The Influential Factors Of Collateral Circulation Formation In Cerebral Arteries Stenosis

Objective:The clinical manifestations of patients with ischemiccerebrovascular disease are not consistent with the severity of cerebral artery,which confirmed by vascular investigation, are concerned with the collateralcirculation. On the condition of cerebral artery vascular occlusion, brain tissuemay damaged mildly, even without symptoms and signs if completelycollateral circulation compensatory exist. But when collateral compensatoryability was damaged or incompletely, brain tissue damage may be severe anddisabled or fatal infarction results. Therefore, effective collateral circulationmay improve the prognosis of patients with ischemic cerebrovascular disease.Compensatory ability of the collateral circulation is influenced by manyfactors, including the integrity and variability of collateral vessels, the luminaldiameter of the collateral arterys, the extent and speed of cerebral vascularstenosis, the risk factors and genetic factors. Some risk factors can becontrolled. It has been reported that hypertension, high cholesterol, diabetes,age are related to collateral circulation, but have not reached a consensus;other risk factors,such as long-term smoking, previous history of stroke, hyperhomocysteinemia, hyperfibrinogenemia, have no conclusive evidence aboutthe influence on collateral circulation.The aim of this study is to investigate the impact factors of collateralcirculation in cerebral artery stenosis by analysis risk factors of symptomaticcerebral artery stenosis between collateral circulation group and uncollateralcirculation group. So as to provide strategies for the prevention and treatmentof patients with cerebrovascular stenotic disease.Methods:202patients with ischemic cerebrovascular disease wereenrolled from September,2010to September,2012, who were in hospital andperformed DSA investigation in Tangshan workers’ Hospital. Using angiography as a diagnostic method,all these patients had severe vascularstenosis varing from70%to100%(cerebral artery stenosis is calculated withthe North American pilot symptomatic carotid artery stenosis (NASCET)standard). According to the United States of Neuroradiology InterventionalTherapy Association and Interventional Radiological Society of collateralflow grading criteria, all the patients were divided into two group, collateralcirculation formation and unformation group.The number of different types ofischemic cerebrovascular disease cases were compared between the twogroups,and we also compared the history correlated with cerebrovasculardisease(cerebrovascular disease, cardiovascular disease, hypertension,diabetes), smoking, routine measurement of blood pressure, blood of collateralcirculation compensatory biochemistry examinations (fibrinogen, platelet,blood sugar, blood fat, homocysteine), and record the clinical datas. ESR,anticardolipin antibodies and other autoantibody were detected to excludevasculopathy induced by vasculitis. The difference of sex, age,cerebrovascular disease history, cardiovascular disease, hypertension, diabetes,smoking information, blood pressure, lab examination (fibrinogen,platelet,blood sugar,blood fat,homocystein e), numbers of vascular lesion, the degreeof stenosis, stenotic position between the two groups were analgyed by singlefactors analysis.The significant different factors were further analyged bymultivariate logistic regression.Results:1202cerebral arteries severe stenosis (≥70%) cases were selected.120patients (59.41%)exist formation of collateral circulation,82patients (40.59%)not. Comparing the incidence: CCBI have higher proportion in collateral circ-ulation group than the other, while the proportion of TIA, CI are lower, but thedifference was not statistically significance (P>0.05). NIHSS score, infarctvolume in patients with CI was significantly lower than that in collateralcirculation unestablished group, the difference was statistically significant (P<0.05).2Clinical data comparison:Patient’s contractive pressure, diastolic blood pressure in collateral circulation group is much lower and blood platelet countis much higher than that in another group; cerebrovascular disease past historyhas statistical significance between two groups(P<0.05).3Evaluated measurement data according to clinical significance.Therewere significante difference in sex, smoking information, blood pressure,fibrinogen, numbers of vascular lesion, the degree of stenosis, stenoticposition between two groups by single factor analysis (P<0.05).4Those statistical significance factors were further analgyed usingmultivariate logistic regression, independent variable smoking（OR=3.030；95%CI：1.514～6.064）, diastolic pressur（eOR=2.502；95%CI：1.631～3.838）,fibrinogen（OR=0.179；95%CI：0.060～0.532）, vasculopathy degree（OR=0.292；95%CI：0.179～0.477）entered regression equation. The equation hasstatistical significance, χ2test, χ2=70.632,P=0.000. LogisticP=-0.166+1.109X1(smoking)+0.917X2(diastolic pressure)-1.722X3(fibrinogen)-1.232X4(vasculopathy degree).Conclusions:1Collateral circulation has a protective effect on cerebral artery stenosisor occlusion, The more sufficient of collateral circulation compensatory, themore smaller and milder clinical symptoms.2Some cerebrovascular disease risk factors have influence on collateralcirculation formation in cerebral arteries stenosis or occlusion patients.Smoking, high diastolic pressure are harmful for collateral circulationformation; but high fibrinogen, severity vasculopathy degree are beneficial tocollateral circulation formation.