| Objective:Althoughwhite matter lesions(WML) was the results of small vessel disease, It is noteworthy that there are inter-relationships between white matter lesionsand large artery atherosclerosis(LAA) rather than absolutely independence.Until now, limited data are available about the potential interaction and causal relationships of coexisting WML in patients with LAA. This researchwas made up of two parts - to study the risk factors for WML in patients with large artery atherosclerosis ischemic stroke by analyzing its incidence and the relationship between WML and retrograde and antegrade flow in patients with MCA stenosis or occlusion.Methods: Part one: Patientswith large artery atherosclerosis ischemic stroke in single academicinstitution from 1 / 2011 to 6 / 2016 were divided according to the burden and portions of WML. Their risk factors for vascular diseases, location of large artery stenosis, lesion of bilateral artery and type of ischemic stroke were compared.Part two : Patients with unilateral/ bilateral MCA stenosis or occlusionon angiographywere identified and analyzed from 6 / 2015 to 10 / 2016. Their WML,retrograde and antegrade flowwere evaluatedby modified Scheltensscale,ASITN/SIRgrading system and mTICI scale, respectively.To analize the relationship between WML and retrograde and antegrade flow.Results:Part one: The sex, age, history of hypertension and stroke, serum albumin and cystatin C differed greatly in PVH groups, while the age, history of hypertension and coronary heart disease,serum albumin,triglyceride and cystatin C in DWMH groups (P<0.05,P<0.001).Age,history of hypertension and stroke were the independent risk factors for PVH and were positively related with PVH. In DWMH groups, only age has the independently positive effect(P<0.05, P<0.001).There were positive relationship between the gradeof hypertension, age of onset and PVH. The longer the disease course was, the severer the PVH was in 45-64 years old patients(P<0.05, P<0.001).Location of large artery stenosis, lesion of bilateral artery and type of ischemic stroke were not the risk factors for WML.Part two: Patients with history of hypertension suffered from severer PVH than non-hypertension patients(P<0.05). This difference were not obvious in WML and DWMH groups(P>0.05).The LA scale revealed non-statisticallysignificant difference in moderate, severe and occlusion groups(P>0.05).Although the LA scale in lesion side were higher than in normal side, there were no significant difference in the two sides(P>0.05).No matter in which brain area, the mean WML scale in robust antegrade were higher than in poor antegrade. But only the frontal and the whole DWMH indicated significant difference in the two groups(P<0.05).The mean WMLscale in poor and robust collateralshad non-significant difference(P>0.05).Conclusion:Part one: (1) There were no obvious relationship between location of large artery stenosis, lesion of bilateral artery, type of ischemic stroke and WML.(2)Risk factors for vascular diseases play major roles in the development and progression of WML in patients with large artery atherosclerosis ischemic stroke. In PVH groups,age ,history of hypertension and stroke were the independent risk factors, but only age in DWMH groups.(3) The effects of hypertension to PVH were related to grade and course of disease. Patients with higher grade hypertension underwent severer lesions.The longer the disease course was, the severer the PVH in patients suffered from hypertension in middle age.Part two(1) Antegrade flow was not the risk factor for WML but the protective factor.(2) There was no relationship between WML and collaterals flow. |
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