| Acute ischemic stroke(AIS)is a serious global health problem with high incidence rate and mortality.AIS not only brings physical and psychological pain to patients,but also brings heavy economic burden to families and society.AIS is a complex disease caused by many factors.At present,it is considered that timely vascular recanalization is an effective way to reduce the long-term disability rate of AIS patients.Intravenous thrombolysis and mechanical thrombectomy are the two most important treatment strategies for AIS patients to achieve revascularization.There are many researches on the pathogenesis and prognosis of AIS at home and abroad,among which lipid and cerebral collateral circulation are two controversial factors.To provide a new way for the prevention,diagnosis and treatment of AIS,we studied the influence of blood lipid composition and level,collateral circulation on the prognosis of AIS patients.PART 1 Clinical study on the effect of collateral circulation on the prognosis of patients with acute ischemic strokeObjective: To evaluate the effect of collateral circulation on the prognosis of patients with acute ischemic stroke after endovascular intervention.Methods: We conducted a retrospective study on patients with acute ischemic stroke(AIS)who received intravascular therapy between December 2010 and May 2016.Preoperative DSA angiography was used to evaluate the preoperative grading degree of cerebral collateral circulation(ASITN/SIR standard)in patients,and stratified statistics were conducted at levels 0,1 and ≥ 2.Univariate and multivariate logistic regression analysis was used to investigate the correlation between 3-month clinical prognosis(m RS),3-month mortality,intracerebral hemorrhage(symptomatic and asymptomatic)within 24 hours after surgery,and ASPECTS of cerebral infarction.Results: Worse collateral circulation is one of the risk factors for low baseline ASPECTS score(0-5)(p=0.031)(OR 3.56;95% CI,1.12 to 11.28).However,low baseline ASPECT score was closely correlated with poor clinical prognosis in patients(m RS≥3)in the multivariate regression analysis(p=0.0002)(OR 7.55;95% CI,2.56 to 22.24).Conclusions: The grading degree of cerebral collateral circulation was positively correlated with the area of cerebral infarction in AIS patients,and the area of cerebral infarction in AIS patients affected the clinical prognosis and mortality at 3 months.Part 2 The effect of blood lipid on the prognosis of patients with anterior cerebral artery-occluded acute ischemic strokeObjective: In this study,we investigated whether certain types of lipid profiles are major contributors of acute ischemic stroke(AIS).Methods: We screened 13,285 hospitalized patients in two stroke medical centers treated with thrombolysis,thrombectomy,or conventional care for anterior cerebral artery-occluded AIS,and found 266 patients.We examined their plasma lipid profiles using the cutoff values from a receiver operating characteristic(ROC)curve.We applied a multivariate logistic regression or Fisher’s exact test to compare their outcomes and risk factors.We used the modified Rankin scale(m RS)score to assess the major clinical outcome of the patients 3 months after disease onset.Mortality and symptomatic intracranial hemorrhage(s ICH)were both evaluated as risk factors.We analyzed symptoms’ improvements at discharge as a disease outcome measure.Results: In the patients with anterior cerebral artery-occluded AIS(NIHSS≥10)treated by intravenous(IV)thrombolysis,a total cholesterol(TC)level greater than 5.07mmol/L predicted a poor outcome(p = 0.021)(OR 3.55,95% CI 1.21,10.46).Conclusions: In patients with anterior cerebral artery occluded AIS,the TC level is a promising prognosis marker for the IV thrombolysis outcome. |
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