| Purpose:To study the hazards of intracranial artery stenosis and discuss the parts liable to intracranial artery stenosis and clinical prognosis affecting factors of the cerebral infarction related to intracranial artery stenosis through the investigation and analysis of various factors including the blood pressure, blood sugar, blood fat, living habits, history of stroke and family medical history of the patients suffering from acute cerebral infarction.Materials and Methods:148cases of acute cerebral infarction are selected from the patients admitted to our hospital from October2008to June2012. All the patients satisfy the diagnostic criteria amended at the4th National Academic Conference on Cerebral Vascular Diseases and intracranial artery stenosis was confirmed in84cases of acute cerebral infarction by magnetic resonance angiography (MRA) while the result of MRA of the other64cases is normal. We targeted the patients suffering from acute cerebral infarction with intracranial artery stenosis as the object group to be studied, which include74male patients and10female patients aged between41and80(average age:61±9) while the patients suffering from acute cerebral infarction without intracranial artery stenosis are considered as contrast, including48male patients and16female patients aged between38and77(average age:56±4.8). The two groups of patients have no cardiogenic embolism, aorto-arteritis, concurrent infection, tumour and severe cardiopneumatic diseases. In the early morning of the second day when the patients were admitted to the hospital, the venous blood was drawn with an empty stomach to test the blood sugar, triglyceride (TG), cholesterol (TC), apolipoprotein A (ApoA), apolipoprotein B (ApoB), lipoprotein a, high density lipoprotein (HDL), low density lipoprotein (LDL) and we also monitored the blood pressure, improved the electrocardiographic examination, asked about the history of smoking, alcoholism, high blood pressure, history of stroke and family medical history. A comparison and analysis was made for the dangerous factors between the research group and comparison group. Intracerebral arteries to be studied include the intracranial internal carotid artery, intracranial vertebral artery, basilar artery, middle cerebral artery, anterior cerebral artery and posterior cerebral artery. Based on the analysis of the cerebral MRA of the research group, the distribution characteristics of intracranial single artery stenosis and intracranial multiple arteries stenosis are evident. The patients of the two groups were scored according to the National Institute of Health Stroke Scale (NIHSS) every morning of the first week and in the morning of the10th day to observe the short-term progress and prognosis. Those factors which may affect the prognosis are analyzed, including the infarct size, infarct type, arteriostenosis part, arteriostenosis range, body temperature, blood sugar and blood pressure.Results:Hazards of intracranial artery stenosisAfter the analysis of any single factor and based on the result of the analysis and professional knowledge, the multiple factor analyzing method is used to adjust the variables that may cause the hybridism. Among those variables like ag(?) gender, smoking, alcoholism, diabetes, hyperlipidemia, high blood pressure, coronary heart disease, family medical history, lipoprotein a(mg/L), APO-B, HDL-C, it is found out that gender, smoking, diabetes, hyperlipidemia, high blood pressure, lipoprotein a(mg/L), APO-B, HDL-C are of great significance to the statistics.Relation between intracranial artery stenosis and blood fatAccording to the chi-square test (x2=4.24,P<0.05), the proportion of hyperlipidemia in the two groups of patients suffering from hyperlipidemia is also significant to the statistics. The proportion of hyperlipidemia in the group with intracranial artery stenosis is larger than that of the group with no intracranial artery stenosis. The risk of intracranial artery stenosis for the patients suffering from cerebral infarction is2.05times of that of patients without hyperlipidemia. The index of blood fat such as lipoprotein a (mg/L), APO-B, HDL-C entry are all included in the multiple factors analysis, OR value of lipoprotein a is2.21, OR value of APO-B is1.86and OR value of HDL-C is0.48.Clinical prognosis of cerebral arterial occlusive cerebral infarctionAccording to Cox regression analysis of multiple factors, RR value suggests that older age, male, concurrent diabetes, infarct size>80cm3, multiple focus, stenosis and fever are prognosis factors; however,95%of the confidence interval include1, the suggestion has no significance to the statistics. Perhaps it is because only21cases were selected.Vulnerable parts of intracranial artery stenosisAccording to Diagram6, among the84cases, patients of77cases (91.6%) suffer from diseases of internal carotid