death happened within 10 days of admission between 106 patients.Base on the results above, we summarized such conclusions as following: severe vascular stenosis was a main factor for poor prognosis of PCI patients and progressive PCI patients. There were still 42.11% of the progressive PCI patients had no any form of vascular inspection. Nearly 1/3 PCI patients and 1/2 of the severe PCI patients had no any examination of cerebral blood vessels. In the severe stenosis group, the PCI patients had better prognosis receiving interventional treatment. But we had not found a significant difference. Hypertension and atrial fibrillation were the most important factors for bad prognosis of the PCI patients. The admission the National Institute of Health Stroke Scale (NIHSS) score were negatively correlated with the prognosis. The multiple lesions had worse prognosis than single lesion. These patients with the distal and proximal lesions had worse prognosis than those patients the proximal lesions. The total mortality was 9.43% when admitted to hospital in 1 month. Most of the time of death in patients hospitalized within 10 days.We presumed that the prognosis may be different, depending on early stage cerebral vascular screening and timely treatment with the PCI patients and intervention in the PCI patients with progressive disease. Because of some limitations, the study needed to expand the sample size, by the randomized double-blind comparison to further explore more suitable treatment of the PCI patients.