Chinese Herbs For Nourishing Qi And Activating Blood Circulation And Restenosis After Vertebral Artery Origin Stenting—Literature And Clinical Research

With the development of neural interventional materials and technology,interventional treatment of ischemic cerebrovascular disease is developing rapidly.Neural interventional treatment becomes one of a important method to treat ischemic stroke.But same as coronary artery,restenosis is always a big problem after cerebral artery stenting,especially after vertebral artery origin stenting,because the restenosis rates of vertebral artery origin stenting is the highest in all intracranial or extracranial arteries.Studies on Chinese herbs treating restenosis after percutaneous transluminal coronary angioplasty(PTCA)have acquired many achievements.But studies on Chinese herbs preventing and treating restenosis after cerebral artery stenting are still at initial stage.There are lack of high quality evidences to support the effectiveness of Chinese herbs.In this study,we use the method of systematic review to evaluate the quality of the literatures and the effectiveness of Chinese herbs for preventing restenosis after cerebral artery stenting.We also observe the effects of Chinese drugs for nourishing Qi and activating blood circulation on restenosis after vertebral artery origin stenting and analyze the relationship between restenosis and blood stasis syndrome,Qi deficiency syndrome by randomizd controlled resarch.This study is divided into two parts:Part 1:Systematic Review on Chinese herbs Preventing Restenosis after Cerebral Artery StentingObjective:To evaluate the effectiveness and safety of Chinese herbs preventing restenosis after cerebral artery stenting.Method:The clinical researches were collected from databases including Pubmed,Cochrane library,CBMdisk,CNKI,Wanfang Database,VIP,Chinese Clinical Trial Registry,etc.Two reviewers screened literature according to the inclusion and exclusion criteria defined beforehand.The data was analyzed by using RevMan5.3 software.The quality of researches was evaluated by using risk evaluation tool.The level of evidence was recommended by using GRADE score.Results:Totally 4 clinical researches involving 304 patients of Chinese herbs preventing and treating restenosis after cerebral artery stenting were included in the analysis.The results of Meta analysis indicated that compare with the conventional western medicine treatment,Chinese herbs based on the conventional western medicine treatment could probably reduce restenosis without obvious side effects.The clinical end point events were no statistical difference between treatment group and control group.Conclusion:The treatment with Chinese herbs combined with the conventional western medicine was maybe an effective therapy method to prevent restenosis after cerebral artery stenting which was superior to the conventional western medicine treatment alone.But the evidence was inadequate because of the potential biases existed in those researches influencing the reliability of this conclusion.The conclusion needs to be proved by more high quality researches.Part 2:Chinese Drugs for Nourishing Qi and Activating Blood Circulation and Restenosis after Vertebral Artery Origin Stenting:A Randomized,Double-blind,Placebo-controlled researchObjective:To observe the effectiveness and safety of Chinese drugs for nourishing Qi and activating blood circulation reducing restenosis after vertebral artery origin stenting.Method:By randomized,double-blind,placebo-controlled research,93 vertebral artery origin stenting patients were randomly divided into conventional western medicine treatment plus Chinese drugs group(treatment group,48cases)and conventional western medicine treatment plus placebo group(control group,48cases).The follow-up underwent 6 months.Occurrence of restenosis,recurrence of cerebral ischemic events,change of blood stasis score and Qi deficiency score were observed.Results:The rate of restenosis was 19.1%(9/47)in treatment group and 28.3%(13/46)in control group.There was no statistical differences between two groups(P>0.05).Recurrence of ischemic events was no statistical differences between two groups(P>0.05).The score of blood stasis and Qi deficiency decreased significantly in treatment group versus control group(P<0.01)on 6 months after entering the group.Conclusion:The occurrence of restenosis on 6 months after vertebral artery origin stenting in treatment group was less than control group.Chinese drugs for nourishing qi and activating blood circulation could reduce the score of blood stasis and Qi deficiency.Restenosis was associated with blood stasis and Qi deficiency.Blood stasis and qi deficiency syndrome probably was one of the influence factors of restenosis after vertebral artery origin stenting.