system while7cases (8.4%) are about the vertebral artery. The middle cerebral artery stenosis accounts for the largest part (39.3%with33cases) and anterior cerebral artery plus middle cerebral artery stenosis comes after that (14.3%with12cases).Conclusion:Smoking, diabetes, hyperlipidemia and high blood pressure are especially dangerous factors of intracranial artery stenosis and smoking is the first and most important dangerous factor.Among the index of blood fat, lipoprotein a (mg/L), APO-B, HDL-C are related to intracranial artery stenosis; HDL-C is the protective factor for intracranial artery stenosis; the larger value of lipoprotein a (mg/L) and APO-B will cause the intracranial artery stenosis more easily.The more dangerous factors are combined; the intracranial artery stenosis will be caused more easily.The intracranial artery stenosis exists in the cerebral artery in most cases, irrelevant to the distribution of age and stenosis. Purpose:Intracranial atherosclerotic stenosis (ICAS) is the most common cause of ischemic stroke in the world. We should have a better and comprehensive understanding of the characteristics and pathogenesis of iconography data of intracranial artery stenosis related cerebral infarction. In this essay, the diffusion weighted imaging (DWI) of magnetic resonance is utilized to analyze the characteristics of the focus of intracranial artery stenosis related cerebral infarction as suggested on DWI and explore the pathogenesis of acute cerebral infarction caused by the intracranial artery stenosis based on TCD emboli-monitoring and electrocardiogram result.Materials and Methods:84cases of acute cerebral infarction are selected who were attacked by the disease in less than one week and the diagnosis of these patients all satisfy the diagnostic criteria amended at the4th National Academic Conference on Cerebral Vascular Diseases. Magnetic resonance angiography (MRA) confirmed that intracranial artery stenosis or occlusion exists, among which,77cases are anterior circulation arterial occlusion while7cases are posterior circulation arterial occlusion. MRI and DWI images are used to analyze the characteristics of the infarct of the patients and TCD emboli-monitoring functions and abnormal hemoperfusion helps to explore the probable pathogenesis of all kinds of infarcts.Results:Among the77patients suffering from diseases of internal carotid artery:According to the result of DWI, the characteristics of infarcts can be classified as follows,1)9cases of complete infarction (10.4%);2)11cases of cortical infarction (14.3%) including8cases of multiple cortical infarction (10.4%) and3cases of large single cortical infarction (3.9%);3)11cases of semiovale centrum zone infarction (14.3%):2case of single infarction (62.6%),9cases of multiple infarction in medullary substance (11.7%);4)18cases of multiple infarction involved in cotical and semiovale centrum zones (23.4%);5)10cases of deep and small infarction (13.0%);6)18cases of cerebral watershed infarction (23.4%) including1case of front and rear watershed (1.3%),17cases of inner watershed infarction (22.1%).Among the7patients suffering from diseases of vertebral artery, According to the lesions on DWI, the infarction patterns are categorized as1)2cases of deep single infarction (28.6%);2)2cases of single cotical infarction (28.6%);3)3cases of multiple cerebral infarction (43.9%);58cases of multiple cerebral infarction, positive features are found in21cases and the positive rate is36.2%;26cases of single cerebral infarction, positive features are found in2cases and positive rate is7.7%. There are big differences between the two situations (P<0.05).There are58cases of multiple cerebral infarction, among which, the electroc-ardiogram suggests sinus bradycardia in18cases (31.0%) while among the26cases of single cerebral infarction, the electrocardiogram suggests sinus bradycardia in only3cases (11.5%). The difference is quite significant.(P<0.05)Conclusion:1. Characteristics of infraction:When performing DWI, the acute cerebral infarction caused by intracranial artery stenosis is multiple cerebral infarction in most of cases. The multiple infarction involved in cotical and semiovale centrum zones as well as the inner watershed infarction are most common. 2. Pathogenesis:The pathogenesis of cerebral infarction due to intracranial artery stenosis includes:artery-artery occlusion, inadequate hemoperfusion, pathological changes in home position. The pathogenesis of multiple cerebral infarction includes: artery-artery occlusion and inadequate hemoperfusion. Moreover, the sinus bradycardia plays a role in the process leading to cerebral infarction caused by low hemoperfusion while the thrombogenesis caused by in-situ lesion is the main pathogenesis of single infarction in basal ganglia zone. |
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