| BackgroundIntracranial large-artery stenosis is an important risk factor of ischemic stroke. Clinical researches have shown that about 8-10%of ischemic stroke are due to intracranial large-artery atherosclerotic stenosis,and this percent is much higher in Asia.The ischemic stroke rate of patients with intracranial large-artery atherosclerotic stenosis in the first year is at least 11%,and may have varying degrees of risk based on severity of patients with symptomatic atherosclerotic stenosis of intracranial large-artery.The percent stenosis of intracranial large-artery above 50%is a independent risk factor of stroke in progression and stroke again in 30 days,above 70%is the greatest risk.The possible mechanisms of cerebral infarction caused by intracranial large-artery atherosclerotic stenosis are:(1)hypoperfusion;(2) thrombosis at the site of stenosis due to plaque rupture,intraplaque hemorrhage or occlusive plaque growth; (3) thromboembolic events distal to the site of stenosis;(4) direct occlusion of small penetrating arteries at the site of the plaque.Medication treatment has poorly effect to intracranial large-artery atherosclerotic stenosis.The results of the Warfarin versus Aspirin for Symptommatic Intracranial Disease Study demonstrates that the drug of anti-platelet aggregation and anti-coagulation have no effect and can not reduce the risk of ischemic stroke with senosis above 50%in patients with intracranial large-artery stenosis.With the improvement of materials and imaging technique,percutaneous transluminal angioplasty and stenting(PTAS) are applied to patients with symptomatic intracranial large-artery atherosclerotic stenosis.It have been proved that this therapy method was proven technique and clinically effective with a substantial reduction of rate of stroke and death.It has been proved that atherosclerosis will be accompanied with vascular endothelial cell damage and abnormal plasma levels of markers such as von Willebrand factor(vWF),fibrolysis function such as tissue Plasminogen activator(tPA) and Plasminogen activator inhibitor-1(PAI-1).These hematological markers are correlated with the degree of intracranial atherosclerotic stenosis and the morbidity and prognosis of stoke.The detection of these markers may provide a simple and fast method to prevent stroke in high-risk groups and evaluate the efficacy of treatment.Part 1:Correlational study between plasma level of tPA,PAI-1 and vWF and degree of stenosis of Intracranial large-artery in patient with acute atherosclerotic cerebral infarctionObjective:Obtain the relationship between plasma level of tPA,PAl-1,vWF and degree of stenosis of Intracranial large-artery in patient with acute atherosclerotic cerebral infarction.Mothods:96 in-patients with acute atherosclerotic cerebral infarction were consecutively recruited from our department as case group.And then were divided into severe and non-severe subgroups accoding to whether the degree of stenosis of the Intracranial large-artery is above 70%(measured by digital subtraction angiography).98 healthy people who take a health examination in the same period were chose as control group.Plasma levels of tPA,PAI-1 and vWF antigen were measured by S-ELISA.Results:Plasma levels of tPA,PAI-1 and vWF of case group were significantly higher than that of control group,and the variations of plasma levels of tPA,PAI-1 between subgroups was not significant.The plsma levels of vWF in severe stenosis subgroup was significantly higher than that of the non-severe subgroup(p=0.000).Conclusions:Among patients with acute atherosclerotic cerebral infarction,the plasma level of vWF in patients with intracranial stenosis above 70%was significantly higher than those with stenosis between 50%and 70%,thus the level of plasma vWF may be a predictor for stroke risk.Part 2 Comparative study of the influence of interventional therapy and medication treatment on the plasma level of tPA,PAI-1 and vWF in patients with acute atherosclerotic cerebral infarction.Objective:Explore the influence of percutaneous transluminal angioplasty and stenting combined with anticoagulation and antiplatelet to fibronolysis system and vascular endothelial in patients with acute atherosclerotic cerebral infarction.Methods:96 in-patients with acute atherosclerotic cerebral infarction were consecutively recruited from our department as case group,which was divided into three subgroups:ASP,PTAS and LMH.the control group was same as previous section.Venous blood was sampled in the first and 7th day after admission at 7:00 am. Plasma levels of tPA,PAI-1 and vWF antigen were measured by S-ELISA.Results:Plasma level of tPA,PAI-1 and vWF of case group were significantly higher than that of the control,and the variations among subgroups have not statistical significance.The Plasma levels of tPA and PAI-1 in case group were strongly correlated at both time points,the Plasma levels of tPA and vWF in PTAS subgroup were significantly higher than that of ASP and LMH subgroup (P=0.000,0.001,P=0.000),and the Plasma level of PAI-1 was significantly lower than that of ASP and LMH subgroup(P=0.047,0.008).The variation of Plasma levels of tPA,PAI-1 and vWF before and after treatment in PTAS subgroup all have a significantly difference compared with that of ASP and LMH subgroup(P=0.000)。 Conclusion:The treatment of PTAS combined anticoagulation and antiplatelet maybe outweigh medication treatment of antiplatelet or anticoagulation in protecting fibrinolysis ability,and have advantageous in preventing re-thrombosis in patient with acute atherosclerotic cerebral infarction,in case of the endothelial damage was lessened.Statistical analysis:The statistical analysis was implemented in SPSS 13.0.Data are presented as mean±standard deviation.Baseline characteristics between case group and control group and among three subgroups were evaluated by differences.χ~2 test was used to test differences in proportions for categorical variables.An independent sample t test and one-way ANOVA was used to test differences in means for continuous variables.The Pearson correlation coefficient was used to analyze the correlation between tPA and PAI-1.All tests are Two-tailed.The statistical significance level was set to 0.05. |
PDF Full Text Request