Analysis Of The Risk Factors And Clinical Short-term Prognosis Of Acute Cerebral Infarcin According To Chinese Ischemic Stroke Subclasification

ObjectivObjective To analysis the proportion of etiological subtypes and clinical short-termprognosis of acute cerebral infarction patients based on CISS(Chinese Ischemic StrokeSubclassification). Methods We consecutively registed 350 acute infarction patients inour departments from 1 May 2010 to 31 October 2010. All patients were subclassifiedaccording to the Chinese Ischemic Stroke Subclassification criteria. Neuronal functionimpairment degree was evaluated by the NIHSS on admission and at discharge in orderto assess the clinical short-term prognosis. Results Of 350 ACI patients,the mostfrequent subtype was large artery atherosclerosis (LAA)(n=155,44.3%),including 3aortic arch atherosclerosis and 152 intra- and extra- cranial large arteriesatherosclerosis,followed by penetrating artery disease(PAD)(n=93,26.6%),undetermined etiology(UE)(n=63,18.0%)containing 18 unknown etiology and 33inadequate evaluation and 12 multiple etiology,cardiogenic stroke (CS)(n=35,10.0%),other etiologies(OE) (n=4,1.1%).The OE group was out of statistic test because of thesmall samples. Compared with the other etiological subtypes,the NIHSS on admissionwas obviously elevated in CS,with the distinct declined neurological function recoveryat discharge(P=0.000). The NIHSS on admission was obviously reduced in PAD,withthe distinct raised neurological function recovery at discharge(P=0.000).Of theunderlyi ng mechanisms of ischemic stroke caused by intracranial or extracranial LAA,the most frequent subtype was artery-to-artery embolism(n=64),then was parent artery(plaque or thrombus) occluding penetrating artery (n=38),multiple mechanism(n=37),and hypoperfusion/impaired emboli clearance successively.Conclusion All of the 350 ACI patients,LAA has the highest proportion,PAD has thelightest admission condition and the best clinical short-term prognosis,while CSpatients have the worst admission illness and clinical short-term prognosis . The mostfrequent mechanism of intracranial or extracranial LAA was artery-to-artery embolism,the rare mechanism was hypoperfusion/impaired emboli clearance.PART IIObjective To analysis the distribution of risk factors among etiological subtypes of acute cerebral infarction patients and its connection with the clinical short-term prognosis .MethodMethods We consecutively registed 350 acute infarction patients in our departmentsfrom 1 May 2010 to 31 October 2010. All patients were subclassified according to theCISS criteria. The risk factors for ischemic stroke in all patients were assessed. Therelationship between the risk factors and clinical short-term prognosis at discharge wasanalysed. The OE group was out of statistic test because of the small samples. ResultsThere was no significant difference in age,hyperhomocysteinemia,hypertension,uri cacid,and diabetes among the 4 etiological subtypes ( P >0.05). Compared with the otheretiological subtypes,the level of hsCRP,FIB,PT,D-dimers was obviously elevated inCS,with the lowest prevalence of smoking,drinking and hypertension mergerdyslipidemia(p<0.05). LAA showed highest prevalence of transient ischemic attack,smoking,drinking,hyperlipidemia and hypertension,and higher level of FPG,randomblood glucose than CS,UE(P<0.05). The prevalence of smoking,drinking,hyperlipidemia,ST depression on ECG,left ventricular hypertrophy were more commonin PAD than in CS and UE(P<0.05) . The level of hsCRP,PT,FBG,temperature,PLT,FPG,random blood glucose correlated with NIHSS on admission positively(P<0.05)andneurological function recovery at discharge negatively (P<0.05). Conclusions Thedistribution of risk factors among etiological subtypes of acute cerebral infarctionpatients were different,which could indicate the severity of neuronal function impairmenton admission and clinical short-term prognosis at discharge.PARTâ…¢Objective To analysis the distribution of lesions and the image characteristic of ACIpatients based on CISS. Methods To determine if the lesion patterns and the imagecharacteristic of ACI patients are associated with stroke subtypes determined by CISSclassification.Then to further study the characteristics of the etiology and pathogenesisof anterior and posterior circulation. Results There were 210 cases of anteriorcirculation patients (60.7%),123 cases of posterior circulation patients(35.5%),and 13cases of both anterior and posterior circulation stroke patiens(17.08%) . The proportionsof CISS subtypes in the anterior circulation in order were as follow: LAA 105 cases(50%),PAD 46 cases(21.9%),UE 35 cases (16.7%),CS 24 cases(11.4%),that in theposterior circulation were as follow: PAD 47 cases(38.2%),LAA 43 cases (35%),UE28 cases (22.8%),CS 8 cases (6.5%). All patients including 206 cases of singlelesion(59.6%),140 cases of multiple lesions(40.4%). Single cortical lesions,cortical-subcortical lesions,a single vascular territory of the multiple lesions more common inLAA,subcortical <15mm lesion also was observed in CS subtype . For the underlyingmechanisms of intracranial or extracranial LAA whether in anterior circulation or posterior circulation,the most frequent subtype was artery-to-artery embolism. The groupof 152 cases of intracranial or extracranial LAA patients have CCA stenosis 87branches,ICA stenosis 87 branches,ACA stenosis 86 branches,MCA stenosis 143branches,PCA stenosis 78 branches,VA stenosis 97 branches,BA stenosis 27 branches.Extracranial artery stenosis was 21.7% (198/152 * 6),intracranial stenosis was 37.9%(518/152 * 9). ConclusionConclusions The distribution and imaging features of lesions havecorrelationship with CISS subtypes. The artery to artery embolism are most frequent inthe underlying mechanisms of intracranial or extracranial LAA both in anteriorcirculation and posterior circulation,which have more common intracranial stenosis,mainly involving the MCA.