| ObjectivesTo explore the relationships between locations with CWI and the stenotic in ICA and MCA , and the prognosis of the CWI at different locations,in order to provide the basis theory and prevention for the clinical individuation treatment .Methods1 Patients researchedThree hundereds and thirty-nineth patients with ischemic stroke were selected in department of Neurology Kailuan Hospital of Hebei Union University from June 1,2008 to December 31,2010.?All the patients were consistent with the diagnostic criteria of the fourth national cerebrovascular disease academic conference in 1995 and detected by CT and/or MRI.2 Grouping methodsAccording to the neurorlogical template, all the patients researched were divided into two groups:the group of CWI and the group of the non-CWI. According to Bogousslavsky classification, all the patients researched of CWI were divided into three clinical subgroups:the patients with cortical border-zone infarction,internal border-zone infarction, combined border-zone infarction.3 Methods of research3.1The informations of all the patients who selected were recorded,such as age,sex, hyp ertension, diabetes mellitus, dyslipidemia, stroke,smoking, drinking, heart diease, low perfusion factors.3.2 All the patients had done cerebral vascular examination (TCD,CDS,MRA,some patients had done DSA). 3.2.1We analyzed the different incidence of stenosis in ICA and MCA from the lesion side between patients with CWI and non-CWI.3.2.2The different incidence of stenosis in ICA and MCAwere compared between the lesion side and the other side in any types of CWI.3.2.3The different incidence of stenosis in ICA and MCA from the lesion side were compared in the different types of the patients of CWI.3.3According the outcomes of CDS,the different incidence of patients who had the carotid plagues were compared between the two groups,also between the two sides of the patients of CWI.The different incidence of patients who had the carotid plagues in the lesion side were compared in the different types of the patients of CWI.3.4 All the selected patients,the National Institutes of Health Stroke Scale(NIHSS)score was checked serially at within 48 hours,3,5 and 7days after admission.The clinical course was determined on the seventh day after admission compared with within 48 hours and was defined as(:1)improved(NIHSS score decreased by≥2 points)(.2)stabl(eNIHSS score decreased by<2 points)(.3)deteriorated (NIHSS score increased after admission).3.5 All the selected patients should be follow-up visited at 1 month from onset,then be evaluated about the short-term prognosis.The barthal Index (BI)was checked after 1 month from onset and was defined as: (1)improved(BI=90-100 points).(2)deteriorated(BI=0-85 points).Results1 339 patients with acute cerebral infarction were included in the study.Among the 339 patients ,136 patients had CWI and 203 patients had non-CWI. There were not statistically significant differences about the distribution in the two groups in age, sex,hyp ertension,diabetes mellitus,dyslipidemia,stroke, smoking, drinking and heart diease(P>0.05). There were statistically significant differences about the low perfusion factors(P<0.05).It shows that the low perfusion factors were associated with the patients of CWI.2 There were statistically significant differences in incidence of MCA and ICA with stenosis of the lesion side between the two groups(P<0.05). Compared with the non-CWI patients,CWI patients had a higher degree of moderate stenosis,severe stenosis or occlusion in ICA/MCA? (P<0.05).With the degree of of stenosis increased,the risk of occurrence of CWI increased.3 There were statistically significant differences in incidence of MCA and ICA with stenosis between the two sides in each types of CWI patients(P<0.05). Compared with the other side,the lesion side of the patients with cortical border-zone infarction, internal border-zone infarction and combined border-zone infarction are all had a higher degree of moderate to severe stenosis or occlusion in ICA,MCA and ICA+MCA.4 Between ICA and MCA with moderate to severe stenosis or occlusion, CWI patients more frequently had MCA with moderate to severe stenosis or occlusion(55/136). There were statistically significant differences in incidence of MCA and ICA with stenosis in locations of CWI patients(P<0.05).Among the three types of CWI patients, cortical border-zone infarction had a higher degree of ICA with moderate to severe stenosis or occlusion, internal border-zone infarction had a higher degree of MCA with moderate to severe stenosis or occlusion,combined border-zone infarction had a higher degree of ICA+MCA with moderate to severe stenosis or occlusion.5 CWI patients are definitely correlate with the lesion side of carotid plagues(P < 0.05). There were statistically significant differences in incidence of who had the different carotid plaques of CWI patients between the two sides(P<0.05). Compared with the other side, the lesion side had a higer degree of soft plaques and combined plaques. There were not statistically significant differences about the distribution of incidence of patients who had different carotid plagues or not(P>0.05). The patients of CWI are not only correlate with the lesion side of the ICA and MCA with moderate to severe stenosis and occlusion but also definitely correlate with the lesion side which had soft plaques and combined plaques;The patients of different locations of CWI are correlate with the lesion side of the different occurrence of ICA/MCA with moderate to severe stenosis or occlusion.6 There were statistically significant differences in the changes during the first 7 days in patients of CWI and non-CWI (P<0.05), CWI patients had a higher degree of improved outcome. There were statistically significant differences in the changes during the first 7 days in locations of CWI patients(P<0.05). Cortical border-zone infarction had a higher degree of stable outcome, internal border-zone infarction had a higher degree of improved outcome,combined border-zone infarction had a higher degree of deteriorated outcome.7 There were statistically significant differences in the changes after 1 months after stroke in patients of CWI and non-CWI?(P<0.05).There were statistically significant differences in the changes after 1 months after stroke in locations of CWI patients? (P<0.05).The poor outcome after 1 months after stroke was more prevalent in combined border-zone infarction than the other locations of CWI patients.Conclusions1 Before the formation of CWI,many patients have the low-flow occasion.2 The patients of CWI are not only correlate with the lesion side of the ICA and MCA with moderate to severe stenosis or occlusion but also definitely correlate with the lesion side which had soft plaques and combined plaques;The patients of different locations of CWI are correlate with the lesion side of the different occurrence of ICA/MCA with moderate to severe stenosis or occlusion.3 CWI patients had a higher degree of improved outcome than non-CWI patients during the first 7 days and the short-term prognosis.But Patients of combined border-zone infarction had a higher degree of deteriorated changes during the first 7 days. The poor outcome after 1 months after stroke was more prevalent in combined border-zone infarction than the other locations of CWI patients. |
PDF Full Text Request