Clinical Follow-up Study On Integrated Treatment Of The Traditional Chinese And Western Medicine For The Symptomatic Intracranial Arterial Stenosis

ObjectivesSymptomatic intracranial atherosclerotic stenosis is the primary cause of ischemic stroke. Endovascular stent angioplasty has been used as a treatment of symptomatic intracranial arterial stenosis. Currently, there are only a few short or medium term follow-up study reports about the endovascular treatment for symptomatic intracranial arterial stenosis, medium or long term follow-up studies are lacking, and the clinical studies about the treatments integrating traditional Chinese and western medicine are rare. The aim of our study is to evaluate the clinical efficiency of Yin and Yang symptom divisions of the traditional Chinese medicine in the perioperative period of endovascular stent angioplasty for symptomatic intracranial arterial stenosis, and to analyze the influencing factors, summarize the results of medium or long term follow-up, dissect the pathology characteristics and the influences of Yin and Yang symptom divisions of the traditional Chinese medicine on the clinical endpoint events.MethodsFor the patients with symptomatic intracranial arterial stenosis received from October2005to July2010, the integrated treatments of endovascular stent angioplasty and Yin and Yang symptom divisions of the traditional Chinese medicine were adopted, all the cases were the patients who still showed symptoms after conservative medical therapy, and they were divided into Yin symptoms and Yang symptoms according to the symptoms categorizing standards of the traditional Chinese medicine, and they were given corresponding traditional Chinese medicines. At the same time, the regular western internal medicine therapy was provided, too. And on the basis of the combined treatment of the traditional Chinese medicine and western medicine, endovascular stent angioplasty was operated. The curative effects of the perioperative period and medium and long term follow-up of the patients with symptomatic intracranial arterial stenosis was analyzed retrospectively; the clinical symptoms of the patients included in the team, the iconographical features, the morphological characteristics of the stenosis and the similarity and difference of the treatment of Yin and Yang symptom divisions of the traditional Chinese medicine were summarized; and the influences of the above factors on the operation success rate and clinical endpoint events were analyzed.Results:Totally75cases (79lesions) with symptomatic intracranial arterial stenosis were included in the study.77lesions were given endovascular stent angioplasty successfully, and the procedural success rate was97.5%. In the perioperative period (within30days),9(11.4%) complications cases occurred. Among them,2(2.5%) were non disabling complication cases,7(8.9%) were disabling complication cases,4(5.1%) were death cases,5(6.3%) were hemorrhagic stroke cases,3cases were related with balloon choice and guidewire perforation;3(4%) were ischemic stroke cases, according to the mature technology standards for the intracranial artery stent placement surgery based on the SAMPPRIS study.2ischemic stroke cases occurred in the non mature state of operation,1case occurred in the mature state of operation. The incidence of ischemic stroke in the perioperative period of the mature state of operation was lower than that of the SAMMPRIS trial.30days after period of stent treatment,68cases were followed up,7cases lost connection. Follow-up period was6-78months, an average30.4months; In the follow up period, stroke reoccurrence were10cases, with7cases of ipsilateral recurrent stroke,4cases of cerebral infarction,1cases of death,3cases of TIA, and3cases of lateralrecurrent stroke. The Chinese medicine taking rate in the follow-up period was72.5%. The cumulative stroke incidences of this study in the1st and the3rd months were0.054and0.07, The UCLA follow up study were0.203and0.24, WASID trail reports were0.12and0.16, the cumulative stroke incidences in the1st and the3rd months were0.203and0.245respectively. And the results of the WASID study reports were0.12and0.16. The cumulative incidence of stroke occurring in the follow-up period of this research was lower than the research results of the UCLA and the WASID. The atherosclerosis risk factors, the severity of the stenosis, and the Yin and Yang symptoms of traditional Chinese medicine had no obvious effect on operation’s success rate and safety and clinical prognosis. Among the follow-up79lesions,26cases received radiological follow-up, of which,5cases of stent restenosis occurred, the incidence rate was19.9%, with symptomatic restenosis accounting for11.5%.ConclusionsThe patients with symptomatic intracranial arterial stenosis treated with integrated treatment of western medicine and traditional Chinese medicine still facing the risk of high incidence of perioperative period complications, so the application of endovascular stent angioplasty on such patients should be more cautious. The traditional Chinese medicine treatment can lower the incidence of perioperative period ischemic strokes. The medium and long term follow-up results showed that, for the patients with severe stenosis did not show a higher incidence of post-operation recurrent stroke comparing with the patients with moderate stenosis. For patients with severe stenosis, endovascular stent angioplasty shows a much higher efficiency comparing with medicine treatment. The integrated treatment of traditional Chinese and western medicine might help to reduce the post-operation recurrent ischemic strokes. Further study might be needed to evaluate the efficiency of traditional Chinese medicine in the stents perioperative period for symptomatic intracranial artery stenosis.